6 Month ES Reviews Yer What??? Dr Richard de Ferrars January 2014

Dr Smith found his trainee’s attitude to the e-portfolio a little bit challenging

Objectives for the Session Ask ANY GP: Jumping through hoops with minimum effort – is this a key GP skill???

Objectives for the Session How do I prepare for a 6m review? What is a 6m ES review? How does WPBA fit in with the rest of the MRCGP? Working backwards….

Overview of MRCGP Exam What are the three components? AKT = Applied Knowledge Test (ST2/3) 3 hours extended MCQ, £500, 60-80% pass-rate CSA = Clinical Skills Assessment (ST3) 13 station simulated-patient OSCE, £1700, 60-75% pass-rate WPBA = Workplace-based Assessment £400 - £600 per year Recorded in e-portfolio Standard assessments (mini-CEX, CbD, DOPS, MSF, CSR) Learning log/ PDP monitored by Educational Supervisor..

Key Messages Key message 1: Key Message 2: Understand what the Domains of Competence is all about Key Message 2: Understand how to find good quality evidence for reviews – assessments & learning logs.

Key Messages Key message 1: Key Message 2: Understand what the Domains of Competence is all about Key Message 2: Understand how to find good quality evidence for reviews – assessments & learning logs.

Detour – Educational Theory

Consider Miller’s Pyramid Action (in vivo) Performance (in vitro) Competence (simple application) Knowledge (basic ingredients) WPBA CSA AKT / CSA Entry/ AKT How & where does the MRCGP exam assess each level?

Educational Objectives Bloom’s Taxonomy A standard classification & structure for learning objectives Educational Objectives Attitudes Knowledge Skills An assessment of progress should look at knowledge, attitudes, skills.

Overview of MRCGP Exam What are the three components? AKT = Applied Knowledge Test (ST2/3) Lower levels of Miller’s Pyramid Mainly knowledge, some skills CSA = Clinical Skills Assessment (ST3) Middle levels of Miller’s Pyramid Mainly skills, some applied knowledge & attitudes WPBA = Workplace-based Assessment Top level of Miller’s Pyramid Mainly attitudes/ behaviours and skills, some applied knowledge

Overview of MRCGP Exam Structure & template for WPBA Knowledge, attitudes, skills? Too simple Curriculum?

Overview of MRCGP Exam Structure & template for WPBA Knowledge, attitudes, skills? Too simple Curriculum? WONCA framework Not very suitable for exams & assessments Domains of Competence Similar to the curriculum framework Better structure, easier to understand Summary of attitudes & skills required for working as a GP

12 Domains of Competence Communication & Consultation Skills Practising Holistically Data Gathering & Interpretation Making a Diagnosis / Making Decisions Clinical Management Managing Complexity Primary Care Administration and IMT Working with colleagues and in teams Community orientation Maintaining performance, learning and teaching Maintaining an ethical approach to practise Fitness to practise Brief interlude to see who is paying attention.... How many of the 12 Domains can you name?

12 Domains of Competence Practising holistically = problem with patient at centre (Health) community orientation = problem with NHS at centre = use of resources Primary care/ IMT = overall use of records/ IMT Communication & Consultation Skills Practising Holistically Data Gathering & Interpretation Making a Diagnosis / Making Decisions Clinical Management Managing Complexity Primary Care Administration and IMT Working with colleagues and in teams Community orientation Maintaining performance, learning and teaching Maintaining an ethical approach to practise Fitness to practise

12 Domains of Competence Grouped into “performance areas” R Relationship D Diagnostics M Management (non-clinical) P Professionalism Communication & Consultation Skills Practising Holistically Data Gathering & Interpretation Making a Diagnosis / Making Decisions Clinical Management Managing Complexity Primary Care Administration and IMT Working with colleagues and in teams Community orientation Maintaining performance, learning and teaching Maintaining an ethical approach to practise Fitness to practise

12 Domains of Competence Grouped into “performance areas” R Relationship D Diagnostics M Management (non-clinical) P Professionalism Communication & Consultation Skills Practising Holistically Data Gathering & Interpretation Making a Diagnosis / Making Decisions Clinical Management Managing Complexity Primary Care Administration and IMT Working with colleagues and in teams Community orientation Maintaining performance, learning and teaching Maintaining an ethical approach to practise Fitness to practise

12 Domains of Competence Grouped into “performance areas” R Relationship D Diagnostics M Management (non-clinical) P Professionalism Communication & Consultation Skills Practising Holistically Data Gathering & Interpretation Making a Diagnosis / Making Decisions Clinical Management Managing Complexity Primary Care Administration and IMT Working with colleagues and in teams Community orientation Maintaining performance, learning and teaching Maintaining an ethical approach to practise Fitness to practise

12 Domains of Competence Grouped into “performance areas” R Relationship D Diagnostics M Management (non-clinical) P Professionalism Communication & Consultation Skills Practising Holistically Data Gathering & Interpretation Making a Diagnosis / Making Decisions Clinical Management Managing Complexity Primary Care Administration and IMT Working with colleagues and in teams Community orientation Maintaining performance, learning and teaching Maintaining an ethical approach to practise Fitness to practise

12 Domains of Competence Grouped into “performance areas” R Relationship D Diagnostics M Management (non-clinical) P Professionalism For the CS Review: Same overall format Some headings change for “clarity” For ES Review: This exact format. Communication & Consultation Skills Practising Holistically Data Gathering & Interpretation Making a Diagnosis / Making Decisions Clinical Management Managing Complexity Primary Care Administration and IMT Working with colleagues and in teams Community orientation Maintaining performance, learning and teaching Maintaining an ethical approach to practise Fitness to practise

Key Messages Key message 1: Key Message 2: Understand what the Domains of Competence is all about Key Message 2: Understand how to find good quality evidence for reviews – assessments & learning logs.

