The Assessment of Clinical Skills Portfolio New ways of viewing clinical assessment
Why Change? • Audio/video in use in a number of Clin Psych training programmes in UK and abroad. Standard practice in IAPT services. • Significant numbers of trainees already making recordings for supervision purposes – gaining momentum as technology improves. More in line with everyday practice. • Allows for more direct observation • PPR’s a good academic exercise, but lack an in-vivo focus on therapeutic skill
Overview • Clinical Portfolio will have two parts: • Part 1: Formulation and Evidence for Intervention Review (3000 words)- submitted in March/April of Year 1 • Part 2: Clinical and Professional Skills Assessment: Digital recording (30 mins) showing five generic and three model specific competencies, Annotated transcript and a Viva (submitted in June)
Part 1: Formulation and Evidence Review • Similar to first part of a PPR: • Addresses the competencies needed to develop a clinical formulation and make an appropriate clinical judgement about the most appropriate intervention. • Will test trainees’ ability to link intervention to available evidence and describe support in literature for chosen intervention
Trainee should be able to reference national guidance in relation to general presenting issues • Should describe and provide a rationale for any adaptations being made to ensure best fit for client within this service context • It should be appropriately critical of the existing limitations of the evidence base • A brief action plan resulting from the chosen intervention should be described
Part 2: Digital recording, Transcript and Viva • Candidate will have sought the consent of the client: guidance will be sought from Trust or organisation where work was carried out. • Trusts have own guidance regarding use of clinical material for educational purposes. We are working towards service level agreements. • It is hoped that TTC’s will play a key role in the gaining of service level agreements with Trusts.
Trust policies • Oxleas the first Trust in the region to define a protocol specifically for the Visual and Audio Recording of Patient’s/Families. (Others, eg Surrey and Borders have policies pertaining to the use of clinical material for educational purposes). Sussex to follow in October, 2011. • Oxleas follows general principles laid down by the British Medical Association. • States that clients’ permission should be sought to make the recording and written consent obtained for any use or disclosure
Clients should be under no pressure to give their permission • The recording should be stopped if the client asks you or if it is having an adverse effect on the consultation or treatment • Ensure that the recording does not compromise the client’s privacy and dignity • Do not use recordings for purposes outside the scope of the original consent for use, without obtaining further consent
Avoid sending or recording identifiable images in ways that allow the recipient to forward it to others or use it for purposes beyond the original content • Make appropriate secure arrangements for the secure storage, retention, disposal and destruction of recordings. • The client may request a copy of the recording in the same way as they have a right to request a copy of their written clinical record (in line with NICE guidelines)
Confidentiality • Written evidence of consent to be kept in the clinical records of the client and not submitted with the portfolio • Presented material to be fully anonymised • Recordings should be submitted to the University on encrypted memory stick. Recordings should not be saved to computers and never transmitted electronically.
Equipment • Department has limited number of video/audio recorders. Will be a requirement of course that trainee will provide his/her own digital recorder • Needs to be MP3 compatible as well as compatible with Windows Media Player. • Recorder should be kept exclusively for purpose of producing recordings for the course. No mobile phones!!
Supervisors • Supervisors to play an active role in selection of client material • Supervisors and trainee to work with the material in supervision • Essential to read assessment guidelines in the Assessment Handbook
The recording: • Can be an audio-recording or video recording with soundtrack just showing trainee, or video and soundtrack showing client and trainee • Must be of 30 minutes’ duration and a continuous section of one therapeutic session • The selection of therapeutic work should demonstrate five basic core competencies (active listening, empathy, accurate reflections, ability to be responsive to the client and exploration of client concerns) as well as three ‘model specific’ competencies
The Annotated Transcript • Should be a transcript of the whole of the session that has been recorded, for sake of context • The annotation should only be of the selected 30 mins presented • Annotation should identify each of the five core clinical competencies and three model specific interventions
If three model specific interventions cannot be identified, opportunities should be identified where they could have occurred • Transcript should make one reflective comment about the individual life circumstances of the person • It should make a critique of the therapeutic work pointing where improvements could have been made
Guidelines: Clinical Viva • Viva should explore areas of competence that may not have been demonstrated • Explore with the trainee their depth of understanding of clinical competencies and therapeutic alliance • Explore their understanding of the model in which they were working • Will last 30 -45 mins and be carried out by two examiners who marked part 1 of the portfolio
Where next? • Assessment has been validated and is currently being piloted to iron out snags • Trust Training Co-ordinators to work on helping to secure Trust policies as well as to ‘prime’ first year supervisors