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Part 3 Updates and practical supervision issues

Queensland Supervisor Training Workshop. Part 3 Updates and practical supervision issues. The aims and goals of the CBFP. Align training with international best practice Increase Flexibility of training Examination pass rates Decrease time taken to complete training

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Part 3 Updates and practical supervision issues

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  1. QueenslandSupervisor Training Workshop Part 3 Updates and practical supervision issues

  2. The aims and goals of the CBFP • Align training with international best practice • Increase • Flexibility of training • Examination pass rates • Decrease time taken to complete training • Address workforce shortages • Meet increasing demands for mental health care

  3. Workshop objectives • Discussion about what is working well and what’s not in the CBFP • Helping trainees pass a rotation • Facilitating completion of EPAs (via WBAs) • Conducting an OCA • Introducing the new stuff: • Stage 3 requirements • Targeted learning plans • Supportive plans • DOPS (direct observation of procedural skill) (WBA)

  4. Reflections from current supervisors and recent supervisees on the CBFP • What is working well? • What are the challenges? • How could it be improved?

  5. Is the program delivering? Supervisor perspectives Supervision was described as ‘a random bag of arrangements’ • Lack of conceptual framework and preparation for their pedagogical role. • Expressing a desire for feedback from trainees about their performance. Trainee perspectives • Most trainees reflect favorably on their supervisory experiences. • Challenges relating to the availability of feedback based on direct observation of trainee performance described. Cheung, G. and A. Stephan (2017). "Supervision: 'a random bag of arrangements'? Perspectives from psychiatrists on how to improve clinical teaching." Australas Psychiatry25(5): 510-513. Stephan, A. and G. Cheung (2017). "Clinical teaching and supervision in postgraduate psychiatry training: the trainee perspective." Australas Psychiatry25(2): 191-197.

  6. Is the program delivering? QLD Trainee results 2017+

  7. Successfully navigating the CBFP requires multi-tasking Term requirements: • Minimum of 2 EPAs • OCA Long-term game: • Meeting mandatory EPAs in time • Scholarly Project • Psychotherapy Written Case • Examination preparation • Stage 3 Psychotherapy requirements Supervisors have a key role in modelling and observing professional practice, and assessing competencies. Helping trainees plan their rotation with view to achieving the required EPAs is critical on commencement.

  8. Helping Trainees Plan Their EPAs EPAs across the stages and rotation types are described in the EPA Handbooks. Consider relevance of EPAs for your area of practice and for the specific trainee (training Stage, outstanding mandatory requirements) Not less than the required minimum of 2 EPAs, but for Stage 2 trainees at least 3-4 in every rotation to avoid barriers to progression at 36 months. Not too many or it's a meaningless tick-box exercise – Maximum of 6 EPAs per rotation

  9. * *

  10. EPAs are attained based on supervisor judgement including a minimum of 3 Work Based Assessments (WBAs) WBAs are aimed to facilitate provision of structured feedback from supervisors. Protocols are available on the College website that outline the aims for the different assessment types and how these should be undertaken. • Can carry over across rotation • Mere completion of does not equate to competence • Should be prospectively planned • More than 3 may be needed to demonstrate competence*

  11. Workplace-based Assessments (WBAs) Mini-CEX Mini Clinical Evaluation Exercise (briefly observed clinical tasks) CbD Case-based Discussion (detailed case discussions with supervisor) PP Professional Presentation OCA Observed Clinical Activity (a full 60 + 60 minute assessment with structured feedback and clear standards) DOPS Direct Observation of Procedural Skills Highly recommended that trainees experience these tools early in their training At least 3 of these will determine if an EPA is achieved

  12. DOPS: Aims • The aim of the DOPS is to enable supervisors to provide structured feedback across the following areas: • communication skills (including therapeutic relationship/approach) • demonstrated knowledge of procedure • procedural, technical or supervision skills • organisation, time management and documentation • management of any issues arising • boundaries and professionalism • another skill at the supervisor’s discretion (optional). • Prior to conducting each DOPS, the trainee and supervisor should determine together which of the assessment criteria to focus on during the formative assessment. The feedback should focus on the agreed specific tasks rather than on the trainee’s general performance.

