nMRCGP and WPBA

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					new Membership of the Royal College of General Practitioners
Work Place Based Assessment
  36 month process (for GP specialist trainees starting Aug
   07)
  Trainee led
  Trainees use ePortfolio to amass evidence
        many tools to provide evidence of competence, depending on context
        aim to demonstrate competence in number of domains by end of WPBA
         ▪ The standard by which you should assess, throughout WPBA, is “fit for
            independent practice in UK NHS general practice”
         ▪ Tools have a rating scale ‘needs further development’, ‘competent’, ‘excellent’
            (+ ‘insufficient evidence’ = not assessed)
         ▪ Important note: the step before ‘competent’ is not ‘incompetent’ - trainees at
            the beginning of WPBA are expected to have professional developmental needs




nMRCGP & WPBA introduction for clinical supervisors
  The RCGP website provide the latest information and
   guidance
    http://www.rcgp.org.uk/
    It is being continually updated.
  Whilst the process is Trainee led, this will be supported by
   an educational supervisor
  There are 3 monthly reviews throughout training at
   which progress will be reviewed and actions agreed




nMRCGP & WPBA introduction for clinical supervisors
http://www.rcgp-curriculum.org.uk/
http://www.rcgp-curriculum.org.uk/extras/curriculum/index.aspx


   The curriculum covers
    the knowledge and
    skills that all GP StRs
    need to learn in order
    to deliver the highest
    quality standards of
    patient care




               nMRCGP & WPBA introduction for clinical supervisors
   The WPBA is designed to assess what trainees actually do
   12 competences
     Best tested in the workplace setting
     Developmental progression for each competency area
     Competency demonstrated “when ready”
     Process is learner led
   Triangulated
     Different raters
     Many tools (e.g. CBD, COT, CEX, DOPS, MSF and PSQ)
     Different settings (general practice and secondary care)




    nMRCGP & WPBA introduction for clinical supervisors
1.   Communication and                                     7.  Primary care
     consulting skills                                         administration and IMT
2.   Practising holistically                               8. Working with colleagues
3.   Data gathering and                                        and in teams
     interpretation                                        9. Community orientation
4.   Making a diagnosis/                                   10. Maintaining performance,
     making decisions                                          learning and teaching
5.   Clinical management                                   11. Maintaining an ethical
6.   Managing complexity and                                   approach to practice
     promoting health                                      12. Fitness to practise




     nMRCGP & WPBA introduction for clinical supervisors
   Some tools will be
    familiar from FY1 & 2,                       CbD       Case based discussion
    but may be applied                           COT       Consultation observation
    differently for GP                                      tool (GP only)
    training                                     DOPS      Directly observed
                                                            procedures
   The different tools test                     CEX       Clinical evaluation exercise
    different competency                         MSF       Multi-source feedback
    areas                                        NOE       Naturally occurring
                                                            evidence
   Not every tool is used                       PSQ       Patient satisfaction
    in every setting (ie                                    questionnaire (GP only)
    primary vs secondary                         CSR       Clinical supervisor’s report
    care)



      nMRCGP & WPBA introduction for clinical supervisors
                                                   CbD          COT   DOPS   CEX   MSF   NOE   PSQ
Communication and consulting skills                                                       

Practising holistically                                                                  
Data gathering and interpretation                                                         

Making a diagnosis/ making decisions                                                      

Clinical management                                                                      
Managing complexity and promoting health                                                    

Primary care administration and IMT                                                         

Working with colleagues and in teams                                                       

Community orientation                                                                  
Maintaining performance, learning and teaching                                          

Maintaining an ethical approach to practice                                                 

Fitness to practise                                                                        


          nMRCGP & WPBA introduction for clinical supervisors
                1                Communication and consultation skills
     This competency is about communication with patients, and the use of recognised consultation techniques.

