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November 2012
Updates……
CurriculumWPBAsRecruitmentQI: Learning To Make A Difference Programme
curriculum updatesAll CMT trainees (CT1 and CT2) are now using the
same ‘live’ Curriculum apart from the few who started CMT before August 2011.
All trainees using the 2012 amended Curriculum are using the 2012 ARCP Decision aid.
Common Competencies and Emergency Presentations are unchanged.
The Top 20 presentations have changed to “The Top Presentations – Common Medical Presentations”.
curriculum updates List of Top presentations is now 22 with new additions “Acute Kidney Injury and Chronic Kidney disease” “Management of patients requiring Palliative and end of Life Care”.
Increased emphasis in existing grids for other topics:• patient safety• dementia• back to work• bioethics• transitional care• domestic violence• obesity
CMT procedures from Aug 2011 essential, clinical independence mandatory (5)
– CPR; LP; ascitic tap; pleural aspiration; NG tubeessential, clinical independence desirable (3)
– CV cannulation; DCCV; chest drain insertion using Seldinger technique with ultrasound guidance where appropriate
desirable– abdominal paracentesis; knee aspiration; skin biopsy– (arterial lines; long lines; joint injections; temp pacing)
Procedures documentationfrom August ’12:•stronger wording re competence and maintaining competence•DOPS forms adjusted to clarify formative OR summative•2 (minimum) summative DOPS from separate assessors to confirm independence for life-threatening procedures•new DOPS form for CV cannulation•specialty DOPS forms to be more widely available (chest drain, DCCV, temporary pacing)
ARCP DA updates from Aug ’12fewer WPBAs (CbD, mini-CEX, ACAT)
– reduced to 10 pa (must include 4 ACATs) from 13.5 pa
‘evidence of engagement’ with curriculum• all emergency and top presentations• most common and other important presentations• WPBAs, reflection, courses etc
‘evidence of engagement’ document- allow ‘group sign-off’ for common and other important
‘evidence of engagement’ documentCMT Year 1 CMT Year 2
Common competencies
These competencies require a minimum of 2 pieces of satisfactory evidence linked. WPBA can be included but reflection on clinical/learning events, teaching attendance, e- learning is acceptable.50% ie >12 with this level of evidence indicates satisfactory progress in CT1.
These competencies require a minimum of 2 pieces of satisfactory evidence linked. WPBA can be included but reflection on clinical/learning events, teaching attendance, e- learning is acceptable.80% ie 20 with this level of evidence indicates satisfactory progress for CMT completion.
Emergency presentations
Each of these competencies require a minimum of 2 pieces of satisfactory evidence linked, at least 1 of which must be a WPBA. Each must then be signed off individually by the educational supervisor.Note Decision aid advice re anaphylaxis.All 4 to be achieved in CT1.
Top Presentations Each of these competencies require a minimum of 2 pieces of satisfactory evidence linked, at least 1 of which must be a WPBA. Each must then be signed off individually by the educational supervisor.11 to be achieved in CT1.
Each of these competencies require a minimum of 2 pieces of satisfactory evidence linked, at least 1 of which must be a WPBA. Each must then be signed off individually by the educational supervisor.All 22 to be achieved by the end of CT2.
Other Important Presentations
These competencies require a minimum of 2 pieces of satisfactory evidence linked. WPBA can be included but reflection on clinical/learning events, teaching attendance, e- learning is acceptable.15 with this level of evidence indicates satisfactory progress in CT1.
These competencies require a minimum of 2 pieces of satisfactory evidence linked. WPBA can be included but reflection on clinical/learning events, teaching attendance, e- learning is acceptable.30 with this level of evidence indicates satisfactory progress for CMT completion.
WPBA forms from Aug ’12fewer but better
forms simplified– ‘radio buttons’ assessment for each domain removed– but free comments are required
constructive feedback mandatory for WPBA to ‘count’
overall rating remains– CMT ratings will differ from HST ratings
some forms (eg CV line insertion) remain accessible only from http://www.jrcptb.org.uk/assessment/Pages/WPBA-Documents.aspx
DOPS form• formative or summative (use latter for confirmation of
competency)• DOPS form for ‘potentially life threatening’ should be used for
central line insertion, chest drains etc• domain gradings retained but fewer
– below, meets, above expectation for stage of training• overall rating now includes skills lab competence
Unable to perform the procedure
Trained and competent in skills lab or course (this does not equate to clinical independence)Able to perform the procedure under direct supervision / assistance
Able to perform the procedure with limited supervision / assistance
Competent to perform the procedure unsupervised and deal with complications
Top tips…..1 Be clear about, and agree, what you and the trainee want to achieve from the workplace-based assessments (WPBAs) at the start:
CBD (Case-based Discussion) uses a case to explore the trainee’s application of knowledge, clinical reasoning and decision-making, including the ethical and professional aspects of the patient’s care. CBD is not just a discussion about an interesting case.
