Planning your Registrar Year

1. Planning your Registrar Year Louise Willcocks Swindon/Bath GP Registrar DRC March 2007

2. AIMS • Starting out • Exams • Certification and paperwork • Top Tips

3. Starting out

4. EMIS • A-Z map for home visits. • Doctor’s bag and stuff • Remembering everyone’s names. • Who/what/ how and when to refer?

5. Half day for study (shopping). • DRC once a week. • No weekends • No nights/evenings • No bleeps

6. The Year • Goes really fast

7. Exams – Summative Assessment • COGPED MCQ • Video • Audit • Trainer’s report • CPR certificate

8. COGPED MCQ • May 2007. • Free • Can resit up to 5 times • 3 hrs long • Quite random questions e.g. DVLA/sick certs/fitness to fly/dandruff. • Don’t read into questions too much.

9. COGPED MCQ • If you pass the MRCGP MCQ automatically pass the summative. • Questions are of a different standard in the two exams. • Final COGPED MCQ is May 07. If you fail- which you won’t- will do AKT.

10. VIDEO • Can submit to SA or “single route” for MRCGP. • Criteria for SA and MRCGP different. NOSA and RCGP websites give information on this. • 2 hours long. No consultation longer than 20 mins.

11. “Single Route” Video • Logbook on RCGP website. • 7 consultations, at least 1 child under 10 yrs and one psychosocial. • 15 mins maximum for each consultation. • Judged by 14 criteria (10 pass and 4 merit). Need 4/7 for each pass criteria to pass.

12. Need to send logbook with video • Need to keep consent forms and all patients must be consented. COGPED video route not available from August 2007. ?Submit videos Oct 2007.

13. Tips for video • Start early on • The more you do the easier it gets. • You can have a printout of the MRCGP criteria in front of you as long as not in camera shot. • Check sound quality, position of camera, date/time on tape recording. • Make sure patients not exposed on camera.

14. Audit • Keep it simple • Start asap • Discuss with Trainer/practice/colleagues for ideas. • Relate to recent guideline changes/QOF/hot topics.

15. Audit • Tips on Bath web site. • 8 proforma • 3000 words double spaced and anonymised. • Send 3 copies and keep one for yourself.

16. Trainer’s report. • Do as you go along • Familarise yourself with it. Generally trainer fills it in. • Send it into deanery approx 6 weeks before reg year finishes with VTR1.

17. Exams- MRCGP • MCQ • Written paper • Video • Oral Each module costs ₤340. Closing date for applications 9/2/07.

18. Syllabus available on RCGP website which is invaluable. For MCQ preparation PEP CD’S and onexamination.com are fantastic resources. Courses like hot topics and revision course (Portsmouth or Taunton.)

19. Study Group • Essential preparation for written paper. • Past papers on line RCGP website. • Look at past examiners comments. If question done badly topic may come up again. Good gossip session. Food and wine essential!

20. Exams- nMRCGP From August 2007 single training route and new assessment process. • AKT- applied knowledge test • CSA- clinical skills assessment • Enhanced trainer’s report

21. AKT • 200 questions • Machine marked • Extended matching questions and single best answers. • 3 times a year Feb/May/Oct

22. CSA • OSCE format • Assesses clinical, professional, communication and practical skills. • ? To be held 3 times a year.

23. Enhanced Trainer’s report • Similar to current Trainer’s report but more in depth. • Requires evidence as proof of reaching a certain standard.

24. Out of Hours • Minimum 72 hours. • Log book to be completed • Should be supervised. • Shifts short 3-5 hrs so start soon. • Variety of shifts weekends/evenings, base or visiting.

25. Often good fun • Might want to do more of it when you finish GPR year. • Log book doesn’t need to be sent anywhere. • Keep a log of interesting patients for PDP.

26. Certification and paperwork • Join RCGP costs ₤350 in order to complete CCT. • Submit your VTR2 forms once you have done this to RCGP certification unit. Make sure all the dates are correct, stamped and filled in correctly. They will get sent back if not.

27. Do this as soon as possible. Dull but essential and will save lots of hassle later. • Then known as an associate member and in theory get BJGP.

28. Before the end of the job need to register with PMETB. • Submit VTR1 form with ₤500 and should then receive CCT. Can’t do this till 6 weeks prior to finishing. • Look at NOSA website and RCGP for guidelines and application forms.

29. Top Tips • PDP keep a record of your tutorial topics, list of education meetings, interesting patients, referrals e.t.c. Do as you go along, it’ll be a lot less tedious and easier in the long run. • Keep electronically or paper.

30. Journals • BMJ • BJGP • Pulse/Doctor/GP • BMJ careers • Internet up dates e.g. doctors.net

31. Courses • Exam related- revision courses • Hot Topics • Others- DFFP, DRCOG. Minor surgery. No study budget so can get expensive.

32. Contacts • Summative assessment • http://www.nosa.org.uk • Moira Linden; 01962 893 813 • moira.lindenl@sevwesdeanery.nhs.uk • RCGP certification • 020 7930 7228 • certification@rcgp.org.uk • PMETB • 0871 220 3070 • info@pmetb.org.uk • article11@pmetb.org.uk • HOT Topics course • 0191 489 0555 • www.nbmedical.co.uk • MRCGP course • Carol White; 01264 355 005 • cwhite@rcgp.org.uk

33. Audit criteria 1.Reason for choice of audit Potential for change Relevant to the practice 2.Criterion/Criteria Chosen Relevant to audit subject and justifiable, eg. Current literature 3.Standards set Targets towards a standard with a suitable timescale 4.Preparation and Planning Evidence of teamwork and adequate discussion where appropriate 5.Data Collection (1) Results compared against standard 6.Change(s) to be evaluated Actual example described 7.Data Collection (2) Comparison with Data collection (1) and standard 8.Conclusions Summary of main issues learned

34. Video criteria PC1 the doctor is seen to encourage the patient's contribution at appropriate points in the consultation PC2 (M) the doctor is seen to respond to signals (cues) that lead to a deeper understanding of the problem PC3 the doctor uses appropriate psychological and social information to place the complaint(s) in context PC4 the doctor explores the patient's health understanding PC5 the doctor obtains sufficient information to include or exclude likely relevant significant conditions PC6 the physical/mental examination chosen is likely to confirm or disprove hypotheses that could reasonably have been formed OR is designed to address a patient's concern PC7 the doctor appears to make a clinically appropriate working diagnosis PC8 the doctor explains the problem or diagnosis in appropriate language PC9 (M) the doctor's explanation incorporates some or all of the patient's health beliefs PC10 (M) thedoctor specifically seeks to confirm the patient's understanding of the diagnosis PC11 the management plan (including any prescription) is appropriate for the working diagnosis, reflecting a good understanding of modern accepted medical practice PC12 the patient is given the opportunity to be involved in significant management decisions PC13 (M) the doctor takes steps to enhance concordance, by exploring and responding to the patient’s understanding of the treatment PC14 the doctor specifies the appropriate conditions and interval for follow-up or review

35. Clinical Patient Self-management Agenda Decision Aids Benefits Education Death & Driving Support Groups Ideas, concerns & expectation Transcultural Doctor Risk management Up to date DEN’s Evidence-based Confidentiality/Consent Health promotion Open questions Prejudice Prescribing Empathy Record-keeping/Referrals Practice Protocol Register Audit Change management Training IT Contract/clinics Ease Wider Goldberg & Huxley’s filters to care Rationing Inverse care law Medicilisation Screening Health Inequalities Teamwork Ethical Consultation Prescribing Constructs

36. Any Questions?