nMRCGP and WPBA Dr. Jon Chadwick , Scarborough VTS 2007

1. new Membership of the Royal College of General Practitioners Work Place Based Assessment nMRCGP and WPBADr. Jon Chadwick, Scarborough VTS 2007

2. Some key principles • 36 month process (for GP specialist trainees starting Aug 07) • Trainee led • Trainees use ePortfolio to amass evidence • many tools to provide evidence of competence, depending on context • aim to demonstrate competence in number of domains by end of WPBA • The standard by which you should assess, throughout WPBA, is “fit for independent practice in UK NHS general practice” • Tools have a rating scale ‘needs further development’, ‘competent’, ‘excellent’ (+ ‘insufficient evidence’ = not assessed) • Important note: the step before ‘competent’ is not ‘incompetent’ - trainees at the beginning of WPBA are expected to have professional developmental needs nMRCGP & WPBA introduction for clinical supervisors

3. More key principles • The RCGP website provide the latest information and guidance • http://www.rcgp.org.uk/ • It is being continually updated. • Whilst the process is Trainee led, this will be supported by an educational supervisor • There are 3 monthly reviews throughout training at which progress will be reviewed and actions agreed nMRCGP & WPBA introduction for clinical supervisors

4. The GP curriculum http://www.rcgp-curriculum.org.uk/ http://www.rcgp-curriculum.org.uk/extras/curriculum/index.aspx • The curriculum covers the knowledge and skills that all GP StRs need to learn in order to deliver the highest quality standards of patient care nMRCGP & WPBA introduction for clinical supervisors

5. Work Place Based Assessment • The WPBA is designed to assess what trainees actually do • 12 competences • Best tested in the workplace setting • Developmental progression for each competency area • Competency demonstrated “when ready” • Process is learner led • Triangulated • Different raters • Many tools (e.g. CBD, COT, CEX, DOPS, MSF and PSQ) • Different settings (general practice and secondary care) nMRCGP & WPBA introduction for clinical supervisors

6. The 12 competency areas • Communication and consulting skills • Practising holistically • Data gathering and interpretation • Making a diagnosis/ making decisions • Clinical management • Managing complexity and promoting health • Primary care administration and IMT • Working with colleagues and in teams • Community orientation • Maintaining performance, learning and teaching • Maintaining an ethical approach to practice • Fitness to practise nMRCGP & WPBA introduction for clinical supervisors

7. Assessment tools • CbD Case based discussion • COT Consultation observation tool (GP only) • DOPS Directly observed procedures • CEX Clinical evaluation exercise • MSF Multi-source feedback • NOE Naturally occurring evidence • PSQ Patient satisfaction questionnaire (GP only) • CSR Clinical supervisor’s report • Some tools will be familiar from FY1 & 2, but may be applied differently for GP training • The different tools test different competency areas • Not every tool is used in every setting (ie primary vs secondary care) nMRCGP & WPBA introduction for clinical supervisors

8. Different tools allow different competences to be demonstrated nMRCGP & WPBA introduction for clinical supervisors

9. There are detailed descriptors for the different competency levels nMRCGP & WPBA introduction for clinical supervisors

10. There are detailed descriptors for the different competency levels nMRCGP & WPBA introduction for clinical supervisors

11. There are detailed descriptors for the different competency levels nMRCGP & WPBA introduction for clinical supervisors

12. There are detailed descriptors for the different competency levels nMRCGP & WPBA introduction for clinical supervisors

13. There are detailed descriptors for the different competency levels nMRCGP & WPBA introduction for clinical supervisors

14. There are detailed descriptors for the different competency levels nMRCGP & WPBA introduction for clinical supervisors

15. There are detailed descriptors for the different competency levels nMRCGP & WPBA introduction for clinical supervisors

16. There are detailed descriptors for the different competency levels nMRCGP & WPBA introduction for clinical supervisors

17. There are detailed descriptors for the different competency levels nMRCGP & WPBA introduction for clinical supervisors

18. There are detailed descriptors for the different competency levels nMRCGP & WPBA introduction for clinical supervisors

19. There are detailed descriptors for the different competency levels nMRCGP & WPBA introduction for clinical supervisors

20. There are detailed descriptors for the different competency levels nMRCGP & WPBA introduction for clinical supervisors

21. WBA tools in hospital posts Supervisor and trainer (or other member of team) Trainee via ePortfolio Multi-source feedback Naturally Occurring Evidence Patient Satisfaction Questionnaire • Case based discussion • mini-CEX is instead of COT in secondary care • Directly Observed Procedures • Naturally Occurring Evidence • Clinical Supervisors Report nMRCGP & WPBA introduction for clinical supervisors

