SLEs are supervised learning events that include
- Mini-CEX (mini clinical evaluation exercise)
- CBD (case-based discussion)
- DOPS (direct observation of procedural skills)
These form part of the compulsory e-portfolio, but most aren’t taught how to complete them effectively & make them useful. As a registrar, I have sent & signed a large number and there is a great variation on what people do with them. This is my take on how to make them useful.
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What is the point of SLEs?
Workplace-based assessments were introduced to enforce structured continuous assessment with more rigorous feedback. These are then linked to the curriculum objectives to ensure your assessments cover all the things you need to know. The aim is to somewhat prioritise training over simple service provision, allowing your learning needs to be evaluated and for you to be given constructive feedback to allow advancement.
Your SLEs may be looked at under the following circumstances
- At each meeting (with your clinical/educational supervisor)
- At ARCP (annual review of competency progression) where your portfolio is looked at by a panel (usually without you being there) to judge whether you “pass” the year
- You may print some off to showcase your commitment during specialty interviews
- Potentially when a complaint is raised or you’re investigated to show whether there is a pattern of poor progression and what multiple staff members have thought about you over the years
Therefore your SLEs must indicate the growth you are undergoing as a doctor. They should highlight what you have done well & what you are looking to improve on.
How to get it right
The SLE should therefore be structured to consider all of the above circumstances. By focussing on what you did well, you become better at answering interview questions with the same focus. For example, if asked “what are some key attributes an IMT doctor needs to deal with an emergency”, instead of listing qualities you showcase with a written example how you can demonstrate the key attributes required and constantly evaluate your own performance. This means you should do far better in the interview.
Detailed Example
Mini-CEX and CBDs follow a similar format; the difference is that a CBD would be more of a discussion. Here is an example of a mini-CEX, yours doesn’t need to be this long!
The “Title” allows the reader to immediately know the focus of what you have done.
The “Brief anonymised history” does not include any patient identifiable details & gives as little information as is necessary to understand the patient’s issues. It is not a copied & pasted clerking or an endless list of past medical history and investigation results.
The “Focus of encounter” lists as many items as possible. This allows mapping to more curriculum items and helps you include all aspects of the case (documenting, communication, clinical assessment etc.).
I was impressed with how he coordinated the nursing team, asking them by name to perform tasks and report back to him. I also liked how he debriefed with the MDT to ensure everyone had an opportunity to reflect on what went well and how teamworking could be improved in the future. I was also impressed with how he explained what had happened to the family and dealt with their anger that this had not been picked up sooner. His excellent bedside manner meant the family felt they had been listened to and confident in the treatment had been put in place.
An improvement would be to speak out loud the differentials he is considering, such that the whole team is aware of what is being considered. When he did this with some prompting, the nursing team then were able to suggest they could call the x-ray department to organise a portable CXR.
A further improvement would be to consider the causes of delirium more thoroughly including the indications for a CT brain.
The “Feedback backed on behaviours observed” can discuss different skills required which you can usually find in an application handbook. They tend to be quite generic so useful for all applications (e.g. leadership, communication, IT skills, clinical) the focus is different for different specialties e.g. more on practical skills for surgery.
I always like to use the SMART framework here. It allows for an achievable action rather than what most people write which is “improve management of x situation”.
- Specific (defining exactly what you intend to do)
- Measurable (be able to provide evidence that you’ve done it)
- Attainable (actually something you can do)
- Relevant (align with long term objectives e.g. specialty applications)
- Time-based (have a realistic end-date e.g. by the next case or a certain time period)
For reflection, if you’re unsure how to construct this you can consider Gibb’s cycle. Another place for you to showcase what you did well & demonstrate that you’re looking to grow.
