V0.3 1 SUPERVISION WORKSHOP CBFP – PART 1 RANZCP Fellowship Regulations 2012

V0.32 Contributors Dr Felicity Plunkett Director of Training, NZ Auckland Dr Wayne de Beer Deputy Chair Board of Education, NZ Hamilton Dr Martin Cohen Director of Training, NSW Newcastle Dr Neil Port Supervisor, NSW Newcastle

V0.33 Workshop program AM session 9.00 – 10.30amInformation about CBFP Discussion and questions – 10.45amBreak – 12.15pmInformation and practical exercises: Workplace-based Assessments (WBAs) – Mini-CEX and Case-based Discussion – 12.30pmFinal discussion and questions

V0.34 Workshop program PM session 1.30 – 3.00pmInformation about CBFP Discussion and questions 3.00 – 3.15pmBreak 3.15 – 4.45pmInformation and practical exercises: Workplace-based Assessments (WBAs) – the Mini- CEX and Case-based Discussion 4.45 – 5.00pmFinal discussion and questions

V0.35 Workshop Objectives Following this session, you should be able to: Understand the key elements of the new CBFP training Understand the main ways in which CBFP training will affect you as a supervisor Understand the main ways in which CBFP training will affect your trainees Understand the new Mini-CEX and Case-based Discussion (Workplace-based Assessments) Undertake the new Mini-CEX and Case-based Discussion with your trainees

V0.36 Why change the curriculum? Reflects current learning and teaching trends Regular timely (immediate) feedback during training Clear expectations for Trainees and Supervisors Enable Trainees to focus on competency as a goal Assessments in practice prepare Trainees for job readiness

V0.37 Modern educational trends Miller’s triangle - hierarchies of competence DOES Performance SHOW HOW Demonstrates competence KNOWS HOW Applied knowledge KNOWS Factual knowledge Workplace-based Assessments OCI, OSCE, Entrustable Professional Assessments Written Exam

V0.38 Modern educational trends Multi-dimensional competency framework The seven CanMEDS roles

V0.39 Educational pressures External regulation of medical education – AMC/NZMC accreditation, Government funding Standard of psychiatrists graduating Efficiency and effectiveness of training Changed social contract and expectations of psychiatrists and mental health services Modern technology and ways of accessing and using information Generational changes in our Trainees

V0.310 Changes to the assessments Different drivers for these changes Expert educationalist advice to improve exam fairness and reliability (by Dr Gareth Holsgrove and Professor Brian Hodges) Too costly in time and resources to continue with separate trainee and exemptions exams Coalescing them back into one sitting means the clinical exams are exit exams

V0.311 When does CBFP start? The 1 st year Trainees will start under the new 2012 Training Regulations -from December 2012 in NZ, and - from January 2013 in Australia Current Trainees stay under the existing 2003 training regulations Transition time line and conversion matrix now available on College website Trainees from overseas part-way through training start under the existing 2003 training regulations

V0.312 Transition - Two parallel programs Allows training & adjustment time for all involved Those under the current regulations will all be transitioned to CBFP by the end of 2015 Will have case-by-case decisions, especially for 3 rd year plus Trainees New ZealandAustralia Stage 1 December 2012Stage 1 January 2013 Stage 2 December 2013Stage 2 January 2014 Stage 3 December 2015Stage 3 January 2016

V0.313 Which parts are different? 3 training stages – Stage 1, Stage 2, Stage 3 No longer 2 - Basic and Advanced Training Basic training is across 2 stages –Stage 1 is 1 st year –Stage 2 is 2 nd and 3 rd years Stage 3 is Advanced training – 4 th and 5 th years

V0.314 Stages of training DEVELOPMENTAL TRAJECTORY STAGE 1STAGE 2STAGE 3 Basic Proficient Advanced

V0.315 Competency driven training Explicitly defined competencies and role of psychiatrist Competencies are a combination of knowledge, skills and attitudes Required competencies have to be achieved to become eligible to sit the written and clinical exams and to progress through the 3 Stages

