SLEs are supervised learning events that include
- Mini-CEX (mini clinical evaluation exercise)
- CBD (case-based discussion)
- DOPS (direct observation of procedural skills)
- LEARN (learning encounter and reflection note)
- LEADER (clinical leadership, work-based review)
- DCT (developing the clinical teacher)
These form part of the compulsory e-portfolio. There is lots of conflicting information regarding how may are required, and this will often vary by trust. Guidance for FY2 is that you need a minimum of 5 unique SLEs to map to the first five learning outcomes. Although if you aim for 5 per rotation as a rule of thumb you will end up with more than enough to map to the curriculum sufficiently.
Despite their importance, they are often not taught or explained well. Often you have to explore them yourself and work out how to use them through trial and error. This guide aims to offer more information surrounding the SLEs, including where and how you can potentially use them.
What is the point of SLEs?
Workplace-based assessments were introduced to enforce structured continuous assessment with more rigorous feedback. These are then linked (mapped) 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.
When to use each type of SLE
This is one of the SLEs that you will probably being using the most it is a very good option when you carried out an aspect of medical care. This could include things like an A-E approach, family discussion or breaking bad news. It covers more detailed clinical assessment and action than just a more straightforward DOP. These are perfect to map to the HLO 1 section when evidencing your skills which have developed throughout your time as a Foundation Doctor.
This is the other main SLE you will probably be completing often. This is perfect for evidencing informal teaching discussions and personal growth resulting from these. Often these will be following discussions with your seniors regarding an aspect of care, i.e ways of communicating or the knowledge and background of the speciality you are currently working in, e.g. ECG interpretation. Finding different ways to creativity use these to cover weak points in your portfolio is especially useful towards the end of the year before ARCP.
One will probably be more familiar with this from medical school as it will be your standard skills. Excellent for simple skills like suturing or NG tube. For slightly more unique skills like a baby check, try to discuss with a senior to turn in a Mini-CEX or CBD as these are typically more favourably looked upon.
This is a more formal way of reflecting and will be a very good option if you have performed and discussed the event with a senior, as they will be able to sign off the experience with you. This is slightly different to a normal reflective form that you can complete be yourself due to the slightly more formal nature of the form.
If the worst were to happen and you are involved in an adverse event or death, then this form could be incredibly useful and form part of a debrief with your seniors. It will provide a very good framework for you to acknowledge and analyse the situation.
This form is great if you have created a teaching programme, or lead an audit as it allows you to display a different area of medicine that you may not normally consider. The process of medical leadership is vital for a medical career and should not be overlooked if possible. This allows a great framework to consider in detail what you have done and how it benefited the team you are working in. This is a much longer form compared to some of the others and therefore will require additional time and effort to complete. Whilst not necessary it definitely makes your portfolio stand out from the crowd. Other scenarios you could use this form in include, leading an acute medical situation (e.g. cardiac arrest, met call).
This form is perfect to complete alongside the other teaching opportunities that you may have already added to your portfolio. It allows for an overview of all the teaching to be collected, along with acknowledgment of the feedback. It is also a really good way to summarise a number of individual teaching sessions as a whole and again will look better than many individual teaching certificates.
Your SLEs may be looked at under the following circumstances
- At each meeting (with your clinical/educational supervisor), typically at the start and end of your rotations
- 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.
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.).
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. Always try to include your thoughts and feelings as this will make your reflection a lot more detailed and you will really see a growth in the way you approach stressful and acute situations as you move towards the end of the year.
- Consider these SLEs early in each block and try to get them completed and signed off early so you do not have to worry about them
- After the first block, map the SLEs to learning outcomes so you can focus on areas lacking in evidence
- Don’t be afraid to ask FY2s or other seniors from help and SLE opportunities
- Try to focus on getting more senior grades to sign these, ideally registrar and above (some CT sign offs are fine)
- Chase people to sign these off you, they do not count if not signed
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