- Firstly, here is the RCGP guidance
- The competency framework for the WBPA
- Suggested plan of action for the annual review (prior to the Deanery panel)
For the six monthly reviews, the GPStR will first conduct a self-assessment.
Progress will be assessed by the trainer or educational supervisor against each of the twelve competence areas. Each review will be informed by the evidence collected through the WPBA tools, augmented by any naturally occurring evidence. A learning plan will then be agreed. All this information will be recorded in a standardised format in the ePortfolio. It is anticipated that the review will take somewhere between 1 and 2 hours.
The reviews provide an opportunity to consider the breadth of coverage of the curriculum as well as the specified competence areas. It maybe useful to refer to the blue print, which demonstrates how different areas of the curriculum might be related to training experience but this should not be used as a rigid checklist
The reviews will not cover evidence of learning that is rich in knowledge, such as may arise from tutorials. However, this type of evidence will allow the GPStR and the trainer to monitor how the knowledge base of the curriculum is being covered in preparation for the AKT.
In the early stages of training it is unlikely that the GPStR will be able to provide evidence of readiness to practise. The structured evidence, considered against the competence framework will highlight the areas where the GPStR is doing well and those areas where more learning and support is needed. Thus each of the six monthly reviews will lead to a learning plan designed to enable the GPStR to collect more evidence of competence and to build up a richer picture of readiness for practice.
Toward the end of training a final review is conducted, this time without the self assessment of the GPStR. The trainer or educational supervisor will make a recommendation to the deanery regarding the overall competence of the GPStR. This recommendation will be subject to external moderation in the deanery by an expert panel including a lay person and a representative of the RCGP.
The standard against which the GPStR is judged is always the level of competence expected of a doctor who is certified to practise independently as a general practitioner. This standard is used throughout the three years of training. This means that in the first two years of training the GPStR is being judged against the standard they should have reached at the end of training. Inevitably there will be less evidence from the application of the WPBA tools in the first two years of training, and more developmental needs will be identified. This is what the assessment system is designed to do, so that further training experiences can be directed toward the developmental needs of GPStRs.
The GPStR must show competence in all twelve competence areas by the end of year 3.
Trainers are expected to use their personal experience as a GP to judge whether the evidence for each competence area and the totality of evidence indicate that the GPStR is ready for independent practice.
The six monthly reviews are used to provide feedback to the GPStR on overall progress, to identify areas where there needs to be more focused training and to identify doctors in difficulty. These reviews must be carried out even if they do not coincide exactly with the end of placements. This ensures there is sufficient evidence for useful feedback to be offered on every occasion. Doctors training flexibly are also required to undergo reviews at six monthly intervals and must collect the same amount of evidence for each review as full time trainees.
Q. Should appraisals be incorporated into the review process?
A. The six-monthly reviews are educational appraisals. The evidence collection and regular review process should satisfy any modification of the NHS appraisal process.
Q. What would an educational supervisor or trainer do if they have concerns about a GPStR?
A. The educational supervisor would follow the arrangements in their deanery for reporting concerns. Educational supervisors will need to be familiar with these arrangements, particularly in respect of serious concerns which arise outside the cycle of deanery panels. Serious issues of professional performance or ill health during hospital training will need to be handled by normal trust/PCT/deanery mechanisms.
Q. Should there be calibration of CbDs and COTs at scheme or at deanery level?
A. This is not necessary as these tools simply serve to gather information which is considered at the six-monthly reviews. Although each CbD or COT is pushing the trainer to make judgements against the competences, the purpose of this is to elicit information which feeds into the overall picture of the GPStR and generates feedback to them. There is no pass or fail for CbDs and COTs or for any other separate WPBA tool.
Q. How much evidence of each competence does a GPStR need in order to complete the WPBA?
A. Assessment of competences is about making a qualitative judgement not a quantitative one. We would expect that at the end of ST3 the GPStR will have several sets of evidence in each competence area, collected from a range of settings and through different tools. However, the only requirement is that there is enough evidence to enable the trainer to feel confident that the GPStR is competent to practise. Each portfolio will look slightly different, but it should provide a rich picture of competence built up over three years. The ticks in the ePortfolio are simply a way of keeping a shared, transparent and systematic record of evidence.
Q. How do we record when a trainee is poor at his or her work, or incompetent?
A. The process of workplace-based assessment is about recording when and at what level an individual demonstrates competence. If an individual is incompetent there are often reasons related to employment or personal reasons why that may be so, and they need to be addressed through the appropriate channels. Any probity issue should, of course, be recorded within the ePortfolio.
