West Herts GP Specialist Training Programme

1. West Herts GP Specialist Training Programme ST1 Induction Meeting 14th August 2014 www.westhertsgpstp.com

2. Programme Directors(TPDs) • ST1 Group • Paul Heatley & Bruce Covell • ST3 Group • Pauline & Nick Foreman • GPSTP Administrator • Gemma Sleet • Postgraduate Centre Manager • Kim Hull

3. West Herts GPSTP – 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 currently separate

4. NHS Stuctures • Health Education: East of England • Formerly East of England Deanery • Herts Valleys Clinical Commissioning Group (HVCCG) • Formerly Herts PCT • NHS England – Herts and South Midlands Area • Formerly East of England SHA

5. VTS Teaching Programme • ST1 and ST3 groups have a weekly half day meeting, usually at Watford Hospital Postgraduate Centre from 2.15 to 5pm. Broadly follows school terms • ST2 group have three study days per year but no weekly programme. • Programme will be circulated and is displayed on our website www.westhertsgpstp.com

6. Content of Teaching 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 MRCGP • Your views are important and will be sought

7. Residential CourseJune 18th & 19th 2015

8. Cumberland Lodge2014 ST1 Group

9. Visit to Nice

10. GPSTP Training Rotation • Intake of 18 ST1s per year • 18 months in general practice and 18 months in a variety of secondary care posts • The local trusts have four month posts • In order to achieve the 18:18 month split one of your posts will be 50%GP and 50% secondary care

11. Rotation – 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/MSK medicine

12. Rotation – ST2 & ST3 • ST2 • 4/12 Paediatrics • 4/12 Obstetrics and Gynaecology • 4/12 Psychiatry • ST3 • 12/12 full time General Practice • Usually the practice where you did ST1

13. Part-time working • Job sharing in hospital posts (50% only) • Flexibility in GP posts (50-90%) • LTFT • apply to Deanery for approval • Granted for changes to family circumstances • Apply to change back

14. Monitoring of training posts • July 2014 visit from the Deanery • Generally very positive • We need your feedback • Informally to us • Formally • On line survey at the end of each post for HEEoE • Twice yearly survey of posts by GMC • Please respond to both – they don’t take long

15. Interruptions to training • You have an obligation to report sick leave to Southend • >14 days sick leave per year may trigger review of finishing date • Returning to work following prolonged sickness or Mat Leave • TPDs will help to find training posts that satisfy requirements for CCT • TPDs will re-calculate your finishing date

16. Career Break • When is the best time? • After ST3 is best • Between ST2 and ST3 is possible • We do not advise this between ST1 and ST2

17. Working week in GP attachments(HEEoE Guidelines) • 40 hours • Ten sessions • Seven sessions consulting with patients • One session of formal teaching • One session at the half-day release • One session of private study • Plus out of hours experience (approx one session per month). • Experience of extended hours

18. Out of Hours Training • Herts Urgent Care GP Registrar induction training on September 4th 2014 • Submit your application form today if you have not already done so!

19. Specimen timetable for full time GP attachment

20. Your Employer • New arrangements from August 2013 • Formerly Trainer/Hospital or Community Trust • You are employed by Southend University Hospital Trust during your GP training

21. Educational Supervisor • Same person throughout the three year training • Usually your ST1 GP trainer • Educational Supervision review at end of November and end of May each year

22. 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 John Howard) Don’t…

23. What we expect of you • Attendance at the half day meetings is part of your paid working week • A register is maintained and attendance figures are reported to Southend and the Deanery. • Sign the register or e-mail Gemma if you are on days off, nights, sick etc • Prompt response to e-mails about the programme

24. MRCGP

25. MRCGP • Applied Knowledge Test (AKT) • Clinical Skills Assessment (CSA) • Workplace Based Assessment (WPBA)

26. Applied Knowledge Test (AKT) • Can be done in ST2 or ST3 • Maximum of four attempts • 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 • Held at one of 150 Pearson Vue testing centres; Oct, Jan & April each year

27. 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

28. 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 and Assessment Skills • Clinical Management Skills • Interpersonal Skills

29. 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

30. 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

31. 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.

32. CSA - III • Three marks for each domain • Maximum of 9 per case • 13 cases x 9 = 117 marks • Pass mark varies, usually 72-75 • Held at RCGP HQ Euston • Previously Nov, Feb & May each year, in future will be held more often • Maximum of four attempts

33. 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)

34. Prior to review at 4 months (end Nov 2014) 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 (end May 2015) 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

35. Educational Supervision - timing • Your 4 month review will take place in November 2014 – time is tight! • Register with the RCGP now • Your 10 month review will take place in May 2015 • The “Annual Review of Competence Progression” ARCP Panel meets in June and December

36. E-portfolio • Shared Learning Log: regular reflective recording of two or three entries per week • Clinical encounters • Tutorial • Thursday afternoon teaching • Trainee Self-Rating

37. E-portfolio continued… • Personal Development Plan (PDP) • Regular entries and review “SMART” format Specific Measurable Achievable Relevant Time Bounded

38. Associate in Training (AiT)Cost • AiT joining fee £167 • AiT annual fee £240 (each April) • AKT £465 (AiT rate) • CSA £1563 (AiT rate) • CCT (GMC) £390 • Fees checked 12.7.14

39. 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

40. What I wish I’d known continued.. • What to expect from your trainer • Educational Contract • Learning needs analysis • One to one teaching • Supervision and support

41. Useful web sites • Royal College of General Practitioners • rcgp.org.uk • Health Education:East of England • https://www.eoedeanery.nhs.uk/medical/page.php?page_id=1757 • Bradford VTS • www.bradfordvts.co.uk • Pennine VTS • http://www.pennine-gp-training.co.uk

42. 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