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WPBA COMPETENCE BASED FRAMEWORK

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WPBA COMPETENCE BASED FRAMEWORK Powered By Docstoc
					ADVANCED MASTERY OF THE e-
       PORTFOLIO




            HDR
           4.11.10
         SET OBJECTIVES
   WHY this topic?
   WHAT DO YOU WANT TO GET OUT OF
    TODAY?
                  Programme
   Objectives
   Changes to the eportfolio
   Engaging with the eportfolio
   What to do pre ES meeting
   Why do trainees go to panel-what happens at a
    panel?
   Naturally Occurring evidence.
   Log entries-How to make better reflection.
   Exercises on reflection and validation
          UPDATE Eportfolio v5
   Need to sign‘Probity: Professional Obligations’,
    ‘Health: Professional Obligations’ and ‘Educational
    Agreement’ need to be signed at the start of Training in
    a Deanery. If you change Deanery, you will need to
    resign these. You will not be able to enter Learning Log
    entries without these three being signed
   . Your Educational Supervisor will not be able to start a
    review, without countersigning the Educational
    Agreement.
   Probity: Convictions and disciplinary actions, and
    Health: Regulatory and voluntary proceedings now
    must be signed for each review. There will be a review
    by review option for you to sign these. You cannot
    accept a review without signing them
           UPDATE Eportfolio v5
   ES must create a review before you can update your self
    assesssment
   Educational Supervisor's review - Educational
    Supervisors cannot sign & submit a review unless
    the Trainee has completed the Competences Self-
    Rating.
    Expanded rating scales-relate to stage-
      NFD – Below Expectations; NFD – Meets
       Expectations; NFD – Above Expectations
      Competent for Licensing
      Excellent
   Reviews come in RDMP clustering model
RDMp Clustering Model




                    Relationship                                                              Diagnostics

                                          Practising Holistically                      Data Gathering &
                                                                                        Interpretation

                Communication &
                 Consulting Skills                                                                          Making a Diagnosis
                                                                                                            Making Decisions

                                                          Professionalism
                                                                                                     Clinical Management
                                                           Maintaining an Ethical
                                                           Approach to Practice
                                                                                                              Managing
                Working with Colleagues                                                                       Medical
                      & in Teams                           Fitness to Practice                               Complexity

                                                                                              Community
                                                                                              Orientation

                                          Primary Care
                                           Admin and                Maintaining Performance
                                              IMT                    Learning and Teaching



                                                            Management
             E –portfolio Version 6.0
– Planned release date - early August 2011
It was agreed that major changes to the ePortfolio will only be introduced
    at the start of a new ST year. Version 6.0 will be the next major update,
    and will be released in early August 2011.

   The list of work for Version 6.0 is still very much a work in progress,
    but at the moment we are planning to address the following:

   A major review of the curriculum and its likely impact on the ePortfolio
   A review of the Learning Log functionality and linkage
   A review of the Case Based Discussion (CBD) WPBA tool
   Minor aesthetic improvements e.g. text display and layout of tables
   Housekeeping of the database and updating coding for the website
       Engaging with the E-portfolio
Common Reasons Why Trainees don't make effective use of
  their e-portfolio

   • do not understand its value (both in terms of assessment, i e for
    others, and in terms of recording experiences and reflection, i e for
    self
   does understand its value but hasn’t got into a routine of doing it,
    in which case may need rather explicit suggestion of a routine
    does understand its value but thinks can’t find the time in his busy
    job
   does understand its value but is lazy and/or disorganised
   doesn’t know how to do it – in this case, he might need to look at
    someone else’s. You could get permission from one of your other
    supervisees to show him/her theirs? Mainly the reflective aspects.
    confused by moving goalposts!
    Engaging with the E-portfolio
   Make entries personal
   How many/often?- 2 -3 per week avoid
    clustering
   Quality not quantity
   Have it open in surgery –so that can do brief
    one liner notes at end on relevant cases and
    develop later
    Trainee suggestions to engage in e-portfolio
   What do I write? -familiarise with curriculum headings and competences and
    what they mean to use as framework to follow
   Time issues-
        consider coming in half an hour early each day during your hospital or GP post to
         add log entries
        load the e-portfolio at the same time as you do your GP surgery; in that way you
         can add 'rough notes' on interesting patients you see and you can then 'smarten'
         them up later
        -use your half day admin time to add in entries
         use 'gaps' in your daily hospital work as opportunities to add stuff on
        - if it takes ages to drive home (because of rush hour traffic eg after half day
         release), consider pulling over and adding some stuff on until the traffic dies
         down. Of course, you may wish to invest in mobile broadband to do this.
   Change your attitude: many of you hate the eportfolio and feel sick at the
    thought of it. But the e-portfolio is here to stay. If one cannot change the e-
    portfolio, then perhaps one needs to change oneself. Change your attitude
    and adapt to it. The more you start looking at it positively, the less it will
    impact on you negatively. LIKE LIFE!
   Typing skills –consider typing tutor ('Mavis Beacon Teaches Typing' - type
    this into somewhere like Amazon; costs less that £20.) or digital dictation
    software eg Dragon Naturally speaking.
              Suggestions re quantity
Non WBPA MINIMUM criteria to be achieved prior to the end of the ST year
ST1
 96 quality log entries (10 pages of the e-portfolio) and 12 SMART PDP entries
 Reflections on post held, 2 Presentations, 6 x SEA