22. Assessments in practice • Trainee led • Well planned with adequate notice to supervisor • Preparation by both parties is strongly advised • Case selection is very important to allow demonstration of different competences. All need to be covered to complete WPBA • Each assessment is followed by feedback and completion of the forms in the ePortfolio nMRCGP & WPBA introduction for clinical supervisors

23. Assessments in practice • The college website details the minimum evidence required for each post http://www.rcgp.org.uk/the_gp_journey/nmrcgp/wpba_and_eportfolio/minimum_evidence.aspx • More assessments may be done if required • Minima prior to 6 month review (ST1 ST2):- • 3 x CEX (COT in GP) • 3 x CbD • 1 x MSF, 5 clinicians only • DOPS • Clinical supervisor’s report nMRCGP & WPBA introduction for clinical supervisors

24. Case Based Discussion(CbD) • Allows demonstration of competence in 10 of the 12 competency areas • An overall balance of cases is required. • In ST1 and ST2 - a minimum of 3 CbDs in each 6 month post (whether hospital or GP) • One week prior to the discussion two cases should be selected and presented with relevant records to the assessor • The assessor will choose one of the cases for discussion nMRCGP & WPBA introduction for clinical supervisors

25. Case Based Discussion (CbD) • It is essential that the assessor is given the cases a week in advance to allow for proper preparation of questions • Although not essential, trainees can facilitate a good outcome by, in addition to submitting the relevant clinical records, also • providing a commentary of why the case was chosen • and indicate which competences are demonstrated • Case selection is important • It is difficult to demonstrate excellence if the level of challenge is low nMRCGP & WPBA introduction for clinical supervisors

26. The CbD Interview • 20 minutes discussion per case • The assessor should use pre-prepared questions designed to allow demonstration of competence. • These questions will focus on things such as what you did and why you did it • One CbD interview is likely to allow approximately three competences to be discussed (the others will be graded “insufficient evidence”) • 10 minutes for feedback and completion of the assessment form (which will be uploaded to your ePortfolio) • The assessment form includes sections for feedback and recommendations for further development and agreed action nMRCGP & WPBA introduction for clinical supervisors

27. Clinical Evaluation Exercise (CEX) • Mini-CEX is a 15 minute snapshot of doctor/patient interaction, within a secondary care setting • It is designed to assess the clinical skills, attitudes and behaviours of trainees essential to providing high quality care • Trainees will be asked to undertake three observed encounters during 6 months, with a different observer for each encounter • Each of these encounters should represent a different clinical problem and trainees should sample from a wide range of problem groups within the post • Immediate feedback will be provided after each encounter, by the observer rating the trainee • Trainers and trainees will need to identify and agree strengths, areas for development and an action plan for each encounter nMRCGP & WPBA introduction for clinical supervisors

28. Directly Observed Procedures (DOPS) • Can occur at any point in training (Primary or Secondary care) • Opportunities to demonstrate some procedures might present more easily in secondary care (eg female genital examination in a gynaecology post) • Trainee chooses the timing, procedure and observer • A different observer should be chosen for each procedure • Observer should give feedback afterwards • Demonstrate DOP “when ready” • The mandatory procedures are considered sufficiently important to merit specific assessment nMRCGP & WPBA introduction for clinical supervisors

29. Directly Observed Procedures (DOPS) 8 mandatory DOPS 11 optional DOPS Aspiration of effusion   Cauterisation Cryotherapy Curettage/shave excision Excision of skin lesions Incision and drainage of abscessJoint and peri-articular injections    Hormone replacement implants of all types/any types Proctoscopy Suturing of skin wound Taking skin surface specimens for mycology • Application of simple dressings • Breast examination                 • Cervical cytology • Female genital examination    • Male genital examination       • Prostate examination*        • Rectal examination* • Testing for blood glucose       *rectal and prostate exam may be combined in one DOP nMRCGP & WPBA introduction for clinical supervisors

30. Multi Source Feedback (MSF) • 2 questions;- • Please provide your assessment of this doctor’s overall professional behaviour • Please provide your assessment of this doctor’s overall clinical performance • Answers on a 7 point rating scale (<very poor> to <outstanding>) • Space for freetext comments under headings • Highlights in performance (areas to be commended) • Possible suggested areas for development in performance nMRCGP & WPBA introduction for clinical supervisors

31. Multi Source Feedback (MSF) • Trainee chooses raters to give MSF • Trainee gives raters a standard letter explaining • the process of MSF • how to complete the online assessments (inc the URL) • the date by which the assessment should be completed • Results of MSF go to trainer, who will give feedback to trainee • Results are anonymous, but educational supervisor (not trainer) will be aware of who the raters were, to ensure a good spread of different raters • Trainee then adds MSF to ePortfolio nMRCGP & WPBA introduction for clinical supervisors

32. Clinical Supervisor’s Report • Downloadable from RCGP website nMRCGP & WPBA introduction for clinical supervisors