ACAT (Acute Care Assessment Tool) is preferably used on an observed take (but may be on a ward round or covering a day's management of admissions and ward work) assessing clinical assessment & management, decision making, team working, time management, record keeping and handover for the whole time period and multiple patients. Any doctor who has been responsible for the supervision of the Acute Medical Take or ward-based shift can be the assessor for an ACAT.
mini-CEX (Clinical Evaluation Exercise) is an observed trainee/patient interaction designed to assess clinical skills, attitudes and behaviour of the trainee.
DOPS (Direct Observation of Procedural Skills) is assessing competency in a procedure; DOPS assessors need to be competent in the procedural skill that is being assessed.Directly observed procedural skills (DOPS) have been separated into two categories of routine and life-threatening procedures, with a clear differentiation of formative and summative sign off. Formative DOPS for routine and potentially life threatening procedures should be undertaken before doing a summative DOPS and can be undertaken as many times as the trainee and their supervisor feel is necessary. Summative DOPS should be undertaken as follows:1.Summative sign off for routine procedures to be undertaken on one occasion with one assessor to confirm clinical independence.2.Summative sign off for potentially life threatening procedures to be undertaken on two occasions with two different assessors (one assessor per occasion).
MSF (Multi-source Feedback) provides a sample of attitudes and opinions of colleagues (medical, nursing, AHP & clerical) on the clinical performance and professional behaviour of the trainee; the request to do this WPBA will usually come as an email request from the trainee.
Top tips….
2 Make the WPBA a positive learning experience – this is what it is all about and what trainees value the most.
3 Do the WPBA real-time and face-to-face – this makes it as close as possible to a real situation in which the trainee works.
4 Make time to do the WPBA – expect it to take 10-15 minutes of your time.
5 Give constructive face-to-face verbal feedback immediately after the WPBA is completed as this enhances the process, increases the learning potential, and encourages immediate trainee reflection.
6 Complete the necessary form on the ePortfolio at the time of the WPBA with a description of the case(s) and written feedback in the white space – it is easy to forget very quickly what was agreed.
educational supervisors form•enhanced to improve feedback and cover more areas
•expanded summary of clinical skills:– has the trainee participated in appropriate clinical activity– comment on the range of in-patient and outpatient activity– has the trainee demonstrated appropriate K, S B– comment on clinical reasoning, diagnostic & decision-making skills etc
•reflection and study
•Quality Improvement added to audit section
•exam progress
for more information and FAQs re curriculum, documentation & ePortfolio updates see
http://www.jrcptb.org.uk/trainingandcert/Pages/ChangestoCMTandGIMcurriculum2012.aspx
November 2012
Recruitment Update
Specialty Recruitment• RCP-SRO coordinating recruitment
since 2008• CMT & ACCS-acute at CT1 level• 16 specialties at ST3 level• Incorporates:
– England– Northern Ireland (CT1 only)– Wales– Scotland (starting from 2013 recruitment).
2012 - overview• 98.5% fill rate (100% for ACCS-AM)• Visiting assessor and poor performer
pilots undertaken• Process aligned with Scotland• Scoring system made fully transparent• Generally very positive feedback from
all stakeholders• Predictable process
2012 – deanery fill ratesCMT posts ACCS posts Total posts Total CMT
posts filledTotal ACCS posts filled
% CMT filled
% ACCS filled
% Total posts filled
East Midlands North 49 2 51 49 2 100.0% 100.0% 100.0%East Midlands South 31 3 34 31 3 100.0% 100.0% 100.0%East of England 114 9 123 114 9 100.0% 100.0% 100.0%KSS 66 4 70 66 4 100.0% 100.0% 100.0%London 257 12 269 257 12 100.0% 100.0% 100.0%Mersey 63 0 63 63 0 100.0% N/A 100.0%North Western 93 5 98 90 5 96.8% 100.0% 96.9%Northern 70 5 75 70 5 100.0% 100.0% 100.0%Northern Ireland 66 0 66 64 0 97.0% N/A 97.0%Oxford 33 3 36 33 3 100.0% 100.0% 100.0%Peninsula 41 2 43 40 2 97.6% 100.0% 97.7%Severn 55 7 62 55 7 100.0% 100.0% 100.0%Wales 72 2 74 57 2 79.2% 100.0% 79.7%Wessex 51 2 53 51 2 100.0% 100.0% 100.0%West Midlands 100 2 102 100 2 100.0% 100.0% 100.0%Yorkshire & Humber 152 2 154 152 2 100.0% 100.0% 100.0%Total 1313 60 1373 1292 60 98.4% 100.0% 98.5%
CT1 – timelineTimescale Activity
15 Nov – 5 Dec
Application period
applications now open – approx 2800 expected for 1400 posts
until 9 Jan
Long & short-listing
90% will get first choice, virtually all will get an invite
21 Jan – 15 Feb
Interview period
interview format unchanged from previous years
1 March Deadline for first offers
all CT/ST1 specialties must have released first set of offers. Recycling of offers will continue into March
from 19 March
Round 2 approx half of deaneries will enter R2 for unfilled posts
CT1 - developments• visiting assessors incorporated into
CT1 process• interview question bank fully
reviewed• data analysis to understand
differences between deanery assessments
ST3 - update• two rounds of recruitment to 16 ST3 specialties (~ 1200 posts, the
majority of all ST3 posts) are now completed for posts commencing up until 31st March 2013
• the single national centre model used in round 2 worked well, allowing efficiencies of scale and a truly national process – following review, this is likely to be repeated for round 2 recruitment in future years
• the applicant pool is too low for complete fill – only 734 eligible applications from 506 unique candidates were received for 440 NTN & LAT posts in round 2
• recruitment for posts commencing from August 2013 will commence next March; all specialties will use either a single national centre or the single cascadable application system
• MRCP(UK) & MRCPI will be the only acceptable physician exams in 2013 (with a planned move to MRCP(UK) only in 2014).
