Naturally Occuring What? Is That Earthquakes and Stuff?

 

No, that's naturally occuring phenomena. Naturally occuring evidence is a term for a group of things like audit, significant event analysis etc, which do not easily fit into the other assessment tools. They are things that GPs "naturally" do in their professional lives (the extent of which varies from GP to GP, but that's not the point).

 

Naturally occurring evidence should also be recorded in your ePortfolio as further evidence of your professional development.

 

 

 

Do I Have To Do These?

 

No, none of these are essential for getting the MRCGP. But....

- to get a CCT you have to pass MRCGP
• - there are 3 parts to MRCGP: CSA AKT WPBA
• - to pass WPBA you need to demonstrate in your portfolio that you are competent in the 12 competency domains
• - this means that your portfolio must contain enough evidence to convince your Educational Supervisor and the ARCP panel that you are competent in the 12 areas
• - some competencies are best demonstrated in assessments such as COT and CBD
• - others are difficult to demonstrate in assessments and NOE has been designed to help you clearly demonstrate them

 

In Y&H Deanery (and this varies with different Deaneries), all trainees must be exposed to audit, significant event analyses and referrals analysis. For that reason, we give you more guidance on each of these. Click on one of them in the left hand navigation panel.

 

 

 

Can You Give Us Some More Specific Advise?

 

Yeah, sure..... look at the left hand sub-menu above for specific guidance on audits, projects, referrals and significant events.

 

Also, the Y-H Deanery website has further advice and tips here:

http://www.yorksandhumberdeanery.nhs.uk/general_practice/trainees/NaturallyOccurringEvidenceinePortfolio.aspx

 

 

The links will guide you how to go about them as well as providing some handy tools to help you. Please remember that there are other types of "naturally occuring evidence" that are not listed here but can be submitted towards the MRCGP. Further details on the RCGP website www.rcgp.org.uk .

 

 

 

 

Naturally Occurring Evidence (NOE)  and displaying your competencies
Also known as
NOE: why it is necessary

Many AiTs (Associates in Training) in Yorkshire & the Humber wonder why they are asked to complete the Deanery NOE requirements as well as the college required evidence.

 

The aim of all AiTs is to complete their training and get a Certificate of completion of Training (CCT).

- to get a CCT you have to pass MRCGP
• - there are 3 parts to MRCGP: CSA (Clinical Skills Assessment), AKT (Applied Knowledge Test), and WPBA (Workplace Based Assessment). These 3 parts must all be passed.
• - to pass WPBA you need to demonstrate in your portfolio that you are competent in the 12 competency domains
• - this means that your portfolio must contain enough evidence to convince your Educational Supervisor and the ARCP (Annual Review of Competence Progression) panel that you are competent in the 12 areas
• - some competencies are well demonstrated in assessments such as COT (Consultation Observation Tool) and CBD (Case Based Discussion)
• - others are difficult to demonstrate in assessments and NOE has been designed to help you clearly demonstrate them

 

 

It is the Deanery (and not the college) which has the responsibility of implementing the ARCP process in line with the Gold Guide (1999 pp7.20 and 7.40.)

 

The 3 parts of the college exam (WPBA, AKT and CSA) are all linked back to the GP curriculum  which remains the core document for trainees when planning their learning. However for assessment purposes the RCGP has developed the 12 competency domains that each trainee will be familiar with through their self assessment when preparing for ES meetings and through the CbD (though this does not cover all of them).

 

When assessing log diary entries the GP CS and the ES are expected to make links to the competencies to build up evidence relating to each competency domain. (At the same time the AiT will be making links to the curriculum statements which the GP trainers will be checking.)

 

It is very important that there is enough good evidence for each competency domain so that progression can be established in each. Defining the NOE has been a way to enable our AiTs to produce evidence that can be linked appropriately to competency domains and making sure that there is good evidence from real clinical practice to support the formal assessments (COTs, CbDs , MSF PSQ etc. that provide a very different sort of evidence.)

 

 

So what are the links!?

 

Significant Event Analysis  (SEA) (filed under SEA)
By their nature SEAs can link to any of the defined competency domains depending on the nature of the event. They are specifically mentioned in domain 10  (Maintaining performance, learning and teaching) as being an expectation.

 

SEA is particularly good evidence for this domain, because it allows trainees to show reflection on performance and subsequent improvement, which is the heart of what this domain is about.

 

SEA also provides evidence for two domains where evidence is often hard to find:

• - If the SEA includes discussion about the performance of those involved in the event, apart from the trainee, it can be good evidence for domain 12 (fitness to practice).

- The SEA discussion provides an opportunity for the feelings of those involved to be aired. For example, the values, beliefs, prejudices and ethical approaches of those involved might be discussed and reflection on this (anonymised) can provide evidence for domain 11 (maintaining an ethical approach).

 

Very often SEAs provide a good example of several competencies being demonstrated and may highlight the way to developments in others.

