00a Introduction & History

Intro & History

The new rating scales (1) have been developed to help with the education of your trainee. The strength of the scales lies in the fact that they were put together by a number of experienced GP’s. Individual scales were chosen as the skills they outline were felt to be important and their acquisition by trainees essential to good patient care. The main scale gives an overall picture which is broken down into subcomponents in the subscales (easier for the learner to understand and easier for the teacher to assess and give feedback).

Changes

The regional working group have Modified the scales in light of the feedback we have received from you over the last 18 months. These modifications include the addition of written guidance to help you mark the main scales, the formation of an appendix which contains those scales which are checklists (there are references to these scales in the ‘notes to raters’) and the addition of a scale covering referral and the condensation of some of the subscales.

Ways of using the scales

Training in general practice has been evolving in the region in the last couple of years with more emphasis being placed on assessing the trainee’s progress and giving feedback to enable improvement in performance (2). The new scales provide a framework to do this. In view of the breadth of skills they cover and the detail with which they cover them the scales can be used fora variety of purposes (3):

  1. To indicate to a trainee what is expected of him/her.
  2. As a curriculum for in-practice teaching.
  3. To help in the definition and management of problems with the trainee’s performance when this is necessary.
  4. To evaluate this performance at regular intervals and demonstrate improvement ( formative assessment).

Information gathering before completing the scales

Information gathering is an important first step when using scales. Without adequate information, neither trainee nor trainer will benefit from the assessment. Information is available from a variety of sources (see guide). Observation of the trainee at work represents an important part of this information. This requires sitting in, video and talking to partners, staff andother professionals who have observed the trainee. Once the trainer has this information he/she has the difficult task of synthesising and ordering it in a form which can be fed back to the trainee to reinforce the good and agree a plan to improve the not so good.

Using the scales to give feedback

The overall objective of giving feedback is to motivate the trainee to learn. Feedback sessions should be seen as times for discussion and negotiation between trainer and trainee using positive feedback to reinforce what was done well and constructive criticism to highlight weak areas and agree on a teaching/experience plan to improve these. By the third month of the attachment, the trainer should have gathered sufficient information about the trainee to be able to start completing the scales. It is not necessary nor practicable to run through all the scales in one session as we did with the old Manchester rating scales. Trainers need to be selective in choosing the areas they wish to focus upon. Areas in which the trainee has done well will take only a short time to cover; weak areas will need more time and thought.

The process of completing the scales

Each main scale consists of a 10 point scale between two statements which describe, at the left-hand end the most undesirable behaviour that might be observed, and at the right-hand end the most desirable. The rater (in this case the trainer) indicates on the scale his/her estimate of where the trainee current competence lies between the two. We have included guidance beneath the1-10 numerical scale which we hope will help you choose an appropriate mark.

It is hoped that the marking will be done jointly and we suggest that the main scale be read first but not marked. The trainee should be encouraged to self-rate the subscales followed by the trainer’s assessment. The main scale can then be filled in with reference to the subscales to indicate overall progress. Discrepancies in ratings between trainer and trainee are worthy of further discussion.

We have left space for comments which can be used to reinforce areas in which the trainee has done particularly well, to record areas of deficiency and any plan agreed to remedy them. The scales as a whole then provide a written record of the trainee’s progress in practice.

The Appendix

The scales in the appendix may be particularly useful where the trainer/trainee has recognised problems that need more care and detailed consideration. It is intended that the scales included in the appendix are used selectively.

A timetable for using the scales

The Working Group recommends the following guidelines:

  1. That you introduce your trainee to them at the beginning of the attachment so that he/she knows what is expected and the basis on which he/she will be assessed.
  2. Trainer and trainee should meet in the third month of the attachment to discuss the results of those assessments that have been performed thus far, using the document as a framework.
  3. Trainers should dip into the document for teaching purposes, eg topic teaching, to review audits of referrals and prescribing.
  4. Selected scales can be used, after appropriate remedial action, to reassess progress in problem areas and to demonstrate whether improvement has taken place.
  5. Finally, the scales can be used in the sixth month to discuss and record overall progress.

Thus by the end of the attachment, we envisage that all the main scales (1-19)will have been completed along with some of those in the appendix, depending on trainee need.

References

  1. Rating Scales for Vocational Training in General Practice 1988 RCGP Occasional Paper 40.
  2. Conference on trainee Assessment in the Northern Region -Regional Postgraduate Institute for Medicine and Dentistry 1988.
  3. Personal Communication -John Charlewood 1988.

All comments on the content and use of the document should be expressed to one of the members of the working group as listed below:

Drs Britton, Bradshaw, Cock, Cunningham, Hungin, Maini, Rutt and Thornham. 

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