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GPST Clinical Supervisor? The Bluffer’s Guide

GPST Clinical Supervisor? The Bluffer’s Guide. Dr Richard de Ferrars 19 th November 2010. Bluffer’ Guide to CS Role. Organisation of GP Training Overview of MRCGP Exam MRCGP Competency Framework End of Post: New-look CSR Start of Post: PDPs & Planning Meetings.

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GPST Clinical Supervisor? The Bluffer’s Guide

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  1. GPST Clinical Supervisor?The Bluffer’s Guide Dr Richard de Ferrars 19th November 2010

  2. Bluffer’ Guide to CS Role • Organisation of GP Training • Overview of MRCGP Exam • MRCGP Competency Framework • End of Post: New-look CSR • Start of Post: PDPs & Planning Meetings

  3. Organisation of GP Training Currently still three years: • ST3 entirely based in GP practice with a GP Trainer • ST1 3x four-month posts 2 are pure hospital posts(A&E/ medicine) 1 GP post or split post (ITP)3 days GP, 2 days hospital • ST2 3x four-month posts 2 are pure hospital posts (Paeds, O&G, Psych, T&O, ENT) 1 GP post or split post (ITP)3 days GP, 2 days hospital Likely to be more selective with ST1 ITPs next year.

  4. Supervision • Programme Director • Licensed to snoop, nag, trouble-shoot & support • Clinical Supervisor • Hospital consultant during 4-month post • Educational supervisor • GP Trainer who will work with the trainee in ST3 • Completes the RCGP 6m reviews (RITA) • Uses information from assessments & learning log • Importance of GP study leave days

  5. Clinical Supervisor • Start of post meeting (first 3 weeks) • Learning objectives & PDP for the post • Discuss getting the assessments done • Discuss study leave in training practice • Mid-post meeting NOT mandatory • End of post meeting • Feedback • Complete CSR

  6. Bluffer’ Guide to CS Role • Organisation of GP Training • Overview of MRCGP Exam • MRCGP Competency Framework • End of Post: New-look CSR • Start of Post: PDPs & Planning Meetings

  7. Overview of MRCGP Exam Three Components – CSA, AKT, WPBA • CSA = Clinical Skills Assessment (ST3) 13 station simulated-patient OSCE, £1500, 60-75% pass-rate • AKT = Applied Knowledge Test (ST2/3) 3 hours extended MCQ, £400, 60-80% pass-rate • WPBA= Workplace-based Assessment £500 per year Recorded in e-portfolio Standard assessments (mini-CEX, CbD, DOPS, MSF, CSR) Learning log/ PDP monitored by Educational Supervisor

  8. Bluffer’ Guide to CS Role • Organisation of GP Training • Overview of MRCGP Exam • MRCGP Competency Framework • End of Post: New-look CSR • Start of Post: PDPs & Planning Meetings

  9. Curricula & Competencies • Royal College Curricula Easy to find Easy to follow All are voluminous • Assessments & demonstrating competencies Theory – very hard to find concrete information Practice – harder to know what happens in practice Take a quick tour…..

  10. JRCP Curriculum & Competencies JRCP CMT Competencies Symptom-based System-based Investigation-based Procedural-based (100 pages) Theme Knowledge Skills Attitudes/ Behaviour Information on demonstrating competence is patchy

  11. RCOG Curriculum & Competencies MRCOG - 19 Core modules Theme – “knowledge” “clinical competence” “skills & attitudes” Recommendations for assessment & evidence

  12. RCPsych Curriculum & Competencies MRCPsych Core training. 40 pages of intended learning outcomes Theme – “knowledge” “skills” “attitudes” Recommendations for assessment & evidence

  13. RGCP Curriculum & Competencies MRCGP - 30 Core Chapters (20 clinical systems) Theme – “knowledge base” “attitudes & approach” “skills” Lacks detail on how to assessment of competence

  14. How Does the RCGP Assess Trainees? Exam components assessing: Knowledge (skills) Skills (knowledge, attitudes) Attitudes & skills (diagnostics & DOPS) • AKT - • CSA - • WPBA - • WPBA aims to focus on attitude & skills. How? • Skills • - diagnostic skills are central to CbD, mini-CEX, CSR • - clinical examination skills are the focus of DOPS • Attitudes (& behaviour) • - common threads picked from the curriculum clinical chapters • - created 12 “Domains of Competence” • - used in assessments (CbD, CSR) and by ES in reviews