 

The reason that SEAs are included as part of the required Naturally Occurring Evidence includes the fact that they demonstrate so many competencies well especially if the deanery advice is followed that the SEAs should include examples of significant events which look both at individual events and at events that relate to team working (Competency Domain 8 Working with colleagues and in teams .)

 

Because the SEAs chosen are often clinical it is likely that these will cover especially the first 6 competencies , and should provide the ES and the ARCP panel with a short cut to displays of effective reflective learning on several competencies.

 

 

Audit or project/ QoF etc. (filed under Audit)
Involvement in Audit or project work allows a clear demonstration of several competencies.

 

7 Primary Care administration and IMT…
for which the summary description is “about the appropriate use of primary care administration systems effective recordkeeping and information technology for the benefit of patient care. So getting data out and using this to improve care through audit is clearly part of this competency domain.

 

8 Working with colleagues and in teams
Audit is not just about collecting the data and analysing this (which may well involve several other members of the team); it is also about looking for ways to  persuade people to change their traditional approaches and improve care … or “working effectively with other professionals to ensure patient care…”

 

9. Community Orientation
Audit and the project alternatives involve moving away from caring for the patient immediately in front of the GP and looking at “the management of the health and social care of the practice population…” This is a core part of the definition of CO.

 

10. Maintaining performance, Learning and teaching
There are several parts of the word pictures used to describe this competence which particularly address the audit/ project… “investigates personal performance”… and “evaluates the process of learning so as to make future learning cycles more effective.”

 

In addition, the audit should include an evidence-based rationale for why it was conducted and how the standards were set. Doing this automatically provides evidence for tricky sections of Competence domain 10 that deal with accessing the evidence, using critical appraisal skills and often, keeping abreast of contemporary medical issues.

 

 

Reflection on post (filed under Courses/ Certificates)
The expectations of this http://www.yorksandhumberdeanery.nhs.uk/general_practice/documents/GuidanceReflectiononpost.doc encourage the GPSTR to look at the important issue of self care and work life balance (Competency domain 12- Fitness to practice). 

 

The core of the reflection on post will provide significant evidence around Competence domain 10 (Maintaining performance, learning and teaching) by encouraging the GPSTR to look at what has been learnt, and what remains to be learnt from the post that is finishing and starting to plan for learning in the next post. (thus encouraging appropriate PDP entries)

 

The reflection should look at the hospital posts and reflect on the learning that is relevant to GP… which will include a Community Orientation aspect (competency domain 9)  by detailing how the resources encountered in the post can be accessed/ used by GPs.

 

 

Case study/ presentation (filed under Lecture Seminar)
Competency domain 10  covers both learning and teaching.
It is important to ensure that the GMC expectation that Drs are involved in teaching is included and completion of all the word pictures in this competency domain requires demonstration of teaching and learning from that teaching.  (“identifies learning objectives and uses teaching methods appropriate to these” and “assists in making assessments of learners” ).

 

So the process of reflecting and writing up the case study/ presentation is evidence for primarily competency domain 10… though the content of the presentation may also address other competencies.

 

 

Evidence of leave (file under professional conversation)
The reason for including this NOE requirement is more to do with avoiding delays in those finishing their programme getting their CCT and so their ability to practice than to do with the competencies.

 

If the unit reviewing the e-portfolio does not have details of leave it is impossible for them to provide the CCT. If a trainee has more than 10 working  days off in anyone year due to sick, maternity., paternity, compassionate or other extra  leave (i.e. apart from annual and study leave)  then they must by law have an extension to training. Therefore this expectation has been introduced to ensure our graduates avoid delays in getting their CCT .

 

(As this relates to following the accepted codes for the profession  this is also evidence of domain 12 – Fitness to Practice.)

 

 

Attendance at teaching (file under professional conversation)
Engaging in study is clearly part of domain 10 (Maintaining performance, learning and teaching)

But ensuring adequate attendance is also about fulfilling professional expectations (domain 12 – Fitness to practice)
Attendance may be linked to working with colleagues and in teams (domain 8)  … but for this competency domain to be demonstrated there would need to be an explanation of what was done and how it was negotiated to achieve this competency


Complaints and Significant Untoward Incidents (SUI) etc. (file under professional conversation)
Declaring the absence or demonstrating an appropriate response to complaints is a professional expectation (and so relates to domain 12 – Fitness to practice).

 

Complaints are significant events and as such also relate to domain 10 – Maintaining Performance Learning and teaching.

 

Which other competencies are involved will depend on the nature of the complaint made. Statistically complaints are likely to relate to communication (domain 1), practicing holistically (domain 2) and to domain 8 (Working with colleagues and in teams) but there may well be elements of clinical management (5) and of course the data gathering (3) element is often central to establishing what happened… were the notes adequately detailed?

 

Prepared at the request of the SYLO AiT representatives forum  June 10
Mike Tomson
APD