MEDEV

School of Medical Sciences Education Development

Introduction

Most careers now require the use of computer technology to communicate and share information. Therefore it is logical that we would use it, in a secure manner, to share assessment information for doctors at all levels of training. ePortfolios are already widely used in medical careers, but the use of video multi-media on the program to show recordings of assessments would add an additional  dimension to this already successful tool. 

All foundation doctors employed in the UK are required to establish a portfolio; the contents of which are dictated by the United Kingdom Foundation Programme Office(UKFPO) and based on the foundation programme curriculum as well as the General Medical Council (GMC) guideline: The New Doctor (2009) and Good Medical Practice (2009). The portfolio is designed to help doctors draw together the information that will help them on the path to becoming a good doctor, assisting personal development and allowing doctors to demonstrate the attainment of attitudes, skills and knowledge needed to complete the foundation programme.1

Most deaneries now provide access to ePortfolios for foundation doctors, this allows portfolios to be accessed and updated anytime, anywhere, and the online storage of information is safer when compared to paper-copies which may become lost or damaged. The online aspect of this type of portfolio also aids the sharing of data, with assessors, who are then able to view the data and add assessment information, or with prospective employers, who may wish to review the evidence of an individual's career progression, and this system allows them access to substantial material.1

There are some disadvantages to using ePortfolios, a small amount of personal information about the doctor must accompany the portfolio, and it is the responsibility of the website manager to ensure this is kept secure. 

Methods

The North Western Deanery uses the Horus-online Foundation Training ePortfolio. To this we have added a "Media Centre" which makes use of HTML, PHP, JavaScript, Flash and Flowplayer to create a simple interface for trainees to upload videos along with categorisation and other descriptive information. Supervisors can approve or reject uploaded videos for their trainees, and can ask questions of the trainees via the commenting system.

The server setup to encode and host video file:

• Server running Red Hat Linux alone with Adobe Flash media Server.
• Additional software installed: FTP serve, PHP, ffmped, Codesc.

The Process

Video files are uploaded to the Horus server via a web interface on the Horus system ("Media Centre"). These files are periodically transferred to the Media Server via FTP, where they enter a queue for encoding via ffmpeg. Once the files have been successfully encoded the original source files are deleted and the encoded files are made available on the Flash Media Server. Trainees are kept informed throughout the encoding process, via their Media Centre page, to whether or not the video encoding was successful.  Once encoding is complete a thumbnail of the video is created and transferred to the Horus web server for display on the Media Centre screens. 

Demonstration

The "Media Centre" page also gives access to a user guide explaining the upload process. Table 1 give the URL which allows access for demonstration purposes. 

Discussion

The addition of video media to ePortfolios, showing work-based assessments, is the next logical step in development of an already well established system. It would allow the viewer to not only see written reports of practical or communication skills, which are unavoidably biased by the assessors' relationship with the doctor and their approach to marking. This would permit an individual from another clinical area, who may have never met the candidate, to view a recording of them completing a practical task, and assess for themselves their competency. The use of video media would also mean that there could be no doubt of the authenticity of assessments.

Whilst media files have many advantages in supporting trainee portfolios, concerns over data protection have the potential to delay the widespread adoption of this technology. The UKFPO standards and security advice states that portfolio developers should not allow data stored in a trainee portfolio to be identifiable to a particular patient. Whilst public domain software packages exist to airbrush and alter appearance and voices it is unlikely that trainees will have the motivation to utilise them and the workload would be outside the scope of portfolio QA processes. In addition it is possible that the key aspects of an assessment may be lost if non-verbal and verbal aspects of the trainee patient encounter are "doctored".

One way around this problem may before patients to give consent for their assessment to be stored as a mediafile. The GMC provides guidelines for the use of visual and audio recordings of patients,3 which states that permission should be sought before the recording is made, where possible, and that written consent for disclosure of the recording be given. The patients need to be given adequate information about the purpose of the recording, who will be allowed to see it, the circumstances in which it will be shown, whether any copies will be made, arrangements for storage and how long the recording will be kept. It must be made clear that the recording is not for the patients' treatment or assessment, that refusal will not compromise their care in any way, and that when required or appropriate it can be anonymised.4 Normal procedure for obtaining informed consent should be followed, as outlined in the DOH Reference Guide to Consent for Examination or Treatment.4 The patient must have the purpose of the recording fully explained and be autonomous in their decision making. A printable guide for obtaining patient consent to recording of an assessment could be incorporated into the "Media Centre" page, allowing the trainee to achieve informed consent, which can be undertaken as part of the media file. Failure to produce evidence of patient consent, which is the responsibility of the trainee, would result in the recording being rejected from the site by the supervisor.

Media-recording equipment is now readily available; the majority of trainees will have access to some form of recording device, be it a digital camera or mobile phone. However, the quality of recording equipment may be a limiting factor in some cases, and this would undoubtedly lead to the video not being validated by the supervisor.

Another concern is the disposal or deletion of video recording from the media-recording-device (e.g. camera, mobile phone) used, after the data has been uploaded into a trainee portfolio Quality assurance of this process presents a considerable challenge to the developer. Limiting assessment using media technology to specific video devices will allow regular inspection and removal of assessments. However, limiting the media used may restrict asessment opportunities for trainees: part of the reason for introducing this technology is because of the availability of media recording equipment these days. Another option would be random inspections of trainee phones to ensure deletion and an entry into the probity section of their portfolio, alternatively this could be an addition to the Clinical Supervisors Report, which takes place during the end-of-placement review meeting. 

Conclusion

The ePortfolio is an important record of career progression for all doctors, especially foundation trainees, and the addition of video-media for assessments will provide a new dimension and validity to the portfolio. This system will allow all supervisors to view trainees being assessed without having to be there in person, and therefore allow them to make their own evaluation of the doctor's capability. Whilst there are issues regarding consent for and storage of the recordings, these could be resolved with careful planning and documentation.