        Insufficient Evidence             Needs Further                      Competent                     Excellent
     From the available                    Development              Explores the patient’s         Incorporates the patient’s
     evidence, the doctor’s        Develops a working               agenda, health beliefs and     perspective and context
     performance cannot be         relationship with the patient,   preferences.                   when negotiating the
     placed on a higher point of   but one in which the             Elicits psychological and      management plan.
     this developmental scale.     problem rather than the          social information to place
                                   person is the focus.             the patient’s problem in
                                                                    context.
                                   Produces management              Works in partnership with      Whenever possible,
                                   plans that are appropriate to    the patient, negotiating a     adopts plans that respect
                                   the patient’s problem.           mutually acceptable plan       the patient’s autonomy.
                                                                    that respects the patient’s
                                                                    agenda and preference for
                                                                    involvement.
                                   Provides explanations that       Explores the patient’s         Uses a variety of
                                   are relevant and                 understanding of what has      communication
                                   understandable to the            taken place.                   techniques and materials
                                   patient, using appropriate                                      to adapt explanations to
                                   language.                                                       the needs of the patient.
                                   Achieves the tasks of the        Flexibly and efficiently       Appropriately uses
                                   consultation but uses a rigid    achieves consultation tasks,   advanced consultation
                                   approach.                        responding to the              skills such as
                                                                    consultation preferences of    confrontation or catharsis
                                                                    the patient.                   to achieve better patient
                                                                                                   outcomes.




nMRCGP & WPBA introduction for clinical supervisors
                    2                Practising holistically
        This competency is about the ability of the doctor to operate in physical, psychological, socio-economic and cultural
        dimensions, taking into account feelings as well as thoughts.

           Insufficient Evidence             Needs Further                     Competent                      Excellent
        From the available                    Development            Demonstrates                    Uses this understanding
        evidence, the doctor’s        Enquires into both physical    understanding of the patient    to inform discussion and
        performance cannot be         and psychological aspects      in relation to their socio-     to generate practical
        placed on a higher point of   of the patient’s problem.      economic and cultural           suggestions for patient
        this developmental scale.                                    background.                     management.
                                      Recognises the impact of       Additionally, recognises the    Recognises and shows
                                      the problem on the patient.    impact of the problem on        understanding of the limits
                                                                     the patient’s family/carers.    of the doctor’s ability to
                                                                                                     intervene in the holistic
                                                                                                     care of the patient.

                                      Uses him/herself as the        Utilises appropriate support    Organises appropriate
                                      sole means of supporting       agencies (including primary     support for the patient’s
                                      the patient.                   health care team members)       family and carers.
                                                                     targeted to the needs of the
                                                                     patient.




nMRCGP & WPBA introduction for clinical supervisors
                     3                 Data gathering and interpretation
        This competency is about the gathering and use of data for clinical judgement, the choice of examination and
        investigations and their interpretation.

           Insufficient Evidence             Needs Further                   Competent                         Excellent
        From the available                    Development            Systematically gathers           Proficiently identifies the
        evidence, the doctor’s        Obtains information from       information, using questions     nature and scope of
        performance cannot be         the patient that is relevant   appropriately targeted to the    enquiry needed to
        placed on a higher point of   to their problem.              problem.                         investigate the problem.
        this developmental scale.
                                                                     Makes appropriate use of
                                                                     existing information about
                                                                     the problem and the
                                                                     patient’s context.


                                      Employs examinations and       Chooses examinations and         Uses an incremental
                                      investigations that are        targets investigations           approach, basing further
                                      broadly in line with the       appropriately.                   enquiries, examinations
                                      patient’s problem.             Identifies the implications of   and tests on what is
                                      Identifies abnormal findings   findings and results.            already known and what
                                      and results.                                                    is later discovered.




nMRCGP & WPBA introduction for clinical supervisors
                    4                 Making a diagnosis/making decisions
        This competency is about a conscious, structured approach to decision-making.