The Nitty-Gritty… Understand the Domains of Competence

The Nitty-Gritty… Understand the Domains of Competence Know where to go in the e-portfolio to prepare for a review Know where to find good evidence to “tag” for a review Organised portfolio? Review preparation will take 3-4 hours.

The Nitty-Gritty… Understand the Domains of Competence Know where to go in the e-portfolio to prepare for a review Know where to find good evidence to “tag” for a review Organised portfolio? Review preparation will take 3-4 hours.

Review Preparation Select Review Preparation Must be set up by ES: Email them if missing Step 1 DOPS (Skills review) Simple self-rating Step 2 PDP Review…

The Nitty-Gritty… Understand the Domains of Competence Know where to go in the e-portfolio to prepare for a review Know where to find good evidence to “tag” for a review Organised portfolio? Review preparation will take 3-4 hours.

Where is the Evidence? Assessments: Mini-CEX Month 6 Month 11 CBD DOPS CSR MSF PSQ Logs Month 6 3 any 1 (post 1) 1 (ST1) 0-1 (ST1 or 2) 40-50 Month 11 another 3 any another 2 (post 2 & 3) another 1 (ST1) 0-1 (ST1 or 2) 80-90 Missing assessments = mandatory “Unsatisfactory Progress” Missing log entries = mandatory “Unsatisfactory Progress”

Domains of Competence Evidence Communication & Consultation Skills Practising Holistically Data Gathering & Interpretation Making a Diagnosis / Making Decisions Clinical Management Managing Complexity (Primary Care) Administration and IMT Working with colleagues and in teams (Health) Community orientation Maintaining performance, learning and teaching Maintaining an ethical approach to practise Fitness to practise Sources for Evidence: Mini-CEX (COT) CBD DOPS CSR MSF PSQ Log entries Exercise in pairs: Pick one “domain of competence” What are likely to be the best sources of evidence?

Domains of Competence Evidence Communication & Consultation Skills Practising Holistically Data Gathering & Interpretation Making a Diagnosis / Making Decisions Clinical Management Managing Complexity (Primary Care) Administration and IMT Working with colleagues and in teams (Health) Community orientation Maintaining performance, learning and teaching Maintaining an ethical approach to practise Fitness to practise Sources for Evidence: Mini-CEX (COT) CBD DOPS CSR MSF PSQ Log entries Exercise in pairs: Pick one “domain of competence” What are likely to be the best sources of evidence?

Key Messages Key message 1: Key Message 2: Understand what the Domains of Competence is all about Key Message 2: Understand how to find good quality evidence for reviews – assessments & learning logs.

Review Preparation Overview of Evidence: Ignore the grid laid out against Curriculum Coverage Look at the grids laid out against Competence Areas “ZEROES” in the Current Review?

Evidence – Good and Bad Sources: Assessments Log entries Quality: Evidence can be poor Evidence can be clear…

Evidence - Assessments You will be invited to tag evidence (more later) This must be good quality evidence Assessments: Can use if a meaningful & relevant comment about that Competence has been made

CBD - Bad Evidence:

CBD - Good Evidence:

MSF – Good Evidence MSFs need to be “released” – email your ES if you cannot see the result

Evidence - Log Entry You will be invited to tag evidence (more later) This must be good quality evidence Assessments: Can use if a meaningful & relevant comment about that Competence has been made Log Entries: Can only use entries where your ES has validated evidence

Good Evidence - Log Entries 1) Simple list of useful information from teaching: CURB scoring Causes of amenorrhoea Please do not share 2) Recording of a “required event” Audit project Child protection Leave taken OOH session Leadership 3) Genuine educational activity Tutorials, VTS sessions, interesting cases, reading-up Bread and butter of the “2 per week” 4) “Domains of competence” event Reflection from a competency, not a clinical, perspective Target of 1-2 per month, use in ES reviews

Good Evidence - Log Entries 4) “Domains of competence” event Reflection from a competency, not a clinical, perspective Target of 1-2 per month, use in ES reviews More detailed log entries “Domains of Competence” issues, not just clinical issues ES has the option to validate = good evidence for reviews Good entries, not validated? – talk to your ES Consider starting the entry with a prompt!

Competence Area Self-Rating For each of the 12 Domains (10-15 mins each) Rating Tag evidence (three items required) Reflect (comment) on the evidence Action plan

Preparing for the ES Review Set a date! (latest mid-Feb) Check you have a review set up (email ES) Evidence – quality matters… Assessments Learning Logs (category 4) MSF not released? (email ES) Look at Competence Areas grid Use log entries to fill blanks Complete self-ratings (including Skills & PDP)

The End