SYSH Postgraduate Dean Office by MikeJenny

VIEWS: 5 PAGES: 28

									                             Sheffield VTS November 2005




            SYSH Postgraduate Dean’s Office



     Report on a triennial visit to a vocational training
                          scheme




Name of VTS:          Sheffield

Date of visit:        10th November 2005

Visitors:             Prof Pat Lane
                      Dr Steve Ball (Lead)
                      Dr Jo Buchanan
                      Dr Gary Chambers
                      Dr Dave Rose
                      Dr Nick Tupper (Observing)




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                                        Sheffield VTS November 2005



Contents

           1. Introduction                                            Form    Page
           2. Note on process                                                  3
           3. Visit Report                                             SA8     4
                a. Findings
                b. Summary
                c. Recommendations
                d. Outcome
           4.   Report on Release Course (1,2)                         SA3        10
           5.   Report on Administrative and Educational
                                                                       SA4        13
                       Resources
           6.   Report on Meeting with Trainees                        SA5        14
           7.   Report on Trainer Workshop                             SA6        19
           8.   Report on GP Tutors – CME                              SA7        21

           9. Appendix
                a. Criteria for Vocational Training Schemes SYSH       SA2        25




Key:

Throughout the reports the following convention is used in grading a criterion.

E      Essential standard met
E*     Essential standard met: no desirable standard is specified
D      Desirable standard is met




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                                     Sheffield VTS November 2005             SA8




Note on Process
SYSH Deanery, as part of its mandate to quality assure Vocational
Training for General Practice within the Deanery, conducts a series of visits
to each of the Vocational Training Schemes. These visits are on a three
yearly cycle.

Prior to the visit the VTS is asked to complete a self assessment against
the published criteria, which the Deanery will assess at the visit. All criteria
have an essential standard; some have a desirable standard. Each
criterion must be fulfilled to at least the extent of the essential standard, for
the VTS to have been judged as successful.

The Visitors conduct interviews with current trainees, course organisers
and administrative staff. The visitors observe some teaching on the release
scheme. Separate arrangements are made to observe a trainers‟
workshop. The GP Tutors (CME) are interviewed as a separate part of this
process.

If all the criteria have been met the Deanery re-approves the scheme for a
further period of three years, re-appointing the Course Organisers and GP
Tutors for the same period.




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                                 Sheffield VTS November 2005            SA8



Visit Report

A. Findings


     Criterion           Comments


1    Hospital Posts

1.1 Identification of    Future needs of scheme: problems enumerated.
    new hospital         Meeting planned in 2 weeks to progress. Current
    posts                state understood via Mid Point Visits and other
                         contacts with consultants. Weaknesses known of
                         some posts. Joint Hospital Visits not generally
                         attended but liaison through Faculty Admin prior to
                         visit. (E)

1.2 Monitoring of        Strong reporting system via MPV with continuity and
    existing hospital    leadership from CO‟s. Informal routes via trainees on
    posts/GP trainers    release scheme and forum. Significant issues
                         identified over several trainee attachments in three
                         posts. (O+G Jessop, Respiratory RHH, Med RHH.)
                         (D)

1.3 Relationships with   Clear process in place at MPV. (Stability and
    hospital             continuity through appointing a tutor to link with
    consultants          individual specialty for a reasonable length of time.)
                         Steering committee attended by variable numbers of
                         consultants. Liaison via VTS office for updates,
                         information exchange. (E*)

1.4 Course              Contact prior to visit with RCGP visitor. CO attends
    Organisers‟ role in educational contract review to offer feedback.
    re-approval of      Successful process for 3 trusts (SCH, STH, SCT) (E)
    hospital posts




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                                   Sheffield VTS November 2005            SA8



2    General Practice Posts

2.1 Identification of,    New to Training workshop, led by newly appointed
    and support for,      trainers. 14 new trainers supported since last visit.
    potential trainers.   Clear process to support through approval with
                          progressive formality. Scheme involved in F2
                          canvassing. One CO involved in deanery review of
                          standards linking undergrad, F2, postgraduate
                          training. (D)

2.2 Identification of,    Successfully appointed to recent vacancies; filling
    and support for,      posts with GP‟s who have familiarity with the VTS.
    potential course      CO‟s were able to highlight others who may be
    organisers            interested in future vacancies and had thoughts on
                          developing processes to ensure a future supply, e.g.
                          Innovative Training Posts in Med Ed. (E*)

2.3 Course              Reliably provides briefed tutors for own visits and
    Organisers‟ role in has supported neighbouring schemes where
    approval and re-    possible. (D)
    approval of GP
    trainers

