Bradford VTS · FourteenFish ePortfolio
Ram's Guide to Easy Peasy
Learning Logs
"Because 'I saw a patient and it was interesting' isn't quite the reflection your Educational Supervisor was hoping for."
📌 Jump to a Section
💡 Why Learning Logs Actually Matter ▸
Your learning log entries aren't just boxes to tick on FourteenFish. They serve two distinct and important purposes:
Reflection is how doctors grow. Without it, experience simply accumulates without turning into wisdom. Your log is the space where that transformation happens — if you use it well.
Your log entries are evidence against the 13 Professional Capabilities. At the end of your entire training period — once you've also passed the AKT and SCA — your ARCP panel will review whether there's sufficient evidence for all 13. CCT depends on it.
✅ What Makes a Good Learning Log? ▸
Before you write a single word, know what you're aiming for. A gold-standard entry has these hallmarks:
The Writing Style
- Written in first person singular — use "I"
- Analyses and comments, not just describes
- Focused entirely on learning
- Makes connections between ideas
- Shows links between entries across time
- Shows evidence of planning ahead
- Shows evidence of looking back
- Reflects on your progress
The Three Core Qualities
Describe your own thought processes. What did you consider? What did you discard and why?
Be open and honest about your performance. Consider your own feelings — not just your actions.
Describe what needs to be learned, why, and — crucially — how you plan to learn it.
⚡ Ram's 5 Steps Flash Cards
This is the heart of it. Follow these steps every time and your log entries will be consistently high quality — without exhausting yourself in the process.
Think About the Event
Don't write anything yet. Simply think about the event, encounter, or situation you want to capture. On a scrap of paper, jot a few brief notes — things you found interesting, difficult, or inspiring.
You need to save your mental energy for the sections that actually count — the competency reflections. Don't exhaust yourself at step one. A few bullet points is plenty.
Write a Brief Description (2–5 sentences maximum)
Keep this short, focused, and descriptive. Its only job is to lay the context for everything that follows. Keep clinical details brief unless a specific detail is directly relevant to your reflection.
- Write 2–5 sentences only
- Keep it purely descriptive
- Say "Chest examination — essentially normal" and move on
- Write paragraphs of description
- Include your thoughts or feelings here
- Analyse anything at this stage — save that for later
Quickly Scan the 13 Professional Capabilities
Spend 3–5 seconds on each PC. For each one, ask yourself a single question: "Did this PC have particular relevance or meaning in this case?"
If you know you need more evidence for a particular PC, do not force this event to become that entry if it genuinely isn't. Authenticity matters — and experienced supervisors can spot a forced entry a mile away.
By the end of one minute, you should have a clear set of PCs to write about. Sometimes you'll get a welcome "flash moment" — you realise a PC was more relevant than you first thought. Trust those.
Write About Each Relevant PC — One by One
This is where you spend your brain power. For each selected PC, write in four layers:
Use the PC name as your subheading. For example: PRACTISING HOLISTICALLY. This keeps you focused and helps your supervisor find what they're looking for.
Was there an emotion? Write about what you felt and what caused it. This supports self-awareness — one of the most commonly underdeveloped parts of reflection.
This is the most important part. Ask yourself: What was good? What wasn't? What could you or others have done differently? What did you actually learn? How could you prevent a poor outcome next time?
Take the specific situation and draw a broader conclusion that could apply to future patients or situations. For example: "From this I learned that the patient–doctor relationship is enhanced if one explores the patient's agenda from the start."
Sometimes two competencies are so entwined you can't separate them neatly. That's fine — use a combined heading such as PRACTISING ETHICALLY / FITNESS TO PRACTISE and write them together.
Consider Evidence for Future Learning
A short but important final section. Is there anything you need to learn to improve your future performance?
"I plan to read around the subject."
This is too vague — it could be written about anything and proves nothing.
- "I've booked onto the Leeds Women's Health Course for GPs on 2nd July."
- "I found a BMJ e-module on handling difficult patients — I'll complete it this week."
- "I searched online and found [website] particularly helpful because it explained that the 3 major features requiring admission are…"
Step 1 + Step 2 = roughly 4 minutes. All remaining time → Step 4 (writing about the competencies). The description is the scaffolding. The competency reflections are the building.
