Updates…… Curriculum WPBAs Recruitment QI: Learning To Make A Difference Programme

1. Updates……CurriculumWPBAsRecruitmentQI: Learning To Make A Difference Programme

2. curriculum updates • All CMT trainees (CT1 and CT2) are now using the same ‘live’ Curriculum apart from the few who started CMT before August 2011. • All trainees using the 2012 amended Curriculum are using the 2012 ARCP Decision aid. • Common Competencies and Emergency Presentations are unchanged. • The Top 20 presentations have changed to “The Top Presentations – Common Medical Presentations”.

3. curriculum updates • List of Top presentations is now 22 with new additions • “Acute Kidney Injury and Chronic Kidney disease” • “Management of patients requiring Palliative and end of Life Care”. • Increased emphasis in existing grids for other topics: • patient safety • dementia • back to work • bioethics • transitional care • domestic violence • obesity

4. CMT procedures from Aug 2011 • essential, clinical independence mandatory (5) • CPR; LP; ascitic tap; pleural aspiration; NG tube • essential, clinical independence desirable (3) • CV cannulation; DCCV; chest drain insertion using Seldinger technique with ultrasound guidance where appropriate • desirable • abdominal paracentesis; knee aspiration; skin biopsy • (arterial lines; long lines; joint injections; temp pacing)

5. Procedures documentation • from August ’12: • stronger wording re competence and maintaining competence • DOPS forms adjusted to clarify formative OR summative • 2 (minimum) summative DOPS from separate assessors to confirm independence for life-threatening procedures • new DOPS form for CV cannulation • specialty DOPS forms to be more widely available (chest drain, DCCV, temporary pacing)

6. ARCP DA updates from Aug ’12 • fewer WPBAs (CbD, mini-CEX, ACAT) • reduced to 10 pa (must include 4 ACATs) from 13.5 pa • ‘evidence of engagement’ with curriculum • allemergency and top presentations • mostcommon and other important presentations • WPBAs, reflection, courses etc • ‘evidence of engagement’ document • - allow ‘group sign-off’ for common and other important

7. ‘evidence of engagement’ document

8. WPBA forms from Aug ’12 • fewer but better • forms simplified • ‘radio buttons’ assessment for each domain removed • but free comments are required • constructive feedback mandatory for WPBA to ‘count’ • overall rating remains • CMT ratings will differ from HST ratings • some forms (eg CV line insertion) remain accessible only from http://www.jrcptb.org.uk/assessment/Pages/WPBA-Documents.aspx

10. DOPS form • formative or summative (use latter for confirmation of competency) • DOPS form for ‘potentially life threatening’ should be used for central line insertion, chest drains etc • domain gradings retained but fewer • below, meets, above expectation for stage of training • overall rating now includes skills lab competence

11. Top tips…..

12. Top tips….

13. educational supervisors form • enhanced to improve feedback and cover more areas • expanded summary of clinical skills: • has the trainee participated in appropriate clinical activity • comment on the range of in-patient and outpatient activity • has the trainee demonstrated appropriate K, S B • comment on clinical reasoning, diagnostic & decision-making skills etc • reflection and study • Quality Improvement added to audit section • exam progress

14. for more information and FAQs re curriculum, documentation & ePortfolio updates see http://www.jrcptb.org.uk/trainingandcert/Pages/ChangestoCMTandGIMcurriculum2012.aspx

15. Recruitment Update November 2012

16. Specialty Recruitment • RCP-SRO coordinating recruitment since 2008 • CMT & ACCS-acute at CT1 level • 16 specialties at ST3 level • Incorporates: • England • Northern Ireland (CT1 only) • Wales • Scotland (starting from 2013 recruitment).

17. 2012 - overview • 98.5% fill rate (100% for ACCS-AM) • Visiting assessor and poor performer pilots undertaken • Process aligned with Scotland • Scoring system made fully transparent • Generally very positive feedback from all stakeholders • Predictable process

18. 2012 – deanery fill rates

19. CT1 – timeline

20. CT1 - developments • visiting assessors incorporated into CT1 process • interview question bank fully reviewed • data analysis to understand differences between deanery assessments

21. ST3 - update • two rounds of recruitment to 16 ST3 specialties (~ 1200 posts, the majority of all ST3 posts) are now completed for posts commencing up until 31st March 2013 • the single national centre model used in round 2 worked well, allowing efficiencies of scale and a truly national process – following review, this is likely to be repeated for round 2 recruitment in future years • the applicant pool is too low for complete fill – only 734 eligible applications from 506 unique candidates were received for 440 NTN & LAT posts in round 2 • recruitment for posts commencing from August 2013 will commence next March; all specialties will use either a single national centre or the single cascadable application system • MRCP(UK) & MRCPI will be the only acceptable physician exams in 2013 (with a planned move to MRCP(UK) only in 2014).

