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nMRCGP Assessments on the e portfolio. A summary for hospital clinical supervisors Maggie Eisner June 2009. Components of nMRCGP. Applied Knowledge Test (machine marked test) – done in ST2 or ST3 Clinical Skills Assessment (simulated GP surgery) – done in ST3 in GP post

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Nmrcgp assessments on the e portfolio

nMRCGP Assessments on the e portfolio

A summary for hospital clinical supervisors

Maggie Eisner

June 2009


Components of nmrcgp
Components of nMRCGP

  • Applied Knowledge Test (machine marked test) – done in ST2 or ST3

  • Clinical Skills Assessment (simulated GP surgery) – done in ST3 in GP post

  • Workplace Based Assessment - mini CEX (COT in GP posts), CBD, CSR, MSF, DOPS

  • Learning log - including clinical encounters, tutorials and seminars, significant incidents, professional conversations (etc)

  • All components matched to curriculum headings and to competency framework


The e portfolio
The e portfolio

  • Is the only record used in assessing trainee’s progress

  • Trainee responsible for keeping it up to date – but may need encouraging and reminding

  • Logon provided for Clinical Supervisor – sometimes the wrong name, e g specialty’s educational lead. Can be changed on e portfolio via VTS administrator Vicky at Field House

  • Clinical supervisor can view e portfolio (most of it)

  • Other health professionals can enter assessments via their GMC number or with electronic ‘ticket’ from trainee

  • Educational supervisor is GP educational supervisor for the 3 years


Assessment of progress
Assessment of progress

  • Educational Supervisor (GP trainer or Programme Director) meets trainee twice every 6m (month 2 and 4)

  • At 2nd meeting, ES evaluates evidence on e portfolio and enters Educational Review

  • ARCP once a year (in month 10) to agree to progression from ST1 to ST2, ST2 to ST3, or grant CCT


Number of assessments required before es mtg in month 4
Number of assessments required before ES mtg in month 4

  • DOPS – any time in training –

    • Mandatory (there are others) : breast exam, Cx smears, female genital exam, male genital exam, prostate exam, rectal exam, bld gluc testing, simple dressings

    • Observers may be SpR, staff grade, nurses, consultants

  • miniCEX – at least 3 per 6m

    • 15-min snapshot of doc-pt interaction

    • Observers may be staff grades, experienced SpR, consultant

  • MSF – 1 set of 5 per 6m in ST1, none in ST2

  • CSR – at least 1 per 6m, before ES mtg in month 4

  • CBD – at least 3 per 6m, preferably by experienced educator


Case based discussion what and how
Case based discussion – what and how?

  • Formal, structured exercise with preparation by trainee and assessor

  • Developed from the old MRCGP oral exam (designed to test whether trainees could consider scenarios and issues in breadth and depth)

  • Intended to find evidence of specific competencies, not test knowledge

  • Trainee selects 2 cases, gives copies of records to assessor in advance

  • Assessor selects one and

    • decides which competencies to look at

    • frames questions around the actual case, not exploring hypothetical events


Case based discussion the competencies
Case based discussion – the competencies

  • Practising holistically

  • Data gathering and interpretation

  • Making a diagnosis/decisions

  • Clinical management

  • Managing medical complexity

  • Primary care admin and IMT

  • Working with colleagues and in teams

  • Community orientation

  • Maintaining an ethical approach

  • Fitness to practise


Case based discussion rating
Case based discussion – rating

  • Expect progress from NFD to competent – ‘excellent’ is a description of a mature practitioner

  • Insufficient evidence – if you haven’t looked at that competency, or the case doesn’t address it

  • Needs further devel – rigid adherence to rules, superficial grasp of facts, can’t apply knowledge, little judgement

  • Competent – accesses and applies knowledge, sees things in context, conscious planning, ability to prioritise

  • Excellent – intuitive grasp of situations, doesn’t have to rely on rules, identifies underlying principles, understands context for applying knowledge


Case based discussion making it useful
Case based discussion – making it useful

  • Prepare in advance

  • Get trainee to self rate and discuss whether you agree and why

  • Record a few details of the case (e portfolio has no specific slot for this, put in Feedback section) to

    • help educational supervisor to assess

    • help trainee to reflect

  • Encourage trainee to select case for next time which reflects the competencies they need evidence for


Further information
Further information

  • www.bradfordvts.co.uk: nMRCGP for Consultants – Elderly medicine

  • www.rcgp.org.uk: GP curriculum


Appendix
Appendix

  • Detailed descriptions of the 12 competency areas and the criteria for the 4 grades

  • NB Each kind of assessment tests a different selection of competencies – e g CBD doesn’t include nos 1 (communication) and 9 (maintaining performance, learning and teaching)


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