These 13 capabilities capture everything a GP does. Every case maps onto one or more of them — and your CCT depends on evidencing all 13. Click any capability below to see exactly what to write, what to avoid, and which theories to reference.
🗒️ The Capability Cheat Sheet
For each capability: what it really means, exactly what to write, what to avoid, and how to link it to theory. ★★★ = trainees consistently struggle with these most.
1 Fitness to Practise ★★★(FtP) ▼
✅ What to Write About
- A mistake you made — and what you learned
- A mistake you noticed in a colleague — significant event?
- How you protect yourself from constant interruptions
- Your work-life balance — or lack of it
- A time you felt stressed or unwell — and what you did
- Not going beyond your competence — seeking help
- How you handle the pressure of on-call
- Going the extra mile to ensure patient trust
❌ Common Mistakes
- Writing "I am fit to practise because I did a good job" — this misses the point entirely
- Confusing this with clinical competence (DGI, CEPS, CM)
- Forgetting the reflective dimension — just describing what happened without turning the lens on yourself
- Ignoring safety and quality issues involving others
🔗 Link to Theory
GMC Duties of a Doctor · Work-life balance literature · Significant Event Analysis frameworks · Emotional intelligence theory · Maslow's hierarchy (self-care before patient care)🚨 FtP — Must-Not-Miss Scenarios & Required Actions
| Scenario | Required Action |
|---|---|
| Colleague with apparent alcohol/substance problem affecting patient care | Escalate to clinical supervisor or practice manager; document your concern; do not cover for colleague — duty to patients overrides collegial solidarity |
| Your own health affecting clinical performance | Seek support; consider reducing workload; disclose to educational supervisor; access Practitioner Health Programme (0300 030 5300) |
| Prescribing error or clinical mistake | Duty of candour — be open with the patient; report via significant event analysis; do not conceal |
| Patient safety concern about a system or process | Raise via practice governance procedures; escalate if not addressed (CQC, GMC if necessary) |
| Colleague asks you to collude with a dishonest report | Decline; document the request; seek MDU/MPS advice immediately |
💛 Trainee Wellbeing — The Numbers Matter
GMC data shows approximately 20% of GP trainees are at high risk of burnout, with over 60% reporting moderate-to-high burnout risk — double pre-pandemic levels. The GMC (GMP 2024 Para 78) now explicitly states doctors should take care of their own health and wellbeing.
Support available: BMA Wellbeing Support Service: 0330 123 1245 · Practitioner Health Programme (England): 0300 030 5300 · RCGP Wellbeing resources
2 Maintaining an Ethical Approach ★★★(MEA) ▼
✅ What to Write About
- Consent issues — especially complex or unclear ones
- Confidentiality dilemmas
- Capacity assessments — reference the four functional elements
- Balancing autonomy vs beneficence vs non-maleficence vs justice
- Rationing decisions — utility vs individual rights
- Situations where you had to move between ethical positions
❌ Common Mistakes
- Writing "I discussed consent" without exploring the ethics behind it
- Not referencing any ethical framework — just describing what you did
- Confusing malfeasance (wrongdoing) with maleficence (causing harm)
- Forgetting that capacity is functional and decision-specific — not global
🔗 Theory Toolkit
Four pillars (Beauchamp & Childress): Autonomy · Non-maleficence · Beneficence · Justice · Mental Capacity Act 2005 (four-stage functional test) · Aristotle's virtue ethics · Utility vs rights-based rationingThe Four Elements of Capacity — Never Forget These
- Understand — the information about the decision
- Retain — that information long enough to make the decision
- Weigh up — the pros and cons of the options
- Communicate — their decision (in any way — not just words)
Lacking any one of these = lacks capacity for that decision. But capacity is always decision-specific and time-specific.
🏛️ The Four Principles — ABCJ (use in both portfolio entries and SCA)
Autonomy
Patient's right to make informed decisions. Never override without strong reason.
Beneficence
Act in the patient's best interests — positive action to promote wellbeing.
Non-maleficence (Care)
Avoid harm; weigh risks of action vs inaction carefully.
Justice
Fair allocation of resources; treat patients equitably without discrimination.
⚖️ Montgomery Principle (Consent) — AKT & MEA
You must disclose any risk the patient would consider significant in their own circumstances — even if very unlikely. The standard is the patient's perspective, not what a reasonable doctor would disclose. Failure to provide sufficient relevant information can be legally challenged.
