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Fellowship by Assessment archive Already undertaking it!

• Planning
• The videotape component
• Presentation
• Before the visit
• The visit

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Planning

Planning is important to make the process of working for FBA run smoothly. Look carefully through the criteria to see if there are any areas which you may find difficult. If so, discuss these with your local FBA adviser.

• It is probably best to look at section 8 first. Your protocols must be defined, and the audit loop completed - this usually takes the longest time. Check your audits against a benchmark . Many candidates have a n extra "spare" audit as insurance!
• Practice videotaping your consultations so that you feel comfortable with having a camera in the room: ask a colleague to watch the videotapes with you so that you may improve your consultation skills. The video workbook takes longer to fill in than you think!
• Define your sources of help and delegation: the practice manager is usually a key aide, and a dedicated secretary with a good word processor is a boon.
• Define your protocols or check your current ones. Ensure that the standards for care are set and that you have defined the criteria by which you will measure your achievement of those standards.
• Look at what you have achieved in the practice over the last 5 years or more. Did you achieve all you set out to? What are your plans for the future? How will you go about this?

Presentation

Your presentation should be designed around making the documentation as easy as possible for the examiners to understand and find their way around in.

• Structure the layout of your document so that it is easy for the assessors to find their way about. Interleaved documents can make the documentation difficult to follow.
• Numbering the pages helps the examiners reference their comments. Nave an indexed and numbered "contents " page too.
• Layout : keep the formatting, style, typeface, margins etc. of your application the same for a professional look.
• Binding your documentation professionally is cheaper than you might think. Contact local binding firms or the local university library, who may have their own binding facility or will be able to put you in touch with the binders they use. The RCGP requires 4 copies, one for each examiner and one for the RCGP to keep. You will want some additional copies for yourself, too.
• Multiple applications from the same practice could be presented either as
  1. A series of separate application documents for each candidate.
  2. One document with the personal areas (on coloured pages) for each candidate. Coloured pages in the application documents work well as this enables the assessors to easily separate the individual candidates in a multiple application.
  3. A series of documents with the personal pages individually coloured.
• Graphs and charts are not often seen in FBA documents, but can make the presentation of your data a lot clearer. Spreadsheet packages will often design these automatically for you.
• Make it personal : although not defined by criteria, consider adding a little information about the history of the practice, the practice team, areas of particular acheivement or interest and published papers.
• Comments about your data are important. The figures on the page may give you the information easily but the examiners may find it all confusing or difficult to understand.
• Honesty in the discussion of the case studies is implortant as it reveals perceptions eg early diagnosis.
• Typing up: do this (or get it done!) as you go, don't leave it all until the end. Try to keep the style similar throughout the document for clarity.

The video component

It may be that the focus on audit and practice management in recent years has detracted from post-trainee work on consultation skills, as this is the area which candidates seem to be having the most difficulty with during FBA. Assessors all over the country are reporting that this is often the weakest part of a candidates application for FBA.

Candidates sometimes

• are not experienced in the use of video
• have little insight into their own strengths and weaknesses
• are unconfident with the theoretical principles of the consultation
• are unsure how to improve their consulting skills

Make sure your videotape includes patients with psychiatric/psychological problems, as this is the bulk of GP work. Don't video the surgery after you come back from holiday, or a surgery consisting of patients with only acute problems. Think about how, why and when you write in the records/use the computer during the consultation: does this compromise the flow of the consultation? Where is your computer screen sited? Is it behind you so that you have to turn your back on the patient to use it?

When videoing the surgery, just leave the video running during the surgery - don't switch it on and off as it is too distracting. Arrange the surgery so that the consent forms are dealt with by the receptionist rather than by you.

The assessors will be scanning the video for

• strengths
• weaknesses
• educational objectives to discuss

and will want to hear that you have identified some of these and have a plan to improve your consulting skills.

See patient-centred consulting for areas where candidates sometimes have difficulty, and the Leicester Assessment Package (LAP) for a video assessment tool which you could use on yourself.

You are likely to find that the identification of tasks and subtasks in the video workbook is easier than you originally thought, although the process of doing this will take some time. If you cannot find the subtasks easily, it might be better to scrap the tape and start again: you might also wish to show a tape to your adviser or another colleague, to explore the discussion points raised in each consultation.

