nMRCGP Assessments on the e portfolio A summary for hospital clinical supervisors Maggie Eisner

Components of nMRCGP Applied Knowledge Test (machine marked test) – done in ST2 or ST3 Clinical Skills Assessment (simulated GP surgery) – done in ST3 in GP post Workplace Based Assessment - mini CEX (COT in GP posts), CBD, CSR, MSF, DOPS Learning log - including clinical encounters, tutorials and seminars, significant incidents, professional conversations (etc) All components matched to curriculum headings and to competency framework

The e portfolio Is the only record used in assessing trainee’s progress Trainee responsible for keeping it up to date – but may need encouraging and reminding Logon provided for Clinical Supervisor – sometimes the wrong name, e g specialty’s educational lead. Can be changed on e portfolio via VTS administrator Vicky at Field House Clinical supervisor can view e portfolio (most of it) Other health professionals can enter assessments via their GMC number or with electronic ‘ticket’ from trainee Educational supervisor is GP educational supervisor for the 3 years

Assessment of progress Educational Supervisor (GP trainer or Programme Director) meets trainee twice every 6m (month 2 and 4) At 2nd meeting, ES evaluates evidence on e portfolio and enters Educational Review ARCP once a year (in month 10) to agree to progression from ST1 to ST2, ST2 to ST3, or grant CCT

Number of assessments required before ES mtg in month 4 DOPS – any time in training – Mandatory (there are others) : breast exam, Cx smears, female genital exam, male genital exam, prostate exam, rectal exam, bld gluc testing, simple dressings Observers may be SpR, staff grade, nurses, consultants miniCEX – at least 3 per 6m 15-min snapshot of doc-pt interaction Observers may be staff grades, experienced SpR, consultant MSF – 1 set of 5 per 6m in ST1, none in ST2 CSR – at least 1 per 6m, before ES mtg in month 4 CBD – at least 3 per 6m, preferably by experienced educator

Case based discussion – what and how? Formal, structured exercise with preparation by trainee and assessor Developed from the old MRCGP oral exam (designed to test whether trainees could consider scenarios and issues in breadth and depth) Intended to find evidence of specific competencies, not test knowledge Trainee selects 2 cases, gives copies of records to assessor in advance Assessor selects one and decides which competencies to look at frames questions around the actual case, not exploring hypothetical events

Case based discussion – the competencies Practising holistically Data gathering and interpretation Making a diagnosis/decisions Clinical management Managing medical complexity Primary care admin and IMT Working with colleagues and in teams Community orientation Maintaining an ethical approach Fitness to practise

Case based discussion – rating Expect progress from NFD to competent – ‘excellent’ is a description of a mature practitioner Insufficient evidence – if you haven’t looked at that competency, or the case doesn’t address it Needs further devel – rigid adherence to rules, superficial grasp of facts, can’t apply knowledge, little judgement Competent – accesses and applies knowledge, sees things in context, conscious planning, ability to prioritise Excellent – intuitive grasp of situations, doesn’t have to rely on rules, identifies underlying principles, understands context for applying knowledge

Case based discussion – making it useful Prepare in advance Get trainee to self rate and discuss whether you agree and why Record a few details of the case (e portfolio has no specific slot for this, put in Feedback section) to help educational supervisor to assess help trainee to reflect Encourage trainee to select case for next time which reflects the competencies they need evidence for

Further information www.bradfordvts.co.uk: nMRCGP for Consultants – Elderly medicine www.rcgp.org.uk: GP curriculum

Appendix Detailed descriptions of the 12 competency areas and the criteria for the 4 grades NB Each kind of assessment tests a different selection of competencies – e g CBD doesn’t include nos 1 (communication) and 9 (maintaining performance, learning and teaching)