Structured ethical decision-making (when principles conflict):
- Name the ethical issue — identify which principle is in tension
- Check if additional information is needed before deciding
- Default to the single obvious option if one exists — most GP ethics has a clearly right answer
- If conflict persists: attempt to resolve (persuasion, alternative plan, more information)
- Seek professional guidance (GMC guidance, MDU/MPS hotline)
- Document the reasoning carefully
3 Communication & Consultation Skills(CCS) ▼
✅ What to Write About
- Rapport building — how and why
- ICE (Ideas, Concerns, Expectations) — and how it changed your management
- PSO (Psycho, Social, Occupational) impact
- Active listening, verbal & non-verbal cues
- Chunk-and-check explanation method
- Shared decision-making — not just telling
- Safety-netting with rationale
- Three-way consultations, telephone/remote consultations
❌ Common Mistakes
- "I explained everything clearly" — vague, no evidence of skill
- Forgetting to say how ICE changed the consultation
- Treating communication as a tick-box rather than an intelligent process
- Not mentioning the Calgary-Cambridge model even when clearly applied
🔗 Theory Framework — Calgary-Cambridge Guide (71 skills)
Initiating the session · Gathering information · Physical exam · Explaining & planning · Closing the session · Building the relationship (runs throughout)4 Data Gathering & Interpretation(DGI) ▼
✅ What to Write About
- History, examination, and test results — concisely written
- Red flags you covered (or actively sought)
- Other information sources — letters, records, relatives, other HCPs
- Narrative to contextualise findings
- How you interpreted the data to reach a working hypothesis
❌ Common Mistakes
- Being too verbose — "I then proceeded to measure the RR which was 32..." (concise!)
- Listing data without interpreting it
- Forgetting other information sources beyond the patient themselves
- Not covering red flags, even to say "red flags were absent"
5 Clinical Examination & Procedural Skills(CEPS) ▼
✅ What to Write
- Examination outcomes in medical-note style
- For example (respiratory): "Good chest movements, no distress, RR 18, O2 sats 98%, BS vesicular, no added sounds"
- Positive and relevant negative findings
❌ What to Avoid
- "I then proceeded to auscultate the chest and was pleased to find..."
- Excessive narration of the examination process
- Vague statements like "examination was unremarkable" — be specific
6 Making Diagnoses & Decisions ★★★(MDD) ▼
✅ What to Write About
- Working diagnosis and differentials you considered
- Why you chose each investigation — and what you expected to find
- Pros and cons of treatment options considered
- Admission decision — grounds for and against
- The reasoning behind your decisions (not just the decisions)
❌ Common Mistakes
- "I decided to prescribe amoxicillin" — no reasoning shown
- Not mentioning differentials you considered then ruled out
- Ignoring the decision-making process when admitting/not admitting
- Not linking to any theoretical framework even when it clearly applies
🔗 Decision-Making Theory Toolkit
7 Clinical Management(CM) ▼
✅ What to Write
- Clear, concise management plan — numbered if helpful
- Justify any decision that deviates from standard practice
- Include safety-netting where clinically appropriate
- Follow-up arrangements and review plans
❌ Common Mistakes
- Writing paragraphs when bullet points work better
- Including safety-netting for every entry whether appropriate or not
- Stating the plan without any justification when non-standard
📋 Example — Asthma Exacerbation Management Plan
- Salbutamol nebuliser 2.5mg — administered in surgery
- Prednisolone 40mg OD for 5 days — as per BTS/SIGN guidelines
- Regular salbutamol MDI 2 puffs QDS for 48 hours
- Safety-netted — return or call 999 if SOB worsens, unable to talk, lips go blue
- Review in 48 hours — assess response, smoking cessation, inhaler technique
Note: Drug doses in your entry should always be verified against BNF/NICE CKS at the time of writing.
8 Managing Medical Complexity ★★★(MMC) ▼
⚠️ Complicated vs Complex — The Distinction
COMPLICATED (not MMC evidence)
- CKD management pathway — many steps, but all predictable
- Managing sticky eye + sore throat + a mole + fungal nail — 4 things, but all simple
- Following a complex protocol step-by-step
COMPLEX (good MMC evidence)
- Hypertension + CKD — treating one affects the other unpredictably
- COPD + depression + frailty + social isolation — all interacting
- Where managing one problem creates unpredictable effects elsewhere
✅ What to Write About
- Two or more complex medical problems with genuine interactions
- Coordinating care where multiple specialists are involved — preventing Collusion of Anonymity
- Managing genuine uncertainty — how did you handle not knowing?