  15. 12 Domains of Competence Used for CbD framework Used for CSR framework Used by ES for reviews But.... terminology confusing: Practising holistically = problem with patient at centre Primary care/ IMT = overall use of records/ IMT (Health) community orientation = problem with NHS at centre Communication & Consultation Skills Practising Holistically Data Gathering & Interpretation Making a Diagnosis / Making Decisions Clinical Management Managing Complexity Primary Care Administration and IMT Working with colleagues and in teams Community orientation Maintaining performance, learning and teaching Maintaining an ethical approach to practise Fitness to practise

  16. Bluffer’ Guide to CS Role • Organisation of GP Training • Overview of MRCGP Exam • MRCGP Competency Framework • End of Post: New-look CSR • Start of Post: PDPs & Planning Meetings

  17. Domains of Competence Grouped into “performance areas” Relationship Diagnostics Management (non-clinical) Professionalism Unclear areas have been banished practising holisticallycommunity orientationprimary care IMT Only changed CSR and not CBD Domains increased from 12 to 14 Harder to get teeth into “Relationship” (“Diagnostics” at top more CSR-friendly) Relationship Explores patient’s agenda (Ideas, Concerns and Expectations) Works in partnership to negotiate a plan Recognises the impact of the problem on the patient’s life Diagnostics Takes history, examines , investigates appropriately Elicits clinical signs & interprets information appropriately Suggests an appropriate differential diagnosis Recommends appropriate management plans and follow-up Refers appropriately and co-ordinates with other professionals Management (non-clinical) Keeps good medical records Uses resources cost effectively Keeps up-to-date, commitment to addressing learning needs Professionalism Identifies and discusses ethical conflicts Shows respect for others Deals appropriately with stress Look through guidance notes…

  18. What to Write in the CSR? Grades: Below Expectations Borderline Meets Expectations Above Expectations Unable to Grade Comments box? Minimal needed for “meets expectations” Briefly explain “unable to grade” Explain your concerns if “borderline/ below” Positive feedback if “above expectations” Relationship Explores patient’s agenda (Ideas, Concerns and Expectations) Works in partnership to negotiate a plan Recognises the impact of the problem on the patient’s life Diagnostics Takes history, examines , investigates appropriately Elicits clinical signs & interprets information appropriately Suggests an appropriate differential diagnosis Recommends appropriate management plans and follow-up Refers appropriately and co-ordinates with other professionals Management (non-clinical) Keeps good medical records Uses resources cost effectively Keeps up-to-date, commitment to addressing learning needs Professionalism Identifies and discusses ethical conflicts Shows respect for others Deals appropriately with stress

  19. Bluffer’ Guide to CS Role • Organisation of GP Training • Overview of MRCGP Exam • MRCGP Competency Framework • End of Post: New-look CSR • Start of Post: PDPs & Planning Meetings

  20. Do GPs Ignore Knowledge? WPBA focuses on attitudes & diagnostic skills Do we bother to monitor “acquisition of knowledge?” • Trying hard to avoid endless e-pages of box-ticking • Curriculum informs trainees (& CS) of “knowledge base” • Trainees keep PDP & learning log of educational activities • The learning log & PDP are scrutinised at ES reviews Knowledge aspect of WPBA focuses on encouraging self-directed leaning and is monitored by ES We are grateful for any encouragement from CS

  21. What About Start of Post Meetings? Curriculum informs trainees (& CS) of “knowledge base” - Basic post-specific summaries of the GP Curriculum GP Faculty Handbook www.frimleyvts.org - CS could simply ask them if they have had a look Trainees keep PDP & learning log of educational activities - CS could help with a PDP that reflects the GP Curriculum? (first item on PDP could be to look at RCGP learning outcomes..) - CS could outline educational opportunities in post - CS could encourage log entries, especially those linked to educational activities.

  22. In Summary…. The RCGP Curriculum is no bigger dog’s dinner than your own one, so don’t complain Summaries of intended learning outcomes available: GP Faculty Handbook www.frimleyvts.org (ST1/2 pages) The WPBA focuses on attitudes & diagnostic skills The new headings in the CSR do make more sense than the old ones (but these are still used in CbD) Start of post meetings – encourage self-directed learning, PDPs and log-book entries

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