LOOKING FOR SOMETHING ELSE?
Here are some frequently asked questions by both trainers and trainees. These have been split into two categories – general queries and technical problems. Please take a moment to read them because by doing so you will understand the ES process better. We are sure that these will answer at least 90% of your questions and queries. So, before firing off a quick question to your Training Programme Director, please check this list out first.
ALWAYS INFORM THE TRAINING PROGRAMME DIRECTORS IF YOU ARE AWARDING AN ‘UNSATISFACTORY PROGRESS’ OR ‘REFER TO PANEL’ ES REPORT
Relax…. although it might sometimes feel like we’re checking up on you, please remember that it is mainly about doing what’s right FOR YOU as an INDIVIDUAL. We want to make sure you are on track for training so that YOU DON’T LOSE OUT and we want YOU to make the most of the OPPORTUNITIES that are available to you during your time with us.
We’re not here to tell you off. We are here to help you make things better or put things right. If you find your relationship with your ES is not as good as you hoped then it is worth discussing it early on with your Programme Directors. Similarly if it works well it is also worth mentioning as they will be keen to develop models of good practice.
In assessment the trainee tries to hide what they are bad at; in Educational Supervision they should be comfortable about displaying it.
For Educational Supervision to work its ‘magic’ for you, there are three prerequisites:
- That you “open up” and tell your supervisor if there are any difficulties (personal, work or otherwise)
- That you be honest (and own up to anything you are responsible for)
- That you do all the preparation work mentioned at the beginning of this page.
NUMBERS: COGPED guidance on OOH (2009) indicates a MIMIMUM benchmark of one 4-6 hour session per month in any GP post. Therefore, in some training programmes, trainees could have as little as 24 hours experience over six months depending on the length of OOH sessions locally. The Deanery considers 24 hours to be the bare minimum required to demonstrate experience and learning and stresses that the minimum of SIX SESSIONS are necessary to provide appropriate exposure and learning.
LENGTH: The length of any session is therefore ultimately defined by the local circumstances of OOH provision and the length of the Clinical Supervisors session. Each session should include sufficient time for debrief and the opportunity to record the session on the e-portfolio. The maximum amount of hours allocated to any single session should be 6 hours.
- It is recognised that some OOH sessions provide more experience than others and therefore it is considered the responsibility of the trainee to provide clear evidence of the learning they have derived from their OOH sessions on their portfolio.
- If the GPStR is in an integrated training post based in General Practice they should undertake the same number of sessions as those in traditional General Practice placements.
- Less than full-time trainees should undertake the same number of sessions as their full time colleagues but over a longer timeframe.
- The number and frequency of out of hours sessions to be completed whilst working in a training practice is defined in the Form B for each post.
- You must engage with OOH right from the start of a GP post. Failure to complete the requisite number of sessions will lead to a face-to-face deanery ARCP panel review. Remember, this isn’t much if you reflect back and think of how many times you had to do on-call in your hospital posts (take Paeds for instance – so stop the groaning!)
- Our full Bradford OOH Policy can be opened and viewed from the downloads box above.
Don’t worry. Your ES will simply check how things are going for you. The focus of the meeting will be to get to know you so that both of you develop a good working relationship together and creating a climate of respect, openness and honesty. The aims of the first meeting are
- To develop rapport and establish a good educational climate – getting to know you as an individual, showing respect, being open and honest (this goes both ways remember).
- To synchronise both of your wavelengths – so that you are both clear about what is expected.
- To help develop your educational and reflective skills – so that you really understand the different levels of reflection and how you can write up their e-portfolio entries in a more reflective way and therefore learn more!
They will also probably want to get some good behaviours started off early. For example, they may want to see if
- You are using your ePortfolio regularly (i.e. 2-3 entries per week)
- You understand what reflection is and how to write a reflective log entry – perhaps even taking one of your examples to make it more reflective.
- You understand what the Curriculum Headings are and how to link your entries to them.
- You understand what the 12 Professional Competencies are and that you write your log entries to ultimately demonstrate these. It’s these 12 Professional Competencies that you are ultimately tested against throughout all years of your training right up to CCT.
- Your post is providing you with the enough educational experience and whether you are experiencing any difficulties so that these can be put right.