2.4 Trainer               5 separate workshops. 2 plenaries p.a. Separate
    workshops             workshops for high interest areas. Meets 20 hours
                          standard for each workshop. Most workshops self
                          led and resourced – support available from CO‟s
                          when required. Evidence from interviews of new
                          trainers suggests The New to Training workshop
                          functions very well. Has provided resource to other
                          schemes e.g. nMRCGP curriculum workshop. (D)

2.5 Other educational     Examples available to illustrate CO‟s support for
    activities for GP     VTS initiatives and Deanery wide course. National
    trainers              resources have been invited to support changes in
                          GP training. (D)




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                                 Sheffield VTS November 2005           SA8



3    GP Registrars

3.1 Selection Process for Provides required sessions to support this. 2
    GPR‟s                 tutors involved in development. Many trainers
                          involved too. (E*)

3.2 Release Course         Several groups run, depending on trainee
                           seniority and current post. Each group meets time
                           requirement. Attendance rates variable for
                           hospital trainees. Greatest variable is probably
                           the trainee but recent problem in O+G (Jessop)
                           needs monitoring. Paeds (SCH) and AE (NGH) an
                           issue but successfully offer high quality protected
                           teaching in these posts relevant to GP, so
                           attendance is lower. Reasonable to make
                           allowance in these latter circumstances. Trainees
                           involved in delivering the programme. (D)

3.3 Other Educational      Info re ITP‟s easily accessible. Sustained
    Activities for GPR‟s   competition for terminal and intercalated posts.
                           Innovative Training Year started recently. Study
                           leave review and consequent action in place.
                           Courses for particular study areas annually (minor
                           ops, rheum, derm, FP) (D)

3.4 Monitoring of          Strong consistent record of visiting post
    Performance of         incumbents. Recently reviewed. Information
    GPR‟s                  handled appropriately at tutor group level. RITA
                           process incepted actively. Appraisal system in
                           place. (D)

3.5 Preparation for  Input into scheme for SA and MRCGP. Recent
    Summative        look at nMRCGP. Current leading examiner
    Assessment/MRCGP facilitates work group. (D)




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                                  Sheffield VTS November 2005            SA8



4    Miscellaneous

4.1 Career                Informal and formal processes. Scheme admin. First
    counselling of        contact for potential GPR‟s, more complex issues
    potential, current    referred to SCO. Strong appraisal system. Many
    and previous          CO‟s are GP appraisers. Attend careers fair annually
    GPR‟s                 and Selection Centre information evening. Link to
                          undergrad dept for info to medical students re GP
                          career. Established PRHO (F1) post in Sheffield
                          training practice. (D)

4.2 Management of         Consultation under way using external resource:
    administrative        comprehensive list of issues in remit. Regular
    staff                 informal meetings. Electronic contact with Scheme
                          Organisers copious. Admin attends tutors group.
                          Admin appraisal with Institute management structure
                          (M Lidster) – SO involved from 2005. (D)

4.3 Office                Sufficient space available. Free use made of
    accommodation,        electronic links. General view that housing in the
    equipment and         Institute is appropriate currently. (E)
    electronic links

4.4 Teaching facilities   Currently adequate rooms. Some concern that MEC
                          NGH has cancelled prior booking: difficult to find
                          alternative accommodation at this stage. Large
                          amount of admin time required to book rooms for
                          forthcoming year. Perception of increased pressure,
                          two groups met off-site last term. Finance
                          arrangements for rooms not transparent. Library
                          present. (D)

4.5 Relationships         Regular minuted meetings with tasks allocated
    between the           consensually. Leadership (Scheme organiser)
    Scheme‟s Course       appointed through the tutor group. (D)
    Organisers

4.6 Relationships with    Regular attendance at Deanery meetings. SCO
    external bodies       attends ACO Exec. (D)

4.7 Training for the      Personal development plans held by tutors.
    scheme‟s              Common themes addressed by meetings, resources
    Organisers            as appropriate. (E)

4.8 Appraisal             Deanery led peer appraisal process used and
                          apparently valued. (E*)




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                                    Sheffield VTS November 2005            SA8



B. Summary


  1.   Course organisers continue to demonstrate a cohesive team
       structure, which develops a corporate leadership for the trainees.
       Change, whether imposed or proactive, has been managed
       successfully. The Tutor group has recruited effectively to vacancies,
       enabling it to continue to fulfil the expectations of the Deanery in
       completing tasks.

  2.   The VTS is supported by a very effective administrative structure that
       is valued immensely by the trainees.

  3.   A clear process of visiting posts is in place across the scheme.
       Considerable value is obtained from this for trainees, supervisors
       and course organisers.

