Details, details…
Despite the perpetual change in medical education in the UK over the last decade, one consistent theme is increasing reliance on logbooks as evidence of what an individual trainee has done during their everyday work. The onus is now firmly on the individual doctor to prove what they have spent their time doing, and what skills they have acquired.
Nevertheless, guidance on how much detail to record is very scarce and sometimes contradictory. The level of detail you require in your logbook will inevitably vary depending on your stage of training and the level of scrutiny you are likely to be subject to. Your best guide for this is to refer to the syllabus for your individual specialty training programme, which in the UK is available from the Joint Royal Colleges Postgraduate Training Board (https://www.jrcptb.org.uk/specialties). Specific year-on-year guidance on what you should be able to do, and what you need to be able to prove, is provided by the ARCP decision aid for your specialty, though in many cases you need to read between the lines to see what evidence the ARCP panel could require.
This lack of clarity is evident, for example, in the ARCP decision aid for General Internal Medicine, in relation to experience with acute hospital admissions. The decision aid requires you to see 1000 patients on the acute take prior to completion of training, but gives no guidance on how you should set about proving you have done this. The safest interpretation here is that the responsibility is on you, as the trainee, to maintain a logbook that provides sufficient detail to corroborate that you’ve seen the required number of patients, but not so much detail that it violates patient confidentiality. This is a difficult line to tread, particularly when you consider the stringent requirements of the UK’s Data Protection Act.
My own experience leads me to think that the best strategy is always to record as much information as possible, as the requirement for detail from your assessors is only ever going to increase. Of course you must be careful to maintain patient anonymity at all times, as well as satisfying the provisions of any other regulations in the jurisdiction where you work.
In the UK, despite numerous revisions and refinements to medical training over the last decade, this fundamental contradiction between the requirement for verifiable records of training activity, versus the Data Protection Act’s need for patient consent for inclusion of any personal identifiable data in your logbook, remains unresolved.
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