Less than Full Time Training (LTFTT) – a guide for GP Trainees

COTs/MiniCEX/CbDs – Assessment tools

  1. Every trainee, whether part time, full time, on sick leave or on maternity leave will have an educational review and report written by their Educational Supervisor (ES) every 6 months, throughout their GP Training.
  2. The number of assessments that a less than full time trainee (LTFTT) does every 6 months may appear unfair but it is based on the requirement to make the assessment system valid and reliable.
  3. The minimum number of assessments for a full time trainee (FTT) was fixed at its present minimum level so that the assessment result allows the ES to confidently judge their progress.
  4. Permitting a LTFFT to do fewer assessments in each 6 month review period would make it impossible for the ES to gauge the trainee’s progress.
  5. The RCGP has stipulated that:
  6. All LTFTTs will do the same number of COTs/CbDs/MiniCEXs in each 6 month review period as a FTT, and
  7. All of these assessments must have been completed before the ES review and the report is written
  8. If any assessments are missing in any one 6 month review period the deficit must be made up in the following 6 months
  9. If there are any missing assessments, it is expected that the ES will rate the trainee’s progress as “Unsatisfactory”
  10. If the trainee has not done the minimum number of assessments expected by the time of their Deanery ARCP Panel, they will receive a report from the panel saying that their progress has been unsatisfactory and that they have submitted insufficient evidence.

MSF/PSQ/DOPS

  1. The same numbers of DOPS need to be done throughout the whole of the GP Training as a FTT. As with FTTs, the LTFTT, as a minimum, needs to have shown adequate competency in the mandatory DOPs by the end of the ST3 phase of training. There is no minimum requirement to perform a certain number of DOPS every 6 months
  2. As with FTTs, MSFs are done twice in the ST1 and twice in the ST3 phases of training. The number of respondents is the same as for FTTs.
  3. The timings of the MSFs are such that they are performed prior to the mid-point and final ESRs of either the ST1 or ST3 phases of training
  4. There is no requirement to do an MSQ in the ST2 phase of training although from time to time the ES or ARCP Panel may ask that one (or more) may be done for educational reasons.
  5. Only 1 PSQ is required of an LTFTT during either the ST1 or ST2 phases and
  6. is performed towards the end of the LTFTT’s GP Practice attachment during ST1/2
  7. the results must be available for the ES review at the end of the GP Post.
  8. Only 1 PSQ is required of an LTFTT during the ST3 phase of training and
  1. is performed towards the end of the LTFTT’s ST3 GP Practice post
  2. the results must be available for the final ES review.

Learning Log/PDP

  1. LTFTTs must write log entries at the same rate as FTTs so that at the end of every 6 month review period the ES has sufficient evidence to make a valid assessment of the trainee’s professional development.
  2. There is no fixed number of learning log entries required every 6 months but on average ST1s will write one good quality reflective log entry per week, and ST2s will write 2 entries a week as their skills at reflective writing should be much better than those of an ST1.
  3. There is no fixed number of learning log entries that an ST3 needs to write each week but as the learning opportunities are much more numerous, in this phase of training, the average FTT or LTFTT will be writing between 3 and 6 good quality reflective log entries a week.
  4. Each log entry should:
  5. State why the trainee has chosen the particular experience to reflect upon
  6. Show what the trainee has learned from their chosen experience
  7. How and why their future practice has been influenced and improved as a result
  8. Learning Log entries should include Significant Event Analysis (SEAs) and evidence of Audit understanding/activity.
  9. In the ST3 phase of training there must be evidence in the Learning Log that, within the 12 months prior to completion of training, the trainee has successfully completed an update course on CPR and AED techniques. A scanned image of the course certificate must be attached to the log entry.
  10. The trainee’s PDP must be kept up to date in an appropriate manner. Both the quality and quantity of PDP entries depends on the individual developmental needs of the trainee.
  11. There is no fixed number of entries required every 6 months but full and part time trainees must use their PDP actively, regularly reviewing and updating it as necessary.
  12. An absence of PDP activity within the 6 months before the ES review is regarded as unsatisfactory professional behaviour.

