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Making the best of

Workplace Based Assessment

The Southend GPSTP Guide

Introduction

The MRCGP consists of 3 components:

1. The Applied Knowledge Test (AKT)

2. The Clinical Skills Assessment (CSA)

3. Workplace Based Assessment (WPBA)

In some ways WPBA is seen as the ‘Cinderella’ of the MRCGP but it is the most important part of the assessment process as it is based in real life, rather than the examination room, and demonstrates what you do as opposed to demonstrating knowing what to do.

Understanding both the process of WPBA and the principles on which it is based are crucial to your professional development.

This short introduction to WPBA consists of three “5 minute Guides” to the following areas:

• The WPBA process

• The GP curriculum

• How to produce high quality log diary entries

They can be read singly but are really designed to be read together and in the order suggested above.

Whilst I hope they will prove useful, they are a long way short of being comprehensive and are best used as a springboard for further reading.

Roger Tisi (Former Essex AD and Southend GPSTP TPD)

August 2009 (Revised October 2018 by Jon Rouse)

The Southend GPSTP

5 minute guide to the WPBA process

What is WPBA?

• Workplace Based Assessment is one of the 3 components of the MRCGP. Unlike the other components it extends throughout the whole of your training period. Its purpose is to assess your actual performance in the workplace and to monitor your progress over time.

• The tool used to record your progress is the e-portfolio and the RCGP will give you one of your very own when you start your training (in return for your stumping up some cash).

• WPBA uses various assessment tools, such as Case Based Discussions (CBDs), Multi-Source Feedbacks (MSFs), Clinical Observation Tools (COTs) etc. The details on these components and requirements for training may be found on the RCGP website and within the e-portfolio itself. During each 6 month training period you will have a minimum number of these assessments to complete.

• Your educational progress is mapped against the GP curriculum and you will be expected to show adequate coverage of the curriculum areas over your period of training.

• Your performance is judged against the curriculum related competence framework (see the guide to the curriculum) and you will be expected to have achieved competence in all of the framework areas by the end of your training.

How is my progress monitored?

This occurs at 3 levels:

1. Clinical supervisor / GP trainer

2. Educational supervisor (ES)

3. ARCP panel

Role of the clinical supervisor / GP trainer

• This is basically the person who supervises your day to day clinical work. In hospital posts it will be one of your consultants and in GP, your GP trainer.

• In each hospital post you need to ensure that you get your consultant to complete a clinical supervisor’s report (CSR) towards the end of your period of training with them – you will find a pro-forma for this on your e-portfolio. You don’t usually need to have a CSR done during GP placements.

Role of the educational supervisor

• This is the person who monitors and assesses your educational progress. Your educational supervisor will also make judgements about your professional progress against the competence framework.

• In ST1 it will be one of the programme directors and in ST2 and ST3, your GP trainer. Your ES will regularly read and respond to the learning log in your e-portfolio (see below).

• At the end of every 6 month period your ES will complete an educational supervisor’s report (ESR) with you, during which your progress to date will be assessed and recommendations made for your ongoing training.

Role of the ARCP panel

• This is a local panel (usually consisting of local GP trainers and a training programme director) that routinely assesses your progress at the end of each training year. In addition to this, your educational supervisor can ask for an additional panel review at any time if they have concerns about you, which would ordinarily be conducted centrally by the Local Education and Training Board (LETB – formerly deanery).

• You will receive written notice towards the end of each training year that the ARCP panel will be reviewing your progress. Most reviews will be done remotely (as described below) but you may be called for interview by the panel if conducted centrally.

• Prior to each ARCP panel you MUST complete a Form R (downloadable from the LETB webpages). This is a vital part of your revalidation as a doctor.

• They will review your clinical and educational supervisor’s reports and review your e-portfolio to ensure that you have completed the compulsory assessment tools and have maintained a meaningful learning log.

• The panel will report back to you at the end of each training year with their assessment of your progress (see below).