  4.   Trainees compete actively for ITP‟s. Clear information systems
       regulate process and outcome.

  5.   GP Trainers continue to be universally highly valued by GPR‟s. In
       particular the experience gained in the training practices is perceived
       as giving an excellent grounding in “…real General Practice”.

  6.   Two hospital posts in particular are held in high regard by trainees:
       O&G at Rotherham, A&E NGH. The new psychiatry post received
       good, early reports.

  7.   Through the release scheme, there has been significant investment
       in consultation teaching. The scheme has been involved in
       development of the competency based teaching.




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                                        Sheffield VTS November 2005                SA8




C. Recommendations

       1.   The scheme should reflect on how it engages with trainees to fulfil
            their expectations of the release course. This should include an
            evaluation of feedback processes and trainee inclusion in developing
            release sessions.

       2.   The Deanery will review, with the scheme, the continuing value of
            posts highlighted by trainees to be of limited value: O+G (Jessop),
            Rehab. Medicine (NGH), Neonates (Jessop), Respiratory Medicine
            (RHH).

       3.   The scheme will consider the implications of PMETB (Article 5) and
            the RCGP curriculum changes.


D. Outcome

The Deanery takes the view that the Sheffield Vocational Training Scheme has
fulfilled its expectations and should be re-approved for a period of three years.



Signature of Director of                                    Signatures of other visitors
Postgraduate GP Education




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                                      Sheffield VTS November 2005           SA3



                    REPORT ON RELEASE COURSE


Scheme: Sheffield              Date: 10-11-05          Visitor: Gary Chambers


In total 15 registrars attended the session. These were all in the final 6
months of general practice. 10 arrived on time, 3 were late [10mins] and 2
very late [30mins]. I'm not aware that any explanation was sought - or
whether this was a regular occurrence in the group and if it had been
addressed. The group split into 2 [13 in a group looking at the MRCGP oral
exam with Gill and 2 did their appraisals with Bill] I mainly sat in on the
larger group and my comments relate to this unless otherwise stated.


Criterion                                               Notes

Relevance of chosen         The topic was entirely appropriate and relevant to the
topic                       registrars at this stage. The content had been
                            previously discussed and requested by the group. (D)

Level of preparation of     The tutor was well prepared. Aims and objectives were
tutor/external              discussed at the start of the meeting although only 2
resource, if used           registrars contributed to these and I wasn‟t sure how
                            much group consensus there was, and how much it
                            was tutor led [probably entirely appropriate]. (E)

Level of preparation of     The registrars were prepared to an appropriate level
registrars                  [the major point of the session was them not knowing
                            what to expect -i.e. exam conditions]. There was full
                            participation in the meeting. (D)

Level of educational        The tutor kept the session flowing well, using different
skill of tutor/outside      methods appropriate to the task [brainstorming, work in
resources if relevant       pairs and goldfish bowl] The registrars seemed fairly
                            enthusiastic in taking part. The scenarios used were
                            entirely appropriate. In the goldfish bowl setting the
                            registrars involved were de-briefed and handled
                            appropriately. (E*)

Evidence of                 The session was formally evaluated at its end. The
evaluation of the           process seemed rather rushed -but this was probably a
session                     reflection of the time pressure enforced by our visit.
                            [See comments on VTS session evaluation from the full
                            registrar group in the recommendations.] (E)

Evidence of                 Time was to be put aside at a future VTS session to
identification of further   discuss further learning needs. This process was not
learning needs              observed at today's visit. (E)


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                           Sheffield VTS November 2005              SA3



Other comments   The tutor managed this session skilfully. She used a
                 variety of techniques and fully involved all the
                 registrars. I found the 2 sessions going on in the one
                 room very distracting, especially during the goldfish
                 bowl part of the session when it was difficult to
                 concentrate with Bill talking 6ft away to his registrars.
                 Using another room would have been more
                 appropriate. (D)




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                                      Sheffield VTS November 2005             SA3



                    REPORT ON RELEASE COURSE


Scheme: Sheffield              Date: 10-11-05          Visitor: Jo Buchanan


This group were in their first six months in practice. The session was a
review of one participant‟s video. The tutors are: Steve Barnell, Jane
Fitzgerald and Ian Nerurkar.


