MMC – workplace based assessments

Dr Lisa JoelsPostgraduate Organiser

Singleton Hospital6th August 08

Postgraduate Medical Training

• Move to competency based training

• Curriculum defines– Competencies– Knowledge – Skills – Attitudes

• Assessment is key to progression (or not)

• Assessments will be fair and consistent

The trainee’s responsibilities

• At appointment– Educational agreement with the Postgraduate

Deanery• GMC Good Medical Practice• Work effectively as an employee• E&D, Human Rights• Contact with TPD/FPD• Learning Portfolio• Appraisal • Assessments – specialty specific

Competency based training

Educational agreementLearning objectives

Demonstrate competencies:Assessments,PortfolioAudits, papers, log books

Multisource feedback

Appraisal

Annual Review of Competence Progression

Outcome

Educational supervisor

• Agrees learning objectives• Formative (mid point) assessments• Reviews evidence• Submits report to ARCP panel• Agrees action plan according to outcome of

ARCP

• Clinical supervisor VS Educational supervisor

ARCP panel

• Trainee may not be called to attend (therefore can’t explain gaps)

• If it isn’t written down, it didn’t happen• Outcomes

– 1. Satisfactory– 2. Development needed (no extra time)– 3. Inadequate progress (extra time)– 4. Released from training programme– 5. Incomplete evidence (report in 5 days)– 6. Completed training

Ref The Gold Guide www.mmcwales.org

Competencies

• Foundation programme– Foundation curriculum

• Specialty training– Royal College curricula– Targets for each year of training

Assessments

• Mini clinical evaluation exercise• Case based discussions• Direct observation of procedural skills• Multisource feedback• Observed video assessments• Observations in clinical skills facilities• Essential courses• Drills

Mini CEX

• Assesses:– History taking– Physical examination– Professionalism– Clinical judgement– Communication skills– Organisation/efficiency– Overall clinical care

CbD’s

• One aspect of a case• Assesses:

– Medical record keeping– Clinical assessment– Investigation and referrals– Treatment– Follow up and future planning– Professionalism– Overall clinical judgement

DOPS

• A procedure from day-today practice• Assesses:

– Understanding e.g. anatomy/indications– Informed consent– Analgesia/sedation– Technical ability– Aseptic technique– Asks for help– Post procedure management– Communication skills– Professionalism– Overall ability

Multisource feedback

• 360 degree appraisal– Multiple assessors (usually >10)– Nurses, AHP’s, clerical staff– Peers & senior staff

• Patient survey

Portfolio

• Electronic or paper

• Collates evidence needed to prove competence & progress

• What to keep in portfolio– Reflective notes– Log books (n.b. confidentiality)– Attendance certificates, qualifications– Copies of audits & publications– Compliments (& complaints)

CCT or CESR

• Foundation competencies

• Only route to CCT is via prospectively approved training posts– N.B. if joining at ST2, 3 or 4 need evidence

• Certificate confirming Eligibility for Specialist Registration (Article 14)

• CEGPR (article 11)

Wales Deanery

• All StR’s will have University of Cardiff e mail account

• All documentation will be e mailed

Problems

• If trainee hasn’t done required assessments will need to justify in writing to ARCP panel

• If trainee fails to meet competencies won’t move to next level

• It is possible to fail – now the Gold Guide only allows 12 months re-training (aggregated)

Summary

• Learning objectives are now more explicit

• Multiple assessment tools to demonstrate competence and progression

• The new system has teeth!

• If you need help– Educational Supervisor– Training Programme Director– Postgraduate Deanery via PGO

Resources

• Gold Guide –– www.mmcwales.org/

• Foundation Curriculum– www.foundationprogramme.nhs.uk/

• Wales Deanery– www.cardiff.ac.uk/pgmde/