Educators’ Notes

  1. Within the Trainee’s ePortfolio there is a section entitled “Educator’s Notes”.
  2. The Trainee should check this section from time to time to see if there are any comments or messages from their ES, Programme Director or Deanery personnel.
  3. The Trainee can read everything. in the Educators Notes but they cannot write anything in this section of the ePortfolio

Out of Hours (OOH)

  1. All OOH activity performed during GP Practice training must be recorded as reflective learning log entries.
  2. A completed OOH work sheet should be signed by the trainee’s OOH supervisor and a scanned copy of this work sheet must be attached to the relevant log entry.
  3. Please look in the “Resources and Information” section of the Wessex GP School website for more details:
  1. The total amount of GP OOH activity for a LTFTT in a particular phase of GP training remains the same but the LTFTT will have pro rata longer to fulfil the OOH requirements e.g. an ST3 needs to do 72 hours of OOH activity. If working 60% of full time their ST3 training will last 20 months and the OOH can be spread over this longer period, with the proviso (as with FTTs) that the OOH is completed by the time of the final ES review.
  2. The minimum total amount of documented GP OOH activity for a LTFTT ST1/2 in a 6 month WTE GP Post is 36 hours. For example, a 60% LTFTT 6 month WTE GP post will last 10 months and the OOH activity can be spread over the spread throughout the whole of the post.
  3. The minimum amount of documented GP OOH activity for a LTFTT ST3 is 72 hours and needs to cover all aspects of OOH care i.e. Telephone triage, emergency clinic sessions and home visiting.

Educational Supervisor Review and ARCP

  1. LTFTTs will have an educational review every 6 months
  2. The review will occur in the final month of each 6 month review period, unless:
  3. The ES review is before an ARCP panel, when the Deanery will send out prior warning of this Deanery review:
  4. For final ARCP Panels before applying for a CCT, the ES review will need to be done towards the end of the 4th month of the review period
  5. For other ARCP Panels, the ES review is done towards the end of the 5th month of the review period
  6. The ES has stated that the ES review is to be performed at a certain time
  7. The trainee is going on maternity leave. An ES review must be done before each episode of maternity leave.
  8. The trainee and ES should liaise to set an agreed date, time and venue for the educational review.
  9. The minimum number of assessments, MSFs, PSQs, etc. must have been completed prior to the ES review.
  10. As part of the 6 monthly review process, the trainee must complete a self-rating of both their practical skills and professional competences recording their reflective comments in the “Review Preparation” section of their ePortfolio.
  11. Every trainee (FTT and LTFTT) will have an ARCP (Annual Review of Competency Progression) once a year, usually just prior to the anniversary of the start of the GP Trainee’s rotation.
  12. Every Trainee (FTT and LTFTT) will have an ARCP before the transition from ST1 to ST2 and ST2 to ST3 and before the completion of training.
  13. Usually (3) and (4) above coincide, but many LTFTTs will find that the transition from one phase of training to another no longer coincides with the anniversary of the start of their training rotation. As a result, these trainees will have more than one ARCP in a calendar year.
  14. It is important that LTFTTs are aware of when their ARCP panels are to be held so that they can plan their work accordingly. If there is any doubt, please contact the Deanery.

Summary

For further details please see the RCGP website at:

Dr Jonathan Foulkes October 2010

Appendix:

Learning Log Entry Information

  1. Reflective writing is a rehearsal for and of professional practice - a bit like a flight simulator for a pilot learning to fly. The more times a trainee thinks and writes about a particular scenario and "rehearses" in their mind what they did, what they might have done, what were the consequences of their actions, what they learned, how this learning has influenced/improved future practice etc., then the more patterns of behaviour are imprinted in the developing professionals mind.
  1. It is the AKT which tests clinical knowledge not log entries. Log entries are linked to the various clinical areas so that the ES and Deanery can be assured that the trainee has been using their professional competences in all types of clinical environment. There are 12 competencies and 31 curriculum areas. Just because a trainee can show a good level of holistic care and communication skills in a consultation with an old lady, this does not mean that the trainee can do the same in a psychiatric or paediatric consultation. The Professional competences are contextual and cannot be transferred from one clinical area to another. Placing the consultation in the correct clinical setting (i.e. linking it to a curriculum statement)enables the ES and Deanery to see whether the trainee is trying out their professional skills across all clinical areas.
  1. Over linking of log entries to curriculum statements makes it impossible for the ES and Deanery to see how the trainee is applying their professional skills.