- Your home life is okay or whether there are added external pressures. Please be as open and honest as you can. We are here to help make your training journey as easy as possible but we cannot do this if we don’t know how things are for you.
ES meetings should essentially be a dialogue rather than a grilling process. Here are some suggestions of things we encourage you to do before your first ES meeting…
- Read this e-portfolio guide: E-portfolio pearls – making it work for you
- Read this guide on reflection: Levels of reflection and learning log entries
- Print, read and do this ES checklist for the first meeting of ST1. This will help you get used to some of the bits in preparation for the final meeting for that post.
- You and your ES MUST fill in the ePortfolio’s Educational Supervisor’s Report (ESR).
- This report will highlight any difficulties – either personal, educational or with the post. Please don’t worry about these being documented. Educational Supervision is not about disciplinary procedures but more about helping you overcome or see you through the difficulties.
- Therefore, the report has an “agreed action plan” to help your training journey become smoother.
We at Bradford think that your Clinical Supervisor should read most of your log entries and validate them. If you’re in a GP post, the Clinical Supervisor will be your nominate GP Trainer. If you’re in a hospital post, the Clinical Supervisor will be the hospital consultant you are working for. PLEASE encourage and remind them to look at your ePortfolio entries frequently. They lead such busy lives that they often forget – and they need someone like you to nudge them. Perhaps one tutorial you might say ‘Would you mind if we just go through my learning log entries today to see what you think or how I might improve on them?’ We are sure they will find this a welcome suggestion. They don’t have to read all of them – but as a minimum, they should aim to read at least 60%, preferably 70-80%.
The reasons why we think it should be your Clinical rather than Educational Supervisor who reads them are…
- It’s more practical – it’s very time consuming for an ES to go through all the eportfolio entries and validate them. Otherwise, most will end up losing the will to live and we need to keep our Educational Supervisors enthused! If ES’s did it, it would take them around 3h to do leaving very little time for all the other EQUALLY important aspects of Educational Supervision.
- A good proportion of the e-portfolio entries will have been discussed with the Trainer or hospital consultant already. They would then be able to easily and more reliably validate that entry against the 12 professional competencies
- If the Clinical Supervisor does it in a progressive way (i.e. gradually throughout the 6m period), then he or she is also in an ideal position to employ a drip method of feedback. In this way, skills can be gradually developed and feedback more readily accepted. As the ES and trainee only meet twice a year, giving volumes of feedback during these sessions would prove overwhelming for anyone.
- Reviewing how their trainee are writing up e-portfolios in a progressive manner provides the Clinical Supervisor with another informal form of assessment on how the trainee is progressing. No doubt this will contribute to a more reliable and valid Clinical Supervisor’s Report.
Ramesh (as GP Trainer) says: What I do with my trainee, which might help some of you, is to periodically (say once every 6-8w) hijack the practice based tutorial to look at the e-portfolios, read them and see what we can learn from them.
The indicative benchmark is at least one session (of at least 4 hours) every month for a full timer, adjusted for part-time trainees on a pro rata basis. Sessions usually last between 4-6 hours depending on the OOH provider but in some areas, it’s not as simple as ‘one session every month’.
- The minimum is 4 hours per month = 48 hours per year
- The ideal is 6 hours per month = 72 hours per year
In Bradford, for example, sessions do not last 4 hours, and hence a Bradford GP Trainee needs to do more; a full timer would need to do around 2 per month (where one session usually lasts 3 hours). Remember, this isn’t much compared to what they do in hospital posts (Paeds for instance). Failure to complete the requisite number of sessions will lead to a face-to-face deanery ARCP panel review.
TYPES OF SESSION
OOH sessions may include an appropriate mixture of
- OOH as provided by the local deanery approved provider,
- ambulance sessions,
- psychiatric service sessions,
- social service sessions and so on.
Because the availability of traditional sessions will be different from scheme to scheme the scheme, guidance on what non-traditional services will be accepted should be included as a log entry in the e-P if there is a lack of normal GP OOH so that the ARCP panels can review what has been approved locally. The skills needed for OOH can be acquired to some extent in these other situations and so where there are for organisational reasons difficulties in completing the expected total of 76 hours it is important for the trainee to complete other evidence to demonstrate the competencies which would normally be acquired in the OOH setting.
