1. 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

2. 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

4. 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

5. 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

6. © Tim Norfolk

7. 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

8. 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

9. “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.

10. 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 )