Dr Mike Tomson HEE Y&H GP APD lead for Performance and ARCP Doctors in Difficulty Dr Mike Tomson HEE Y&H GP APD lead for Performance and ARCP

Gathering information /reaching a diagnosis Structuring and Recording Contemporary recording of events 2 Evidence triangulation 3 Timely contacts SMART plans Clear summaries Signposting process of reviews Identification Building and maintaining Relationships   Building trust and Transparent communication with Trainee ES CS Scheme School (DiD tutor) Others SJT5, Admin behaviours6, IPUs7, Exams, ESR, ARCPs, 360’s, Absence8, GMC, SUI9   Gathering information /reaching a diagnosis Assessing risk to patients10   Confirming and Agreeing evidence 11 Using Self-assessment and comparing with Educator assessment(s) 12 Classifying evidence 13 to reach and share an initial RDM-p diagnosis (defining the problem) Reviewing Relevant background information to achieve a SKIPE understanding 14, 15 Reviews17 Including diagnosis and Causes as well as plans

Practising Holistically RELATIONSHIP DIAGNOSTICS Data Gathering & Interpretation Practising Holistically Communication & Consulting Skills Making a Diagnosis / Making decisions professionalism Maintaining an Ethical Approach to Practice Working with Colleagues & in Teams Clinical Management Managing Medical Complexity Fitness to Practise Community Orientation Primary Care Administration & IMT Maintaining Performance, Learning & Teaching GP COMPETENCIES (WPBA) MANAGEMENT © Tim Norfolk 2006 Tim Norfolk

So how do we make an RDM-p diagnosis? Screening forms trainee + trainer & compare Perception from the trainee Use information from all sources (e-P, but also team members, patients, incidents etc.) and link to R, D, M, or p This looks like a challenging conversation… 5

© Tim Norfolk

RAG scoring (all on the scheme or those where there are triggers) Identification RAG scoring (all on the scheme or those where there are triggers) PDT ( SJT) is highly predictive ST1 and ST2 Mock CSA in schemes Monitoring attendance, form R and other organisational tasks MSF .. There is a good association with lower MSF scores (both prof and clinical elements) and AKT, CSA (1st attempt) and needing extension to training PSQ .. there is a smaller statistically significant connection between PSQ + CSA (1st attempt) and final outcome There is no connection between CbD scores in hospital and trainee performance There is a good connection between ESR competency assessment and AKT/ CSA outcomes Doctors in training who require ATT are significantly more likely to have received lower scores on their PSQ (Group 1 mean = 5.02, Group 2 mean = 5.33; p<.001; effect size is medium = 0.33). Doctors who required ATT were significantly more likely to have received lower scores on their MSF (professional) (Group 1 mean = 5.00, Group 2 mean = 5.54; p<.01; effect size is medium = 0.37) and their MSF (clinical) (Group 1 mean = 4.75, Group 2 mean = 5.23; p<.01; effect size is medium = 0.30), compared to those who did not require ATT. 7

Preventive inputs Leeds linguistics course ( for those who are IMG/ non native speakers) Understanding GP course ( Respectful Curiosity) for those who are SJT/ PDT 2 and / or IMG Early identification CSA preparation course (high risk of CSA failure only: derived from CSA familiarisation course- more cases – more examiner input more training for trainers on assessment

“Curative” inputs Dyslexia screening (for those who fail AKT twice / by more than 4% when in St3) or on request AKT support course (for those who have failed AKT) Mentoring (Y&H or private) especially for those with organisational issues Gym and Tonic course (for those who have failed AKT (or CSA) 1 2 1 input from examiners/ specialists for those who have failed CSA (individual or group) 1-2 sessions more if in a group.

Trainer inputs 1-3 Trainer workshops each 6m for trainers to get support and ideas for those who have a trainer in extension (attendance paid for!) Spring and autumn school workshops on : information mastery and preparing trainee for AKT Share involve and document the Trainee in trouble Consulting skills for CSA Problem Registrars ( with Equal opportunities) Awareness and respectful curiosity an approach to working with diversity Teaching clinical reasoning … planned Using Video beyond the COT … in creation (ARCP and ESR and WPBA workshops )