REPORT FOR REAPPROVAL VISIT

Trainer Visited:

Date:

Visitors:1.

PRACTICE

General comments:
Well organised supportive practice which the current GPR enjoys
Notes fulfil the regional criteria
Protected teaching time
Registrar is exposed to practice audit but not actively engaged in doing one.
Use of video for formative consultation teaching averages more than one per month over the training period.
None of the partners do OOH, therefore registrar remains unexposed
Retainer Practice
No problems highlighted with the educational supervision process. Both parties appear to be satisfied.
Positive / unusual features of the practice worth disseminating:
Audit ( or X) / X / Library and IT ( or X) /  / Induction Package ( or X) / 
Summaries ( or X) /  / Registrars On Call ( or X) / X / Timetable ( or X) / 
Video analysis monthly /  / ( or X)
Practice complies with Regional Criteria? No
Suggestions for improvement:
  1. Next registrar MUST engage in OOH. Advised to discuss further with Course Organiser for Leeds in order to implement a local strategy
  2. Next registrar MUST actively engage in AUDIT, rather than passively being exposed to practice audits. Advised trainer to look at simple audits for the registrar eg GPAQ feedback from patients, referred to web resource:
  3. Outdated large analogue vide recording equipment; advised to invest in a digital camera; Deanery to help with funding.

TRAINER

General Comments:
Experienced amiable trainer who clearly establishes great rapport with his registrars and provides invaluable pastoral care
Any original teaching / assessment methods worth promulgating:
Practice has developed electronic “post-it” notes enabling registrar to jot down learning needs identified during consultations there and then.
Usually have 2 registrars (one full time, other innovative community post); engage in both 1-1 and joint teaching promoting “collaborative learning”
Video assessment:
  1. Tutorial:
COMMENTS
  • Clarifies registrar statements when vague or unclear
  • Relaxed style
  • Use cases to make the it more experiential
POINTS FOR CONSIDERATION
  • Video started without the beginning so not able to see aims and objectives and how they were set; NEED to HOOK the GPR
  • No commentary available – how did they decide on the methodology?
  • Dynamism – try to use a variety of methods: books, handouts, mini-powerpoint, flipchart; engage multiple senses in learning. Too much Q&A type session; comes across as an examination session than a challenging tutorial
  • Trainer led questions; ask registrar what they find difficult about the subject and what they would like tackling NEEDS TO BE LEARNER CENTRED
  • 70:30 % chat (trainer:GPR, aim for 50:50/60:40)
  • Set the GPR some homework; eg cases they have seen in surgeries
  • Learn together: Trainer acknowledged his own needs eg breast cancer risk; which is excellent for encouraging the GPR to detail his, but then both could have both looked up this information together (also adding to dynamism)
  • Explaining risk – look at process rather than content, eg looking at the various ways of explaining risk: pictograms; how to best portray figures to patients; doing a Google search on “explaining risk”
  • not particularly based on evidence
  • “We’ve done that to death, shall we call it a draw”: not a motivating statement; better to end on a positive note eg “I hope you found that useful”; summarising statements tend to be positive statements too.
  • Always summarise to pull together what has been learned into some sort of framework
  • Consider evaluating some sessions to get some feedback on one’s own teaching performance
  1. Random Case Analysis:
COMMENTS
  • Good psychosocial exploration of cases
  • Good reassurance of registrar – “do you think I should have done an examination” (abdo pain)
  • Registrar looks very comfortable with trainer
  • Trainer always ends each case with the registrar: “anything else you want to say about this case”
  • Some good scenarios with challenge eg “I always find abx helpful and I am going away this weekend”
POINTS FOR CONSIDERATION
  • Start off by asking the registrar if there were any difficulties (s)he had; tackle those first
  • Consider making notes to help navigate your thoughts; in addition this results in a list you could discuss with your registrar to see what areas (s)he would consider a priority; not necessary to cover everything on the list
  • Consider using informal role play “so what exactly would you say to me if I am the patient?”
  • Don’t feel you need to exhaust all possible issues on a single consultation, otherwise there is a fear of not picking up more important stuff from other others (through running out of time)
  • Use more scenarios to push the registrar: “what do you do if the abdominal pain does not settle and the surgeons discharge her back to your care”; “so the bloods come back as normal, how do you make the link between TATT and psycho social problems”
  • Differentiate between methods which identify what he “says” he would do vs what he “actually does”; so, rather than asking him how he would say something, ask him to say it to you as the patient
  • You may get this particular registrar to open up a bit more is to ask him how he FELT about that consultation; may result in a shift from a clinical discussion to that based on attitudes/emotions (a deeper level of learning)
  • Summarise learning points to help form a framework of what has been covered in today’s tutorial
  • Occasional evaluation of tutorials will provide the trainer some feedback on how to do things in the future – you can do this informally or formally
Trainer’s training needs identified:
To expand his repertoire of teaching methodologies
Suggestions for improvement:
Advised to consider attending one of the “Experienced Trainers’ Workshops”; re-ignite his old skills (eg Problem Based Inteviewing)
Recommendation: 3 years
Concerns (if any) which need addressing before 3 years:
Concerns:
By what date:
By whom to be checked:
Evidence necessary:
  1. CONCERN: Next registrar MUST engage in OOH.
ACTION: Advised to discuss further with Course Organiser for Leeds in order to implement a local strategy
BY WHAT DATE: to be implemented by the time next registrar starts
RESPONSIBILITY: trainer
BY WHOM TO BE CHECKED: Course Organiser (Leeds)
EVIDENCE NECESSARY: Registrar OOH Logbook
  1. CONCERN: Next registrar MUST actively engage in AUDIT, rather than passively being exposed to practice audits.
ACTION: Advised trainer to look at simple audits for the registrar eg GPAQ feedback from patients, referred to web resource:
WHEN: to be implemented by the time next registrar starts
RESPONSIBILITY: trainer
CHAMPION: Course Organiser (Leeds)
  1. WHAT: Outdated large analogue vide recording equipment
ACTION: advised to invest in a digital camera; Deanery to help with funding if still available.
WHEN: within the next year
RESPONSIBILITY: trainer
CHAMPION: trainer
Signature of Lead Visitor:

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