Criterion                                               Notes

Relevance of chosen         The topic was relevant to registrars at this stage of
topic                       training (D)


Level of preparation of     At one point reference was made to relevant
tutor/external              consultation models (D)
resource, if used

Level of preparation of     The registrars were clearly used to reviewing videos
registrars                  and engaged by the process. Three videos were
                            offered for review. (D)


Level of educational        The tutors used the Cambridge Calgary method well. It
skill of tutor/outside      was good to have two registrars viewing as patients.
resources if relevant       The session flowed well positive feedback and
                            challenge were used appropriately. (E*)

Evidence of                 The session ended with a review of individual learning
evaluation of the           which was effective. This review of learning was
session                     summarised by one of the tutors and circulated after
                            each session to all group members. (D)

Evidence of                 This process was not observed at today's visit. The
identification of further   tutors described a recent review meeting to discuss
learning needs              group functioning. (E)

Other comments              The tutors managed this session effectively. It was
                            lively with evidence of healthy group functioning and
                            contributions at some stage from all group members.
                            The registrars were reflective and skilful in their use of
                            group time. (D)




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                                Sheffield VTS November 2005            SA4



       REPORT ON ADMINISTRATIVE AND EDUCATINAL
                     RESOURCES


Scheme: Sheffield        Date: 10-11-05          Visitor: Pat Lane,Steve Ball



Criterion                                         Notes

Number of working     Current evaluation under way; External resource used.
hours for scheme      Initial report due Feb 2006. One admin. Staff due to
administration        retire. CME and VTS support combined in one office.
                      Regular discussions with SO. Appraisal and line
                      management through the Institute of GP. (D)

Office facilities     Adequate for effective working (E)

Electronic links      Effective. Communication mode of choice for most
                      scheme activity: works with GPR‟s (D)

Relationships with    Good working relationships. Acts as a “hub”. Attends
Course Organisers     and inputs in to Tutor meetings. (E*)

Relationships with    Largely immaterial given that VTS resides within the
Hospital Management   Institute of General Practice. Aware of structures within
                      hospital. (E)

Teaching Facilities   Considerable admin time expended on booking rooms.
(rooms and            Estimated at 40hours to book rooms required for 6
equipment)            months of VTS. Twice per year (est.) a group meets off
                      site. Concerns re MEC cancelling booked rooms at
                      short notice. Impression Sam Fox House at capacity.
                      Unsure of financial arrangements for room use. (E*)

Library facilities    Book resources in cases in Institute corridor. Extensive
                      information on web site with links. (D)




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                                   Sheffield VTS November 2005            SA5



              REPORT ON MEETING WITH TRAINEES


Scheme: Sheffield        Date: 10.11.2005           Visitors:
                                                    Sections 1,2: Gary
                                                    Chambers & Jo Buchanan
                                                    Sections 3,4,5: Steve Ball &
                                                    Pat Lane


1. Course teaching                                   Notes
(GC&JB)

Content of teaching      Experienced registrars all stated that they had the
programme provided       opportunity to plan half day and day release sessions.
                         The first time registrars stated that whilst they had been
                         asked what the content of the half day release should
                         be the reality was that they had little influence over the
                         content. However most of these registrars stated that
                         this content was relevant. A small group disagreed.
                         (E*)

Quality of course        Evaluations were carried out after every session, and
teaching                 this was felt to be unnecessary and in particular
                         generated work for the office as these evaluations were
                         summarised weekly. The hospital group had found their
                         method of evaluation useful – the evaluations were
                         returned to the people who had set the course up. (E*)


2. Training                                          Notes
Practices

(GC&JB)
Facilities within the    Positive feedback was received about all aspects of the
practices                practice experience. Any problems that were identified
                         had been dealt with either in the practice or through the
                         mid point visit process.

Content and quality of   Only positive feedback received about this.
the practice teaching
programme

Formative                Is occurring, the registrars describe a sense of being
assessment within the    overwhelmed by the paperwork required for TRAP and
practices                RITA folders. There was a sense that this was merely a
                         paper exercise and the registrars felt that they received
                         no feedback on their RITA folders in particular unless
                         there was a problem.


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                                      Sheffield VTS November 2005               SA5



General highlights         The quality of the training experience in the practices.
                           The enthusiasm for training and the personal interest
                           that trainers took in each registrar.
                           There was a resounding and unanimous
                           commendation of the quality of support offered by the
                           Scheme administrator Linda Latif.
                           The midpoint visit process.

General problems           The difficulties of certification at a national level were
                           raised in particular inefficiency in the certification office.
                           The amount of paperwork required for the assessment
                           processes.

3. Hospital posts          There were 16 SHO‟s present: currently in post at the
                           Northern General Hospital, Sheffield Children's
(SB&PL)                    Hospital, Rotherham District General Hospital and the
                           Royal Hallamshire Hospital + Sheffield Care Trust

Hospital „hotel‟           These were reported as adequate. No specific
facilities for residents   concerns
Appropriateness of         In general SHO‟s saw the relevance of posts to a
hospital posts to GP       career in General Practice. Some reservations were
training                   expressed around neonates. MPV‟s happen reliably
                           and are useful.