V0.316 Competency driven training What are the Roles of a Psychiatrist? What Competencies are needed for these? What are the Learning Outcomes for these Competencies? CanMEDS roles Fellowship Competencies and Developmental Descriptors Detailed Learning Outcomes for each Stage

V0.317 Competency driven training Defined syllabus for each stage of training Assessments mapped to syllabus and learning outcomes Formative assessment o formal and informal assessment procedures o involves qualitative feedback (rather than scores) Summative assessment o Tests the knowledge and understanding of information, skills, concepts or processes o Final evaluation

V0.318 Which parts are the same? Still a 5 year program Stage 1 – General Adult Psychiatry, 6 months Acute Commence a College accredited Formal Education Course Stage 2 - mandatory rotations: Consultation-Liaison (6 months) Child & Adolescent (6 months) 2 optional rotations

V0.319 Which parts are the same? Stage 2 competencies: o Addiction o Old Age o ECT o Several psychotherapy modalities Stage 3 can still be Generalist or in a Certificate program – advanced level competencies Certificate programs – the same 7 as before (Addiction, Adult, Child, C-L, Forensic, Old Age, Psychotherapy)

V0.320 Which parts are the same? The structure of the Written, OCI and OSCE exams remains the same (the timing and standard has changed) Written exam - still 2 x 3 hour exam papers (in late Stage 2, set at junior consultant standard) OCIs - still must pass 2 of 3 OCIs (in Stage 3, at advanced standard) OSCE – 12 stations, 8 short cases, 2 long cases, 2 byes (at advanced standard)

V0.321 What about supervision? Business as usual in many ways Same time requirements for supervision One 1:1 hour and 3 clinical supervision hours per week Across min. 40 weeks of the year Similar training and accreditation requirements for supervisors

V0.322 What about supervision? Aspects of supervision that are different WORKPLACE-BASED ASSESSMENTS FEEDBACK AND GRADING ARE MORE FORMALISED CLEARER STANDARDS Structured workplace- based assessments Written feedback More training resources for supervisors More guidance about the standards expected in each Stage of training

V0.323 Which parts are different? The 1 st Episode Case History has been removed Professional writing tasks are required in some WBAs The Psychotherapy long case will be restructured The Scholarly Project is a new mandatory requirement and can be commenced at any stage

V0.324 Which parts are different? The OCI and OSCE exams will be set at exit level and will be sat closer to the end of training (Stage 3) OCI and OSCE exams will be sat in 4 th and 5 th year (some time during certificate training) Entrustable Professional Assessments (EPAs) are new EPAs are summative assessments

V0.325 NEW - Workplace-based Assessments (WBAs) CbDCase-based Discussion PPProfessional Presentation Mini-CEX Mini Clinical Evaluation Exercise OCAObserved Clinical Activity Highly recommended that trainees experience all of these tools early in their training

V0.326 Range of WBAs You can choose: Mini-CEX Briefly observed clinical tasks CbDD etailed case discussions with supervisor PP Case Presentations OCA A full 50 minutes assessment with structured feedback and clear standards At least 3 of these will determine whether an EPA has been achieved.

V0.327 Why Workplace-based Assessments (WBAs)? On the job assessment (efficient use of supervision time) Relevant tools to assess key clinical activities Feedback is ensured and structured Clearer standards and guidelines for the supervisor A clearer paper trail to document trainee’s performance

V0.328 WBA in the first month The initial formative WBA is to be scheduled in the first month of the rotation Aim to do it within the first 4 weeks that the trainee and supervisor have worked together To help the supervisor assess the trainee’s strengths and weaknesses, and alert them to any significant problems

V0.329 Entrustable Professional Activities (EPAs) Relate to activities identified as core to the profession Complex, whole tasks (requires knowledge, skills, professional behaviours and attitudes) Involve more than one learning outcome Relate to more than one of the seven CanMEDs roles

V0.330 Entrustable Professional Activities (EPAs) 2 summative EPAs per 6 month rotation Mandatory EPAs in each of the 3 Stages Despite signing off an activity as “entrustable”, the supervisor remains responsible to oversee the trainee’s clinical performance

