Graham Rutt - Northern Deanery

Welcome to
Health Education
North East
Postgraduate School of Primary Care
Graham Rutt
June 2014
Introduction to all the
less exciting stuff
But it’s important nevertheless…
Graham Rutt, Director Postgraduate School of Primary Care
Nb: the links in this ppt. only work if you view it as a slide show…
Who does what?
• Health Education England
– Delivery of all aspects of education and training
– Setting standards, curriculum and exams
– Regulation of doctors and educational systems
• NHS Employers
– Terms and conditions of service for trainees
• Health Education North East
– Local LETB and part of HEE
• Medical and Dental Advisory Group
– Responsible for overseeing the organisation of
what we do
• The Dean
– Accountable to the GMC for the training,
assessment and revalidation of all trainees
• Postgraduate School of Primary Care
– Us!!
Head of
Associate Directors
for Continuing
(Remediation, Returners)
Advisors for
Continuing Practice
Lead Training
Programme Directors
(Appraisal + Revalidation,
Sessional GPs)
(Rotations, Trainee remediation,
Trainer training, Curriculum
Associate Directors
for Specialty Training
(R+S, ARCP, QM, Faculty
Training Programme
GP Tutors
(Taught Course delivery, QC of
posts, Trainer support and
apparaisal, Trainee support,
exam preparation, IMG support)
(QA Appraisal, Education,
(half-funded by LAT)
Hospital Clinical
172 (head count)
Out of Hours
Clinical Supervisors
GP Educational
283 (head count)
The context
3 million patients
2342 GPs (2125 wte)
523 Trainees
Best place in the world
Most rural county in England
• The School contracts with trainers to provide
a service
• You employ the trainees
• We are all in this together
• If you are ever concerned about a trainee
phone your TPD and read the advice about
managing concerns: information-for-trainersand-tpds/managing-trainees-in-difficulty
Overriding philosophy
• Caring and compassion; common sense and problemsolving are core skills for GPs
• Caring for the practitioner and learner-centredness are
core skills for trainers of GPs
• It is more important to teach problem-solving skills
than the solution to each problem (just as with
– Thus the skills focus to the ITC so that new trainers can
teach about anything, not just about specific subjects.
– Hence the focus on flexibility, adaptability and learner
Philosophy of teaching
• Becoming a good GP will help you pass your exams,
not vice versa
– Thus the resistance to the pressures to focus on exam
technique in GP training
• Training should involve signposting to other resources
when knowledge alone is needed
– Thereby freeing teaching time to reflect on real-life
• There is no single right way to teach or learn, but there
are many wrong ways
– E.g. if viewing the consultation using one model is not
help, try another…
Questions so far?
The RCGP GP curriculum
• Written by the RCGP
• Approved and signed off by GMC
• Sets out what is required to practice as an
independent General Practitioner in the UK
• Defines the knowledge, skills and qualities
expected of GPs
• Describes useful learning and
teaching activities.
Curriculum contd.
• Forms the foundation for GP training and
assessment across the UK
• Download the Introduction and user guide
• Do this tonight (well next week anyway)
• Explore any areas that interest you
• No need to remember it all – the e-Portfolio
does that for you
• Integrated assessment system,
• Must be passed before trainees can apply for
a certificate of completion of training (CCT)
and full Membership of the RCGP.
• Comprises three separate components:
– Applied Knowledge Test (AKT)
– Clinical Skills Assessment (CSA)
– Workplace Based Assessment (WPBA)
MRCGP contd.
• Tripos
• Each test different competences using
validated assessment methods
• Together cover the spectrum of knowledge,
skills, behaviours and attitudes defined by the
GP Specialty Training curriculum.
• Summative assessment of the knowledge
base that underpins independent general
• Trainees who pass will have demonstrated
their competence in applying knowledge at a
level which is sufficiently high for independent
• For those who like to know more: MRCGP
• Summative assessment of a doctor’s ability to
integrate and apply clinical, professional,
communication and practical skills appropriate for
general practice.
• Simulates a typical NHS surgery clinic with a
range of scenarios from general practice relevant
to most parts of the curriculum which can also
target particular aspects of clinical care and
• For those who like to know more: MRCGP
Commonest reasons for failing?
• Many described
• Overiding themes:
Poor exam technique
Forgetting what the A stands for (Applied…)
Concentrating on own performance and not what
the simulator has just said (the simulators are
paid to deliver the relevant cues: listen and thou
shalt pass)
– Not being good enough
• Loads available via Training Programmes for
trainees struggling to pass these exams
• Frequent topic at educator conference,
trainer plenaries and trainer groups for
trainers wanting to learn some strategies to
help their registrars
Workplace Based Assessment
• Evaluates the trainee’s progress in areas of professional
practice best tested in the workplace
• Provides an opportunity for gathering evidence and
reflecting on performance
• Evaluates aspects of professional behaviour that are
difficult to assess in traditional examinations
• Provides constructive feedback on areas of strength and
developmental needs, identifying trainees who may be in
• Drives learning in important areas of competence
WPBA contd.
