Developing high quality evidence: balancing your portfolio 

Across each of the domains, your portfolio needs to be balanced with a triangulation of professional outputs, personal reflection and corroborative observations or testimony from independent third parties.

  • Professional outputs are intended to show objective and demonstrable evidence of the outcomes.
  • Personal reflection is a metacognitive process that creates a greater understanding of both yourself and the situation so that future actions can be informed by this understanding. It allows you to ‘tell your story’ about the evidence and describe your individual role in creating that output.
  • Observations or testimonials from third parties are intended to show independent corroboration of your capability against the outcomes in real-life and provide independent assurance.

Illustrative examples of evidence traiangulation types 

These examples are for illustrative purposes only; there is no singular ‘right’ cocktail of evidence for your portfolio as it depends on your individual context.

Domain: Professional Practice

Outcome: 2.1 - ‘Delivers care using advanced pharmaceutical knowledge and skills for individuals and/or groups with highly complex needs, including where evidence is limited or ambiguous.

Context: Pharmacist working in a hospital setting

Triangulation

Illustrative evidence

Professional output

  • Audit of volume and breadth of their own independent prescribing practice (evidence of breadth of application of knowledge and skills)
  • Evidence of completing an advanced clinical examination course (evidence of advanced pharmaceutical skills)
  • Lead authorship of a local guideline for specialist use of an off-license medicine in certain circumstances in a tertiary hospital (evidence of delivering care using advanced pharmaceutical knowledge for groups with highly complex needs)

Personal reflection

  • Personal reflections on learning to become more confident with highly complex autonomous practice, including dealing with high levels of risk and unknowns
  • Personal reflections on growing the breadth of clinical areas in which you are practicing
  • Personal reflections on dealing with incidents where patients did not get the desired outcome of therapy following pharmacist-led medication changes via independent prescribing

Corroborative observations from third parties

  • Case based Discussion (CbD) with consultant medic on use of independent prescribing and advanced clinical examination at an outpatient clinic, when the patient did not fit exactly into the evidence-based or typical presentation (evidence of delivering care using advanced pharmaceutical knowledge and skills for individuals)
  • Case Presentation (CP) to pharmacist colleagues on the use of independent prescribing, clinical examination, and clinical test investigation on the differential diagnosis of a new condition at an outpatient clinic (evidence of delivering care using advanced pharmaceutical knowledge and skills for individuals)
  • Direct Observation of a Practical Skill (DOPS) from an Advanced Nurse Practitioner on interpretation of multiple ECGs during a ward round (evidence of delivering care using advanced skills for individuals)
  • Acute Care Assessment Tool (ACAT) from a specialist doctor on the use of independent prescribing, advanced clinical examination and complex decision making in five consecutive patients during a ward round (evidence of delivering care using advanced skills for individuals)
  • Expert Mentor Review (Clinical) from consultant medic on overall observation of the pharmacist's clinical role and impact, including patient-level and service-level e.g. local guideline, committee involvement etc (evidence of whole outcome Delivers care using advanced pharmaceutical knowledge and skills for individuals and/or groups with highly complex needs, including where evidence is limited or ambiguous.)

Domain: Person-centred care and collaboration

Outcome: 1.4 - ‘Builds strong relationships with colleagues working as part of multidisciplinary teams influencing the delivery of positive healthcare outcomes

at a team and/or organisational level.

Context: Pharmacist working in a community setting

Triangulation

Illustrative evidence

Professional output

  • Copy of a guideline/SOP developed collaboratively with local practices to support people to use community pharmacy as a fist port of call (evidence of working with others influence care)
  • Evidence of an audit/service evaluation demonstrating how the guideline above impacted on care delivery (evidence of impact on outcomes)
  • Terms of reference and minutes from a local palliative care network for community pharmacists set up/chaired by the candidate (evidence of development of networks beyond immediate care setting, and collaborating with a range of professionals)

Personal reflection

  • Personal reflection describing the challenges and benefits of developing the local guidance/SOP, clearly articulating the candidate’s contribution (evidence of working with others influence care)
  • Personal reflection on setting up a local palliative care network for community pharmacists, describing the challenge of engaging other healthcare professionals and how this was overcome (evidence of development of networks beyond immediate care setting, and collaborating with a range of professionals)
  • Personal reflection on starting in a new pharmacy and how the candidate built new relationships with the pharmacy team and a broad range of local healthcare professionals (evidence of fostering effective team working)

Corroborative observations from third parties

  • DONCS from GP member of working group who developed the guideline/SOP commenting on the candidates contribution to the development (evidence of working with others to influence care and shape strategy)
  • CbD about a complex palliative care patient who required the candidate to work with the GP, district nursing teams, the palliative care consultant and the hospice pharmacist (evidence of working with senior MDT colleagues in the delivery of safe care).
  • MSF from members of the palliative care network
  • EMR from GP clinical mentor describing how the candidate works with and influences colleagues and HCPs from across the healthcare system (evidence of whole outcome)

Communicates complex, sensitive and/or contentious information effectively with people receiving care and senior decision makers.

Domain: Professional Practice

Outcome: 2.3 - ‘Demonstrates effective clinical reasoning skills, making autonomous, evidence informed, person-centred decisions about treatment for individuals

or groups with complex clinical needs, managing risk in the presence of significant uncertainty

Context: Pharmacist working in a general practice setting

Triangulation

Illustrative evidence

Professional output

  • Copy of presentation describing a complex patient where you had to co-develop a bespoke treatment and monitoring plan accounting for multiple co-morbidities, using medicines off-label and outside of the scope of local/national guidelines (evidence of clinical reasoning, and autonomous decision making)
  • Copy of a shared care guideline developed with specialist mental health colleagues for the safe and effective use of newly initiated antipsychotic medicines (evidence of evidence informed person-centred decisions for groups with complex needs)
  • Patient survey responses from an opioid deprescribing clinic (evidence of person-centred decisions for individuals)

Personal reflection

  • Personal reflection describing development of clinical reasoning skills over a period of time and how practice has evolved (evidence of developing clinical reasoning skills)
  • Personal reflection on the development of a shared care guideline, describing how you applied the evidence base, negotiated issues where evidence was lacking (evidence of informed decisions about treatment for groups)
  • Personal reflection on starting a new opioid deprescribing clinic, how the candidate has managed  the challenging clinical conversations and managed to implement an individualised approach for people, (evidence of managing risk in the presence of significant uncertainty)

Corroborative observations from third parties

  • Case presentation feedback via SLE
  • CbD about a complex patient requiring multiple treatment trials before finding the appropriate course of action (evidence of autonomous management of people with complex needs).
  • ACAT by specialist pain pharmacist observing opioid deprescribing clinic
  • DONCS by mental health consultant re input into shared care guideline
  • EMR from GP clinical mentor describing how the candidate works with and influences colleagues and HCPs from across the healthcare system (evidence of whole outcome)