End of year reflections

I have collated feedback from trainer appraisals, ES meetings and trainees at HDR; I hope this will be helpful for the next training year.

ePF

The majority of trainees and trainers have got to grips with using the ePF effectively; most ePFswere complete by the date required in June.

There are a few areas to draw your attention to.

1. Log entries

  • Many trainee’s log entries are descriptive without any evidence of reflection.
  • Trainees tend to be over link their entries to the ‘GP consultation’ and ‘patient safety’.
  • While most trainers regularly read, link and comment on entries, many supervisors in secondary care are not doing this.

Action

  • HDR 8th August will focus on the art of making reflective entries and linking them appropriately.
  • All clinical supervisors should be encouraged to read, link and comment on entries regularly. Trainees should let one of the TPDs know if their entries are not being read.

2. COTs

  • The majority of these should be done using videoed consultations. It is acceptable to include a directly observed consultation or home visit.

Action

  • Possibly a topic for a trainer workshop.
  • HDR on consultation skills will usetrainees’ videos in small groups, to learn more about the consultation, and giving and receiving feedback.
  • Trainees should be encouraged to use videos as part of their regular learning not just for COTs.

3. WPBA

  • Trainees should ideally ask consultants or GP trainers to undertake WPBA.

4. CSR

  • The standard of these is very good.
  • If a trainee is above or below average it is essential to indicate using free text why the rating has been given.
  • A trainee who is progressing appropriately should be ‘meeting expectations’ in all areas.

5. Competency ratingsand ESR

  • Trainees are not always familiar with the word descriptors for each of the competencies.
  • The rating ‘competent for licensing’ can only really be awarded in a GP post as the trainee needs to provide evidence they are competent in the context of general practice.
  • If a trainee is not meeting expectationsin all 12 competencies it is appropriate for an ESR and panel to rate their progress as unsatisfactory.
  • If a trainee has concerns raised in a CSR then it is appropriate for their progress to be rated as unsatisfactory.

Action

  • HDR session 8/8/2012 will raise awareness of the word descriptors for the competency framework.

Trainees who do not complete their training in 3 years

After several years of experience it is evident that the when a trainee is not making satisfactory progress the ePF provides the evidence. What is also evident is that when a trainee is not meeting expectations across the competency framework ST1 and 2 we, as educators tend to give the trainee the benefit of the doubt and mark their progress as satisfactory. The problem then only comes to light whenthe trainee fails the CSA and /or AKT.

We now feel more confident in using the evidence in the ePF and feel it is important to intervene early to provide additional support andguidance to a trainee if they are not making satisfactory progress in St1 and ST2.This will result in an increase in the number of trainees we refer to Deanery panel but will hopefully improve trainees success rate at passing their exams and reduce the need for trainees to have extended training.

Trainees mayfind Nick Whelan’sreport from 5/5/2011 useful. (Bev can email this if required)

Based on his observation on many trainees across the Deanery he advises trainers to;

  • Undertake regular video review not just for COTs
  • Formally teach consultation skills in tutorials, rather than focus on WBPA.
  • Give constructive feedback and be honest (don’t be a dove or a hawk)
  • Challenge poor consultation skills but also provide examples of alternative ways of managing issues within the consultation.
  • Use role-play.

The full report has more information on AKT/CSA and tutorial work.

Action

The art of giving feedback could be a good topic for a TWS.

The process of supporting a trainee who is struggling to progress satisfactorily would also be a good topic for TWS.

Trainees should be encouraged to read a consultation skills book early in ST3 if not before.

HDR

Trainees and trainers all felt that the changes to HDR have been very positive.

Traineesmade the following comments.

  • The liked small group but wanted variety in its format and did not want Balint style sessions each week. They liked the ideas detailed in the newsletter earlier this year.
  • They liked working in small groups developingconsultation skills with role-play especially before the CSA.
  • They would prefer to spend more time planning HDR and not do it in an evening when everyone is tired and wants to get home; they felt this resulted in some poor choices.
  • They liked sessions that were well planned, where the aims and objectives were relevant to primary care.
  • They felt they needed time to plan aims and objective properly so the needs of the group are met.
  • They wanted to use the expertise of the trainer. Possibly by the trainer having a 10minute slot at the end of the session to summarise the key learning points from their perspective as an experienced GP.
  • They liked having specialist knowledge.
  • They wouldprefer the ST1 and ST2 trainees to plan with ST3 trainees so the aims and objectives are more pertinent to primary care.
  • They would like some flexibility in some of the sessions to take new needs into account.
  • They liked sessions that covered the main chronic diseases.
  • They would like more sessions on ‘being prepared for life after VTS’ at the end of the year.

Actions

  • HDR sessions will be planned in an HDR afternoon session.
  • Trainees will be encouraged to bring their own learning needs along and to look at the GP curriculum before coming.
  • All the topics chosen will be discussed in the group so the aims and objectives can be relevant to the whole group
  • ST1/2s will be paired with a ST3 trainee to plan a session.
  • Bev will contact the lead trainers for each HDR session and list their area of special interest so the topics can be matched to a trainer.
  • The lead trainer will be encouraged to take an active role in theafternoon contributingtheir knowledge and experience.
  • Trainees will have an annual session on presentation skills, encouraging them to feel confident presenting without relying on a long power point presentation.
  • Expert resources canbe used and funded but only if they meet the aims of a Primary care agenda.
  • Any topics that arise as specific needs in the first 6 months will be timetabled into the second six months and we will leave two sessions in the second six months free to allow for greater flexibility in managing needs that arise for the group as the six months progress.

Nicola Gill10/8/2012