Trainees in difficulty Rachel Roberts Ann Telesz July 2015

Aims of session What is a trainee in difficulty? What is the process once they are identified? How is an educational diagnosis made and management plan arrived at? How is the TID monitored? Scenarios Questions

What is a trainee in difficulty? Someone who cannot achieve a satisfactory outcome in assessments Someone who is not performing at the level expected for their ST grade What is the size of the problem across NCEL? Suggest we open this up as a question to the group? I am probably more vague, and also agree with the “ pre TID” or “ at risk “ learner as well.

Difficulty, and individual variation! You tube comedy link

What is the process once a TID is identified? There is a flowchart which is quite complex to look at but we will work through it in stages

From the learner ( example of differing view point of learner from past educators, global / holistic history) Past education and assessments ( including prior to medical qualification) From previous educators, e portfolio/ ARCP reports From past patient feedback/complaints/events From past MRCGP assessments History

Starting if possible gently, as if tension may behave in atypical fashion Informal feedback and observation as settles into the team. Engagement and motivation Learning styles ( look at depth of learning eg. Blooms taxonomy) Learning needs assessment ( very important where any learner difficulty anticipated) Examination !

Dr Benjamin Bloom, ed psychology 1956

Of course may not be simple and may well need outside help and reports etc to decide RDM-p, Tim Norfolk Diagnosis

In essence, general practice involves a subtle interaction between three core activities: relationship, diagnostics and management. They could perhaps be visualised as three interlocking ‘cogs in the wheel’, for which professionalism then provides the essential oil. Within the dynamic interaction between these three areas lies every component of the job, though most attention centres on relationship and diagnostics. RDM-p

Once you‟ve teased out the nature of the performance difficulty into these four areas, the model then gets you to explore their causal and influential factors; again in a structured way (using something called the SKAPE framework - Skills, Knowledge, Attitudes, Personal qualities and External factors

Now use SKAPE on left to work out the causal and influential factors to issues on right

So a diagnosis has been made – what next? How is the TID monitored? Back to the flow chart

Scenarios and group work

Case 1 Number of “ missed diagnoses “ declared by trainer Patient complaints re manner and concentration Team complaints about odd behaviour Past history ? Reasons? Case 1

Case 2 Trainer very stressed on the phone Learner managing work only very slowly Not reflective Many detailed discussions about how to achieve this, no progress so far Struggles to make any diagnoses, asks trainer nearly every patient Path results and paperwork left in large piles Case 2

Case 3 Significant history of physical health problem Also appears anxious during tutorials and with feedback being given Tending to ask peers or salaried doctor rather than trainer / partners for opinion Writes very long portfolio entries, and reflective Surgeries over run very badly, been tearful a couple of times when patients become irritated Case 3

Feedback on scenarios Case 1 diagnosis and plan

What can a trainer do? Learner must accept that they have a need to change and take ownership of their progress

Examples of interventions for learners in difficulty Increased joint surgeries, and two way observations – hands on help and “ modelling “ on trainers skills. “ COT “plus” including video for self reflection MSF very important CBD “ plus” describe method and techniques Observed examination and practical procedures Detailed review of diagnoses and mx plans- increased random case analysis Examples of interventions for learners in difficulty

Issues Documentation – who writes what and where if there are concerns? Information sharing – where several agencies are involved what principles should be followed? What happens at ARCP panels? What support can I expect if I take a TID?

Questions?