Sickness and holiday       Comments made about rotas with prospective cover
cover                      being on occasion vulnerable to last minute change.
                           Reported issue around HR Dept (STH) not working
                           notified holiday into the rota when this is feasible i.e.
                           well organised SHO notifying his subsequent post
                           several months in advance, having gained approval for
                           holidays from supervisor.


Release to General         In 2004 this was achieved by 79% of GP SHO‟s.
Practice Scheme




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                       Sheffield VTS November 2005             SA5




Highlights   Rotherham D.G.H. - Obstetrics and Gynaecology..
             Outstanding support for GP trainees. The job content
             and training is excellent. Education programme
             designed to meet needs of „future‟ GPs. Paradoxically
             described by SHO‟s as “the best hospital job on the
             Sheffield VTS”.

             Northern General Hospital - Accident and
             Emergency.
             Teaching is well organised, protected, reliable (i.e. it
             happens) and largely relevant for GP SHO‟s. Clinical
             supervision is good. The personal interest
             demonstrated for GP SHO development, particularly
             during the induction phase, was highlighted.

             Sheffield Children’s Hospital – Paediatrics.
             Good support and training. Consultants aware of need
             to focus on GP as career. Educational supervision is
             thorough.

             Jessop’s Wing - Obstetrics and Gynaecology.
             Introduction of a first class course for DRCOG.

             Royal Hallamshire Hospital - General Medicine.
             Most educational needs are being met and GPR‟s
             generally enjoyed the jobs. One of the jobs is being
             restructured and the deanery has not been consulted
             as yet regarding its continuing approval.

             Royal Hallamshire Hospital – Dermatology.
             ITP posts – very popular with good teaching.

             Sheffield Care Trust – Psychiatry.
             Good posts with generally positive approach to
             teaching and supervision. The recently introduced
             Community Elderly Psychiatry post was rated very
             highly.




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                     Sheffield VTS November 2005            SA5




Problems   Jessop’s Wing - Obstetrics and Gynaecology.
           GP SHO‟s feel that they are treated differently in
           comparison with career SHO‟s. (Communication issues
           with some midwives).
           Some examples of difficulty in accessing clinical
           supervision at times – especially during the induction
           phase. Planned Registrar led Ante-natal Clinic not
           happening.
           Recent education supervisors changes.
           Protected time teaching largely pitched at career
           SHO‟s and SpR‟s. Several core teaching sessions
           have been cancelled recently.
           Influx of many new consultants (good).
           SHO‟s would welcome more contact with consultants.

           Northern General Hospital - Health Care of the
           Elderly with Rehabilitation
           The rehabilitation component, as currently configured,
           is not considered very relevant or helpful for GP
           training. There is a problem with lack of senior
           supervision and paucity of teaching. However, the
           acute admissions and medical care component is
           good.

           Northern General Hospital – Medicine
           These are good, relevant posts. Some good personal
           support from the consultants.
           Teaching is variable from very helpful, to questionable
           relevance to general practice.

           Jessop’s Wing - Paediatrics.
           Neonatal training – induction generally good for the first
           SHO in the 6 month rota but less good for the second
           SHO and almost non-existent for the third SHO.
           Recently the education supervisor has advised new
           SHO‟s not to attend the first few deliveries on their
           own. Situation is improving (i.e. evidence of change in
           the job) and needs to be monitored.

           Royal Hallamshire Hospital - Respiratory Medicine.
           This is a converted Trust SHO post yet there are
           persistent problems related to work intensity with
           inadequate education opportunities. Extremely difficult
           to obtain clinic exposure which is essential for GP
           training. Learning objectives for GP not being met.




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                                   Sheffield VTS November 2005           SA5




4. Other Comments

The GP SHO‟s would like to experience a wider range of specialties which
include e.g. Dermatology, ENT, Ophthalmology, and Rheumatology.

From February 2006 the VTS will be increasing the availability of full days
of GP education to 16 per 6 months for the hospital based GP SHO‟s. This
welcome flexibility will contribute to the management of study leave and
rotas.

Two GPR‟s in training practices passed comments of a personal,
confidential nature to one of the visitors. These were passed onto the
relevant CO for action.