• At the end of your training programme it will be this panel that will decide whether you have successfully fulfilled the requirements of WPBA. They will then issue your certificate of satisfactory completion, provided you have passed the other MRCGP components, the CSA and the AKT.

Where does the e-portfolio fit in?

• This is where you record your assessments and your clinical and educational supervision reports. It is also where you maintain a log diary that describes your clinical and educational encounters and reflects on what you have learnt from them.

• As well as being a repository of evidence, the e-portfolio is a resource that allows you and your educational supervisor to reflect on your progress and plan for your further development. It is also important to note that it provides external evidence that you have met the required standard of independent practice as a GP by the end of training.

• Your e-portfolio stays with you throughout your training and should demonstrate evidence of your educational and professional progress. By the end of your training it should show evidence of adequate coverage of the GP curriculum and the attainment of competence in all the framework areas.

• Your e-portfolio is accessible by your educational supervisor and the ARCP panel, who will use it to assess your progress.

• It is possible that information contained within could be requested by third parties, for example, during legal procedures, and it is therefore important that any information inputted should be anonymised sufficiently.

How do I use my log diary?

• You should be aiming to complete as many log entries as are required to demonstrate that you have sufficiently covered the curriculum and professional competences. In reality this would equate to 2 – 3 log entries per week on a regular basis. However, good quality entries are preferable to large numbers of poor-quality ones. Your entries should reflect on your clinical and educational experiences and hence allow your educational supervisor to make judgements about you.

• Log diary entries need to be ‘shared’ in order that they become accessible to your educational supervisor. You can choose not to share them if you want to make entries that are entirely for your personal benefit.

• Your educational supervisor will read your shared entries and comment on them. If they feel that that your entry shows evidence of having properly addressed the competence framework they will then ‘validate’ your entry accordingly.

• ‘Validated’ entries will count towards your evidence of having addressed the competence framework (see the guide to validating log entries).

• Your log diary needs to be regularly updated. A common failing is that this is neglected, resulting in a lack of available evidence in your e-portfolio. In simple terms, if you don’t document your progress and then share it in the e-portfolio you will not be credited with having achieved it.

How do I keep the ARCP panel happy?

Keep your educational supervisor happy

The ARCP panel pays a good deal of attention to your educational supervisor’s report. They are very unlikely to judge that you are making satisfactory progress if your ES feels otherwise.

Ensure that you complete the required number of assessments within each training period

Because the ARCP panel typically sits 2 months before the end of each training year (e.g. in June for the period that ends in August), this means that you need to ensure that you have completed your assessments by then.

You also need to ensure that you have up to date clinical and educational supervisor’s reports.

Keep a decent log diary

The panel will assess not just the volume of your evidence but the quality of it. Low volume may be counterbalanced by excellent quality, but if both are lacking, it is unlikely that they will consider that you have presented adequate evidence.

Ensure you have adequately covered the GP curriculum

This will depend on your level of training. An ST1 trainee for example will inevitably show large gaps in their coverage of the curriculum.

By the end of your training you must demonstrate both breadth and depth of coverage of the curriculum and there should not be any obvious gaps.

Ensure that you have adequately addressed the competence framework

These are the competences laid out in the e-portfolio that you are expected to have acquired by the end of your training (see the guide to the GP curriculum). By the end of ST3 the ARCP panel will need to feel confident that you have done so.

What judgements can the ARCP panel make about me?

They can decide you are making:

1. Satisfactory progress for stage of training - (you’re doing fine)

2. Unsatisfactory progress for stage of training but not at present expected to require additional training - ( a warning slap across the wrist)

3. Unsatisfactory progress and requiring extended training - (you will need to have your training extended)

4. Unsatisfactory progress and not amenable to extended training - ( you have failed WPBA )

5. Satisfactory completion of training – (congratulations you have made it)

The commonest reason for unsatisfactory progress is that the trainee has presented insufficient evidence in their e-portfolio. This is entirely avoidable by paying simple attention to regularly updating your e-portfolio.