            Insufficient Evidence           Needs Further                   Competent                        Excellent
        From the available                   Development            Addresses problems that         Uses methods such as
        evidence, the doctor’s        Taking relevant data into     present early and in an         models and scripts to
        performance cannot be         account, clarifies the        undifferentiated way by         identify patterns quickly
        placed on a higher point of   problem and the nature of     integrating information to      and reliably.
        this developmental scale.     the decision required.        aid pattern recognition.        Uses an analytical
                                                                    Uses time as a diagnostic       approach to novel
                                                                    tool.                           situations where
                                                                    Uses an understanding of        probability cannot be
                                                                    probability based on            readily applied.
                                                                    prevalence, incidence and
                                                                    natural history of illness to
                                                                    aid
                                                                    decision-making.
                                      Generates and tests an        Revises hypotheses in the       No longer relies on rules
                                      appropriate hypothesis.       light of additional             alone but is able to use
                                      Makes decisions by applying   information.                    and justify discretionary
                                      rules or plans.               Thinks flexibly around          judgement in situations of
                                                                    problems, generating            uncertainty.
                                                                    functional solutions.




nMRCGP & WPBA introduction for clinical supervisors
                5                 Clinical management
This competency is about the recognition and management of common medical conditions in primary care.
      Insufficient Evidence               Needs Further Development                      Competent                                     Excellent
From the available evidence, the   Recognises the presentation of common Utilises the natural history of common        Monitors the patient’s progress to
doctor’s performance cannot be     physical, psychological and social     problems in developing management            identify quickly unexpected deviations
placed on a higher point of this   problems.                              plans.                                       from the anticipated path.
developmental scale.               Responds to the problem by routinely   Considers simple therapy/expectant           Uses drug and non-drug methods in
                                   suggesting intervention.               measures where appropriate.                  the treatment of the patient,
                                                                                                                       appropriately using traditional and
                                                                                                                       complementary medical approaches.
                                  Uses appropriate but limited                 Varies management options               Generates and offers justifiable
                                  management options with little flexibility   responsively according to the           approaches where specific guidelines
                                  for the preferences of others.               circumstances, priorities and           are not available.
                                                                               preferences of those involved.

                                  Makes appropriate prescribing decisions, Routinely checks on drug interactions Prescribes cost-effectively but is able
                                  routinely using important sources of     and side effects and shows awareness to justify transgressions of this
                                  information.                             of national and local prescribing     principle.
                                                                           guidance.

                                  Performs up to, but does not exceed, the     Refers appropriately and co-ordinates   Identifies and encourages the
                                  limits of their own competence.              care with other professionals in        development of new resources where
                                                                               primary care and with other             these are needed.
                                                                               specialists.
                                  Ensures that continuity of care can be       Provides continuity of care for the     Contributes to an organisational
                                  provided for the patient’s problem e.g.      patient rather than just the problem,   infrastructure and professional culture
                                  through adequate record keeping.             reviewing care at suitable intervals.   that allows continuity of care to be
                                                                                                                       facilitated and valued.


                                  Responds rapidly and skilfully to            Appropriately follows-up patients who   Ensures that emergency care is co-
                                  emergencies.                                 have experienced a medical              ordinated within the practice team and
                                                                               emergency, and their family.            integrated with the emergency
                                                                                                                       services.
          nMRCGP & WPBA introduction for clinical supervisors
                    6               Managing medical complexity
          This competency is about aspects of care beyond managing straightforward problems, including the
          management of co-morbidity, uncertainty and risk, and the approach to health rather than just illness.