The panel has a responsibility to assess 2 areas in relation to OOH.
- The competencies relating to the skills needed for OOH care – as defined in the RCGP curriculum.
- Completion of the contractual responsibilities for OOH provision (COGPED define as a minimum of 1 session per calendar month of 4-6 hours on average and BMA standard trainee contract defines as 76 hours per 12 months)
The Panel will expect evidence of the educational quality of the OOH experience. Therefore, the trainee needs to make sure that each session is supported by a log entry clearly indicating what they have learned. Ideally they should make clear how this relates specifically to the OOH setting (as opposed to what they might have learned from the same case in a routine setting). They can maximise the chances of their OOH experience being accepted if they write an extra OOH log entry which summarises the evidence in their EP supporting the ‘OOH competencies’ – see the 4 points below.
- Can consult effectively on the telephone
- Recognise and manage acute illness in the OOH setting
- Refer acute illness appropriately in the OOH setting
- Understand the organisational aspects of OOH care
By the way, if the trainee is progressing well and there and no concerns other than the fact they have a couple of outstanding OOH sessions that are due to be completed AFTER the ARCP panel, then get the ESR or scheme administrator to ensure that these are done. Prior to the final ST3 panels GPRs should be encouraged to include a log entry detailing the evidence contained within the eP which demonstrates competency in OOH care.
To read more about Out Of Hours, click here.
A NOTE ABOUT EXTENDED HOURS – which is not OOH work!
Extended hours is not classed as OOH work. Trainees are to be encouraged to do some Extended Hours but this is not compulsory.
- At the CCT point doctors should be revalidated and start the 5 year revalidation cycle. The normal GMC policy is to set the revalidation for approximately 3m post CCT date so that there is time for admin systems to line up post final ARCP / CCT with GMC revalidation systems.
- That said, there have been some issues where this has not occurred and trainees have found themselves INCORRECTLY having to be revalidated within 12-24 months of CCT.
- The typical reason for the system failing is where there has been a change in CCT date because the GP trainee has extended training for whatever reason. For this reason, it is really important the eP is updated to accurately reflect the new CCT date as this is what the GMC base their revalidation date on.
- Sometimes though, it seems the GMC just gets it wrong and sets an inappropriate revalidation date.
- So, if an educator or a trainee thinks the revalidation date is wrong (there shouldn’t be many), PLEASE flag this to the revalidation lead (Emma Morris for Y&H Deanery: Emma.Morris@yh.hee.nhs.uk), she will advise. It is important to do this whilst still in training, before CCT as – once CCT is past there is a little the Y&H revalidation team can do as responsibility for revalidation passes to the Local Area Team.
SPECIFICALLY FOR EDUCATIONAL SUPERVISORS
MY GP TRAINEE ISN'T RECORDING MUCH IN THEIR ePORTFOLIO. I'VE TRIED AND TRIED. HELP! WHAT ELSE CAN I DO?
It would be useful to explore why he or she isn’t doing it. Often, we assume (quite wrongly) it’s because the trainee is being a bit lazy and ‘needs to pull their finger out’. But don’t forget, we’re talking about young doctors – it’s difficult to get into medical school if your lazy and have a generally laissez faire attitude to life. There are an infinite number of reasons why they are not engaged with their ePortfolio. Here’s just a small list of possibilities…
- He doesn’t understand its value both in terms of assessment (for others) and of recording experiences and reflection (for him) – an attitudinal shift required.
- He understands its value but hasn’t got into a routine of doing it. He can’t find the time in his busy job. He is otherwise disorganised. He may need an explicit suggestion of a routine.
- He is scared of the ePortfolio. Who will read it? Is this big brother judging him? Not feeling comfortable about writing about his feelings and emotions for others to read (and especially as he doesn’t even know these others).
- Not knowing what to write about (a knowledge deficit). Is it just clinical type stuff? What sorts of clinical stuff? The emotional stuff – will that not make him look weak to others? Which of his plethora of experiences does he pick? Linking to curriculum coverage/professional competencies (and understanding what these truly mean).
- Not knowing how to reflect (a skills deficit) – how does one reflect? What does a reflective entry look like? What is the educational value of reflecting? ‘I do it all in my head anyway’.