ST2
 112 additional quality log entries (12 additional pages of the e-portfolio and an
   additional 18 SMART PDP entries - Running total = 22 pages of e-portfolio
   entries and 24 SMART PDP entries. Reflections on post held, 4
   Presentations, 12 x SEA

ST3
 144 additional quality log entries (15 additional pages of the e-portfolio) and an
   additional 18 SMART PDP entries - Running total = 37 pages of e-portfolio
   entries and 36 SMART PDP entries. Reflections on post held, 6
   Presentations, 18 x SEA, 1 x two cycle audit
                   PDP Linking
   Try and write PDPs in terms of either what knowledge,
    skills or attitudes you need to develop.
   Remember, you can "send" outstanding things from
    your learning log entries to your PDP - use it because it
    saves you writing it all out again for your PDP.
   If you don't have time to write out the PDP completely,
    why not just add something 'quick and dirty' for the
    time being to serve as a signpost for you to smarten up
    later?
   Whilst you dont have to be too comprehensive, you do
    have to be specific.
                   SMART PDP
   The SMART model was developed by psychologists as
    a tool to help people set and reach their goals. It’s a
    simple approach that lends itself to creating good PDP
    entries in your e-portfolio.
   Specific
   Measurable
   Attainable
   Relevant
   Time-bound
                      SMART
   Specific
    Is your goal well-defined? Avoid setting unclear or
    vague objectives; instead be as precise as possible.
   Instead of: To be a better GP
    Make it specific: To develop my consultation skills,
    especially those relating to communication.
   Measurable
    Be clear how will you know when you have achieved
    your goal. Using numbers, dates and times is one way
    to represent clear objectives.
   Instead of: Feel better about my consultations
    Make it measurable: Better PSQ outcomes and
    achieving more COT competencies during assessment.
                            SMART
Attainable
   Setting yourself impossible goals will only end in
    disappointment. Make your goals challenging, but realistic.
   Instead of: Master consultation skills by the end of the month
    Make it attainable: I will go on a consultation skills course and
    read ‘The naked consultation’.
Relevant
 Try and step back and get an overview of all the different areas
  of your life: Academic, Personal and Career. Consider how
  relevant each objective is to the overall picture.
Time-bound
 Set a time scale for completion of each goal. Even if you have to
  review this as you progress, it will help to keep you motivated.
 Instead of: I will address these issues.
  Make it time-bound: By the end of the my current post I will
  have been on the course and read the book.
            STRs-PRE ES meeting
   Arrange meeting! Ask ES to create a review.
   log and share an e-portfolio entry entitled Ed Sup Rev
    current date. Attach:
       COT & CBD competency mapping
       HDR spreadsheet and sick leave/all leave spreadsheet. List
        complaints.
   Ensure CSR report done.
   Ensure self rating assessment and PDP up to date.
   Ensure compulsory assessments (inc MSF in modular
    posts)?include NOE
   Ensure last objectives achieved.
   Ensure declarations all signed off
         Deanery Guidelines ES
How Many ES Meetings and When?
 ST1: 2 meetings in first post, 1 meeting in second (i.e.
  3 for that year: 1 informal + 2 formal)
 ST2: 1 per 6m post (ie 2 for that year: both formal)

 ST3: 1 per 6m post (ie 2 for that year: both formal)

