Reflective practice – why?

• To widen our professional boundaries• To benchmark our performance• To develop as adaptive experts• To increase our knowledge and apply it• To generate the questions that will develop

service and research agendas

Curriculum Assessment

Where does WPBA fit in?

Competence

AKT

CSA

WPB

A

WPBA Tool Minimum Requirements for ST1 per 6months

Case-based Discussion (CbD) 3Clinical Evaluation Exercise (MiniCEX) for use in hospital posts only

3

Multi-Source Feedback (MSF) 1 (5 clinicians each)Direct Observation of Procedural Skills (DOPS)

Progressing to Clinical Examination and procedural skills (CEPS)

Clinical Supervisors Report (CSR) to be undertaken in all hospital posts, but can also be used in the primary care setting

1

Learning Log and Personal Development Plan (PDP)

Aim for 2 LL per week and ongoing PDP items (1 per month)Placement planning meetingSignificant event analysisAudit (1 per year)

Educational Supervisors Report (ESR)

1

Patient Satisfaction Questionnaire (PSQ) for use in primary care only

1 per year

Consultation Observation Tool (COT) for use in primary care only

3

Other things

• Audit or quality improvement activity• Child protection training level 3• BLS + AED training in GP• Out of hours (GP placements)

• Link

CBDs

Specialty training years one and two (ST1 and ST2)• In ST1 and ST2, you’ll select two cases. You present

the clinical entries and relevant records to your clinical supervisor or educational supervisor one week before the discussion. Your clinical or educational supervisor selects one of these cases for discussion.

• Balance of cases including:– Children, mental health, cancer and palliative care, older

adults

Mini-CEX• The Clinical Evaluation Exercise (miniCEX) assesses clinical skills,

attitudes and behaviours in a secondary care setting. • The miniCEX provides a 15-minute snapshot of how you interact with

patients in a secondary care setting.• Each miniCEX should represent a different clinical problem, and you

should have drawn samples from a wide range of problem groups by the end of the speciality training years one and two (ST1 and ST2).

• The mini-CEX may be observed by a staff grade doctor, nurse practitioner, clinical nurse specialist, an experienced specialty registrar (ST4 or above) or consultant. The observer should not be a peer - a fellow GP trainee or specialty trainee at a similar stage in training.

DOPS CEPSClinical Examination and Procedural SkillsThis competence is about clinical examination and procedural skills and by the end of training, the trainee must have demonstrated competence in Breast examination and in the full range of male and female genital examination

Insufficient Evidence Needs Further Development Competent Excellent

From the available evidence, the doctor’s performance cannot be placed on a higher point of this developmental scale  

Chooses examinations broadly in line with the patient’s problem(s)

Chooses examinations appropriately targeted to the patient’s problem(s)

Proficiently identifies and performs the scope of examination necessary to investigate the patient’s problem(s)

Identifies abnormal signs but fails to recognise their significance

Has a systematic approach to clinical examination and able to interpret physical signs accurately

Uses an incremental approach to examination, basing further examinations on what is known already and is later discovered

Suggests appropriate procedures related to the patient’s problem(s)

Varies options of procedures according to circumstances and the preferences of the patient

Demonstrates a wide range of procedural skills to a high standard

Demonstrates limited fine motor skills when carrying out simple procedures

Refers on appropriately when a procedure is outside their level of skill

Actively promotes safe practice with regard to examination and procedural skills

Observes the professional codes of practice including the use of chaperones

Identifies and discusses ethical issues with regard to examination and procedural skills

Engages with audit quality improvement initiatives with regard to examination and procedural skills

Performs procedures and examinations with the patient’s consent and with a clinically justifiable reason to do so

Shows awareness of the medico-legal background to informed consent, mental capacity and the best interests of the patient

Helps to develop systems that reduce risk in clinical examination and procedural skills

The intimate examination is conducted in a way that does not allow a full assessment by inspection or palpation. The doctor proceeds without due attention to the patient’s perspective and feelings 

Ensures that the patient understands the purpose of an intimate examination, describes what will happen and explains the role of the chaperone. Arranges the place of examination to give the patient privacy and to respect their dignity.Inspection and palpation is appropriate and clinically effective. 

Recognises the verbal and non-verbal clues that the patient is not comfortable with an intrusion into their personal space especially the prospect or conduct of intimate examinations. Is able to help the patient to accept and feel safe during the examination.  

Learning Logs• What happened?• What if anything happened

susequently?• What did you learn?• What will you do differently

in future?• What further learning needs

did you identify?• How and when will you address

these?