22. Further recruitment updates • The UK Offers System (centralised, multi-specialty offers) is on track to be introduced in 2013 • there will be a moratorium on CT2 recruitment for some specialties in 2013, but CMT can continue to recruit at this level, to replace trainees ‘lost’ to other specialties and to increase the CMT feed into ST3 • there will be a moratorium on LAT recruitment for some specialties in 2013, but at present physician specialties are exempt. Further clarification is awaited, due to the impact that this decision could have on the running of acute hospital care provided by a significant number of our specialties, already running with gaps • DH have mandated that all LAT recruitment must be done as part of the national process from 2013. • An additional clinical lead for RCP-coordinated recruitment is required - all enquiries to ST3recruitment@rcplondon.ac.uk

23. Contact Any questions, comments, feedback: ct1recruitment@rcplondon.ac.uk st3recruitment@rcplondon.ac.uk

24. Learning to Make a Difference RCP/ JRCPTB Dr Emma Vaux – Clinical Lead Dr Katharine Woodall – Project Manager August 2012

25. Pilot Study 2010/11 61 Trainees undertook 46 quality improvement projects across 5 deaneries Trainees were enthused by the process Positive participant experience - They felt they made a real difference to patient care at the front line LTMD has demonstrated more evidence of benefit to patients than any of the current workplace based assessments. (Publication Clin Med Dec 2012)

26. From August 2011 • Expectation set for CMTs to complete a QI project rather than clinical audit • LTMD website and resources • Deaneries to implement • Variable success

27. April 2012 – Survey Survey sent to College Tutors and Trust Programme Directors Over 80 trainees were undertaking quality improvement projects Where no trainees were doing projects, 80% of respondents were considering introducing quality improvement projects But, often there is no clear process to facilitate quality improvement project implementation.

28. Keys to successful implementation • Face to face meetings in each deanery by the clinical lead • Further development of LTMD website • eportfolio changes • QI support

29. FACE TO FACE – DEMYSTIFY PROCESS 15 talks in 13 deaneries this autumn Speaking to trainees and supervisors at induction Disseminating induction packs

30. Website • Recently updated: • Revised trainee and supervisor packs • Powerpoints from last year’s trainees • Presentations on QI methods

31. ePORTFOLIO CHANGES • Quality Improvement Project Assessment Tool (QIPAT) • Quality improvement or clinical audit in curriculum and ARCP Decision Aids • Recruitment application forms also recognise equal status QIPs

32. QI Champions A network of QI champions at Trust Level is being identified Support supervisors and trainees by acting as a knowledge resource Currently about 30 QI champions spread across UK

33. Developing networks London Deanery - QI training trainees & consultants Faculty for Medical Leadership NHSIII MEE/HEE Better Training Better Care Royal Berkshire Foundation Trust awarded 100K to implement LTMD approach across all specialties and grades LTMD programme £75K November 2012

34. Moving forward LTMD is no longer a pilot but expected practice LTMD programme enables training in improvement methodology for the development of new skills relevant to being a physician in the 21st century Embed improvement methodology in CMT training Partnership working with other agencies to facilitate delivery Develop networks to support this process

35. What does this mean in practice for the trainee?

36. What does this mean in practice for the Training Programme Director and College Tutors? • Set the expectation and value • The trainee knows this matters to their Trust, training programme and so themselves • Involve the College Tutors in helping getting started and maintaining momentum; identification QI champion for further support • Set a regional date for all trainees to present May 2013 (Orally/posters) • Confirm completion at ARCP (or if not done ensure completed audit cycle)

37. Contact • Emma.vaux@royalberkshire.nhs.uk http://www.rcplondon.ac.uk/projects/learning-make-difference-ltmd