Employment issues for employees and employers

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nMRCGP Curriculum Dr Fergus Donaghy
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Drivers Levers

• Fashion !
• Fit for Purpose valid reliable
• Summative Assessment RCGP
• Orals Video
• PMETB, RCGP, Curriculum

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What is a GP

• GP
• Tolerate uncertainty, explore probability
  marginalise danger
• Defined by a relationship rather a body of
  knowledge.

• Specialist
• Reduce uncertainty, explore possibility,
  marginalise error
• Marinker

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Dennis Pereira Gray

• Role reversal between primary secondary care
• Primary care is now the place where lives are
  saved
• Curative medicine, will be provided almost
  exclusively within primary care.
• Secondary care will become a a repair factory
  for pensioners where activity will focus on
  routine replacement of body organs.

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nMRCGP

• Work Based Assessment
• Clinical Skills Assessment
• Applied Knowledge Test

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WPBA - opportunity

• Reconnect teaching, learning and assessment
• Assessment to get as close as possible to the
  real situations in which doctors work.
• Assessment of performance in the workplace
  provides us with the only route into many aspects
  of professionalism - some areas (professional
  development, probity, team-working) cannot be
  assessed effectively in any other way as they are
  impossible to disentangle

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WBA

• No pass/fail standard to WBA.
• Progression towards expertise
• Tools harvest information and provide the
  supervisor with material for feedback,
  identification of learning needs

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WPBA - components

• CBD - Case-based Discussion
• 6 in ST1, 6 in ST2 and 12 in ST3
• COT - Consultation Observation Mini-CEX
• 6 in ST1, 6 in ST2 and 12 in ST3
• DOPS - Direct Observation of Procedural Skills
  Until log
  complete
• Clinical Supervisors Report Evidence recorded
  through direct observation of the trainee by the
  trainer in primary care.
• MSF - Multi-Source Feedback
• Two cycles - ST1 and ST3
• Patient Satisfaction Questionnaire (PSQ)One
  cycle in ST2 when in primary care, and one in ST3

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CBD

• ST picks 2, trainer selects one of them.

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COT - video headings

• Encourage contribution Respond to cues
• Social and psychological context
• Health understanding
• Safety netting
• Appropriate examination, diagnosis language
• Confirm patient understanding
• Appropriate Mx plan Involved in Mx plan
• Effective use of resources
• Follow up-- time conditions

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MSF

• Assessment of clinical ability and professional
  behaviour
• ST1 Rated by 5 clinical colleagues, 2 occasions
• ST3 Rated by 5 clinical and 5 non-clinical
  colleagues on 2 occasions
• Simple web based tool
• Is able to discriminate between doctors
• Needs skill of trainer in giving feedback

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PSQ

• Measures consultation and relational empathy
  (CARE)
• 30 consecutive consultations in GP setting
• Central optical scanning and generation of
  results
• Can differentiate between doctors
• Needs skill of trainer in giving feedback

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DOP

• Mandatory 8
• Dressing
• Breast Ex
• Cx Smear
• VE
• Male Ex
• PR prostate
• Blood Glucose

• Optional 11
• Aspiration effusion
• Cautery Cryo
• Curettage/shave
• Abscess inject/drain
• HRT implant
• Proctoscopy
• Suturing
• Mycology

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CSA

• Criterion, as opposed to norm, referenced.
• Competence-based assessment
• All candidates who meet the criteria set for
  competence will pass
• No pre-conceived idea of pass rates

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CSA

• assessment of ability to integrate / apply
  clinical communication skills.
• October 2007, Feb, May _at_ Croydon
• 13 patients 10 min
• Clear/marginal pass or Clear/marginal fail

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CSA

• Primary Care Management recognition/Mx - common
  medical conditions.
• Problem Solving Skills - gathering and using data
  for clinical judgement, choice of examination,
  investigations and their interpretation.
  Demonstrate a structured and flexible approach.
• Comprehensive Approach - proficiency in Mx of
  co-morbidity risk.
• Person-centred Care communication recognised
  consultation techniques to promote shared
  approach to managing problems.
• Attitudinal - ethics, equality and diversity
• Clinical Practical Skills - proficiency in
  performing physical examinations and using
  instruments.