So, we would say
MAKE SURE YOU ARE EMOTIONALLY NEUTRAL ( or neutralise any negative or angry feelings).
- Only then sit down with your trainee.
- Establish a climate of openness and honesty.
- Define the performance problem (i.e. not recording enough ePortfolio entries and its future implications).
- Signpost clearly that you want to help make things better but that you can only do that if you know how things are going for the trainee.
- Invite the trainee into a dialogue. Simply let the trainee speak.
- Clarify what they say – try and get a good understanding of their situation.
- Jointly formulate some possible causes.
- Jointly formulate an action plan to make things better.
- Review the situation in a couple of months.
Top Tip: consider using The RDM-p manual to help you establish why a trainee is struggling with writing things in their ePortfolio.
Mandatory evidence is mandatory! And the numbers stipulated for things like CBDs and COTs are MINIMUM numbers – in other words, they should be aiming to do a lot more. Therefore, if a trainee is not achieving the minimum number, even if it is one, you have to mark the ES report as unsatisfactory and let your Training Programme Director know.
As you may know, all trainees have to have an annual Panel review, which for the majority is in June. For most trainees, this corresponds to their transition between ST years, so the aim of the review is to determine whether they may progress to the next ST year or to CCT.
However, if a trainee is LTFT and/or out of synch (for example if they have taken maternity or other leave), their annual review may not coincide with their ST transition. In this case, the aim of the Panel review, and the ES report which precedes it, is to determine whether they are generally ‘on track’ – in other words, whether
- they are engaging with the e portfolio
- they are doing COTs, CBDs, DOPs etc at a rate which suggests that by their ST transition date, they will have done the required number
- there are no significant concerns about them
This means that as an Educational Supervisor or a Panel member you are doing a slightly different job for the LTFT and/or out of synch trainees. You can work out whether this applies to your trainee by looking at the Profile page of their EP and checking the dates of their posts. The RCGP guidance on Less than Full Time Trainees and WPBA can be accessed from a yellow box at the top of the page. To help you check whether they are doing a reasonable number of assessments, go to the Evidence page, make sure the drop down Review menu is set to their current ST year (it should be, by default) and set the drop down Review menu to ‘All Reviews’, so you can see the total number of assessments they’ve done in their current ST year.
If a trainee is planning to take some time out of programme (for example to experience work abroad) or go on maternity, you should arrange an ES meeting with a view to doing an ES report JUST BEFORE THEY LEAVE. In this meeting…
- Review the evidence – is it satisfactory for where they are at?
- Make plans for the future – upon their return to the programme.
- Email Deanery and ask them to give the trainee and OOP outcome so that the ARCP panel can record the exact dates the trainee is away. Esme Ross for the West Yorkshire arm of Yorkshire and Humber Deanery: firstname.lastname@example.org
- Another ES meeting and report needs to happen when the trainee returns, and a PDP made.
- If the trainee is Out of Programme for more than 12 months, they need to have their competencies reassessed when they come back.
Trainees going on maternity will also need an ARCP before they leave – please check with the Training Programme Director that this is in place. ARCP panels will need a ES report and a CS report. Make sure the trainee gets the latter from the current post they are in.
A special case: If the trainee is coming back from maternity with just a few weeks before their CCT – they will need two ESRs and two ARCPs. The first (penultimate) set will be done before they leave – to basically say they are fully competent and that you are happy to recommend for CCT once the remainder of their time is completed. Keep in touch with them and then do the final ESR when they come back (but no more than 2 months before the final ARCP) and inform the Training Programme Directors to sort out an ARCP in timely way so they can be quickly signed off. Otherwise, their CCT will be delayed.
- If there’s a problem, share it openly and early with the learner. The best outcomes are always discussed and planned jointly. Things go badly wrong when there are hidden surprises as a result of some things being kept ‘secret’.
- If there’s a problem, try and remain neutral and simply gather more information. It’s easy to inherit the feelings evoked by others like Clinical Supervisors. Remember, you are here to help the trainee. Stop and neutralise any negative feelings you may have developed. Invite the trainee to explore the issue on neutral territory. Simply gather more information.