  13. DOPS – Examples • Psychotherapy • ECT • Physical examination • Participation/leadership in a team interdisciplinary discussion

  14. DOPS (including feedback) should take 30-40 minutes. The trainee makes arrangements with a supervisor to carry out the DOPS and organises all administration required (including providing the supervisor with the DOPS form). The trainee and supervisor determine the assessment criteria to be considered during the DOPS. The supervisor observes the trainee conducting a procedural skill* The feedback session occurs immediately after the observation, this should be constructive and address: areas that were especially good, suggestions for improvement, agreed actions and goals. The supervisor rates the trainee’s performance for the relevant assessment criteria using the 3-point scale on the DOPS form. * The supervisor should not participate unless intervention is required for the patient’s safety.

  15. Observed Clinical Activity (OCA)* Very similar to the Observed Clinical Interview (OCI) in general structure Formative, not summative assessment Trainee to take lead in the organisation of the OCA *IMPORTANT: mandatory OCA every rotation All about the OCA video link

  16. The OCA will be split into two sessions Session 1 The interview will run for up to 50 minutes, with a 10 minute feedback session Followed by self reflection in own time

  17. Session 2 Present the Case(up to 20 minutes) Summary of the salient features of the case An assessment of gaps in the history & other essential information A formulation, diagnosis and differential diagnosis Present a detailed management plan (up to 20 minutes) Feedback All OCAs to be sent to college with end of term ITA

  18. Formulation Guidelines are available • In the context of the RANZCP OCA, formulation is a set of explanatory hypotheses addressing the question: ‘Why does this patient suffer from this (these) problem(s) at this point in time?’ • It is an integrated synthesis of the data, demonstrating an understanding of this unique individual, including their vulnerabilities and resources. • The essential task in formulation is to highlight possible linkages or connections between different aspects of the case (more than a summary).

  19. Assessment 9 point scale Midpoint “the standard to be achieved” (by the end of period of training) Trainee expected to have performance deficits, measured relative to what is expected by the end of period of training!

  20. Developmental descriptors

  21. Stage 3: THE BIG TICKET ITEMS (MANDATORY REQUIREMENTS) • 24 months FTE • Two EPAs per 6-month rotation • One OCA per rotation if you have always been enrolled in the 2012 program • Leadership and Management • Provision of psychotherapies • FEC – generalist trainees attend adult FEC • Fellowship Competencies • Supervision • Achievement of the centrally administered summative assessments • Final qualitative report

  22. Provision of Psychotherapy • Minimum 3 patients for at least 6 sessions each • Different patients to the 40 sessions related to Psychotherapy Written Case (PWC) • Different to patients for ST2-PSY-EPAs • Trainee must receive supervision for these sessions • Stage 3 psychotherapy sessions form RANZCP>Pre-Fellowship>2012 Fellowship Program>About the training program>Stages of training>Stage 3 Psychotherapy Sessions form

  23. Stage 3 EPAs • Fellowship (FELL) EPAs: Can be attained in any rotation • Area of Practice (AOP) EPAs: Can be attained in the area of practice only • 103 St 3 EPAs currently identified RANZCP>Pre-Fellowship>2012 Fellowship Program>EPA forms

  24. Elective Areas of Practice (AOP) EPAs: • Addiction psychiatry • Adult psychiatry • Child and Adolescent psychiatry • Consultation-Liaison psychiatry • Forensic psychiatry • Indigenous psychiatry • Psychiatry of Old Age • Psychotherapies • Medical Administration • Medical Education

  25. Completing Stage 3 • Trainees will continue in Stage 3 until they complete all assessments. All requirements of training apply i.e. EPAs, OCA, supervision • Trainees who have not passed all required assessments by 24 months stage 3, may apply for a break in training to complete assessments. • BIT – maximum 5 years accumulative

  26. Scholarly Project Trainees must successfully complete a College-approved Scholarly Project A Scholarly Project may take the form of: a quality assurance project or clinical audit a systematic and critical literature review original and empirical research (qualitative or quantitative) a case series an equivalent other project as approved by the Scholarly Project Subcommittee

  27. Tracking progress • Regular feedback is critical • Mid-term ITA must be completed • Failing to flag difficulties early in the rotation creates challenges at its conclusion • Supportive plans, Targeted Learning Plans are required to support trainees struggling to meet the requirements of the CBFP Video link ITAs and feedback

  28. Emergent concerns necessitate assertive action • Emergent issues or concerns about trainee is not meeting the required standards necessitate development of a supportive plan in liaison with the trainee, supervisor, DOT and CTS. • Concerns must be documented on the mid-rotation ITA and this process should be commenced immediatelyin order to assist that trainee in addressing the concerns. If concerns were not identified on the mid-rotation ITA this process should be recompleted to assist in clearly documenting the relevant training concerns. Consider whether the concerns are primarily training related or an HR issue more appropriately addressed through organisational processes. • A supportive plan template is available from PGT

