Assessment

Your progress through the three year programme will be assessed and monitored regularly, both formally and informally.

• Formal Assessments
• Examinations

There are two major formal examinations:

• AKT Applied Knowledge Test
• CSA Clinical Skills Assessment

On an ongoing basis there are formal assessments within the surgery work setting.  These assessments are called: Work Placed Based Assessments (WPBA). 

Both examination and work placed based assessments will need to be entered on your ePortfolio.  The former by the Royal College when you undertake these examinations, the latter by those within your working environment who undertake to assess you.  Satisfactory completion of your ePortfolio is dependent on both types of assessments being undertaken and completed satisfactorily.

Work Placed Based Assessments (WPBA)

The assessment takes several forms and involves different people but especially involved are:-

• Clinical Supervisor
• Educational Supervisor

The assessments are individually logged on your ePortfolio and reviewed annually throughout your training programme by the deanery’s ARCP Panel.

During each of your clinical attachments you are obliged to complete various assessments by those with whom you work.  These assessments have the acronyms listed below.  Each will be defined in turn a little later on in this document. 
You will readily find examples of each of these on the RCGP web site: http://www.rcgp.org.uk/Docs/nMRCGP_all%20six%20assessment%20forms.doc

• DOPS
• CBD
• Mini-cex’s
• COTs
• PSQ
• MSF

Clinical Supervisor’s Report CSR

Towards the end of each of your clinical attachments the clinical supervisor must complete a Clinical Supervisor’s Report CSR.

The clinical supervisor should ideally meet you formally three times during your attachment.

• At the first meeting you should define with him your learning needs and opportunities during the post.  This meeting should take place within the very first few weeks of the attachment.
• The second meeting should take place mid-way through the post and look at the progress thus far, match this against the desired outcomes and work out a  plan of action to address the remaining gaps.

• The last meeting should take place towards the end of the post, in the last few weeks and should look at the learning achieved, assess whether the desired expectations for the post have been completed and identify any additional work that may be required to enhance the value of the attachment and have the confidence to undertake this particular specialty work within general practice on an on-going basis.

At this meeting the Clinical Supervisor’s Report should be completed on the ePortfolio.

On the ePortfolio screens each of the assessments is described in detail and there are help screens which give detailed definitions of each of the criteria to be used and how the assessment is to be judged by the assessor.

DOPS - Direct Observational Procedures.  Assessments by senior medical and nursing colleagues on your ability to perform various clinical skills such as taking blood or an ECG or performing wound suture.

CBD - Case Based Discussion.  An assessment by a senior medical colleague, usually the clinical supervisor or trainer, where the management of a patient is discussed in depth including the rationale for every step of the decision making process in their care, including reference to ethical issues.

Mini-cex’s - Mini Clinical exercise.  An assessment by a senior medical colleague in secondary care, usually the clinical supervisor, on a clinical encounter, usually a clinical history and examination.

COTs - Communication observation tool.  An assessment which is carried out exclusively within primary care by your trainer on your communication skills.  This may be carried out by the trainer sitting in on your patients or by the trainer watching a video of a consultation you have selected to present to him.

PSQ - Patient Satisfaction Questionnaire.  An assessment which is carried out exclusively in primary care by patients on what they think of you.

MSF - Multi source feedback.  An assessment by those with whom you work, doctors and nurses, on what they think of your clinical and attitudinal abilities.

Whoever completes the forms must sign not only their name but additionally their professional registration number, GMC or RCN, against the form.  These forms are an integral part of your assessment.  If a friend were to try and do a favour for you and sign up that you were competent to perform a procedure against which some time after there was an allegation of incompetence, they may find themselves listed as a co-defendant in any litigation proceedings. The deanery would take a very severe view were such facts to emerge.

Some attachments lend themselves to these assessments more than others.  For example it is difficult to complete many procedures in public health but other specialities will lend themselves to a plethora of assessments.

Some assessments can only be carried out in specific sectors e.g. COTs in primary care and mini-cex’s in secondary care respectively.  There are a minimal number of assessments which must be undertaken in each stage of your training which varies according to where you are working and how far into your training programme you have progressed.  

The purpose of these assessments is to check off that all trainees on the programme are learning, performing, and developing.

An assessment which has an outcome: ‘needs further development’ is entirely appropriate for most grades and phases of training.  This simply means that you are training to become a GP and still need further development over the course of the three years of the programme.

What is vitally important is your Educational Supervisor’s overall assessment as to whether your progress is ‘satisfactory’.  For the overwhelming majority of trainees this is the case.

 

ARCP  

At 12 month intervals your progress will be reviewed by an ARCP Panel.  The acronym stands for Annual Review of Competencies’ Progression

What is it?

The panel is constituted by the deanery.  It consists of 4 people, an Associate Director, a Programme Director, a Trainer and a Lay Member.  None of the people on the panel should have personal knowledge of you.  The work of the panel is subject to quality review by the Royal College.