 So, especially during the period Feb-Aug of every year
  (as that is when most trainees will move onto the next
  ST stage) make sure you have had your second ES
  meeting before the end of May
WHY do STs get referrred to central
        Deanery panel
   Majority incomplete evidence eg
   out of hours sessions,
   patient satisfaction questionnaires and
   other workplace based assessment tools.
   NOE(Naturally Occurring Evidence)
   Confusion modular posts /LTFTT
   Clustering minimal evidence.
    ARCP PANEL OUTCOMES
   SATISFACTORY –FOR PROGRESSION OR CCT
   OUT OF PROGRAMME
   MAINLY SATISFACTORY-ARCP NOT
    COMPLETED;FEEDBACK TO TRAINEE TO
    OBTAIN MISSING EVIDENCE-PANEL CHAIR
    REVIEWS EVIDENCE 2W LATER.
   POSSIBLE OR LIKELY UNSATISFACTORY-
    ARCP NOT COMPLETED ;WRITTEN
    EVIDENCE TO DEANERY RE REASONS
   ONLY ONE OUTCOME PER TRAINEE IN EACH
    ARCP CYCLE
                            OOH
    There is the service commitment to out of hours work that is
    specified for each training post. Not attending OOH sessions is
    a probity issue.
   In an Innovative Training Post (ITP) most ITPs will have the
    same monthly (6 hour) session of OOH work as normal GP
    training posts. Some will have on call commitments to the
    modular component of their post – eg on labour ward or
    hospice. make clear in the portfolio. If no OOH sessions logged
    panels will find the portfolio unsatisfactory. (PSQ also due in
    modular posts)
   Documentation of learning in OOH sessions -linking that to
    chapter 7 of the GP curriculum – Care of the Acutely Ill.
   One trainee documented 2 OOH sessions in two months prior
    to panel. A total of only 3 patients had been seen in these two
    sessions. This was considered to be unsatisfactory.
   Clustering/demand
                 OOH cont
Advise to document for each OOH
 The type of session – telephone triage, visiting
   doctor, base doctor
 The number of patients seen.

 A selection of the most interesting patients

 The significant learning points and,

 Link these to the curriculum(esp care acurtely
   ill)
   Naturally Occurring Evidence
 1) Significant Event Analysis – 3 per 6 month
  post – file under Significant Event Analysis
 2) Reflection on key learning points from each
  post – file in Reading – expected length 1 side
  A4
 3) Audit or QoF review or NPMS Project – x1 in
  3 year training – file in Audit/ Project
               NOE (cont)
 4) Case study – 2 per year – file in Audit
 5) Statement of Total Leave Taken – file in
  courses/certificates
 6)Attendance Record at VTS teaching – supplied
  by VTS administrator
 7) Complaints and adverse incident reports – if
  any. File in Professional Conversations
                       Learning Log
Role of the Learning Log
 Your learning log is your personal learning record. Log entries
  that you choose to ‘share’ can be read and commented on by
  your clinical or educational supervisor. These entries will
  contribute to the evidence that your educational supervisor will
  consider at your 6 monthly educational supervision meetings.
 Maintaining your log is therefore just as important as completing your formal
  assessments.
 Log entries can contribute to your evidence in two ways. They
  determine your curriculum coverage and contribute to the
  evidence in the 12 competency areas if they are ‘validated’.
                 Learning Log
When linking to curriculum headings take care to look at
  the learning objectives in the relevant curriculum
  statement and ask yourself:
 - does my log entry provide evidence that relates to the
  specific learning objectives in this statement?
 Although in many cases an individual entry may merit
  more than one curriculum heading, try to ensure that you
  don’t choose inappropriate ones.
 Greater reflection and ability to validate against
  competences is likely with clinical encouters;SEA rather
  than lectures or tutorials( which can still be useful for
  curriculum coverage)
                   Log entries
Log entries should on average show:
 evidence of critical thinking & analysis, describing own
  thought processes
 self awareness demonstrating openness and honesty
  about performance and some consideration of feelings
  generated
 evidence of learning, appropriately describing what
  needs to be learned, why & how
 appropriate linkage to curriculum
 demonstration of behaviour that allows linkage to one
  or more competency areas
Gibbs Reflective Cycle
Reflection template
Reflective Writing: role and functions
• To maximise the effectiveness of experiential
  learning
• To evaluate one’s practice
• To promote critical thinking
• To facilitate the integration of theory with practice
• To generate theory
• To evaluate a learning activity
• To demonstrate that learning has taken place
  Reflective writing: description
• What were the significant background factors to
  this experience?
• Describe the experience
– Sequence of events
– Actions
– Observations
• What essential factors contributed to the
  experience?
     Reflective Writing: analysis
• What were the consequences of my actions?
• How do I feel about the experience?
• What factors influenced my decision and actions?
• What knowledge influenced my decision and
  actions?
     Reflective Writing: evaluation
    What went well; what went badly?
    Could I have dealt better with the situation?
    What other choices did I have?
    What would have been the consequences of
    acting on these other choices?
    Reflective Writing: action plan
  How should I change my practice?
 Behaviour
 Standards, procedures
• Should I suggest changes in policy?
• What constraints may exist?
Review changes and their effects!
Reflective Writing: new perspectives
• What have I learnt from this experience?
• How has this experience affected my thinking?
                            Validation
Why does validating entries matter?
   The learning log helps to balance the educational portfolio and
    provides additional evidence of learning and progression,
    capturing evidence from learning opportunities in the workplace.
   There is no limit to the number or quality of entries that trainees
    can make in their eportfolios,
     but not all of them can or should be validated. For example, attendance at
     VTS seminars. Entries which cannot be validated may still be useful for
       curriculum coverage.
   Once validated, each entry then forms part of the trainee’s evidence of
    progression.
   Entries are validated against the 12 areas of the competency
    framework.
                    Validation
What does validating an entry mean?
the entry fulfils the following two requirements:
 a) It addresses one or more of the 12 competence areas
 b) It demonstrates meaningful reflection
 By validating a log entry you are confirming that this is
  valid evidence of learning in an appropriate competency
  area. You are not making a judgement about whether
  that competence has been achieved.