V0.331 EPAs in Stage 1 Stage 1: 4 mandatory EPAs Active participation in multidisciplinary team meeting / ward round Produce succinct, organised and informative discharge summaries in a timely manner Initiating an antipsychotic in a patient known to have schizophrenia Provide an explanation to a family about a young adult’s major mental illness

V0.332 EPAs in Stage 2 Stage 2: 5 mandatory EPAs Demonstrate proficiency in all the expected tasks associated with prescription, administration and monitoring of ECT The application and use of the Mental Health Act Assessment and management of risk of harm to self and others The safe and effective use of clozapine in psychiatry Cultural Competence

V0.333 How it all fits together? An example

V0.334 Tasks in Stage 1 training ROTATION 1ROTATION 2 Formative mid rotation Supervisor assessment EPA 1 Summative EPA 1 Summative Formative mid rotation Supervisor assessment WBA Formative WBA Formative Minimum of 3 WBAs for 1 EPA Supervisor assessment Summative WBA Formative WBA Formative WBA Formative WBA Formative WBA Formative EPA 2 Summative EPA 2 Summative EPA 3 Summative EPA 3 Summative EPA 4 Summative EPA 4 Summative WBA Formative WBA Formative WBA Formative WBA Formative WBA Formative Supervisor assessment Summative First 4 weeks

V0.335 STAGE 1 STAGE 2 STAGE 3 BASICPROFICIENT ADVANCED OCI WRITTEN SCHOLARLY PROJECT PSYCHOTHERAPY LONG CASE EPAs and SUPERVISOR ASSESSMENTS OSCE Summative assessments

V0.336 BREAK Reconvene in 15 minutes

V0.337 Plan - Second Half of Workshop Mini-CEX – information and practical exercises Case-based Discussion (CbD) – information and practical exercises Final discussion and wrap-up

V0.338 Mini Clinical Evaluation Exercise (Mini-CEX) Yes, the name’s hilarious, but get over it A brief, defined clinical task Takes about 20 min Done in the usual hour of 1:1 supervision time Task is negotiated between Trainee and Supervisor beforehand Both trainee and supervisor fill in the mark-sheet Structured written feedback immediately after Formative assessment to shape their practice

V0.339 WBAs: Mini-CEX Mini-CEX can be used for: Mental state examination Detailed cognitive testing A specific aspect of history-taking (like addictions & gambling history or family history) Risk assessment EPSE or other physical assessment Medication/side-effects review Talking to a family Getting consent to treatment

V0.340 Mini-CEX DVD examples 30 minutes Watch DVD – 2 examples Samples of mark-sheets Practice marking Discuss and questions Choose areas to mark : History taking process History taking content Mental state exam Physical exam skills Communication skills Data synthesis Organisation/efficiency

V0.341 Case-based Discussion (CbD) Done in the usual hour of 1:1 supervision time Trainee selects 4 cases they are managing Supervisor chooses 1 of the cases Choose cases from usual clinical work, or an on-call assessment Cases can be focused on a specific diagnosis or issue if that’s best for trainee’s learning Structured written feedback immediately after Formative assessment to shape their practice

V0.342 Case-based Discussion (CbD) Trainee briefly presents the case Supervisor then asks questions to explore the trainee’s knowledge and how they approached the case Presentation and discussion - 30 minutes Trainee and supervisor complete the mark-sheet Feedback - marking is discussed and explained at the end Can be some teaching or suggestions for further reading

V0.343 DVD for Case-based Discussion (CbD) 30 minutes Watch DVD – 4 brief clips Samples of mark-sheets Practice marking Discuss and compare the examples Choose areas to mark: Clinical record keeping Clinical assessment Risk assessment & management Medical treatment Referral Investigation Follow-up, care planning & transfer of care Professionalism Clinical reasoning

V0.344 Final Wrap-up Questions? Final Discussion Part 2 of this Workshop Certificates of Attendance