This was published in FICM’s Trainee Eye Sep 2019 – Issue 12
In 1862, one of the most important ancient Egyptian medical manuscripts in history was bought by dealer Edwin Smith. Named the Smith Papyrus (c.1600BCE), it is presented as a list of 48 case histories of various injuries. That these descriptions were likely collated experiences from physicians of old meant that observations about patterns had been made, a process that is supported by written or mental logs of patient encounters.
In August 2018, I launched the NorthWest ICU Logbook; a free, personal, fully editable spreadsheet- based logbook for ICM practitioners of all levels. While the form of logging might have changed since the times of the Smith Papyrus, medical professionals continue to log cases to aid learning, develop clinical acumen, hone pattern recognition skills and partake in clinical governance and accreditation.
Over a year since its launch, I follow its uptake and spread, reflect on lessons learnt and share some future plans. My hope is that it may serve as an encouragement for other projects that will further enrich and develop our growing specialty.
Logbooks in medicine
One could pick many examples from other specialties to demonstrate the importance of logbooks.
The Royal College of Surgeons’ pan-surgical eLogbook boasts 31000 users. It remains a key part of their ARCP and revalidation processes. For the trainee,
it serves not only as evidence for procedures, but allows them to identify gaps in competence, aids in reflective practice and provides a quantitative way
of gaining confidence as they progress through their training. For the College, the ability to interrogate procedural numbers has allowed them to maintain their standards of competence, while being realistic about achievability after the implementation of the European Working Time Directive. Likewise, the Royal College of Obstetricians and Gynaecology stipulates recommended numbers of various procedures for progression through stages of training.
Logbooks also play a vital role in many procedural accreditation modules. Most ultrasound accreditation modules make use of a logbook to evidence minimum numbers to achieve competence. These not only include FICE and CUSIC within our specialty, but also Emergency Ultrasound from Royal College of Emergency Medicine, Echocardiography from British Society of Echocardiography and Pleural Ultrasound from the British Thoracic Society, amongst many others. The use of a logbook allows different supervisors to ensure trainees achieve competence through deliberate practice, which is evidenced by the logbook and later on, the actual procedural accreditation. This standardised, transparent approach to governance ensures patient safety and practitioner competence in a system focused on providing safe, effective and efficient care.
I was very fortunate to have the support of the Training Programme Director, Head of School and Regional Advisor in my region. Soon after its launch,
I found myself speaking at my own ST3 induction, introducing the logbook to fellow new trainees in the region. From there, various channels of dissemination occurred through online professional groups and word of mouth. Uptake was slow but steady. The logbook website gained a big boost in traffic after it was presented and approved by the Training Assessment and Quality (TAQ) committee for listing on the FICM website.
Three versions have been released since launch, with improvements and corrections made from user feedback. This has helped to keep the logbook relevant and responsive.
Lessons and Reflections
“Doesn’t that sound a little absurd…”
Audacious as the rest of the song might be, it is
the bottom line from Robbie Williams’ song, ‘I Will Talk and Hollywood Will Listen,’ which sums up my disbelief with the current success of the logbook thus far.
Getting help and advice early on from key trainers
and consultants was extremely helpful for the development of the project. They not only gave valuable advice regarding how the logbook would fit into ARCP requirements for trainees, but also expressed interest in the logbook for their own
use. As a result, a few fields were added to cater to consultant use, increasing the target population of the project. Moreover, they sent draft versions to other FICM tutors in the region to gain further advice and input. With their input, the first release of the logbook was already useful for practitioners of various grades and seniority.
Analytical software built into the website allowed me to track the spread of the logbook. This provided a quantitative measure of the success of the logbook. Despite the initially steep learning curve to programme the software into the website, I am very pleased that I had taken this into account at the start of the project. The software has given me data to prove that the logbook indeed had good uptake, but it also gave me reason to continue developing both Mac and Windows versions.
A project like this occupies a significant amount of time, which for a dual trainee with a young family and multiple other responsibilities outside of the curriculum, was extremely stressful. I experienced burnout through the last year, not just due to this project, but several other situations both at work and at home. Fortunately, my wife and some close friends provided essential support during these struggles. I’m thus still in the process of learning how to prioritise and juggle different projects at different times while letting some opportunities pass me by.
Both Mac Numbers and Windows Excel versions will continue to be updated and supported. I am trying to further improve and refine the dataset and summary graphs, while retaining the ability to edit the spreadsheet. This will continue to make the logbook relevant and appealing. I might be unable to keep up with all the diverse interests across our specialty, but the ability to edit the spreadsheet will enable others to personalise their own logbooks easily. I depend on feedback for further version upgrades, so am keen to receive feedback and sharing of edits.
Training data provided by logbooks has the potential to play a larger role in the ICM training scheme. It will allow a more in depth view of each stage of training, provide insight not just into procedural numbers to achieve competence, but also into caseload, which in turn will help influence the evolution of our specialty. We are aiming to analyse pooled logbook data to understand current areas of training excellence and inform improvements where needed.
If you have benefitted from the NW ICU Logbook, please share it with friends and colleagues. I will also be very happy to receive any comments about it.
The NW ICU Logbook is freely available via the Manchester and Mersey Anaesthesia and Critical Care training website: http://logbook.mmacc.uk
The author can be contacted at: firstname.lastname@example.org