E-portfolio - tips

• Think of it like a notebook or diary• Record both the general and specific• Recording your feelings is good• Enter and SHARE logs as you go along• It’s about quality not quantity

An eportfolio learning log entry – not from this area!

What was the subject and aims of the tutorial?

recognising common and uncommon skin problems that may present to general practice.diagnosis, investigation and management of these situations and when to refer

What led to this particular subject being chosen? find it very interesting

What did you learn?

What will you do differently in future?

What further learning needs did you identify?

How and when will you address these?Shared? : Yes

Reflect?Primary Care?

Disagreement with a senior

• It hurts• I was only doing my job,

the patient was unwell...

• I reflected on our professional duties

• He was unprofessional• I was professional, I

didn’t talk to him about it

• It hurts• I was only doing my job,

the patient was unwell...• We were both trying to

help the patient• Lots of health care

problems are to do with communication

• How can I communicate better?

A different voice

Learning Logs• What happened?• What if anything happened

susequently?• What did you learn?• What will you do differently

in future?• What further learning needs

did you identify?• How and when will you address

these?

How did you do?

What are the key competencies of workplace based assessment ?

Competency Framework1 Communication and consultation skills 2 Practising holistically 3 Data gathering and interpretation 4 Making a diagnosis/decisions 5 Clinical management 6 Managing medical complexity 7 Primary care admin and IMT 8 Working with colleagues and in teams 9 Community orientation 10 Maintaining performance, learning and teaching 11 Maintaining an ethical approach 12 Fitness to practise 13 Clinical examination and procedural skills

Tip: ask your ES to open a review for the next 6months

Curriculum headings 1

•The core curriculum statement provides a full description of the knowledge, skills, attitudes and behaviours required of a GP in managing patients and their problems. 1 Being a General Practitioner [PDF]  2 Contextual statements    The four contextual statements explore particular aspects of general practice in greater depth.•2.01 The GP consultation in practice [PDF] •2.02 Patient safety and quality of care [PDF] •2.03 The GP in the wider professional environment [PDF] •2.04 Enhancing professional knowledge [PDF]

•Being a General Practitioner

Curriculum headings 23 Clinical statements

The clinical examples apply the competences in Being a General Practitioner to population groups or to organ based conditions.3.01 Healthy people: promoting health and preventing disease [PDF] 3.02 Genetics in primary care [PDF] 3.03 Care of acutely ill people [PDF] 3.04 Care of children and young people [PDF] 3.05 Care of older adults [PDF] 3.06 Women’s health [PDF] 3.07 Men’s health [PDF] 3.08 Sexual health [PDF] 3.09 End of life care [PDF] 3.10 Care of people with mental health problems [PDF] 3.11 Care of people with intellectual disability [PDF] 3.12 Cardiovascular health [PDF] 3.13 Digestive health [PDF] 3.14 Care of people who misuse drugs and alcohol [PDF] 3.15 Care of people with ENT oral and facial problems [PDF] 3.16 Care of people with eye problems [PDF] 3.17 Care of people with metabolic problems [PDF] 3.18 Care of people with neurological problems [PDF] 3.19 Respiratory health [PDF] 3.20 Care of people with musculoskeletal problems [PDF] 3.21 Care of people with skin problems [PDF]

PDP

• Prospective• SMART

– Specific– Measurable– Achievable– Realistic– Time bound

• 1 per month?

ARCP

CBDs etc

ESRCSR

LLEs PDPs

Six-monthly review

• You meet your educational supervisor every six months to review the evidence you’ve collected against the 12 areas of professional competence.

• You’ll need to complete a self-assessment prior to the meeting.

• December and end of May• 4-8weeks before ARCP

ESR - Trainee Self-Rating• You are able to access a summary table of all evidence during that review

period which relates to each competence.

• You can view each piece of evidence and select a maximum of 3 entries per competence heading.

• These can be learning logs, CbDs, COTs, etc – each will be labelled by date, subject title, etc for easy identification.

• Chosen evidence will then appear as linked items within the self-rating.

• You will still be required to write a summary in the evidence box explaining their reasoning.

• You write suggested action plans for next 6 months.

The goals of training are....

.....to complete a JEST survey!

Joke!But don’t forget it or your revalidation (R) form

ARCP

Turning up to a panel is not “optional”, it is part of your educational contract.

Service commitments do not take preference.

You will know when your panel is, be prepared!

ARCP

CBDs etc

ESRCSR

LLEs PDPs

What’s it for?

• An educational tool for you to develop• A record of evidence of your training