  29. Emergent concerns necessitate assertive action • The supervisor should document carefully concerns about behaviour and communication, and interventions trialled in their supervision notes. • Failing to proactively address concerns when they arise introduce significant complexity and ground for appeal if you fail the trainee on the end-ITA

  30. Target learning plan • Failure of training rotation (rotation-based targeted learning) • “fail” on the end of term ITA • Failure to attain 2 mandatory EPAs for the rotation • Failure to complete minimum required WBAs • Non submission / non receipt of ITA by required time • Two consecutive failures of the same summative assessment (assessment-based targeted learning) • Failure to pass summative assessment by the stated deadline (progression-based targeted learning) • Ethical breach which requires targeted learning

  31. Commencement of TLP • The commencement of a targeted learning plan should be detailed on the Commencement of Targeted Learning Plan form, signed by the DOT indicating approval of the plan • The form should be forwarded to the college within 60 days of rotation failure • Failure to commence the required TLP and submit the form within 60 days will result in the requirement for the trainee to complete the ‘show cause’ process to the CFT

  32. Rotation based targeted learning plan • Required for unsuccessful rotation • The plan must be written and must be designed jointly by trainee, DOT and principal supervisor • The plan must include agreed clear achievable goals aimed at improving the trainees progress • An agreed specified timeframe within which these goals are to be achieved • An agreed review date and agreed means of determining that such goals have been met • At least 3 months duration.

  33. Rotation-Based targeted learning • Completion form required • The DOT will verify a trainee’s completion by signing the Completion of Targeted Learning Plan • Rotational targeted learning is not a barrier to attempt any centrally administered summative assessment • Continued rotation failure – three consecutive or non-consecutive rotation failures – will result in the requirement for the trainee to show cause to the CFT • https://www.ranzcp.org/Files/PreFellowship/2012-Fellowship-Program/RPP-PROGRESSION.aspx for further information linked to failure to progress.

  34. The Summative Assessments (apart from EPAs and ITAs) MCQ Exam Essay Exam • CEQ (Critical Essay Question) 40 minutes, 40 marks, compulsory pass • MEQs (Modified Essay Questions) 140 marks and minutes made up of 4-6 MEQs up to 30 marks each The OSCEs • 3 X 20 minute stations and 1 active bye, 1 inactive bye both 20 mins total 100mins • 8 X 10 minute stations, 2 inactive byes both 10 mins, total 100 mins

  35. Assessment Based and progression based targeted learning • Progression-based targeted learning: required when the deadline for a centrally administered summative assessment is reached as per the trajectory.  • Assessment-based targeted learning: required for two fails of the same centrally administered summative assessment. • Trainees must commence progression and assessment based TLPs within 60 days of notification • Considered complete when assessment is passed – no completion form required • Can be undertaken whilst on BIT • Recommended review every 3 months

  36. Show Cause • 3 x fail of summative assessment • Failure to commence rotation based targeted learning • Failure to achieve mandatory EPAs • Break in training greater than 5 years (cumulative) • Not in training time greater than 1 year • Training maximum reached – 13 years

  37. Show Cause process Show cause in writing to Committee for Training • Set out facts • Include any relevant reasons • Include any mitigating circumstances • Include a proposed plan • References and letters of support should be sought by DOT and BTC as well as others (Supervisors, CTS, service) PGT will contact trainees identified as having to show cause to arrange meeting with DOT

  38. Planning a rotation: Dr A • Dr A is a Stage 1 trainee who has previously worked as a GP. • He has only been in the community term 1 week but already the staff and you are noticing a pattern of late arrivals at work and turning up late for his clinics • You are about to have your first supervision session with Dr A

  39. Dr B • Dr B is described to you as a “star” registrar by her previous supervisor • She is a Stage 2 trainee but appears to be functioning at a level of a Stage 3, being able to work relatively autonomously without requiring “helicopter” supervision • She is keen to have her first supervision session with you, to look at planning her EPAs for the term

  40. Dr C • Dr C is a Stage 3 trainee who is described as being very good with patients and thinks deeply about his work • Previous supervisors have identified though that he seems to have an anxious avoidance about the transition to being a consultant • He has not started on his scholarly project and has not written up his psychotherapy case • Last term he did not submit his ITA by the deadline

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