WPBA-A COMPETENCE BASED FRAMEWORK

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					ADVANCED MASTERY OF THE e-
         PORTFOLIO
   -A COMPETENCE BASED
        FRAMEWORK


      TRAINERS WORKSHOP
             12.10.10
           RIPON SPA
         SET OBJECTIVES
   WHAT DO YOU WANT TO GET OUT OF
    TODAY?
                       Programme
   930 Agenda setting
   945 Update in e-portfolio v5 /Clustering –the RDMP model
   1000 How do we fill in an ES report. Difficulties.Hot tips.
   1030 The journey from ES to panels
   1100-1115 Coffee
   1115 Validation and reflection-exercises in groups
   1230 Update from Deanery
   1245-1330 Lunch
   1330 Trainees in Difficulty
   1500-1515 Tea
   1515 E-portfolio practice and validity tasks.
      An exercise in Observation
   http://www.youtube.com/watch?v=Rbmai1b__
    i4
              UPDATE Eportfolio v5
RCGP update-Positive ideas
 Expanded rating scales-relate to stage-
        NFD – Below Expectations; NFD – Meets Expectations; NFD – Above
         Expectations
        Competent for Licensing
        Excellent
   Each part is on a separate web page - helps to concentrate on each before a
    summary in the seventh part. Each can be saved
   All the evidence for each section is provided on same page.
        Eg the curriculum coverage now provides a curriculum map which can delve into
         before making comments.
        ES rating scales - all the evidence has been pooled together quite nicely. No more
         clicking out of the 'review' section and having to delve into other menus and
         options first.
   Ensures you sign the educational work contract. You can't do a review
    without signing it. Means that we are now less likely to be crucified for not
    having signed the ed. work contract when it comes to ARCP time.
EDUCATIONAL SUPERVISON
   What do we find hard?
   Preparation STs
   Preparation ES
   Documentation-ES report
   Ensure that judgments are fully evidence based
    and referenced.
   Controversies
               ES Controversies
   Time
   Pay
   Validity
   Lack of Guidance
   Do we need to spend as much time for all? Or
    concentrate on those with difficulties?
   Giving feedback.
   Who reads? CS or ES?
   Validation and linkage
   Reflection
            STs-PRE ES meeting
   Arrange meeting!
   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.
               ES pre meeting
   How much do we look at ?
   How long should we spend?
   How to gain the evidence for competences? See
    appendix
   ESR report when looking at evidence or after
    meeting?
   Ensuring evidence is referenced not feelings
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
         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
         Deanery Guidelines ES
“The deanery expects all trainers to be an ES so we need
  to make sure it is achievable “
 read entries, link these to competencies and provide
  feedback
 provide other feedback re: number of log entries/
  whether getting behind on OOH requirements, formal
  assessments numbers of entries/ style of entries etc.
 assess the Naturally Occurring Evidence at the times of
  the ESRs
 There should be a high level of supervision throughout
  the final year as the year will be entirely in GP
          Deanery expectations ES
   Educate trainees about the quality and reflectiveness of the log
    entries from ST1
   You need to be more vigilant at the ST2 stage when in hospital
    often to ensure do not lose sight of attaining GP competencies .
   There is a move to expect more virtual supervision of e
    portfolio by the ES… more reading and responding to log diary
    entries, more use of 'educators notes' (to indicate progress ). we
    do not see doing the ESR meetings as whole role of the ES but
    that these meetings are punctuations on a continuous ( if
    intermittent) interaction between ES and GPSTR!
   Those who are behind/ under performing will need more
    meetings , as well as more continuous checking and reading and
    feeding back etc.
              After ES meetings
   MUST generate an "Educational Supervisor's Report"
    (ESR).
   This report will highlight any difficulties - either
    personal, educational or with the post.. Educational
    supervision is not about disciplinary procedures but
    more about helping you overcome or see you through
    the difficulties.
   The report has an "agreed action plan" to help your
    training journey become smoother.
   The report must be uploaded onto the e-portfolio.
         ESR suggested framework
   Create a review-in advance-reasons
       So that the Trainee's evidence appears in the correct Review
        period
       For an Educational Supervisor to release the PSQ and MSF
        results to the Trainee, they need to have the current review
        set. The system will not allow these to be released if this is
        not currently set.
       Under the new system, in order to make the Trainee “Self
        Rating” Review specific, a Review needs to exist to give the
        trainee this option.
   View and comment on Curriculum Coverage
   View and comment on Skills Log
   Review and comment on the PDP
   Review the Trainee’s Self Assessment of
    Competence
                             ESR Review 2
   Review each of the 12 areas of Competence
   Make an "evidence-based" judgement about the progress of the trainee in
    each of the twelve areas, looking at evidence from the linked forms and
    learning log entries.
        Decide on a rating
        Give evidence to support this rating
        Decide on specific actions to help with progression before the next review
   The trainee is required to go through the same process in their “self
    assessment” of competence
   You will not be able to continue to the next stage of the review process until all sections have
    been completed
   Finish Review
   Review the summary of all comments and actions
        Comment on the quality of the evidence provided
        Make a Recommendation
        Agree a Learning Plan
   The review details can then be edited, saved and edited later, or the review
    can be completed and submitted.
                              ESR
   How do we do it?
   Suggestions re framework-RAM idea
   a) click on learning log and review; look at the NOE (Audit,
    SEA, reflection of post)
    b) click on evidence - review CBDs, COTs, CEXs - minimum
    numbers, competence mapping
    c) stay on evidence - review PSQ, MSF and CSR - look for
    themes
    d) click on the 'Educators' Notes' and see what themes there are
    there
    e) Now click on 'create review' and go through the ESR form in
    order using the evidence made available to you on each page and
    bringing in other stuff noted from steps a)-d).
                Post coffee
   http://www.youtube.com/watch?v=6EElqrgk4
    N0&feature=related
                     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
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
                             Reflection
How do I decide which competence area to attach?
    You may select more than one area if you believe the entry merits this.
   Trainees will be expected to demonstrate progression in all 12-competency
    areas (and hence to have a corresponding spread of validated entries).