- Explaining risk to patients — QRISK scores, contraception failure rates
- Health promotion as part of a complex picture
❌ Common Mistakes
- Thinking "I managed 3 problems = MMC" — not if they're simple problems
- Not explaining why the situation was complex (not just that it was)
- Forgetting Collusion of Anonymity as a key concept
🔗 Theory
Complexity Theory · Collusion of Anonymity (Balint) · Risk communication frameworks · Uncertainty management strategies9 Working with Colleagues & in Teams(WCT) ▼
✅ What to Write About
- Seeking a second opinion — why? How? What happened?
- Involving other professionals — HVs, midwives, DNs, mental health teams, microbiology
- Coordinating care across teams to prevent silo working
- Acute admissions — handover, the referral letter, liaising with on-call
- Team dynamics — meetings, practice culture, ethos
- Teaching colleagues, running workshops
❌ Common Mistakes
- "I referred to orthopaedics" — not sufficient without exploring the team dynamic
- Describing yourself as the team hero — that's OML, not WCT
- Forgetting the non-medical team — admin staff, pharmacists, paramedics
🔗 Theory Toolkit
Tuckman's stages of team development · Belbin team roles · SBAR communication · Communities of Practice (Wenger) · Facilitation skills theory10 Maintaining Performance, Learning & Teaching(MPLT) ▼
✅ What to Write
- Specific learning needs — with specific plans (name the course, name the resource)
- What you learned and — crucially — what it will change in your practice
- Teaching you've done — linked to educational and facilitation theory
- Evaluation of your teaching — how do you know it worked?
❌ Common Mistakes
- "I will read up about facet joint arthritis" — too vague. Where? When? How?
- Copy-pasting content from online learning material
- Describing teaching without linking to theory
- Forgetting to evaluate your teaching
11 Organisation, Management & Leadership(OML) ▼
ORGANISATION
- Primary & secondary care systems
- Medical records — organised, logical
- IT systems to facilitate care
MANAGEMENT
- Managing yourself — results, letters, admin
- Time management strategies
- Productivity — describe how specifically
LEADERSHIP
- Chairing meetings
- Leading a project or change
- Co-ordinating complex care
🔗 Leadership Theory
Developing a vision & purpose · Delegation & motivation · Negotiation & influencing · Learning agility & innovation · Self-awareness · O-HIT values (Openness, Honesty, Integrity, Trust)12 Practising Holistically, Promoting Health & Safeguarding(PHPHS) ▼
HOLISTIC PRACTICE
- Wider context beyond the medical
- Impact on work, family, mental health
- ICE and its effect on management
- PSO dimensions explored
- Cultural/socio-economic context
HEALTH PROMOTION
- Must be appropriate and realistic
- Motivational Interviewing skills
- Risk explanation tools (Cates plots)
- Challenging unhelpful health beliefs
SAFEGUARDING
- Recognising a safeguarding concern
- What you did and why
- Understanding the systems
- How you handled it to minimise patient distress
13 Community Orientation ★★★(CO) ▼
❌ NOT Community Orientation
"I referred Mrs Patel to the community physiotherapy service." — This is WCT or CM, not CO.
✅ IS Community Orientation
"After seeing three Punjabi-speaking patients with poorly understood diabetes, I realised all our leaflets were in English. I sourced Punjabi-language diabetes resources and shared them with the practice team."
