Core medical training logbooks
In August 2017 the Joint Royal Colleges of Physicians Postgraduate Training Board (JRCPTB) launched a new template for CMT trainees to record their experience at medical procedures. For the first time since the old-style RCP training logbooks, which vanished with the Modernising Medical Careers project, it was recommended that trainees record their routine practical work, including clinics and procedures.
The face of procedural medicine has changed considerably in the interim. SHO-grade doctors — the backbone of which is the core medical trainee — undoubtedly perform fewer procedures than they previously did, with many procedures now the domain of specialists and subspecialists, rather than the general medical ward doctor.
Chest drains are perhaps the best example: in the early 2000s it was acceptable practise for an experienced medical registrar to train a general medical SHO in pleural drain insertion, and the SHO could then go on to insert perhaps hundreds of drains independently before moving on to a career in an unrelated specialty. The advent of ultrasound-guided drainage changed this irreversibly, as the use and interpretation of ultrasound images arguably requires more skill and training than the insertion of a pleural drain itself. Once ultrasound-guided drainage became the accepted standard of care, pleural drain insertion fell into the specialist arena of the radiologist, and the skill was quickly lost from the general medical workforce.
This pattern is mirrored across many different areas of medicine, with the consequence that exposure to procedural work has fallen dramatically for junior hospital doctor. This in turn means that the emphasis on juniors performing procedures has moved from service provision to educational. It is perhaps no longer expected that a core trainee should have done hundreds of chest drains, but it is still legitimate to expect to be trained in chest drain insertion. Given that exposure has dropped across the workforce, documentation has become essential to prove competence at these core medical skills.
Trainees will doubtless adopt a range of approaches to keeping a logbook. The basic principles are straightforward: the JRCPTB is clear that records should be anonymised but contain enough information to show what level the trainee performs at, and how much supervision is required.
Whilst some core trainees will find they rarely do procedures, and can easily keep paper records of this work, many will prefer to use an electronic logbook for convenience and to ensure they capture all relevant data at the time. The new core medical training logbook at logitbox.com is, we hope, an excellent addition to the tools available for this task.
Logitbox allows doctors at all levels of training to keep secure records of procedures, outpatient clinics, and other clinical and educational activity, from a mobile or desktop PC. Downloadable reports can be edited and customised as you wish, but the default layouts are aimed at passing training reviews such as the NHS Annual Review of Competencies and Progression (ARCP).