Q. When do GPStRs in flexible Training posts meet with their Ed supervisors for reviews?
A. GPStRs in flexible Training (Less than full-time training – LTFTT-) will be expected to have six-monthly reviews in exactly the same manner as their colleagues in full-time training. They are required to provide the same amount of evidence as a GPStR in Full-time training described for each6 monthly review.
RCGP (adapted) Oct 2007
- Communication and consultation skills. This competence is about communication with patients, and the use of recognised consultation techniques.
- Practising holistically: the ability of the doctor to operate in physical, psychological, socioeconomic and cultural dimensions, taking into account feelings as well as thoughts.
- Data gathering and interpretation: the gathering and use of data for clinical judgement, the choice of physical examination and investigations, and their interpretation.
- Making a diagnosis / making decisions. This competence is about a conscious, structured approach to decision making.
- Clinical management: the recognition and management of common medical conditions in primary care.
- Managing medical complexity and promoting health: aspects of care beyond managing straightforward problems, including the management of co-morbidity, uncertainty, risk and the approach to health rather than just illness.
- Primary care administration and IMT: the appropriate use of primary care administration systems, effective recordkeeping and information technology for the benefit of patient care.
- Working with colleagues and in teams: working effectively with other professionals to ensure patient care, including the sharing of information with colleagues.
- Community orientation: the management of the health and social care of the practice population and local community.
- Maintaining performance, learning and teaching: maintaining the performance and effective continuing professional development of oneself and others.
- Maintaining an ethical approach to practice: practising ethically with integrity and respect for diversity.
- Fitness to practise: the doctor’s awareness of when his/her own performance, conduct or health, or that of others, might put patients at risk and the action taken to protect patients.
The review is a summary of the quality of the eportfolio of the GPStR, and should show development in learning towards a standard expected by you as an educational supervisor commensurate with a fully trained GP. Imagine this as an upward spiral of learning. GPStRs are expected to achieve at least competence in each area by the end of their training. They are not expected to be competent in all areas at any time prior to then but are expected to show the development of competency over time.
This is performed by the GPStR within the eportfolio before he annual review.
These are the notes you make about the eportfolio content, before the interview. This reflection will include
- some comment on the progress from the agreed learning plan 6 months ago
- a check that at least the minimum assessments have been completed
- curriculum coverage
- development of competencies
This is an appraisal of the progress of the GPR. You may wish consider some of the questions below. The eportfolio contains the dynamic PDP (this is an ongoing, living PDP which may change from day to day, rather than the static GP appraisal PDP which is looked at once a year), their learning log (equivalent to PUNs and DENs), their skills log, competency record and curriculum coverage.
These questions are derived from the previous ECVTS appraisal documentation. Look for evidence in the eportfolio to support your thoughts.
- Good Clinical Care
Consider the GP Registrars main strengths and weaknesses with respect to their clinical care. Consider their knowledge; diagnostic skills; hypothesis formation and management ability.
- Maintaining Good Practice
Consider how the GP Registrar develops their knowledge and skills; how they keep up to date; their commitment to avail themselves of educational opportunities; their ability to learn from significant events and reflect on their clinical work.
- Working with Colleagues
Consider the ability of your GP Registrar to work with colleagues and staff. Consider their ability to communicate and delegate.
- Relationship with patients
Consider the GP registrars ability to communicate with patients and their relatives
Were there any health problems apparent which could affect his/her clinical performance?
Consider any evidence of lack of probity?
- Previous learning plan
Have the objectives been addressed in what areas?
- What went well?
- What didnt go well?
- Consider the GP Registrar’s motivation towards his/her career in General Practice and his/her service commitment.
- Consider any aspects of the GP Registrar’s behaviour, qualities or attitudes that you feel have not been adequately covered elsewhere
A summary of the grading of the GPStR.
- Satisfactory progress you are comfortable with the progress of this GPStR and have concluded that there is enough evidence for your decision.
- Unsatisfactory progress this GPStR will be referred to the panel. Ensure that your reasons for your decision are clear and are based on evidence (or lack of it) in the eportfolio.
- Panel opinion requested you are not sure. Ensure that you state what doubts you have, and base these on evidence (or lack of it) in the eportfolio.
Your comments on your recommendation, as above.
The results of your discussion with the GPStR. You may wish to add some information to the GPStRs competency record as well, at this time.
A clear learning plan for the next 6 months. The GPStR may wish to add some issues to the PDP from this learning plan. It is expected that the GPStR will have developed all or most of the issues described in this section by the next review 6 months hence.