Guidance for trainees on recording reflections
Reflections are encouraged by the General Medical Council (GMC) and ‘Good Medical Practice’ makes it clear that all doctors should reflect on their performance, professional values, contributions to team work and feedback received. For reflections to have any effective use as part of the training process they need to be completed openly and honestly, although appropriately anonymised.
However, as a result of a case reported in the medical press, the wisdom of making such records has been questioned. Although details of the case are not entirely clear, the reports indicated that a trainee’s reflections had been used as evidence against them in court proceedings. Understandably, concerns were raised by doctors over the potential for third parties to require trainees, or any doctors, to release their reflective notes where they contain data about other individuals.
The law on the protection of personal data is contained in the Data Protection Act 1998 (DPA). The Act regulates the use of personal data, being data about a living person that could be any information about a person which might allow that person to be identified by another, when used in combination with other available information.
The Information Commissioner’s Office website provides helpful information and examples of ‘personal data’, but nonetheless, it can be difficult to discern exactly what information may fall within the scope of personal data. However, it is now clear that where a trainee ePortfolio record describes an incident or case as part of that record, and that includes patient identifiable information, such a record may be disclosable under the subject access provisions of the DPA.
The Academy of Medical Royal Colleges (the Academy), working alongside the Royal College of Paediatrics and Child Health (RCPCH), has now produced guidance for the Royal Colleges on recording reflective notes in light of confirmation that a request could be made to access any personal data on ePortfolios. While the guidance produced relates to trainee’s ePortfolios, it is important to note that there is the potential for similar data access requests to be made of qualified professionals’ records, where those contain personal data about a subject. Such records might include personal development documents and appraisals, and so such guidance should be heeded more generally.
While it has always been the position that records should be anonymised, this case brings into sharp focus the need to obscure all data that could potentially lead to the identification of a data subject. Information governance demands that no patient identifiable information or personal data is contained within written reflections, or other documents personal to the doctor. The Academy cites matters such as the person’s age, initials, date of birth, unusual characteristics or unique set of circumstances as matters that could lead to a patient being identified.
Instead of including such information, it has been recommended, to the extent that it is necessary to the matter under discussion, that an age bracket is provided and that the patient is referred to by a random alpha or numeric reference, and that no address is included. Any reference assigned should not correspond to any system allowing for the identification of the patient. This is not an exhaustive list and methods should be used to reduce the chances of identification as much as possible. Nonetheless, it is recognised that for extremely rare conditions it may be hard to present a matter entirely absenting all possible personal identifiers, but that every effort should be made to minimise such information.
In addition to patient identifying information, the Guidance advises that care should be taken over the substance of the reflections. Only a brief description of the subject matter is required. The practitioner should then include a comment on their reactions or feelings, and an objective evaluation as to the outcome, in terms of what was good or might have been done differently. The reflection should include a more thorough analysis of what has been learnt and the steps that a practitioner would now take bearing in mind what had been learnt.
The analysis is the most useful section in terms of learning and will mean that few details that could lead to the identification of a patient are required in the other sections. For those matters which have the potential to be investigated or subject to challenge, advice should be sought on the drafting of the record and emotive language should be avoided.
The Academy Guidance is clear that reflections must continue to be undertaken with the transparency and honesty with which they always have been. The Guidance is a timely reminder of the need to appropriately anonymise records. A request for the release of such records is a risk, but this is greatly reduced by taking care over the information that is included.
A copy of the Academy Guidance can be obtained by clicking here.
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This briefing is for guidance purposes only. RadcliffesLeBrasseur accepts no responsibility or liability whatsoever for any action taken or not taken in relation to this note and recommends that appropriate legal advice be taken having regard to a client's own particular circumstances.