Further recruitment updates• The UK Offers System (centralised, multi-specialty offers) is on track to
be introduced in 2013
• there will be a moratorium on CT2 recruitment for some specialties in 2013, but CMT can continue to recruit at this level, to replace trainees ‘lost’ to other specialties and to increase the CMT feed into ST3
• there will be a moratorium on LAT recruitment for some specialties in 2013, but at present physician specialties are exempt. Further clarification is awaited, due to the impact that this decision could have on the running of acute hospital care provided by a significant number of our specialties, already running with gaps
• DH have mandated that all LAT recruitment must be done as part of the national process from 2013.
• An additional clinical lead for RCP-coordinated recruitment is required - all enquiries to [email protected]
Contact
Any questions, comments, feedback:
August 2012
Dr Emma Vaux – Clinical LeadDr Katharine Woodall – Project Manager
Learning to Make a Difference
RCP/ JRCPTB
Pilot Study 2010/11• 61 Trainees undertook 46 quality improvement projects across 5 deaneries•Trainees were enthused by the process•Positive participant experience - They felt they made a real difference to patient care at the front line•LTMD has demonstrated more evidence of benefit to patients than any of the current workplace based assessments. (Publication Clin Med Dec 2012)
From August 2011• Expectation set for CMTs to complete
a QI project rather than clinical audit• LTMD website and resources• Deaneries to implement• Variable success
April 2012 – Survey•Survey sent to College Tutors and Trust Programme Directors•Over 80 trainees were undertaking quality improvement projects •Where no trainees were doing projects, 80% of respondents were considering introducing quality improvement projects• But, often there is no clear process to facilitate quality improvement project implementation.
Keys to successful implementation• Face to face meetings in each deanery
by the clinical lead• Further development of LTMD website• eportfolio changes• QI support
FACE TO FACE – DEMYSTIFY PROCESS
15 talks in 13 deaneries this autumn
Speaking to trainees and supervisors at induction
Disseminating induction packs
WebsiteRecently updated:
•Revised trainee and supervisor packs• Powerpoints from last year’s trainees•Presentations on QI methods
ePORTFOLIO CHANGES
Quality Improvement Project Assessment Tool (QIPAT)
Quality improvement or clinical audit in curriculum and ARCP Decision Aids
Recruitment application forms also recognise equal status QIPs
QI Champions•A network of QI champions at Trust Level is being identified
•Support supervisors and trainees by acting as a knowledge resource
•Currently about 30 QI champions spread across UK
Developing networks•London Deanery - QI training trainees & consultants•Faculty for Medical Leadership•NHSIII
•MEE/HEE Better Training Better CareRoyal Berkshire Foundation Trust awarded 100K to implement LTMD approach across all specialties and gradesLTMD programme £75K November 2012
Moving forwardLTMD is no longer a pilot but expected practice
LTMD programme enables training in improvement methodology for the development of new skills relevant to being a physician in the 21st century
Embed improvement methodology in CMT training
Partnership working with other agencies to facilitate delivery
Develop networks to support this process
What does this mean in practice for the trainee?
Aim How? Time-frame
All core medical trainees to do a QIP
Provided with resources and supported by a supervisor
2012-2013
Each trainee to think of a potential improvement idea(work on own, in small group)
Think about what frustrates you, what is bothersome, what is your department where you are working or the trust’s quality agendaMulti-disciplinary team approach
Sept/Oct 2012
Each trainee to start to develop an understanding of the framework
Read the LTMD tool kits, review the website and learn about QI projects already done
Sept/Oct 2012
Getting started Identify your supervisor Oct/Nov 2012
Complete project May 2013 Present regionally with potential national presentation
May/Jun 2013
What does this mean in practice for the Training Programme Director and College Tutors?
• Set the expectation and value– The trainee knows this matters to their Trust,
training programme and so themselves• Involve the College Tutors in helping getting
started and maintaining momentum; identification QI champion for further support
• Set a regional date for all trainees to present May 2013 (Orally/posters)
• Confirm completion at ARCP (or if not done ensure completed audit cycle)