5. Summary

   Trainees universally appreciated the input and enthusiasm of the GP
    Trainers.
   The mid-point visits led by a course organiser were especially valued by
    the VTS SHO‟s. They demonstrated effective liaison with the education
    supervisors and enabled prompt resolution of concerns in most instances.
   Several Directorates are perceived as examples of good educational
    practice and they are to be congratulated for their impressive education
    and training provision.
   The Sheffield course is trainee centred and promotes adult learning
    techniques. Strong and consistent attempts are made to ensure that
    hospital based SHO‟s are engaged in organised programmed learning as
    much as possible.
   The overall experience in most hospital VTS posts is designed to provide
    support and development of doctors toward their declared aim to enter a
    career in general practice.
   All personnel who manage rotas should be reminded that the Postgraduate
    Dean expects VTS doctors to achieve 80% attendance (i.e. minimum 48
    hours per 6 month post) to their protected time GP training.




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                                       Sheffield VTS November 2005               SA6




                    REPORT ON TRAINER WORKSHOP


Scheme: Sheffield VTS          Date:16.11.05             Visitor: David Rose




Criterion                                            Notes

Relevance of chosen       In previous meetings some trainers had talked of
topic                     problems with their registrars - this session on the
                          Disorganised Problem registrar arose from those
                          needs. (D)

Level of preparation of   The aims had been discussed prior to the meeting. At
Course                    the beginning of the meeting we defined what our
Organiser/Group           objectives would be. An appropriate interactive learning
leader/External           method was chosen. There was no external resource –
resource, if used         the session was run by Christine Kell and Jenny
                          Stephenson.
                          The evidence base had been searched prior to the
                          session and was introduced in the discussion. In was
                          interesting to look at the research showing the link
                          between learning style and registrar problems, between
                          early predictors of professionalism and later problems
                          and that one can use learning style instruction to help
                          registrars through their problems. The list of references
                          was sent to participants by e mail after the session. (D)

Level of preparation of   The aims of the session had been discussed prior to
trainers                  the meeting. Preparation was done in the session –
                          defining and agreeing objectives. (D)

Level of educational      The session was run by Christine Kell, who had
skill of Course           prepared the session, and Jenny Stephenson, who
Organiser/outside         chaired the meeting. Both showed appropriate
resource if relevant      educational skill – Christine in researching the
                          evidence base and linking it usefully to the topic; Jenny
                          in her expertise in moving the meeting along and
                          facilitation of the discussion. (D)

Evidence of               Evaluation forms were given out at the close of the
evaluation of the         meeting.
session                   Before the meeting I was shown a folder containing
                          minutes of previous meetings. Feedback had been
                          used to help improve teaching. (D)




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                                         Sheffield VTS November 2005              SA6



Evidence of                 Leader summarised the session and learning needs –
identification of further   mainly participants felt a need to read the references
learning needs              that were quoted and think about using learning style
                            theory in situations where a registrar is having
                            problems.
                            A written summary was sent by e mail two days after
                            the meeting. (D)

Other comments              The group worked well together and the session was
                            interesting and informative.
                            I felt that two of the three objectives were fully met (the
                            definition of the disorganised problem registrar and the
                            methods used in identification). The third objective of
                            developing strategies to help the disorganised problem
                            registrar was met as a whole but I think that time
                            pressure prevented us from going into strategies in as
                            much detail as I would have liked. Time pressure can
                            be a problem in trainer workshops, particular, like this
                            one, when they are held in the evening. The session
                            was free from interruption.




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                                         Sheffield VTS November 2005




                   REPORT ON GP TUTORS – CME

Main achievements of the CPD tutors in the past year

PCO support

   Provision of educational expertise and viewpoint at PEC clinician
    meetings.
   Active membership of education and training committees
   Support for clinical governance development e.g. around development of
    H Pylori local enhanced services programme and the educational support.
    required for this.
   Support of educational tutors funded by the PCO and collaboration with
    them in the development of initiatives

Protected learning initiatives

   Development of training packages.
   Advice on the quality assurance of educational modules.
   Advice on the potential use of the Primary Care Development Scheme.

NHS appraisal

   Regular attendance to provide educational expertise.
   Chairmanship of meetings when required.
   Advising on quality assurance of NHS appraisal.
   Recent work has included looking at Form 4‟s and a look at the online
    NHS educational toolkit. Future meetings will be looking at appraising
    appraisers, appraising GPwSI and using the patient experience
    questionnaire (specifically how to assist doctors with below average
    scores)
   Assistance with creating professional development processes for
    appraisers
   Revision of existing paperwork (principally form 3) to clarify the nature of
    evidence required for submission for appraisal.