           Insufficient Evidence            Needs Further                 Competent                     Excellent
          From the available                Development            Simultaneously manages        Accepts responsibility
          evidence, the doctor’s     Manages health                the patient’s health          for coordinating the
          performance cannot be      problems separately,          problems, both acute and      management of the
          placed on a higher point   without necessarily           chronic.                      patient’s acute and
          of this developmental      considering the                                             chronic problems over
          scale.                     implications of                                             time.
                                     co-morbidity.
                                     Draws conclusions when
                                     it is appropriate to do so.
                                     Appropriately prioritises     Is able to tolerate           Anticipates and uses
                                     management                    uncertainty, including that   strategies for managing
                                     approaches, based on an       experienced by the            uncertainty.
                                     assessment of patient         patient, where this is        Uses strategies such as
                                     risk.                         unavoidable.                  monitoring, outcomes
                                                                   Communicates risk             assessment and
                                                                   effectively to patients and   feedback to minimise
                                                                   involves them in its          the adverse effects of
                                                                   management to the             risk.
                                                                   appropriate degree.
                                     Maintains a positive          Consistently encourages       Coordinates a team
                                     attitude to the patient’s     improvement and               based approach to
                                     health.                       rehabilitation and, where     health promotion,
                                                                   appropriate, recovery.        prevention, cure, care
                                                                   Encourages the patient to     and palliation and
                                                                   participate in appropriate    rehabilitation.
                                                                   health promotion and
                                                                   disease prevention
                                                                   strategies.

nMRCGP & WPBA introduction for clinical supervisors
                    7                Primary care administration and information management and technology
       This competency is about the appropriate use of primary care administration systems, effective record keeping and
       information technology for the benefit of patient care.

          Insufficient Evidence             Needs Further                   Competent                      Excellent
       From the available                    Development            Uses the primary care          Uses and modifies
       evidence, the doctor’s        Demonstrates a                 organisational and IMT         organisational and IMT
       performance cannot be         rudimentary understanding      systems routinely and          systems to facilitate:
       placed on a higher point of   of the organisation of         appropriately in patient            Clinical care to
       this developmental scale.     primary care and the use of    care.                                individuals and
                                     primary care computer                                               communities
                                     systems.                                                           Clinical governance
                                                                                                        Practice
                                                                                                         administration

                                     Uses the computer record       Uses the computer during       Incorporates the computer
                                     and online information         the consultation whilst        records and online
                                     during the consultation.       maintaining rapport with the   information in the
                                                                    patient.                       consultation to improve
                                                                                                   communication with the
                                                                                                   patient.
                                     Routinely records and          Produces records that are      Seeks to improve the
                                     codes each clinical contact    coherent and                   quality and usefulness of
                                     in a timely manner and         comprehensible,                the medical record e.g.
                                     follows the record-keeping     appropriately and securely     through audit.
                                     conventions of the practice.   sharing these with others
                                                                    who have legitimate access
                                                                    to them.




nMRCGP & WPBA introduction for clinical supervisors
                    8               Working with colleagues and in teams
       This competency is working effectively with other professionals to ensure patient care, including the sharing of
       information with colleagues.

          Insufficient Evidence             Needs Further                    Competent                       Excellent
       From the available                    Development            Provides appropriate            Anticipates situations that
       evidence, the doctor’s        Meets contractual              availability to colleagues.     might interfere with
       performance cannot be         obligations to be available                                    availability and ensures
       placed on a higher point of   for patient care.                                              that patient care is not
       this developmental scale.                                                                    compromised.
                                     Appropriately utilises the     Works co-operatively with       Encourages the
                                     roles and abilities of other   the other members of the        contribution of colleagues
                                     team members.                  team, seeking their views,      and contributes to the
                                     When requested to do so,       acknowledging their             development of the team.
                                     appropriately provides         contribution and using their
                                     information to others          skills appropriately.
                                     involved in the care of the    Communicates proactively
                                     patient.                       with team members so that
                                                                    patient care is not
                                                                    compromised.
                                                                    In relation to the
                                                                    circumstances, chooses an
                                                                    appropriate mode of
                                                                    communication to share
                                                                    information with colleagues
                                                                    and uses it effectively.




nMRCGP & WPBA introduction for clinical supervisors
                  9                 Community orientation
       This competency is about the management of the health and social care of the practice population and local
       community.

