West Herts GP Specialist Training Programme

1. West Herts GP Specialist Training Programme ST1 Induction Meeting 5th August 2009

2. Programme Directors • ST1 Group • Paul Heatley & Bruce Covell • ST3 Group • Pauline & Nick Foreman • VTS Administrator • Maria Parry-Price • Postgraduate Centre Manager • Kim Hull

3. West Herts VTS – a very brief history • NW Herts VTS (Hemel/St Albans/Radlett/Kings Langley/Berkhamsted) • Programme Directors: Paul Heatley & Bruce Covell • Watford VTS • Programme Directors: Pauline & Nick Foreman • Merged August 2007 • Trainers workshops remain separate

4. VTS Teaching Programme • ST1 and ST3 groups have a weekly half day meeting at Watford Hospital Postgraduate Centre from 2.15 to 5pm. Broadly follows school terms • Both groups have a residential course in the summer • ST2 group have three study days per year but no weekly programme.

5. Content of VTS Programme • Guided by GP Curriculum • See RCGP website www.rcgp-curriculum.org.uk • Condensed curriculum guide • External speakers • Case discussion • E-portfolio • Journal Club • Preparation for nMRCGP • Your views are important and will be sought

6. Plus…..

7. Visit to Nice – July 2009

8. VTS Rotation(s) • 18 months in general practice and 18 months in a variety of secondary care posts • The local trusts have four month posts (some have a six month cycle) • We have two rotations A.18 entrants per year established in 2007 B. 4 entrants per year established in August 2009

9. Rotation A – ST1 year • 4/12 full time general practice • 4/12 medicine/geriatrics/A&E • 4/12 part-time GP and part-time GU/Derm/Palliative Care/Community Geriatrics • Allocation process

10. Rotation A – ST2 & ST3 • ST2 • 4/12 Paediatrics • 4/12 Obstetrics and Gynaecology • 4/12 Psychiatry • ST3 • 12/12 full time General Practice

11. Rotation B • Part of national drive to increase training capacity • 18 months secondary care in other Trusts (currently QEII, Welwyn and the Lister, Stevenage). August 2011 posts to be confirmed. • 18 months in local training practice

12. Working week in GP attachments(Deanery Guidelines) • 40 hours • Ten sessions • Seven sessions consulting with patients • One session of formal teaching • One session at the VTS • One session of private study • Plus Out of Hours experience (108 hours over the three years ie 1 session per month) • Experience of extended hours

13. Specimen timetable for full time GP attachment

14. Relationships • GP based posts – you will be employed by your trainer • Secondary care posts - You will be employed by a hospital or community trust • Educational Supervisor - You will be attached to a trainer or PD for the duration of the three year course but there is some flexibility.

15. If you have a problem… • Do talk to……….. • Other members of the group • Consultant or Trainer • Programme Director • Patch Director (Dr Keith Cockburn) • Deanery Director of Postgraduate General Practice (Dr Arthur Hibble) Don’t…

16. Exams!

17. nMRCGP • Applied Knowledge Test (AKT) • Clinical Skills Assessment (CSA) • Workplace Based Assessment (WPBA) • New rule: from August 2010 candidates can attempt the CSA and AKT a maximum of four times.

18. Applied Knowledge Test (AKT) • Can be done at any time in the ST2 or ST3 year • Held at one of 150 Pearson Vue testing centres; Oct, Jan & April each year • 200 multiple choice questions in 3 hours • 80% clinical medicine, 10% critical appraisal and EBM, 10% health informatics & administration • Sample questions on rcgp web site • NMRCGP Practice Papers: Applied Knowledge Test by Rob Daniels (PasTest)

19. Things that come up in the AKT • Legal aspects, e.g. DVLA • Professional regulation, e.g. GMC • Business aspects, e.g. GP contract • Prescribing, e.g. Controlled drugs • Appropriate use of resources, e.g. drugs • Health & Safety, e.g. needlestick injury • Ethical, e.g. Mental capacity, consent