Appraisal training

   Development and delivery of training modules. The most recent addition to
    the training programme has been the Form 4 and Evidence training
    module, now delivered twice in the Deanery

Revalidation workshops
 A series of workshops covering communication skills, significant event
  analysis and patient feedback have been developed and delivered by




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                                          Sheffield VTS November 2005



    tutors to GPs across the deanery, helping them to understand the evidence that
    will be required to demonstrate fitness to practice.

Nurse appraisal project
 Supervision and contribution of ideas to develop this programme.

Individual GPs

   Support of GPs who have performance issues.
   Supporting existing GP peer groups and establishing new ones.

Vocational Training
 Educational module on how to attain and interpret patient feedback
 Development of a module on simple educational theory for non-
  professional educators, that will be of wider application to all those
  involved in training and assessing GPs


F2
 Role in developing the foundation programme of medical training, whereby
   all doctors irrespective of subsequent career intentions are given a
   structured, educationally supervised opportunity to experience and learn
   within primary care.
 Development and delivery of a training programme for the educational
   supervisors, known as F2 trainers.
 Creation of training programmes that are designed from the outset to have
   wider applicability, based on learning needs, to others in the healthcare
   team such as nurses and managers.


Higher professional Education

   Liaising with the vocational Training scheme to ensure a seamless
    transition from training to early professional life.
   Identifying learning needs and creating a curriculum-based programme of
    education for young doctors.
   Delivering an educational programme and providing a structure for peer
    support across the deanery.
   In particular, providing support for non-principals who do not yet have a
    practice-based support system.
   Quality assuring the HPE process by approving funding for stated
    educational needs, providing feedback on learning and disseminating the
    learning outcomes via a deanery web site.
   Encouraging and supporting the career plans of newly qualified GPs,
    specifically to encourage local retention of the medical workforce.




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                                        Sheffield VTS November 2005




Agreed tutor objectives for the coming year:

   1. Support the F2 adviser with the development of F2 programme. In
      particular to ensure that experience from VTS is not neglected in
      developing the different but related F2 programme.

   2. Development of and planning for the approval visits process and
      content for F2 with CPD adviser

   3. Planning achievable systems for ongoing training and support of F2
      tutors with CPD adviser

   4. Development and presentation with CPD tutor colleagues of the initial
      F2 tutor training course.

   5. Continue to support recruitment and preparation of F2 training
      practices.

   6. To lead on the development of appraisal QA for the Deanery

   7. To work closely with other tutors on appraisal training as a way of
      influencing QA.

   8. Facilitate the expansion of the HPE course. Particularly to hone down a
      core of topics these can form the basis for year-by-year learning of the
      candidates.

   9. Improve liaison between vocational training scheme and other tutors,
      thus being able to utilize more „in house‟ resources.

   10. Training in leadership course or negotiation skills course – to facilitate
       future interaction with others involved in the development of HPE – and
       ensure that we propagate the good practice points that we have
       developed locally

   11. Publication of outcomes from local educational initiatives.

   12. Liaison with and development of the HPE tutor group to ensure
      different needs within the deanery are achieved




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                                         Sheffield VTS November 2005




SUMMARY

The Sheffield CPD tutors are amongst the most experienced in the deanery and
actively contribute to a wide range of initiatives. The working relationship of the
group has changed following the appointment of the CPD adviser and the changes
to the PCO tutor work force. In future, the tutors will work less as a “Sheffield” group,
and more as leaders in agreed areas of development.

The tutor educational programme has equipped them with many of the skills required
for the task, but the expectations and challenges of Leadership will require support
from the Deanery in terms of training & mentorship.

The tutors will be engaged in innovative work in F2, GP appraisal and HPE and they
recognise the importance of liaising with the national educational community in order
to learn from and contribute to the development of these areas of professional
development.



RECOMMENDATIONS

   The deanery should support the evolving leadership role of the tutors with training
    where required and with protected time for mentorship from the CPD APD and
    CPD Adviser.
   Attendance at appropriate national events should be sponsored and feedback to
    the deanery from the attendees should be encouraged.
   Tutors should be encouraged to disseminate their innovations in the literature
    using manageable entry levels such as the "Round up" section of the Green
    journal




Signature of Director of            Signature of APD:
G.P. Postgraduate
Education:



Date:                               Date:




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                                                                                                            Sheffield VTS November 2005




                                        CRITERIA FOR VOCATIONAL TRAINING SCHEMES


1. HOSPITAL POSTS


               Criterion                                Essential Standards                                    Desirable Standards

1.1   Identification of new hospital    Evidence of evaluation of future need, including ITPs.   Attendance at Joint Hospital Visits in specialities
      posts                             Regular dialogue with hospital consultants.              potentially relevant to General Practice.