The quality of the recording is very important. Use a good quality tape and a good quality camera. Make sure that the lighting is good (obtain a video floodlight if necessary) and don't forget to shut the windows to reduce ambient noise. You might get better sound quality using a pressure zone microphone (at about £12 from Tandy or other electronic stores) on the desk. Position the camera so that the patient and you can be seen face-on. I usually suggest that you switch the camera on at the start of the session, then just leave it running: this way, you will forget that you are being videoed very quickly. Arrange for the receptionists to organise the consent, and in this way you will only have to switch off the video if consent is declined (usually less than 10% of consultations).

If you are not used to video, get some practice with the medium before you tape your final version. Share the content of your tape with a partner, mentor or your "buddy" assessor to explore both the video quality and the consulting style and content.

Before the visit

• Check library and information systems are tidy
• Check reception desk and other rooms are tidy
• Check waiting room for poster with appointment availability standards
• Make sure the following are available:
  • disease register
  • register of accidents
  • list of housebound patients
  • agencies file
  • educational leaflets
  • minutes of team meetings
  • office procedures book
  • annual reports and annual Health Authority reports
  • the records for your terminal care case
• Make sure the following are in order:
  • sharps provision
  • locked cabinet for drugs
  • CD register
  • security arrangements
  • equipment and drugs in car and surgery
  • appointment, visit and message books

The Visit

By the time you reach this stage, you should not fail! You should be prepared enough for anything the assessors can throw at you. Bear in mind that this is an educational exercise, and the assessors are not there to trick you or catch you out: their task is to evaluate your practice, and they will consider it a privelige to be invited to share your work with you. No doubt the assessors will take away all your best ideas and implement them in their own practices!

The visiting team will consist of 3 Fellows, ideally Fellows who have already undertaken FBA themselves:

• Your "buddy" assessor, who has been assisting you with FBA.
• A second internal examiner, nominated by the local Faculty.
• The lead assessor, an external assessor nominated by the RCGP, and usually with considerable experience of FBA applications.

A few weeks after your application has been sent, a date for the visit will be arranged with you. The process of the visit will take all day , so it is best not to plan surgeries or any other commitments. Afterwards you will feel exhausted!

The lead examiner will send you a timetable of the day, which may look something like this:

9.00        Examiners meet at surgery
9.00-9.30   Examiners conference
9.30-10.15  Tour of premises
10.15-12.30 Interview with candidate
12.30-1.30  Working lunch with other partners and members of PHCT
1.30-2.30   Interviews with staff, examination of records
2.30-4.30   Interview with candidate and examination of video
4.30-5.00   Examiners conference and feedback
 

Have everything ready that the examiners may wish to see:

• 30 randomly-picked sets of records with computer access and an assistant to aid the assessors with the computer system.
• Your emergency bag and any other equipment which you carry in your car.
• The notes of your most recent case of terminal care.
• PACT reports.
• PHCT and practice meeting minutes.
• Office procedures book.
• Accident book.
• Complaints file.
• Agencies file.
• Any patient advice leaflets used.
• Practice annual reports.

The staff may feel quite threatened by the visit, especially the staff interviews. Sell the event to them as an "exercise" rather than an "exam". Tell them that they are free to say what they feel - the interviews are a discussion, not an interrogation; there are no "right " answers to the questions. FBA assesses the practice and the candidate.

You can reduce your own anxiety on the day in a number of ways:

• Remember that by the time you reach the visit day you are unlikely to fail. Your adviser should have covered any difficult areas with you before the visit. Treat the day as an "academic exercise" and remember that the assessors have probably been through the same process themselves, so the do understand what it is like!
• Play to your strengths. The FBA is about selling yourself and the practice in a quality-centered peer-referenced exercise.
• Take a walk during the quieter parts of the day to give yourself a break. Most candidates find doing a surgery during the day too stressful.
• Take two paracetamol for the tension headache!
• Arrange for your "buddy" assessor to visit the practice beforehand to talk to the staff and to cover any perceived difficult areas.

At the end of the day, the assessors should be able to confirm that your name will be put forward for FRCGP, and will discuss any issues which have arisen. I like to get some feedback from the candidate of how he/she felt the day went, and provide a written resume of the issues brought out by the assessment for the candidate and the practice. Good feedback can be used constructively by the practice to aid development.

Brad Cheek:

• Brad Cheek: last updated Dec 2006
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