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

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: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 2:


Detour – Educational Theory

Consider Miller’s Pyramid

Action(in vivo)

Performance(in vitro)

Competence(simple application)

Knowledge(basic ingredients)

How & where does the MRCGP exam assess each level?

WPBA

CSA

AKT / CSA

Entry/ AKT

Educational Objectives

A standard classification & structure for learning objectives

Bloom’s Taxonomy

An assessment of progress should look at knowledge, attitudes, skills.


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 AssessmentTop level of Miller’s Pyramid

Mainly attitudes/ behaviours and skills, some applied knowledge


Structure & template for WPBA

Knowledge, attitudes, skills?

Too simple

Curriculum?


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 CompetenceCommunication & 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 12Domains can you name?





Clinical Management

Managing Complexity






Fitness to practise

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





Clinical Management

Managing Complexity






Fitness to practise

Grouped into “performance areas”

R Relationship

D Diagnostics

M Management (non-clinical)

P Professionalism





Clinical Management

Managing Complexity






Fitness to practise


R Relationship

D Diagnostics


P Professionalism





Clinical Management

Managing Complexity






Fitness to practise


R Relationship

D Diagnostics


P Professionalism





Clinical Management

Managing Complexity






Fitness to practise


R Relationship

D Diagnostics


P Professionalism





Clinical Management

Managing Complexity






Fitness to practise


R Relationship

D Diagnostics


P Professionalism

For the CS Review:

Same overall format

Some headings change for “clarity”

For ES Review:

This exact format.

Key Messages


Key Message 2:


The Nitty-Gritty…

1. Understand the Domains of Competence

The Nitty-Gritty…


2. Know where to go in the e-portfolio to prepare for a review

3. Know where to find good evidence to “tag” for a review

Organised portfolio?

Review preparation will take 3-4 hours.

The Nitty-Gritty…






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…






Where is the Evidence?

Assessments: Mini-CEX

CBD

DOPS

CSR

MSF

PSQ

Logs

Month 6

3

3

any

1 (post 1)

1 (ST1)

0-1 (ST1 or 2)

40-50

Month 11

another 3

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 Evidence1. Communication & Consultation Skills

2. Practising Holistically

3. Data Gathering & Interpretation

4. Making a Diagnosis / Making Decisions

5. Clinical Management

6. Managing Complexity

7. (Primary Care) Administration and IMT

8. Working with colleagues and in teams

9. (Health) Community orientation

10. Maintaining performance, learning and teaching

11. Maintaining an ethical approach to practise

12. 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 Evidence1. Communication & Consultation Skills

2. Practising Holistically

3. Data Gathering & Interpretation

4. Making a Diagnosis / Making Decisions

5. Clinical Management

6. Managing Complexity

7. (Primary Care) Administration and IMT

8. Working with colleagues and in teams

9. (Health) Community orientation

10. Maintaining performance, learning and teaching

11. Maintaining an ethical approach to practise

12. 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 2:


Review Preparation

Overview of Evidence:

Ignore the grid laid out against Curriculum Coverage

Look at the grids laid outagainst 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 Entries1) Simple list of useful information from teaching:

CURB scoring Causes of amenorrhoeaPlease do not share

2) Recording of a “required event”Audit project Child protection Leave takenOOH session Leadership

3) Genuine educational activityTutorials, VTS sessions, interesting cases, reading-upBread and butter of the “2 per week”

4) “Domains of competence” eventReflection from a competency, not a clinical, perspectiveTarget 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

Documents

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