✅ Strong CO Evidence
- Something learned from one patient that you applied to a whole group
- Changes to services made as a result of a case
- Choosing generic prescribing to protect NHS budget (population benefit)
- Involvement with CCG/ICB/PCN or LMC meetings
- Chlamydia screening campaign for a high-risk practice population
- Patient Participation Group attendance
❌ Weak CO Evidence
- Any referral of an individual to a community service
- One-off actions for a single patient without population dimension
- Anything that's really WCT, CM, or OML in disguise
🔗 Theory — Use These in CO Entries
Good reflection isn't just about what you write — it's about how deeply you write. The ISCE framework describes four levels of quality. Most trainees are good at level 1. Most fall short at levels 2 and 3. Level 4 is what makes an entry truly memorable.
| Level | What It Means | What It Looks Like in Practice |
|---|---|---|
| I — Information | What happened? What did you do? | A description of the event, clinical findings, what was said or done. Most trainees do this well — sometimes too well. |
| S — Self-Awareness | How did it make you feel? What were your thoughts? | Honest acknowledgment of uncertainty, discomfort, pride, confusion, or any emotion evoked by the encounter. |
| C — Critical Analysis | What was good? What could have been better? What would you do differently? | A genuine interrogation of your own actions and decisions. Not just "it went well" but why and what specifically could change. |
| E — Extended Learning | What have you learned? How does this apply more broadly? What next? | A generalisation away from the specific event — a principle that applies to all future similar situations. Plus a concrete, specific plan for further learning. |
Trainees often describe the event but don't analyse it (poor C). And this means they can't move on from it if it happens again in the future (poor E). The entries that fail to impress ARCP panels are almost always deficient in critical analysis (C) and extended learning (E) — not in description (I).
You realise a patient became frustrated because you only grasped their real concern near the end of the consultation. Rather than just noting "the patient was unhappy," generalise it: "From this I learned that the doctor–patient relationship is enhanced when the patient's agenda is explored early in the consultation. This also supports shared decision-making throughout."
Some experienced GP Trainers advise trainees to write the educational reflections first and the description last. It sounds counterintuitive — but it works brilliantly for a particular type of trainee.
- Trainees who write paragraphs of description but only a line or two of actual reflection.
- Trainees who feel mentally exhausted by the time they reach the competency sections.
- Trainees who think "I can't wait till this is over" — a sign that your energy is going to the wrong parts.
Description first → brain exhausted → a few rushed lines of reflection → barely any learning captured.
Reflection and competencies first → brain fresh and focused → full, meaningful analysis → description filled in afterwards as context.
If you're spending all your mental energy on the part that doesn't score competency points, try flipping the order. You might be surprised how much richer your reflection becomes.
⚡ One-Minute Recall — If You Only Read One Thing
- A learning log is not a description of what happened — it's an analysis of what you learned and how you grew.
- Write in first person, be honest, and focus on reflection, not narration.
- Ram's method: write a brief description → scan the 13 Professional Capabilities (PCs) → write about the relevant ones → end with future learning plans.
- Spend maximum 4 minutes on the description. Save your brain for the competency sections — that's where the marks are.
- Good reflection must show: Information · Self-awareness · Critical analysis · Extended learning (ISCE).
- Don't force a competency into a log entry if it genuinely isn't there. Write about what's clearly relevant, not what looks impressive.
- End with a specific future learning plan — not "I'll read around it." Say what you'll do and when.
🔤 The ISCE Mnemonic
I S C E
- I — Information (what happened)
- S — Self-awareness (how you felt)
- C — Critical analysis (what could be better)
- E — Extended learning (so what next?)
Think: "I Saw a Case… Eventually." — because the Extended learning (E) is the part most trainees take longest to reach!
🔢 The 13 PCs — At a Glance
- CS Communication & Consultation Skills
- PH Practising Holistically
- DG Data Gathering & Interpretation
- MD Making a Diagnosis / Decisions
- CM Clinical Management
- MMC Managing Medical Complexity
- OML Organisation, Information & Leadership
- WWC Working with Colleagues & Teams
- CO Community Orientation
- PLT Performance, Learning & Teaching
- Eth Ethical Approach to Practice
- FTP Fitness to Practise
- CEPs Clinical Examination & Procedural Skills
🚫 Common Mistakes — Quick Reference
- Writing a lengthy description and short reflection
- Writing "I plan to read around the subject"
- Forcing a PC into an entry where it doesn't belong
- Omitting feelings / self-awareness entirely
- Not generalising away from the specific
- Missing the extended learning (E) component
- Describing events in great clinical detail unnecessarily
- Writing in the third person instead of "I"
🔍 Hot Tip for Trainers: The ISCE Diagnosis
You can often tell that a log entry isn't quite good enough — but can't immediately pinpoint why. When this happens: stop, explore, and don't move on. Analyse the entry systematically against the four ISCE levels.