Roger Tisi

August 2009 (Revised by Jon Rouse October 2018)

The Southend GPSTP

5 minute guide to the GP curriculum

and the nMRCGP competence framework

This is a brief introduction to the design of the RCGP GP curriculum and an explanation as to how it relates to the competence framework for GP training.

The RCGP curriculum statements can be found in full on the RCGP website and are also accessible from the e-portfolio, so I’m not going to go into detail about them here.

This 5 minute guide is not a substitute for reading the GP curriculum and you should aim to develop a working knowledge of its content throughout your period of training.

What is the GP curriculum?

Effectively this is a number of statements written by some clever people. It attempts to describe the knowledge and attributes required by practising GPs.

← Statement 1 - The core statement ‘Being a General Practitioner’

← Statements 2 to 15 – The interpretive statements

The core statement (statement 1)

This has 9 areas, broken down into 6 domains and 3 essential features

← 6 domains

1. Primary care management

2. Person-centred care

3. Specific problem solving skills

4. A comprehensive approach

5. Community orientation

6. A holistic approach

← 3 essential features

1. Contextual

2. Attitudinal

3. Scientific

Why is the core statement particularly important?

The core statement is important as it describes the essence of general practice.

It is also important as providing the foundation for the competence framework (see below) that is used to guide and assess GP training.

It is essential reading and can be read in less than an hour (even by me).

The interpretive statements (statements 2 to 15)

← These statements go into detail about the clinical, administrative and professional behaviours that constitute the work of a GP

← Full details of each of these interpretive statements can be found on the RCGP website

← Put together, they provide a large volume of written material that can seem overwhelming. They are best approached by dipping in and out of the curriculum areas, rather than trying to read them as a whole

← These are the curriculum areas you attach to your e-portfolio entries and a good way of developing familiarity with them is to refer to them as you reflect in your log diary

← Clicking on the ‘Curriculum’ button on the e-portfolio will take you to links to these curriculum statements

Why are the interpretive statements important?

They are used to assess the breadth of your education and equate to your ‘curriculum coverage’.

You need to be able to demonstrate adequate curriculum coverage by the end of your training.

They will guide you and your clinical and educational supervisors in ensuring that your clinical and educational experiences are GP relevant.

The competence framework for MRCGP

Stay with me on this one because it’s important. You won’t find the competence framework in the curriculum documents because it’s derived from the curriculum rather than being part of it. It is the framework that underpins all your training and assessments.

← 13 competences which are derived from the 6 domains and 3 essential features in the core statement

← These 13 competences are what you see when you (or your ES) complete a competence rating scale in the e-portfolio and they are also what your ES attaches to your log diary entries

← It provides the 13 assessment areas in the nMRCGP and the AKT, CSA and WPBA are all based around it

1. Communication and consultation skills: this competence is about communication with patients, and the use of recognised consultation techniques.

 2. Practising holistically: the ability of the doctor to operate in physical, psychological, socioeconomic and cultural dimensions, taking into account feelings as well as thoughts.

3. Data gathering and interpretation: the gathering and use of data for clinical judgement, the choice of physical examination and investigations, and their interpretation.

 4. Clinical Examination and Procedural Skills: This is about clinical examination and procedural skills. By the end of training, the trainee must have demonstrated competence in breast examination and in the full range of male and female genital examinations.

5. Making a diagnosis / making decisions: this competence is about a conscious, structured approach to decision making.

 6. Clinical management: the recognition and management of common medical conditions in primary care.

 7. Managing medical complexity and promoting health: aspects of care beyond managing straightforward problems, including the management of co-morbidity, uncertainty, risk and the approach to health rather than just illness.

 8. Organisation, management and leadership: This is about understanding how primary care is organised within the NHS, how teams are managed and the development of clinical leadership skills.