          Insufficient Evidence              Needs Further                    Competent                     Excellent
       From the available                    Development              Applies an understanding of    Uses an understanding of
       evidence, the doctor’s        Identifies important                 these features to             these features to
       performance cannot be         characteristics of the local         improve the                   contribute to the
       placed on a higher point of   community that might                 management of the             development of local
       this developmental scale.     impact upon patient care,            practice’s patient            healthcare delivery
                                     particularly the                     population.                   e.g. service design.
                                     epidemiological, social,
                                     economic and ethnic
                                     features.
                                     Identifies important             Uses this understanding to     Uses an understanding of
                                     elements of local health            inform referral practices      the resources and the
                                     care provision in hospital          and to encourage               financial and
                                     and in the community and            patients to access             regulatory
                                     how these can be                    available resources.           frameworks within
                                     appropriately accessed by                                          which primary care
                                     doctors and patients.                                              operates, to improve
                                                                                                        local healthcare.
                                     Identifies how the limitations   Optimises the use of limited   Balances the needs of
                                     of local healthcare                  resources, e.g. through    individual patients with the
                                     resources might impact               cost-effective             health needs of the local
                                     upon patient care.                   prescribing.               community, within the
                                                                                                     available resources.




nMRCGP & WPBA introduction for clinical supervisors
                   10                   Maintaining performance, learning and teaching
This competency is about maintaining the performance and effective continuing professional development of oneself and others
         Insufficient Evidence               Needs Further Development                           Competent                                    Excellent
From the available evidence, the        Accesses the available evidence,         Judges the weight of evidence, using     Uses professional judgement to decide when to
doctor’s performance cannot be placed including the medical literature, clinical critical appraisal skills and an         initiate and develop protocols and when to
on a higher point of this developmental performance standards and guidelines understanding of basic statistical terms, challenge their use.
scale.                                  for patient care.                        to inform decision-making.               Moves beyond the use of existing evidence
                                                                                                                          toward initiating and collaborating in research
                                                                                                                          that addresses unanswered questions.


                                        Routinely engages in study to keep             S Shows a commitment to professional             Systematically evaluates performance
                                        abreast of evolving clinical practice and      development through reflection on           against external standards, using this
                                        contemporary medical issues.                   performance and the identification of and   information to inform peer discussion.
                                                                                       attention to learning needs.                     Demonstrates how elements of personal
                                                                                            Evaluates the process of learning so   development are related to the needs of the
                                                                                       as to make future learning cycles more      organisation.
                                                                                       effective.                                       Uses the mechanism of professional
                                                                                                                                   development to aid career planning.

                                             Changes behaviour appropriately in        Participates in audit where appropriate      By involving the team and the locality,
                                        response to the clinical governance            and uses audit activity to evaluate and  encourages and facilitates wider participation
                                        activities of the practice, in particular to   suggest improvements in personal and     and application of clinical governance activities.
                                        the agreed outcomes of audit and               practice performance.
                                        significant event analysis.                    Engages in significant event reviews and
                                             Recognises situations, e.g. through       learns from them as a team-based
                                        risk assessment, where patient safety          exercise.
                                        could be compromised.

                                        Contributes to the education of students I   Identifies learning objectives and                Evaluates outcomes of teaching, seeking
                                        and colleagues.                          uses teaching methods appropriate to              feedback on performance.
                                                                                 these.                                                Uses formative assessment and constructs
                                                                                     Assists in making assessments of              educational plans.
                                                                                 learners.                                            Ensures students and junior colleagues are
                                                                                                                                   appropriately supervised.
                nMRCGP & WPBA introduction for clinical supervisors
                                      Maintaining an ethical approach to practice
                     11
        This competency is about practising ethically with integrity and a respect for diversity.
           Insufficient Evidence              Needs Further                      Competent                        Excellent
        From the available                    Development               Identifies and discusses        Anticipates and avoids
        evidence, the doctor’s        Observes the professional         ethical conflicts in clinical   situations where personal
        performance cannot be         codes of practice, showing        practice.                       and professional interests
        placed on a higher point of   awareness of their own                                            might be brought into
        this developmental scale.     values, attitudes and ethics                                      conflict.
                                      and how these might
                                      influence professional
                                      behaviour.
                                      Treats patients, colleagues       Recognises and takes            Actively promotes equality
                                      and others equitably and          action to address               of opportunity for patients
                                      with respect for their beliefs, prejudice, oppression and         to access health care and
                                      preferences, dignity and          unfair discrimination within    for individuals to achieve
                                      rights.                           the self, other individuals     their potential.
                                                                        and within systems.
                                      Recognises that people are                                        Values diversity by
                                      different and does not                                            harnessing differences
                                      discriminate against them                                         between people for the
                                      because of those                                                  benefit of practice and
                                      differences.                                                      patients alike.