20. Clinical Skills Assessment - CSA • Can only be done in the ST3 year • Simulated surgery with actors and trained assessors • 13 patients, 10 minutes each, 2 minute break • The three domains on which you will be marked are: • DATA-GATHERING, TECHNICAL & ASSESSMENT SKILLS:Gathering & using data for clinical judgement, choice of examination, investigations & their interpretation. Demonstrating proficiency in performing physical examinations & using diagnostic and therapeutic instruments

21. CLINICAL MANAGEMENT SKILLS:Recognition & management of common medical conditions in primary care. Demonstrating astructured & flexible approach to decision-making. Demonstrating theability to deal with multiple complaints and co-morbidity. Demonstrating theability to promote a positive approach to health • INTERPERSONAL SKILLS: Demonstrating theuseof recognised communication techniques to gain understanding of the patient's illness experience and develop a shared approach to managing problems. Practising ethically with respect for equality & diversity issues, in line with the accepted codes of professional conduct.

22. CSA – III – new scoring • Each domain is marked separately to give an overall score • In addition the examiner grades each consultation as: Clear Pass, Marginal Pass, Marginal Fail, Clear Fail • A “cut score” is calculated each day to allow for any variation in the difficulty of the cases and is used to define the pass mark • Held at assessment centre in Croydon four times per year (will eventually move to new RCGP in Euston) • Cases and Concepts for the New MRCGP: CSA and CbD for the NMRCGP by Naidoo, P. • CSA Courses in Rickmansworth run by CSA examiners

23. Workplace Based Assessment (WPBA) • E-portfolio – starts now and you must register with the RCGP to get access • Curriculum www.rcgp-curriculum.org.uk • Case Based Discussions (CBD) • Consultation Observation Tool (COT) • Multi-Source Feedback (MSF) • Patient Satisfaction Questionnaire (PSQ)

24. Prior to review at 4 months (November 2010) CBD x3 COT or mini CEX x3 MSF 5 clinicians Clinical supervisors report (secondary care only) PSQ (primary care only) DOPS (opportunistic) Prior to review at 10 months (May 2011) CBD x3 COT or mini CEX x3 MSF (5 clinicians) Clinical supervisors report (secondary care only) PSQ (primary care only) DOPS (opportunistic) WPBA – Timetable for ST1 Year

25. Educational Supervision - timing • Your 4 month review will take place in November 2010 – time is tight! • Your 10 month review will take place in May 2011 • The “Annual Review of Competence Progression” ARCP Panel meets in June and December

26. E-portfolio • Shared Learning Log: regular reflective recording of at least three entries per week • Clinical encounters • Tutorial • VTS • Personal Development Plan (PDP) • Regular entries and review • Trainee Self-Rating

27. Associate in Training (AiT)Cost • AiT joining fee £145 • AiT annual fee £218 (each April) • AKT £430 (£478 non-AiT) • CSA £1445 (£1606 non-AiT) • CCT (PMetB) £805 • (costs as published on 17.7.10)

28. What I wish I’d known when I started….. • E-portfolio – what to put in and what is meant by reflective learning • The AiT journal “InnovAit” is excellent • Make a learning plan at each stage • Get to know the other members of the group early on – valuable resource • Learn about consultation models early on

29. What I wish I’d known continued.. • What to expect from your trainer • Contract • Learning needs analysis • One to one teaching • Supervision and support • Inform MPS/MDU when you are in a GP post. Higher cost but you can claim reimbursement

30. Useful web sites • Royal College of General Practitioners • rcgp.org.uk • East of England Deanery • Easterngp.co.uk • Bradford VTS • www.bradfordvts.co.uk • Postgraduate Medical and Education Board (PMeTB) • www.pmetb.co.uk

31. Useful Web Sites • RCGP Curriculum www.rcgp-curriculum.org.uk • www.gpnotebook.co.uk - quick,concise clinical guidance • www.patient.co.uk - leaflets & support groups • www.doctors.net.uk - e-mail address, discussion fora and clinical advice • www.bmjlearning.com - excellent learning modules; £70 if not a BMA member