How do I decide whether the entry shows ‘meaningful
 reflection’?
   The trainee should demonstrate the impact on their practice of the experience
    they describe. This may relate to new knowledge and skills or a0n effect on
    insight and attitude.
   The quality of the reflection should be judged against the learner’s stage of
    training with sophisticated reflection as progress.

How should I comment on the log diary entry?
   Your comments vital feedback and should respond to their reflection.
   If you have decided to validate an entry against a competence area, you
    should describe in your view why it has addressed the area you have chosen
    (and this may include your suggestions for further development)
Reflection template
                            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 by you, 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?
 It means that you, in your role as trainer or educational
  supervisor, are confident that 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.
    Reflection and validation exercises
 Eportfolio j smith2
 Password jsmith2

 Dr Pauline example

Task 1- first 3 entries 13.2-7.4.08
     Appropriate no of entries?
     Critically appraise the entry and justify

     Curriculum linkage-acceptable

     Advice re further entries -reflection,linkage etc
                                Task 2
        Log entries 7.6.08-1.7.08
    1.     How many log entries do we read? Does it cahange at
           different stages of training.
    2.     ES comments
              Try making your own pre read comments
              What is function?/how often?
              Comment on quality presented and how may improve
    3.     Validation
              Appropriate?
              Alternatives?
              How many validated entries per week/?
                      Task 3
   Last 2 log entries 4.7.08 9.7.08
   How to validate
   Comments?
   Plenary? Anything to ask or share?
        Lessons from ARCP panels
   Best composition of panel-TPD(Chair)/Trainer who is
    and ES/lay member /Deanery rep
   Evidence given by somebody who does not know ST
    well
   The ‘progress to certification’ view on the portfolio is
    effectively the Educational Supervisor’s report. The
    reviewer’s job prior to the panel is to check that the ES’s
    judgement is backed by evidence in the portfolio and is
    appropriate.
   A Note on OOP-Those trainees ‘Out of Programme’ (eg
    maternity, sick or abroad), still need an ES review. If
    there is substantial evidence in that review period, it
    needs commenting on. If not, mark the review as ‘refer
    to panel’
     Lessons from ARCP panels 2
   For CCT-four critical items: attainment of
    Competences, AKT, CSA, and the must-dos of
    OOH and NOE . If on track ,evidence
    appropriately backed up-minimal discussion &
    quick look at learning log.
   If less straightfoirward –illustrative not
    exhaustive, evidence based not anecdotal
   Curriculum coverage /PDP more for ongoing
    supervision than satisfactory progression.
    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
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.
                            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 is considered to be unsatisfactory.
   Clustering/demand
                 OOH cont
Advise STs 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)
NOE-Naturally Occurring Evidence
   Deanery gives advice/ guidance as to evidence
    that occurs naturally or “Records experience”
    that should be submitted annually
   Despite multiple emails –commonest area that
    Sts fall down on.
   Is it legally enforceable as a local Yorkshire
    criteria?
   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
WPBA – correct number for ST year?