- If there’s a problem, define who’s got the problem? Is it a learner problem? Don’t automatically assume that a trainee labelled as bad is actually bad. We’ve seen trainees who have been labelled as ‘work-shy’ or ‘lacking commitment/professionalism’ just because they complain about the work pressures in a department struggling with its staffing levels. However, there are also times when the learner needs careers advice (esp. if you think they’re in the wrong job).
- Give support at all times: Trainees experiencing difficulty are often at a low point in their lives. They need you to support them, not necessarily join in with those crucifying them! And besides, the best outcome is when plans are made where all the stakeholders are involved and happy.
- Involve others: You may wish to discuss the situation with another trainer for further advice or new ideas (remember, confidentiality though). However, please involve the TPDs and Deanery as EARLY as you can. Often, TPDs are involved way too late – when too much damage has already been done!
- Document all difficulties and plans. Such dysfunctional events are likely to scrutinised further. Good documentation protects everyone – you, the TPDs, the deanery and even the trainee.
As soon as the trainee starts a new post, the ePortfolio now requires you (the ES) to do two things
- Sign the Educational Agreement, Health Declaration and Probity Declaration – actually, both of you have to do this.
- Setup a Review as soon as they start a new post. This doesn’t mean you need to do a review, just that you need to set up a data ASAP. Otherwise, the trainee won’t be able to add things to their ePortfolio in the right time period. Once the ‘Setup’ is completed all evidence pertaining to that post will automatically appear in the correct place. In addition, without creating a review: the trainee cannot do a self-rating scale, the ES cannot see the MSF/PSQ results in a summarised format, and finally the ES cannot release any MSF or PSQ results. To set up review date, simply log into the ePortfolio, select your trainee and then click ‘create review’. ONLY complete the ‘Setup’ section of the Review (takes 2-3 mins) – checking the start and end dates. This rest can then be shelved until you actually meet your trainee for an ES meeting (usually during month 4 of the post).
- I know, I can’t remember it either. To make things easier, all you need to remember is www.bradfordvts.co.uk. On the home page, click on the tab ‘Directory’ (right upper corner) and you’ll find a quick snazzy link their (called Your ePortfolio)
- Now log in using your NORMAL log in username and password.
- Look at the left hand menu for ‘Switch Roles’ – click it and select ‘Educational Supervisor’.
- Now click on ‘Select Trainee’ (again in the same left hand navigation menu).
- Voila, the trainee(s) for whom you are the Educational Supervisor appear as a list. Select one.
IS THERE A DOCUMENT WHICH NEATLY SUMMARISES WHAT WPBA THINGS A TRAINEE SHOULD HAVE DONE AND BY WHAT STAGE?
Simple – write it up as an Educator’s Note. Log into the ePortfolio and look at the left hand navigation menu. You should see a link to Educator’s Notes.
- Log in and click Evidence
- Then click MSF
- Make sure you select the correct Review Period
- Once you’ve done that, you’ll see a little graph icon which if clicked, will analyse the results.
- Log in and click Evidence
- Then click MSF
- Make sure you select the correct Review Period
Once you’ve done that, you’ll see a little graph icon which if clicked, will analyse the results. At the bottom of that page, you will see a box where you can make comments and a button which says something like ‘release scores to trainee’
Don’t worry – remember that we all give and receive feedback in every aspect of our daily lives and that is the essence of good Educational Supervision. It wont be anything new. Relax and enjoy the art of facilitating the session. It is important to:
- LISTEN – THIS IS REALLY IMPORTANT. Eyes & brain open, mouth shut. Don’t interrupt, don’t dominate, don’t pre-judge!
- REFLECT – on what is being said & judge constructively. Identify learning needs.
- SUPPORT – construct & negotiate ACHIEVABLE plans.
In other words, exactly what we do on a daily basis with our patients!
Yes, just two:
First, don’t view the ePortfolio using the trainee’s login in and password. Use your own. The layout and navigation menu is a bit different from the trainee’s view of the ePortfolio.
Secondly, I’m going to re-emphasise the point about the ES meetings being about developing a dialogue and relationship with the trainee in which you both trust, respect and feel you can be open with one another. It is not about a good old grilling. And it’s far more enjoyable and satisfying if you manage to create an optimal educational climate.