   Who Reads entries and validates-ES or CS?
Competence Area                     MSF   PSQ   COT   CbD   CEX   CSR



                                    x     x     x           x     x
Communication and consultation
   skills



                                          x     x     x           x
Practising holistically




                                    x           x     x     x     x
Data gathering and interpretation




                                    x           x     x     x     x
Making a diagnosis/decisions




                                    x           x     x     x     x
Clinical management




                                                      x     x     x
Managing medical complexity




                                                      x
Primary care admin and IMT
                                                                  x


                                    x                 x           x
Working with colleagues and in
    teams



                                                      x           x
Community orientation




                                    x                       x     x
Maintaining performance,
     learning and teaching



                                    x                 x           x
Maintaining an ethical approach




                                                      x           x
Fitness to practise                 x
   Example of a good log entry
Current Selections
 Professional competences 4 Making a
  diagnosis
 Professional competences 5 Clinical
  management
 Curriculum statement headings 8 Care of
  children and young people
 Curriculum statement headings 15
  Cardiovascular problems
              What Happened?
A 2 week old baby was brought to the surgery with a
  history of a few days of coryzal symptoms and poor
  feeding. The parents thought that the baby had a viral
  infection. I examined the baby and thought that she
  had some crepitations on the left lung. She was also
  tachypnoeic and tachycardic. I was concerned about
  this baby as she was not feeding well and the parents
  mentioned that she had been more sleepy than usual. I
  discussed the case with the paeds registrar on call, who
  said it sounded like bronchiolitis and suggested
  conservative management. However I stressed that I
  felt this baby needed to be assessed as she was not well
  and eventually the paeds registrar agreed to see the
  child.
     What happened subsequently
   While in the children’s emergency department,
    the baby had a cardiorespiratory arrest, was
    resuscitated and transferred to a hospital in
    London. She had coarctation of the aorta and
    left basal consolidation of the left lung. She was
    subsequently operated on and is now
    progressing well in intensive care.
            What did you learn?
   To be aware that accurate assessment of a baby
    is vital as they can be seriously unwell and only
    display non-specific symptoms. I am very glad
    that I insisted on sending the baby to hospital
    despite the objections of the paediatric registrar.
    It felt very awkward at the time, but it has taught
    me to trust my judgement and I will find it easier
    to be more assertive next time
    What will you do differently in the
                 future?
   On reflection, the baby arrested while she was in
    the CED. The parents took her there by car. I
    could have arranged a blue light ambulance to
    take her to hospital. However, although I
    thought she was unwell, I did not expect such a
    serious underlying problem and she was
    certainly not looking like a baby that was about
    to arrest.
    An example of a good reflective log
                  entry
   What further learning needs did you      Need to refresh my memory re:
    identify?                                 congenital heart disease & its
                                              presentation in neonates.
   How & when will you address these?       GP notebook & paediatric textbook, in
                                              the next couple of weeks.
   Record created                           15/12/2009 21:24:32

   Comments                                 [16/12/2009 18:50:36] (Educational
                                              Supervisor) You did extremely well
                                              here, recognising the baby was not well
                                              and sticking by your own clinical
                                              judgment when a more specialist
                                              doctor was suggesting an alternative.
                                              This can be a difficult thing to do and
                                              in this case saved this baby’s life. Well
                                              done.
   Example of a good log entry
Current Selections
 Professional competences 4 Making a
  diagnosis
 Professional competences 5 Clinical
  management
 Curriculum statement headings 8 Care of
  children and young people
 Curriculum statement headings 15
  Cardiovascular problems
    An example of a good reflective log
                  entry
   How does this compare with your entries.
   Are the curriculum statements valid?
   What can you learn form this?
                  E portfolio
   Look at own entries in groups of 3.
   How does your reflection compare against the
    criteria?
   Do you think these are correctly linked?
   Could these be validated against competences?
   How could you improve your entries? Provide
    examples.
    Reflection and validation exercises
   Eportfolio j smith2
   Password jsmith2
   Dr Pauline example
   Can use dummy system
   The username is trainer1
    The password is rcgp
             PLENARY
   ANY LEARNING TO SHARE
   FEEDBACK FORMS
   FUTURE LEARNING NEEDS

				
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