nMRCGP & WPBA introduction for clinical supervisors
                         12                 Fitness to practise
          This competency is about the doctor’s awareness of when his/her own performance, conduct or health, or that of others
          might put patients at risk and the action taken to protect patients.
              Insufficient Evidence                 Needs Further                      Competent                      Excellent
          From the available evidence,               Development             Observes the accepted         Encourages scrutiny and
          the doctor’s performance          Understands and maintains        codes of practice in order to justifies professional
          cannot be placed on a higher awareness of the GMC                  minimise the risk of          behaviour to colleagues.
          point of this developmental       duties of a doctor.              disciplinary action or
          scale.                                                             litigation.
                                            Attends to professional          Achieves a balance            Anticipates situations that
                                            demands whilst showing           between professional and      might damage the work/life
                                            awareness of the importance personal demands that              balance and seeks to
                                            of addressing personal           protects professional         minimise the adverse
                                            needs.                           obligations and preserves     effects.
                                                                             health.
                                            Attends to physical or mental Proactive in taking steps to     Promotes an organisational
                                            illness or habit that might      maintain personal health.     culture in which the health of
                                            interfere seriously with the                                   its members is valued and
                                            competent delivery of patient                                  supported.
                                            care.
                                            Notifies when his/her own or     Promptly, discreetly and      Provides positive support to
                                            a colleague’s performance,       impartially ascertains the    colleagues who have made
                                            conduct or health might be       facts of the case, takes      mistakes or whose
                                            putting patients at risk.        advice from colleagues and, performance gives cause for
                                                                             if appropriate, engages in a concern.
                                                                             referral procedure.

                                          Responds to complaints           Where personal                  Uses mechanisms to learn
                                          appropriately.                   performance is an issue,        from performance issues
                                                                           seeks advice and engages        and to prevent them from
                                                                           in remedial action.             occurring in the
                                                                                                           organisation.




nMRCGP & WPBA introduction for clinical supervisors
                                                         TRAINEE VIA EPORTFOLIO
SUPERVISOR AND TRAINER (OR
OTHER MEMBER OF TEAM)
    Case based discussion                                  Multi-source feedback
    mini-CEX is instead of                                 Naturally Occurring
        COT in secondary care                                Evidence
       Directly Observed                                   Patient Satisfaction
        Procedures                                           Questionnaire
       Naturally Occurring
        Evidence
       Clinical Supervisors
        Report



   nMRCGP & WPBA introduction for clinical supervisors
    Trainee led
    Well planned with adequate notice to
     supervisor
    Preparation by both parties is strongly advised
    Case selection is very important to allow demonstration
     of different competences. All need to be covered to
     complete WPBA
    Each assessment is followed by feedback and completion
     of the forms in the ePortfolio



nMRCGP & WPBA introduction for clinical supervisors
   The college website details the minimum evidence required
    for each post
    http://www.rcgp.org.uk/the_gp_journey/nmrcgp/wpba_and_
    eportfolio/minimum_evidence.aspx
   More assessments may be done if required
   Minima prior to 6 month review (ST1 ST2):-
     3 x CEX (COT in GP)
     3 x CbD
     1 x MSF, 5 clinicians only
     DOPS
     Clinical supervisor’s report


    nMRCGP & WPBA introduction for clinical supervisors
      Allows demonstration of competence in 10 of the 12
       competency areas
      An overall balance of cases is required.
      In ST1 and ST2 - a minimum of 3 CbDs in each 6 month
       post (whether hospital or GP)
      One week prior to the discussion two cases should be
       selected and presented with relevant records to the
       assessor
      The assessor will choose one of the cases for discussion




nMRCGP & WPBA introduction for clinical supervisors
   It is essential that the assessor is given the cases a week in
    advance to allow for proper preparation of questions

