1. WPBA for Barnsley Lots is changing… Time to focus on only some bits
Mike Tomson WPBA core group RCGP
HEE Y&H APD lead for ARCP & performance

2. Introduction of concept
Standing exercise

3. WPBA Comparison template

4. Guiding principles
Update to reflect GMC expectations (especially on Prescribing, leadership & quality improvement)
Fit with the all speciality move to GMC’s Generic Professional Capabilities
Develop clarity on which format to use for which occasion
Enable an easier transition to post CCT appraisal format (e.g. separating evidence from Work based learning)

5. Review of current Learning Log Entries (LLE)
Too often many entries relate to knowledge or curriculum acquisition not WPB experiences.
The use of the reflective boxes is less frequent than would be educationally appropriate as WPBA looks at learning based on what trainees actually do.
Trainees do not focus on GP competences in their entries (probably because they do not suggest links to them)
“Rules of thumb” for the numbers of entries per week that a trainee needs push up trainee workload

6. Simpler format enabling transition to post-CCT appraisal
Three broad categories for log entries:
Reflection on keeping up to date (for trainees becoming up to date across the curriculum) – CPD
Reflection on reviewing what you do, and learning from cases, data and events – Quality Improvement Activities (QIA) and Significant Event Analysis (SEA)
Seeking and reflecting on feedback about what you do (For trainees, from colleagues, patients and leadership feedback surveys and reflecting on other unsolicited feedback such as complaints and compliments)

7. Curriculum links: why change?
The links currently made are inconsistent and many trainees have not ever reviewed the relevant modules
There is a poor connection between the number of links and the trainee’s knowledge in an area
The minimum standard of every area being covered once demonstrates little.
GPC suggests we should look at the application of competencies across settings and time

8. New Population linkages
Links will be made by trainees to the following groups (though CS/ES can remove the link if necessary)
Population groups
1. Infants, children and young people
2. People with mental health needs
3. People with long-term conditions and disability
4. Frail and elderly people (including multiple morbidity and care of the dying)
5. People requiring urgent and unscheduled care
6. People with vulnerabilities (including addictions, mental capacity and safeguarding issues, veterans)
People not included in the above groups

9. Advantages of population linkage
Fits with compiling evidence of care of the acutely ill person (instead of OOH number counting)
Enables identifying competency coverage in different settings and over time
The groups make intuitive sense

10. Prominence of Leadership, management & quality improvement
A (GMC) key component to the training of all doctors
Need to document adequate experience and exposure
Currently difficult to demonstrate adequate leadership skills in the existing LLE formats

11. All future formats
Clinical Case Reviews replaces CE and professional conversation and would be expected to be the majority of entries
Supporting Documentation (CPD) replaces reading, e learning, lecture/seminar, course/certificate
CEPS ( unchanged from current format apart from clarifying grade of observer)
Placement planning meeting format unchanged, expected for all posts.

12. All future formats (2)
Significant Event Analysis rewritten to enable reflection and make it clear whether relates to revalidation
Quality Improvement Activity reflection this is separate from the required QIP in ST1/2 and reflects GMC guidance that all Drs should annually reflect on QIA
Leadership management and professionalism Trainees are involved in a range of organisational roles and a LLE format enables this to be reflected on

13. All future formats (3)
Academic activities (for academic trainees only)
Feedback allows and encourages trainee feedback on PSQ, MSF, CSR, patients etc.

14. New: Clinical Case Review
List of population groups to choose from: (max 2)
Suggested capabilities links (from actions and reflections) – Max 2
Title:
Date:
Brief description (limited word entry) *
Describe how your actions and approach link to the capabilities listed above? * [Look at the word descriptors. Think what you would need to change to demonstrate competence or excellence on those suggested]
Reflection: what will I maintain, improve or stop? *
What learning needs have you identified from this event?
Educator comments:

15. Summary Learning log entries are changing
Revised format reflects the change in curriculum and GMC requirements in addition to encouraging more reflective practice
Quality not quantity of evidence required

16. New: Supporting Documentation (CPD Evidence)
Suggested capabilities links – Max 2
Date: *
Subject title: *
Describe your key learning from this event briefly [this could include helping you to maintain existing knowledge and skills]
Reflection: what will I maintain, improve or stop? *
What learning needs have you identified from this event?
Educator comments:

17. Revised Significant Event Analysis
Suggested capabilities links: (max 2)
Date:
Title:  
What happened, including your role? *
Why did it happen? *
What was done well? * [describe your personal involvement]
What could be done differently? * [describe your personal involvement]
Who was involved in the discussion of the event? *
What have you and the team learnt? *
What changes have you or the organisation made in response to this review? *
Does this significant event meet the threshold for reporting as a Significant Untoward Incident (SUI) for revalidation purposes on Form R in England (and   xx in Scotland) * Tick box Yes / No
If yes, additional boxes appear:
Have you discussed this event with your ES/CS? *
How was the SUI identified? *
How did identification and progress of this SUI make you feel? *
Educator comments:

18. New: Reflection on Feedback
Suggested capabilities links – Max 2
Title [e.g. feedback was received]
Date
Brief description (limited word entry) *
How does this feedback make you feel? *
What are your key learning points? *
Reflection: what will I maintain, improve or stop? *
What support have you had or require?
Have you taken your plans to your PDP? How will you re-assess/monitor improvements? *
Educator comments:

19. New: Leadership, management and professionalism
Suggested capabilities links: (max 2)
Date
Title of event
State your role in relation to the activity *
How did you approach this activity? * [what planning you undertook for the activity]
How did you demonstrate your ability to work with colleagues, patients, learners and/or users (individually or in teams)? *
How effective were you within this role? * [Reflect on your achievements and feedback received]
Reflection: what will I maintain, improve or stop?
What have you learnt about yourself? * [Consider what motivates you, your core beliefs and areas to develop]
Educator notes:

20. New: QIA Reflections List of population groups to choose from: (max 2)
Suggested capabilities links: (max 2)
Title:
Date:
Brief description of QIA (limited word entry) * [Be explicit about your role and the extent of your contribution]
What were you trying to accomplish? * [This could include a statement of the problem, a brief summary of relevant literature or guidelines, relevant context, and the priority areas for improvement]
How will we know that a change is an improvement? * [What information/data did you gather – baseline and subsequent data?]
How have you engaged the team, patients and other stakeholders?
What changes have taken place as a result of your work? How will these be maintained? * [If improvement was not achieved, explain why]
Reflection: what will I maintain, improve or stop in QIA? *
Educators notes

21. Requirements (WTE) 2 Clinical Case Reviews per month 1 SEA per year
1 QIA per year (QIP project instead one year)
1 Placement planning meeting per post
Reflection on Feedback – as appropriate
Supporting documentation – as appropriate but must include BLS/Safeguarding
Leadership, management and Professionalism - – as appropriate

22. New CSR CS to have personally done 1+ WPBA
All competencies covered in 7 questions
Do whether in GP or hospital for all posts
+ level of supervision question
In this post, this trainee currently (please choose one of the following):
- requires less supervision than expected in their clinical role
- requires expected levels of supervision in their clinical role
- requires more supervision than expected in their clinical role
- cannot be left without direct supervision

23. Interim ESR Use only between ARCPs and when all going well
Trainee fills in first numbers &comments
ES confirms/ checks
Checklist of penultimate ESR so no surprises at final ESR re OOH and specific tasks

24. ST1 2 Quality Improvement Project
Needs further development
Competent
Excellent
Capability
Date (of submission) *automatically inserted
_____
Project aim and/or objectives
You .aim should be the overarching purpose of your project. You should describe how the QIP is intended to improve the quality or safety of patient care and the target group.
If the project has more than one aspect, you can expand the aim into specific objectives.
The aim is unclear or confusing, It is not clear how the project will improve patient safety or patient care.
The target group is unclear
There is a clear aim that shows the direction for improvement and the aspect of quality to be improved.
It is clear how the project will improve the quality or safety or patient care.
The target group is clear
The aim is summarised in a SMART (Specific, Measurable, Achievable, Relevant and Time defined) format.
The aim as well as being SMART is clearly focussed on patient safety or improving the quality of patient care, ,and the direction for improvement, the specific aspect/s of quality, and the target group are clear.
The target group if appropriate is broken down into different subgroups.
Fitness to practise
What were you trying to accomplish?
You should explain what trigger (case, data or events) led you to look at this area. You should comment on the likely impact of the project on patients, and you should review the guidance or evidence that is relevant to the area (e.g. a literature review).
The reason for choosing the project is unclear or unexplained.
There is no reflection on the known guidance or evidence relating to this area. There is no consideration of the impact on patients.
The reasons for addressing the area are clearly explained.
There is reference to some appropriate guidance and/or to evidence.
There is consideration of the impact of the QIP on patients.
The reasons are clear and are based on an identified practice need or clear personal experience.
The guidance and evidence that is identified is appropriate, clear and well chosen (but not excessive).
The assessment of impact on patients includes reference to prevalence/ incidence and severity etc.
Maintaining performance, learning and teaching, Fitness to practise