Trainee Assessment

1. TraineeAssessment Behavioural attitudes and professionalism

2. What do we learn about trainee: Information Input • Daily reviews of notes/ debriefs • Tutorial discussions, CBDs, • COTs, videos, observed consulting, role plays • Prescribing, referrals, clinical audit, case reviews, SEAs • PSQs, complaints, informal feedback • Colleagues, staff, MSFs, observed behaviours, time keeping, sickness • e-Portfolio logs, reflections, detail, insights

3. Why trainees don’t make progress • Low starting point – poor foundation, not met foundation standards: communication, clinical knowledge skills and experience. • Failure to build on and progress during GP training due to: • External pressures – long travel times, external pressures/ commitments, stress, illness • Low value/priority attached to learning. Not self directed learner. • Unable to overcome/improve specific/more global issues: communication/ knowledge base/ application of knowledge/ attitudinal issues.

4. Formative assessment of issues • Before they arrive – progress within e-portfolio, exams taken, • Early in attachment- informally assess their starting point in four areas: • Communication skills • Knowledge base – GP curriculum • Application of knowledge to clinical situations • Attitudes

5. Formative assessment tools • Traditionally.. • COTs, observed, videos, knowledge tests/ self assessments – Manchester self assessment, nPEP, etc, debriefs, feedback tools and use of e-portfolio • Other areas • Managing attitudinal/ workplace issues • What to do with a trainee who doesn’t accept feedback/ wont do videos.

6. Professional attitudes • Altruism (giving priority to patient interests rather than self-interests); accountability (being answerable to patients, society and profession) • Excellence(conscientious effort to perform beyond ordinary expectation) • Commitment to life-long learning

7. Professional attitudes • Duty (free acceptance of commitment to service – i.e. undergoing inconvenience to achieve a high standard of patient care) • Honour and integrity (being fair, truthful, straightforward, and keeping to one’s word) • Respect for others (respect for patients and families, colleagues, other healthcare professionals, and students and trainees).

8. Teaching Professionalism

9. Detecting un-professional behaviour Seven broad categories of ‘signs and symptoms’ • Abuse of power    • Greed • Misrepresentation • Fraud • Impairment • Lack of conscientiousness • Conflicts of interest ·

10. Abuse of power • abuse while interacting with patients and colleagues • bias and sexual harassment • breach of confidentiality

11. Arrogance • Offensive display of superiority and self-importance • Can be subtle/ missed in mild/ situational cases

12. Greed • When money becomes the driving force • Not common in GP trainees • Beware trainee who is doing lots of locum shifts in A&E/ hospital at weekends and evenings

13. Misrepresentation • Lying, which is consciously failing to tell the truth – ie also includes lies by omission • You may need to look for objective evidence that disproves the lie.

14. Fraud • Conscious misrepresentation of material fact with the intent to mislead, usually for personal gain. • May include stealing from the practice e.g. equipment.

15. Impairment • Any disability that may prevent the physician from discharging his/her duties. • In this context this is where this is self induced and/or undisclosed e.g. impairment due to drug or alcohol misuse, untreated bipolar affective disorder, not declaring an infectious illness without taking precautions, etc.

16. Lack of Conscientiousness • Failure to fulfil basic professional responsibilities, e.g. timely referrals and managing workload/ paperwork/ path results to the extent that this does/ could compromise patient care.

17. Conflicts of interest • Self- promotion/advertising • Unethical collaboration with industry • Less common in trainees

18. Acceptance of gifts; and misuse of services • Inappropriate treatments

19. Case Studies