 9. Working with colleagues and in teams: working effectively with other professionals to ensure patient care, including the sharing of information with colleagues.

 10. Community orientation: the management of the health and social care of the practice population and local community.

 11. Maintaining performance, learning and teaching: maintaining the performance and effective continuing professional development of oneself and others.

 12. Maintaining an ethical approach to practice: practising ethically with integrity and a respect for diversity.

 13. Fitness to practise: the doctor's awareness of when his/her own performance, conduct or health, or that of others, might put patients at risk and the action taken to protect patients.

How does the competence framework relate to the core curriculum statement?

(With thanks to Amar Rughani)

|The Curriculum: |Related MRCGP competency areas: |

|Primary care management |Clinical management |

| |Working with colleagues and in teams |

| |Organisation, management and leadership |

| |Clinical examination and procedural skills |

|Person-centred care |Communication & consulting skills |

|Specific problem-solving skills |Data gathering and interpretation |

| |Making a diagnosis/making decisions |

|A comprehensive approach |Managing medical complexity |

|Community orientation |Community orientation |

|A holistic approach |Practising holistically |

|Contextual features |Community orientation |

|Attitudinal features |Maintaining an ethical approach to practice |

| |Fitness to practise |

|Scientific features |Maintaining performance, learning and teaching |

By the end of your training you will need to have demonstrated competence in all 13 areas to fulfil the requirements of the MRCGP.

Your educational supervisor and the ARCP panel (see the Southend guide to WPBA) will use the competence framework to monitor your progress and to guide your learning plan.

Further reading

Amar Rughani’s ‘Becoming a GP’ explains the competence framework and how it can be applied to guide your learning and teaching. All your GP practices have a copy and I recommend reading it

Roger Tisi

August 2009 (Revised by Jon Rouse October 2018)

The Southend GPSTP

5 minute guide to producing high quality log entries

Introduction

Your log diary is the main repository of evidence in your e-portfolio. This evidence can be validated by your educational supervisor and then used by the ARCP panel in making judgements about your progress.

The comments below explain why validation matters and how you can get your entries to the required standard.

Why do “validated” entries matter?

There is no limit to the number or quality of entries that you can make in your e-portfolio but not all of them can or should be validated. Once an entry is validated by your educational supervisor, it then forms part of your evidence of progression. Trainees are expected to produce regular log entries each week. You must of course share your entry with your educational supervisor before it can be validated.

What are entries validated against?

Entries are validated against the 13 domain competence framework. Details of these competencies can be found by clicking on the ‘Curriculum’ option on the side menu of the e-portfolio (see also the “5 minute guide to the GP curriculum”)

What does a validated entry mean?

It means that your educational supervisor is confident that the entry fulfils the following two requirements:

1. It addresses one or more of the 13 competence areas

2. It demonstrates meaningful reflection

How does my educational supervisor decide which competence area to attach?

When your ES clicks on ‘Validate evidence’, the 13 competence areas are presented in a drop-down menu for them to choose from and then attach to your entry. They may select more than one area if they believe the entry merits this (or none if they aren’t convinced that any have been addressed).

Over the course of their training, trainees will be expected to demonstrate progression in all 13 competence areas (and hence to have a corresponding spread of validated entries).

How can I ensure my entry shows ‘meaningful reflection’?

You should demonstrate the impact on your practice of the experience you describe. This may relate to the acquisition of new knowledge and skills or may relate to an effect on insight and attitude. Such impact may affirm your present practice or stimulate useful change. One way of doing this is to start filling the log entry from the bottom, rather than the top.

 

The quality of the reflection will be judged against your stage of training and more sophisticated reflection will be expected as you progress.

How should I use the comment on my log diary entry?

If your ES has decided to validate an entry against a competence area, their comment should describe how they feel it has addressed the area they have chosen (and this may include their suggestions for further development). These comments are therefore vital feedback in helping you assess your progress.

Roger Tisi

August 2009 (Revised by Jon Rouse 2018)

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