• Determines fitness to progress to the next stage of
• Includes formal tests and reflection on naturally
occurring evidence (“Learning Logs”)
Is the trainee’s responsibility to organise,
undertake, collect, log etc etc, NOT the
Commonest reasons for failing?
• Many described
• Overiding themes:
– Poor reflection
– Not enough evidence
– Not being good enough
Note that it is not a numbers game – 1 high quality
entry is better than 10 poor quality one, and the
assessment process acknowledges that
What is “reflection”?
• Important guidance on reflection available
Help, show me how to do one….
• No!!
• Why not?
– Full guidance on the use of all the tools is available
Case-based Discussion (CbD)
Consultation Observation Tool (COT) for use in primary care only
Multi-Source Feedback (MSF)
Patient Satisfaction Questionnaire (PSQ) for use in primary care
Direct Observation of Procedural Skills (DOPS)
Clinical Evaluation Exercise (MiniCEX) for use in hospital posts only
Clinical Supervisors Report (CSR) to be undertaken in all hospital
posts, but can also be used in the primary care setting
Learning Log and Personal Development Plan (PDP)
• Guidance notes are available on the e-Portfolio every
time you do one
• The basic principles of feedback-giving remain exactly
the same, whichever tool you use
• You will forget everything I say between now and go-live
or the effort needed to remember everything will drive
out the other more important lessons you have been
• I want you and your trainees to enjoy the rest of your
• No single piece of evidence is quite as important as we
think it is (By the time they finish, the average trainee
has amassed 800 pages on their e-Portfolio. If you
haven’t quite got one of them right, so what?)
• You will get many more chances to explore the specifics
during your Supervisory training
• There are always friends you can phone within the
school. Someone somewhere is always available to
• Frequent topic at educator conference, trainer plenaries
and trainer groups for trainers wanting to learn some
strategies to help their registrars
Clinical supervision
• Relates to trainees working in your practice
• Its what the tutors have been teaching you to do
• Make sure assessments do not get in the way of
• When writing the report, be honest etc
• Excellent guide for starters available at: Writing
clinical supervisors reports e-learning module
Educational Supervision
• GP Trainees have the same ES throughout
• Normally work in your practice at some stage
• Meet at start of training and then twice a year to
review progress (the ESR)
• Be available for advice
• Regularly read and comment on the trainee’s log
• Not expected to be the resource for extra support
if struggling: TPDs do that
• Ensure regular feedback and engagement with the ePortfolio
• Provide a report for the official Annual Review of
Competence Progression (ARCP) process
• Every year an ARCP panel examines if the trainee is
making satisfactory progress, and if not what needs to
be done
• The panel needs a recent ESR to inform their decision
• Note that the panel makes the decision, not the ES
• Review meetings usually take between one and two
hours, followed by a write-up in the ePortfolio.
Educational Supervisors Review
• Excellent guide available at: Educational supervisor
review – a step by step quick reference guide [PDF]
• Comment on the evidence in the e-Portfolio relating to
12 Competence Areas
• If ever formulating the opinion that unsatisfactory
progress is being made or if ever unsure whether to
"grade" as satisfactory/ unsatisfactory or panel opinion
requested - phone your TPD and ask for support
and advice and read the advice about managing
concerns: information-for-trainers-and-tpds/managingtrainees-in-difficulty
Key issues
• Quality of evidence is more important than quantity.
• In the early stages of training, the evidence will be
• The review should form the basis of a learning plan,
highlighting where a trainee is doing well and where
more support is needed.
• By the end of ST3, the educational supervisor will be
looking to establish fitness to practise through several
sets of evidence in each competence area, collected
from a range of settings and through different tools. Each
portfolio will look slightly different, but it should provide a
rich picture built up over three years.
It’s still the panel that
makes the final decision,
not the ES
What happens at panel?
• Recommendation of unsatisfactory progress
should not be a surprise at panel.
• At an ARCP panel, e-Portfolios are looked at
in detail by at least four trained panel
members, including lay and external
– a) at the end of ST3
– b) if there is a concern
– c) 10% of all the rest
Useful links
• RCGP Trainee ePortfolio
• Information for trainers, supervisors and
• ESR-step-by-step-Guide-November-2013v4_2
• information-for-trainers-andtpds/managing-trainees-in-difficulty
Useful texts
The Essential Handbook for GP Training and
Ramesh Mehay
The Inner Apprentice
Roger Neighbour

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