The weakness is almost always not in Information (I) — that's usually fine, if anything too lengthy. The failure is most commonly in Self-Awareness (S), Critical Analysis (C), or Extended Learning (E).
Use ISCE as your teaching tool: show the trainee where the entry loses depth, and demonstrate — live in a tutorial — how it could be deeper and more meaningful.
🛠 Tutorial Idea: The Live Rewrite
Ask a new trainee to write a log entry about any patient encounter in whatever way they naturally would. Then in the next tutorial, use that entry as a teaching tool. Walk through it together and demonstrate — in real time — how Ram's method transforms it. At the end, ask the trainee: was the second version more meaningful?
In Ram's experience, the answer is always yes.
❓ Addressing the "Gaming the System" Concern
Some trainers worry that a structured method like this is merely "playing the system" rather than genuine learning. Ram's response: this method provides a framework — nothing more. The quality of the content on that framework comes entirely from the trainee. A shallow thinker will still produce a shallow entry, regardless of structure. But a thoughtful trainee, given this scaffold, will produce something far more meaningful than they would have done freewriting.
The method also has a deeper benefit: it trains trainees to think about their work in terms of the 13 PCs — developing a richer professional identity and a more nuanced understanding of what it means to be a GP.
How long should a learning log entry be?
There's no fixed word count — quality beats length every time. A well-structured entry covering 2–3 PCs with genuine ISCE reflection is far more valuable than a long entry that's mostly description. As a rough guide: the description should take about 2–4 minutes to write. The competency reflections should take the majority of your time and attention.
How many PCs should I cover in one entry?
There's no fixed rule, but covering 2–4 PCs per entry is common. Don't try to shoehorn in all 13 — only write about the ones that are clearly relevant. An entry with 2 deeply written PCs is worth far more than an entry with 8 superficially mentioned ones.
What if I genuinely don't know which PC to write about?
Go through the list slowly, and ask yourself: "Was there anything about this encounter that touched on [PC name]?" If after a few seconds the answer still feels like a stretch — skip it and move to the next. The 13 PCs are broad enough that for any meaningful clinical encounter, at least 2–3 will feel genuinely relevant. Trust your instincts.
Does every log entry need a future learning plan?
Not every single entry — but most meaningful ones should have one. The key is that when you do identify a learning need, you're specific about how you'll address it. "I'll attend the Bradford VTS workshop on mental health on 14th March" is credible evidence. "I'll do some reading" is not.
Can I write about the same PC in multiple entries?
Absolutely — in fact you should. The ePortfolio is designed to accumulate evidence across time. A PC that appears in multiple entries from different clinical contexts shows a pattern of reflection and growth, which is exactly what the ARCP panel wants to see.
What if my trainer disagrees with my reflection?
This is actually a rich educational opportunity. A good Educational Supervisor isn't looking for you to agree with them — they're looking for you to think carefully. If you've analysed the situation thoroughly and reached a considered conclusion, you can absolutely express that. What matters is the quality of your reasoning, not whether your view matches your trainer's.
🏁 Final Take-Home Points
- Your learning log is evidence for the 13 PCs — and CCT depends on all 13 being evidenced.
- Description is the scaffolding. Reflection is the building. Spend your brain power accordingly.
- Use Ram's 5-Step Method: Think → Describe (briefly) → Scan the PCs → Write about each → Future learning plan.
- Apply ISCE to every PC you write about: Information → Self-Awareness → Critical Analysis → Extended Learning.
- Never make something out of nothing. Only write about PCs that are clearly relevant.
- Future learning plans must be specific. "I'll read around it" convinces no one.
- If you write too much description, try the Description-Last Trick — write the reflections first.
- Trainers: use ISCE to diagnose what's missing in a weak entry. It's almost always S, C, or E — not I.
- The 13 PCs capture everything a GP does. Thinking in PC terms develops your professional identity — not just your portfolio.
- A good log entry is one you were honest in, learned from, and found helpful to write. That's the real test.
Bradford VTS · Ram's Guide to Easy Peasy Learning Logs · Last updated: 13 April 2026
Part of the Bradford VTS educational resource library · bradfordvts.co.uk
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wow, this is so comprehensive! Thank you for this, I just came across this website and this is a gem! I will practise writing my reflections based on this from now onwards. I will refer other people to check this out too!