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AKT ST3

• Summative assessment-applied knowledge
• 3 hours - 200 items MCQ
• Computer terminals _at_ 147 Pearson Vue
• 80 clinical, 10 critical appraisal, 10 health
  informatics
• Special needs considered
• Photo ID 2
• Feedback Comparative data 4w later
• 31st Oct, 30th Jan, 7th May.

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12 competencies

• Communication and Consultation
• Practising Holistically
• Data Gathering and Interpretation
• Making a Diagnosis/Making Decisions
• Clinical Management
• Managing Medical Complexity
• Primary Care Administration and Information
  Management Technology
• Working with Colleagues and in Teams
• Community Orientation
• Maintaining Performance
• Learning and Teaching
• Maintaining an Ethical Approach to Practise
  Fitness to Practise

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Monitoring Progress

• Deanery Panel meeting at end of ST1 and ST2
• reviews the training records of every trainee
• face to face review with trainees when
• unsatisfactory achievement in either of the
  complementary tools
• or when requested by the educational supervisor

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Don't shoot the messenger !

• AKT 360
• CSA 1260
• E-portfolio Registration 131 -722
• PMETB 750
• 3k !!

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Action Plan

• Sell a Kidney ?
• Save 3 a day

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What's different?

• Same knowledge, but greater emphasis on the
  practical use of that knowledge.
• That knowledge base defined by curriculum
• Different training more emphasis on GP
• More expensive!
• MRCGP pass rate 70, nMRCGP ?
• No pass No work

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Curriculum

• GP Skills
• Special Groups
• Clinical areas

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Curriculum

• Children
• Older adults
• Gender
• Sex
• Cancer
• Mental health
• Learning disabilities
• Clinical CVS, GIT, EENT, Resp

• Core statement
• GP Consultation
• Personal Professional responsibilities
• Management
• Health promo
• Genetics
• Acutely ill

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Defining a GP

• 1st Point
• Efficient use interface
• Person centred
• Use of Relationship Time
• Continuity
• Promotion
• Community
• Undifferentiated
• Decisions - prevelance

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Each Section

• Defines
• Rationale Prevalence
• UK Priorities
• Learning Outcomes
• Knowledge base
• Set in Domains
• Resources reading
• Where to learn

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MSKprevalence, rationale, priorities

• 20 GP of Consultations
• 1b NHS, 17m LBP, 1 GNP
• 2b Incapacity
• Education Confidence Mx, NSAIDS PPI
• NHS Improvement plan
• NICE Guidance on falls
• ARC learning guide

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MSKLearning outcomes

• Mx MSK in primary care
• Explain aetiology natural history
• Describe roles PHCT, AHP, Complementary
• Referral indications to the most suitable
  GPwSI, Physio, Podiatry, Chiro, Ortho, Rheumo

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Domains

• Person centred wear tear, uncertainty
• Prob solving inflam non-inflam, somatise
• Comprehensive Rx SE, Disability
• Community self help, prioritise, resources
• Holistic carers, occupational,
• Contextual deficiencies, travel,
• Attitudinal empathy, info
• Scientific NICE, SIGN, RCGP
• Pyschomotor injection, Ex, dressing, suture

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MSKPromoting learning

• Work based in primary care
• Work based in secondary care
• Non Work based D.Rheumo, Research Fellowships
• Learning with other HC Professionals -

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And finally

• Good
• By GPs for GPs
• Teaching on a plate
• Justifications References
• The Beast is gone !

• Bad
• Huge
• Navigate

• Ugly
• A few dollars more !
• CO ? PD