1.2   Monitoring of existing hospital   Evidence of:                                             Uses a standard visit proforma.
      posts/GP trainers                  midpoint educational assessment visit by a GP          Nominated tutor for each post.
                                            tutor for each appointment.
                                         collation of registrar feedback on each post.

1.3   Relationships with hospital       Regular (6 monthly) meetings with all consultants
      consultants                       holding VT posts


1.4   Course Organisers‟ role in re-    Provides feedback to Joint Hospital Visit process        Attendance at Joint Hospital Visit for current hospital
      approval of hospital posts        before visits.                                           posts.
                                                                                                 Attendance at Educational Contract Meetings.




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                                                                                                             Sheffield VTS November 2005




2. GENERAL PRACTICE POSTS

               Criterion               Essential Standards                                                      Desirable Standards

2.1   Identification of, and support   Evidence of planning for future training practice needs.   Regularly canvasses local non-training practices for
      for, potential trainers          Timely „informal visits‟ to potential training practices   interest in training. (Provides a workshop for potential
                                       including provision of a report.                           GP trainers).

2.2   Identification of, and support   Evidence of succession planning.
      for, potential Course            Involvement of GP tutor (potential) in half-day release
      Organisers                       or CME activities.

2.3   Course Organisers‟ role in       Attends approval visits when required                      Attends approval visits when required (other
      approval and re-approval of      (own scheme).                                              schemes).
      GP trainers

2.4   Trainer workshops                Ensures a minimum of 12 hours workshops per annum.         Provides 20 hours.
                                       Evidence of educational planning.                          Learner centred.
                                                                                                  Joint ventures with other schemes.

2.5   Other educational activities     Ensures appropriate updates are available e.g. SA,         GP tutors teach on Regional Trainers Courses.
      for GP trainers                  appraisal, PDPs, etc.




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                                                                                                           Sheffield VTS November 2005




3. G.P. REGISTRARS

               Criterion                            Essential Standards                                        Desirable Standards

3.1   Selection process for GPRs     Conforms with and involved in Regional Selection
                                     Centre Process
3.2   The release course             Provides a minimum of 120 hours per annum of                GPR involvement in teaching.
                                     release course teaching.                                    Involvement in joint ventures with other schemes
                                     Collates and follows up attendance rates. GPR               and/or disciplines.
                                     involvement in planning and evidence of planning to
                                     meet assessed GPR needs.
                                     Evaluates the effectiveness of the course.
3.3   Other educational activities   Facilitates access to other activity as appropriate, inc.   Ensures all GPRs eligible for CHS/obstetric/minor
      for GPRs                       ITPs.                                                       surgery/family planning lists.
                                     Facilitates access to study leave.

3.4   Monitoring of performance of   Mid point assessment in each post.                          Personal mentoring scheme for each GPR.
      GPRs                           Collection of feedback for each GPR from each post.
                                     Indicates appropriate remedial activities when required.
3.5   Preparation for Summative      Fully familiar with current process.                        Makes specific targeted provision.
      Assessment/MRCGP               Provides appropriate support when requested.




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                                                                                                      Sheffield VTS November 2005




4. MISCELLANEOUS

               Criterion                          Essential Standards                                     Desirable Standards

4.1   Career counselling of         Documented evidence of career counselling to,          Evidence of career counselling of all current GPRs.
      potential, current and        potential, current and previous GPRs.                  Attend careers fairs and take part in PRHO
      previous GPRs                 Provides references for previous GPRs.                 introduction.

4.2   Management of                 Evaluation of admin support requirements.              Active participation in staff appraisal and training.
      administrative staff          Evidence of meetings with admin staff.
4.3   Office accommodation,         Sufficient to facilitate communication effectively.    Dedicated room for GP tutors.
      equipment and electronic      Sufficient provision to promote a reasonable working
      links                         environment. Private interview facilities available.
4.4   Teaching facilities           Adequate accommodation for group work.                 Library and internet facilities available and accessible.
      (accommodation and            Equipped to facilitate likely teaching methods.
      equipment)
4.5   Relationships between the     Clear individual job descriptions and cover            Structured meetings with evidence of forward
      scheme‟s Course Organisers    arrangements. Evidence of regular meetings.            planning.
4.6   Relationships with external   Representation at all Deanery led meetings.            Representation at regional/national bodies.
      bodies                        Aware of other national, interested parties.
4.7   Training for the scheme‟s     Training needs identified, and communicated to patch   Programme of organisational and educational skills
      Course Organisers             advisor.                                               development.
4.8   Appraisal                     External appraisal every 3 years. Internal appraisal
                                    annually.




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