The panel will review every trainee once a year.  The timing is geared around the anticipated finishing date.  The timing is deliberately phased so that the panel meets a few weeks ahead of the twelve month point.  This is to make sure that if anything special needs to be done there is time to organise it rather than leave the arrangements to the last minute.  However, this does have a knock-on effect that it can make things a little rushed for trainees to complete all the evidence ahead of the cut-off dates.

The panel works in two stages. 

At the first stage all trainees timed to have a review will be looked at.  The review will be a computer screen exercise looking over all aspects of the ePortfolio and especially the recommendations of the Educational Supervisor. 

All aspects of the ePortfolio carry equal weight and progression to certification can not occur unless all components have been completed satisfactorily.

In general most trainees are signed off as being ‘satisfactory’ at this point.

In a few cases this is not the case.  Minimal evidence required on the ePortfolio may be missing.  The completed data may have comments that progress is not satisfactory or there may be adverse reports by the clinical supervisor.  In their final year trainees may not have passed the required examinations or have in place the necessary requirements such as Out of Hours sessions.

In these cases the ‘screen review’ panel may decide a face-to-face interview is required.

At this interview the panel will speak with the trainee and identify as best as they can the outstanding matters and take a view on how training may be continued.

Outcomes thus include that the:

• Trainees is progressing satisfactorily and should continue with the current training programme
• Trainees’ progress has been completed satisfactorily, required competencies attained and the deanery will recommend the Certificate of Completion of Training, CCT should be completed and passed to the Royal College
• Trainees’ progress is unsatisfactory. There are several options here ranging from continuing with additional support to exit from the training programme.

There is a process to appeal against the ARCP recommendations if desired and this process is summarised in the flow chart at the end of this document.

ST3 year only, requirements 

During the first two years of the traineeship the ePortfolio must be completed.  There are no specific examinations but many trainees elect to undertake specialty diplomas in those clinical posts they have experienced.

During the final year there are mandatory additional requirements.

The trainees must:

• Obtain Confirmation of completion of Out of Hours Experience
• Obtain a CPR and AED certificate
• Pass the AKT examination
• Pass the CSA examination

Out of hours experience must be obtained.  This can either be arranged by your own practice should they undertake this service or through one of the contracted providers.

Twelve sessions must be completed and the trainee must be signed up as having the skills to undertake this work.  One of the problems here is that quite a few trainees leave this work too late in the year to complete within the time available.

CPR and AED certificates can be obtained from a variety of sources.  Your trainer or Programme Director should be able to help you should there be any problems.

The CSA exam can only be taken in Croydon.  It is a test of clinical skills carried out in a mock clinical surgery.  It can only be taken when you are in your ST3 year.  Most candidates report they find the exam a very stressful experience.

Both these exams have pass / fail only outcomes.  A breakdown of results will be sent to all candidates.

The results are electronically sent by the Royal College to the deanery and inserted into the ePortfolio.  Training can not be signed by the deanery as being satisfactorily completed until ALL these assessments, documentations and declarations have been completed satisfactorily.  They are all of equal weight.  The deanery can not take a view that as perhaps the overall picture looks reasonable the absence of one or two features on the ePortfolio can be ignored.

Time Lines

Workplace-based Assessment ST1

6 & 12 month reviews will be based on the following evidence:

• 3 x COT or mini-CEX
• 3 x CBD
• 5 x MSF
• Educational Supervisor's report
• 1 x PSQ (if GP post)
• DOPS (if appropraite)
• Clinical Supervisor's report (if appropriate)

10 month review will be a Deaney panel.

Workplace-based Assessment ST2

18 & 24 month reviews will be based on the following evidence:

• 3 x COT or mini-CEX
• 3 x CBD
• 5 x MSF
• Educational Supervisor's report
• 1 x PSQ (if GP post)
• DOPS (if appropraite)
• Clinical Supervisor's report (if appropriate)

22 month review will be a Deaney panel..

Workplace-based Assessment ST3

30 & 34 month reviews will be based on the following evidence:

• 6 x COT
• 6 x CBD
• 5 x MSF
• Educational Supervisor's report
• DOPS (if appropriate)
• PSQ (34 month review only)

The 34 month review will also include a Deanery panel.

 

Finishing off: Certification 

Once fully and satisfactorily completed, the ePortfolio web site will electronically notify the RCGP and PMETB that the trainee has satisfactorily completed their training.  A CCT, Certificate of Completion of Training will be created.  PMETB will now be in a position to issue the trainee with the licence to work as a specialist within general practice.

The RCGP will not be able to process certification unless and until all these steps have been undertaken.

Progressing through: Other requirements

• Probity statements
• Performers list
• Educational Contract

These all feature on the ePortfolio and must be signed electronically as being:-

• read
• understood
• agreed