   Although not essential, trainees can facilitate a good
    outcome by, in addition to submitting the relevant clinical
    records, also
     providing a commentary of why the case was chosen
     and indicate which competences are demonstrated

   Case selection is important
     It is difficult to demonstrate excellence if the level of challenge is low



    nMRCGP & WPBA introduction for clinical supervisors
    20 minutes discussion per case
      The assessor should use pre-prepared questions designed to
       allow demonstration of competence.
      These questions will focus on things such as what you did and why
       you did it
      One CbD interview is likely to allow approximately three
       competences to be discussed (the others will be graded
       “insufficient evidence”)
    10 minutes for feedback and completion of the
     assessment form (which will be uploaded to your
     ePortfolio)
      The assessment form includes sections for feedback and
         recommendations for further development and agreed action



nMRCGP & WPBA introduction for clinical supervisors
   Mini-CEX is a 15 minute snapshot of doctor/patient interaction, within a
    secondary care setting
   It is designed to assess the clinical skills, attitudes and behaviours of
    trainees essential to providing high quality care
   Trainees will be asked to undertake three observed encounters during 6
    months, with a different observer for each encounter
   Each of these encounters should represent a different clinical problem
    and trainees should sample from a wide range of problem groups within
    the post
   Immediate feedback will be provided after each encounter, by the
    observer rating the trainee
   Trainers and trainees will need to identify and agree strengths, areas for
    development and an action plan for each encounter



    nMRCGP & WPBA introduction for clinical supervisors
    Can occur at any point in training (Primary or Secondary care)
    Opportunities to demonstrate some procedures might present
     more easily in secondary care (eg female genital examination in
     a gynaecology post)
    Trainee chooses the timing, procedure and observer
      A different observer should be chosen for each procedure
    Observer should give feedback afterwards
    Demonstrate DOP “when ready”
    The mandatory procedures are considered sufficiently important
     to merit specific assessment




nMRCGP & WPBA introduction for clinical supervisors
8 MANDATORY DOPS                                11 OPTIONAL DOPS

  Application of simple dressings                  Aspiration of effusion
  Breast examination                               Cauterisation
                                                    Cryotherapy
  Cervical cytology                                Curettage/shave excision
  Female genital examination                       Excision of skin lesions
  Male genital examination                         Incision and drainage of abscess
  Prostate examination*                             Joint and peri-articular
                                                     injections
  Rectal examination*                              Hormone replacement implants
  Testing for blood glucose                         of all types/any types
*rectal and prostate exam may be                    Proctoscopy
                                                    Suturing of skin wound
   combined in one DOP                              Taking skin surface specimens for
                                                     mycology




               nMRCGP & WPBA introduction for clinical supervisors
  2 questions;-
1. Please provide your assessment of this doctor’s overall
   professional behaviour
2. Please provide your assessment of this doctor’s overall
   clinical performance
 Answers on a 7 point rating scale (<very poor> to
   <outstanding>)
 Space for freetext comments under headings
   Highlights in performance (areas to be commended)
   Possible suggested areas for development in performance


    nMRCGP & WPBA introduction for clinical supervisors
 Trainee chooses raters to give MSF
 Trainee gives raters a standard letter explaining
   the process of MSF
   how to complete the online assessments (inc the URL)
   the date by which the assessment should be completed
 Results of MSF go to trainer, who will give feedback to
  trainee
 Results are anonymous, but educational supervisor (not
  trainer) will be aware of who the raters were, to ensure a
  good spread of different raters
 Trainee then adds MSF to ePortfolio


    nMRCGP & WPBA introduction for clinical supervisors
   Downloadable from RCGP website




nMRCGP & WPBA introduction for clinical supervisors