The road ahead Eric Bater 18 th September 2013

How do adults learn?

Principles of adult learning Malcolm Knowles 1984 Need to know (goal orientation) Self concept (independent, autonomous, self- directed) Role of experience (connecting knowledge to experience) Readiness to learn Orientation to learn (relevance, immediacy) Motivation to learn

Principles of adult learning (From RCGP Learning and Teaching guide) 1)Self directed (In charge of ones own learning) 2)Experiential (the principal resource for adult learning) 3)Needs based (readiness to learn is related to the tasks required in the role) 4)Problem centred ( apply tomorrow what you learn today)

Kolb Cycle

What do GPs need to know ?

Designing a curriculum Things they need to know Things they should be able to do Experience the learner will have

RCGP Curriculum statements 1) Core curriculum statement 2) Contextual statements 3) Clinical statements

RCGP Curriculum statements 1) Being a General Practitioner

The RCGP Curriculum statement Contextual statements 2.01) The GP consultation in practice 2.02) Patient safety and quality of care 2.03) The GP in the wider professional environment 2.04) Enhancing professional knowledge

RCGP Curriculum statement 3.01 Healthy people 3.02 Genetics 3.03 Care of acutely ill 3.04 Care of children and young people 3.05 Care of older adults 3.06 Women’s health 3.07 Men’s health 3.08 Sexual health 3.09 End of life care 3.10 Mental health 3.11 Intellectual disability 3.12 Cardiovascular health 3.13 Digestive health 3.14 Drug and alcohol 3.15 ENT, Oral, facial 3.16 Eyes 3.17 Metabolic problems 3.18 Neurology 3.19 Respiratory health 3.20 Musculoskeletal 3.21 Skin problems

Using the curriculum Learning Activity Cases Curriculum Cases Learning Activity Curriculum Learning Activity Cases Curriculum Learning Activity Curriculum Cases

The RCGP ‘tripod’ Workplace based assessment Applied knowledge test Clinical skills assessment

Assessment

Miller’s triangle

Miller’s pyramid Knows Knowledge AKT Shows How Knows How Performance Competence CSA Does ActionWPBA

12 MRCGP assessment domains 1)Consultation and communication skills 2)Practising holistically 3)Data gathering and interpretation 4)Making a diagnosis/decision 5)Clinicalmanagement 6)Managing medical complexity and promoting health 7)Primary care administration and IMT 8)Working with colleagues and in teams 9)Community orientation 10)Maintaining performance, learning and teaching 11)Maintaining and ethical approach to practice 12)Fitness to practice

AKT 3 hour, 200 question computer based test. 80% clinical, 10% critical appraisal/evidence base, 10% health informatics and admin. Take from ST2 Sittings in January, April, October Max 4 attempts

CSA 13 simulated consultations Take in ST3 Sittings in February, May, November Max 4 attempts

Tools for WPBA Multi-source feedback Patient satisfaction questionnaire Case based discussion Consultation observation tool Mini-CEX (Clinical evaluation exercise) (Naturally occurring evidence) Directly observed procedural skills Audit Significant event analysis Referral analysis Prescribing analysis

COT Structured observation using 13 ‘performance criteria 3 per six months in ST1 & ST2 6 per six months in ST3 miniCEX when in hospital post

CBD 20 minute exploration of a case Exploration of individual competencies ST1 & ST2 3 per six months; ST3 6 per six months

DOPS Mandatory and optional procedures Must be observed by either a GP or a specialist/ ST4+ specialist trainee

PSQ Carried out in twice during GP posts Based on feedback from 40 patients Correlated and fed back by educational supervisor

MSF 5 clinicians, 5 non-clinicians (in primary care) 7 point grade and feedback entered into e- portfolio

Relationship between the Curriculum and MRCGP For the MRCGP the domains and essential features of the curriculum have been transferred into 12 competency areas which we call The Competence Framework These 12 competencies can be placed in one of 4 Clusters. This is known as RDMp Clustering

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

Overview of structure of e-portfolio

Making reflective log entries

Promoting reflective entries (From RCGP WBPA standards group)

ES and ARCP

The Educational Supervisor (ES) Is responsible for overseeing training to ensure that trainees are making the necessary clinical and educational progress. Where possible, it is desirable for trainees to have the same educational supervisor for the whole of their training programme. (The Gold Guide 4.22 p 22)

What does the Educational supervisor do? Within workplace based assessment conduct six monthly reviews Make at least yearly recommendations to the Annual Review of Competence Progression (ARCP) Panel

How Does the Educational Supervisor do this? Over the year, it is recommended you follow the progress in the e-portfolio that the GP registrar has made with regard to workplace based assessment, their exams and assessments. There need to be a minimum of three face to face meetings each year

The 3 essential meetings each year Annual planning: – within first 4 weeks of the start of the year (i.e. end August/ beginning September) Midyear review: – at about 6 months (i.e. around January) End of year review: – around the beginning/mid June