CBD


COT/MiniCEX


MSF


PSQ


CSR


PDP


Log diary (at least minimum number of entries spread
over time, evidence of reflection and development,
appropriate links to curriculum)
OOH


Records of NOE (Naturally Occurring Evidence):         Access full details of NOE requirements via the link opposite
Significant Event Analysis (6)


Reflection on key learning points from each post


Audit (during GP attachment) (1)
or Reflection on QOF (1)
or Project fitting the NPMS criteria (1)
                E-portfolio
   Post tea
   What happened next?
   http://www.youtube.com/watch?v=mhRxyGlU
    2mQ
         Using the e-portfolio
In small groups
 Practice using new ES report set review own
  ES-and look at how presented and changes.
 Decide on a framework to present back for the
  most efficient way to assess evidence/ESR rv.
 Look at examples of ES descriptors-use sheets
  and own examples.
   Find alternatives
   Give examples of good and weak evidence in ES
    reports (use appendix criteria)
Table 1. Criteria used for assessing EducationalSupervisors’ Reports.

                            Not acceptable                                   Acceptable

  a)   The basis for judgements is not clear, i.e. they are not            Judgements are
       referenced to the evidence. I.e. they are not linked to              generally referenced
       evidence or there is a substantial lack of evidence to               to the available
       support the judgments made by the educational supervisor.            evidence
  b)   Where the judgements can be evaluated, they do not
       appear to be justifiable. I.e. where evidence has been              Judgements appear
       cited for any judgments, the accuracy or robustness of the           to be justifiable
       linked evidence is questionable.
  c)   No comment is made on the current state and the                     The current state
       progression of competence. I.e. there are gaps in the                and the progression
       content of the report or a current ESR is absent.                    of competence are
                                                                            made clear

                                                                           Suggestions for
  d)   Suggestions for trainee development are inadequate                   trainee development
       in number and/or quality. I.e. constructive suggestions              are routinely made
       for how the candidate might progress are lacking.                    and appear to be
                                                                            appropriate
             PLENARY
   ANY LEARNING TO SHARE
   FEEDBACK FORMS
   FUTURE LEARNING NEEDS
CLOSE
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: new perspectives
• What have I learnt from this experience?
• How has this experience affected my thinking?
    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!
   Feedback for ES – using RCGP ESR
               descriptors
Not acceptable
 The basis for judgements is not clear, ie they are not referenced
 to the evidence
  Where the judgements can be evaluated, they do not appear to be justifiable
 No comment is made on the current state and the progression of
 competence
 Suggestions for trainee development are inadequate in number
 and/or quality
Acceptable
 Judgements are generally referenced to the available evidence
  Judgements appear to be justifiable
 The current state and the progression of competence are made clear
 Suggestions for trainee development are routinely made and appear to be
  appropriate

Highlights
 Suggestions for Improvement
                Competences
   How do we demonstrate
   Are there any other ways
   What are the difficult competences?
   Why?
   What can we do to help?
    COMPETENCES THAT WE
       STRUGGLE WITH
 FITNESS TO PRACTICE
http://www.gmc-
  uk.org/guidance/case_studies.asp
GMC interactive videos
 Community Orientation

 Managing Complexity
                        CBD
   How do we make it more relevant
   Using as a tool to get the difficult domains eg
   medical complexity
   Community orientation
   Fitness to practice
   Use examples
          Potential Agenda Items
   ePortfolio update
   Preparing for ES and ARCP for STs and ES
   Reflection and validation of log entries
   Why do Sts struggle at ARCP
   Naturally occurring evidence
   How to enable STs to achieve difficult competences
   How to improve our entries as ES
   Curriculum v competences
   Competences/CBD
   ID problem STs-triangulation with portfolio

				
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