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How should doctors use e-portfolios in the wake of the Bawa-Garba case?

BMJ 2018; 360 doi: (Published 08 February 2018) Cite this as: BMJ 2018;360:k572

Rapid Response:

Re: How should doctors use e-portfolios in the wake of the Bawa-Garba case?

Thank you for clarifying the use of reflective documents in this case.

I am concerned about the discussion in the media and in a letter sent by Professor Sir Terence Stephenson to all doctors. In this letter, Professor Stephenson reassures the profession that:

'The question of reflection has been raised by doctors. I wanted to start by addressing one of the key misunderstandings about this case, which the Medical Protection Society has clarified. Dr Bawa-Garba’s e-portfolio did not form part of the evidence before the court and jury.'

From this BMJ article it is clear that a 'Training encounter Form' was indeed seen by the prosecution team and therefore fed into the criminal trial.

I have seen this training encounter form.

Training encounter forms were previously used by the East Midlands Healthcare Workforce Deanery. At the top of the form is the statement that the form will 'guide decisions made about the trainee in their annual review.'

I think most trainees would therefore consider this to be part of their portfolio of evidence.

The intention of this form is to reflect on significant events. The form was completed by Dr O'Riordhan in his handwriting and lists his perception of Dr Bawa Garba's errors.

She did not sign this form as she disagreed with the contents.

Dr Bawa Garba's handwriting also appears on the form and she reflects about areas where she could have improved- she describes her personal learning.

To me then, this is clear. A document intended for supervision and trainee development, containing Dr Bawa Garba's written reflection, was seen by a prosecution QC who subsequently cross examined Dr Bawa Garba in a criminal court.

This document did form part of her training records and I think many trainees will be alarmed about this. I suspect if Dr Bawa Garba had been told at time that any reflective comments made would be seen by a prosecution barrister in a criminal manslaughter case, she may have taken legal advice before writing anything down.

It appears that the GMC letter to all doctors, does not make it completely clear that trainee reflective documents whether part of eportfolio or not, fed into this case and were seen by an adversarial barrister.

Good Medical Practice reminds all doctors that we should admit our mistakes honestly, and Duty of Candour requires us to apologize when something goes wrong. I am sure that the GMC should be held to the same standards.

The GMC were I am sure, aware that this document was seen by the prosecution in court, as they will have studied the case in detail before making a decision to appeal their own Tribunal's findings.

All doctors need to be aware that at present, there is no legal protection and anything that they write could be used against them in a subsequent court case.

Competing interests: I was Dr Bawa Garba's educational supervisor for a number of years after Jack Adcock's death. I work in a different department and was not involved in Jack's clinical care. I have had extensive discussions over many years with Dr Bawa Garba about this case and her reflections on it. I was cross examined for a number of hours at the MPTS tribunal in this case by a QC appointed by the GMC, where Dr Bawa Garba's portfolio and reflection were extensively discussed.

08 February 2018
Jonathan M Cusack
Consultant Neonatologist and Educational Supervisor
Neonatal Unit, Leicester Royal Infirmay