CT & ACT National Conference Using Capabilities in Practice Shuaib Quraishi Zoe Fleet Winnie Wade

Overview Introduction to Capabilities in Practice (CiPs) Using CiPs in assessment Specialty CiPs and Generic CiPs Workshop activity

Introduction Stage 1 Internal Medicine Curriculum submitted to the GMC for approval Current curriculum based on ‘tick box’ approach to large number of individual competencies New method of assessment based on outcomes Outcomes have been described as Capabilities in Practice (CiP) Ascribing a level to each CIP allows progress to be measured and the level of supervision required Development of new assessment system comes along with the new curriculum

Capabilities in Practice Capabilities in practice (CiPs) describe the professional tasks or work CiPs are based on the format of entrustable professional activities (EPAs) Each CiP has a set of descriptors associated with that activity or task CiPs are defined as generic or specialty specific

Olle ten Cate AMEE Guide 99 2015 CiPs “a unit of professional practice that may be trusted to a learner to execute unsupervised, once he or she has demonstrated the required competence” In the literature called an Entrustable Professional Activity (EPA) Olle ten Cate AMEE Guide 99 2015

What will happen in Practice? CS completes Multiple Consultant Report ES meets with trainee to complete ES report Reviews evidence (MCRs & WBPAs) Entrustment level decided for specialty CiPs Generic CiPs assessed using anchor statements ES report used to inform the ARCP

Generic CiPs Six generic CiPs cover the professional requirements of all specialties These will be assessed using anchor statements stating whether trainee is meeting expectations

Generic CiPs Generic CiPs 1. Able to successfully function within NHS organisational and management systems 2. Able to deal with ethical and legal issues related to clinical practice 3. Communicates effectively and is able to share decision making, while maintaining appropriate situational awareness, professional behaviour and professional judgement 4. Is focussed on patient safety and delivers effective quality improvement in patient care 5. Carrying out research and managing data appropriately 6. Acting as a clinical teacher and clinical supervisor

Generic CiPs Global assessment anchor statements   Below expectations for this year of training; may not meet the requirements for critical progression point Meeting expectations for this year of training; expected to progress to next stage of training Above expectations for this year of training; expected to progress to next stage of training

Specialty CiPs Eight specialty CiPs describe the clinical tasks or activities which are essential to the practice of Internal Medicine Satisfactory sign off will require educational supervisors to make entrustment decisions on the level of supervision required for each specialty CiP

Specialty CiPs Specialty CiPs 1. Managing an acute unselected take 2. Managing an acute specialty-related take 3. Providing continuity of care to medical in-patients, including management of comorbidities and cognitive impairment 4. Managing patients in an outpatient clinic, ambulatory or community setting, including management of long term conditions 5. Managing medical problems in patients in other specialties and special cases 6. Managing a multi-disciplinary team including effective discharge planning 7. Delivering effective resuscitation and managing the acutely deteriorating patient 8. Managing end of life and palliative care skills  

Entrustment level descriptors   Level 1: Entrusted to observe only – no execution Level 2: Entrusted to act with direct supervision Level 3: Entrusted to act with indirect supervision Level 4: Entrusted to act unsupervised • Level 2: Entrusted to act with direct supervision: The supervising physician is physically within the hospital or other site of patient care and is immediately available to provide direct supervision. Level 3: Entrusted to act with indirect supervision: The supervising physician is not physically present within the hospital or other site of patient care, but is immediately available by means of telephone and/or electronic media, to provide advice and can attend physically if required to provide direct supervision https://members.aamc.org/eweb/upload/core%20EPA%20Curriculum%20Dev%20Guide.pdf

Grid for IM specialty CiPs

Questions

Activity Your task in pairs is to use the available information to complete the educational supervisor report for a IM2 level trainee, David Lewis

Activity You will take the role of educational supervisors. You will have access to multiple consultant reports and WPBAs for the trainee ‘David Lewis’.

Activity Use the evidence to score a level of supervision for the following specialty CiPs: CiP1: Managing an acute unselected take CiP 4: Managing patient in outpatient clinic CiP 8: Managing end of life and palliative care

Activity Use the evidence to score a level of supervision for the following generic CiP 6: CiP 6: Communicates effectively and is able to share decision making, while maintaining appropriate situational awareness, professional behaviour and professional judgement

Feedback and Discussion Please comment on the overall process What are the challenges associated with this form of assessment? Did you find some CiPs were more difficult to assess?

Summary, evaluation and close

Plan 20 min lecture 5 min questions 25 min exercise 10 min feedback (35 packs needed)