NOE – general

NATURALLY OCCURRING WHAT?  AIN’T 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 occur ‘naturally’ during the course of a GP’s professional working life.  The more naturally occurring evidence you can record in your ePortfolio, the more evidence you will gather to demonstrate your proficiency in some of the professional competencies that you are ultimately assessed against.

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

If you belong to Y&H deanery, it is expected that you will engage with NOE.  Y&H deanery wants its trainees to be exposed to audit, significant event analyses and referrals analysis – because we do a lot of this in our jobs as GPs and because it provides a wealth of evidence for some of the harder to achieve professional competencies that need to be ticked off before you are awarded your CCT. For that reason, there is more information about each of these on this section of the website.

CAN YOU GIVE ME SOME MORE SPECIFIC ADVICE? (click to open me)

  • Please go back to the horizontal menu above and click on ‘MRCGP’ for specific guidance on audits, projects, referrals and significant events.
  • The Y-H Deanery website has further advice, tips and tools.  Click here to access it.
  • 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 .

WHAT SORTS OF NOE DOES Y&H DEANERY EXPECT ME TO DO?

Y&H deanery would like you to do:

  • 3 SEAs every 6m post
  • 1xcase study OR presentation every 6m post
  • 1x reflection on every post
  • 1xaudit during ST1

In addition towards the end of every post, you must upload to your ePortfolio the following records

  • a summary of your annual/sick/other leave
  • a summary of your attendance at teaching events like half/full day release (it should be around 70%)
  • any complaints
  • a record of your OOH attendance and hours.

THE Y&H DEANERY NOE RECOMMENDATIONS

The following is a quick glimpse at each type of NOE that Y&H deanery would likes its trainees to do.  For more detailed guidance with practical downloadable resources, please go back to the horizontal menu above and click on the MRCGP link.

SIGNIFICANT EVENT ANALYSIS (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 other domains where evidence is often hard to find:

  1. 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).
  2. 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 together and may highlight the way to developments in others.

The reason that SEAs are included as part of the required Naturally Occurring Evidence is because of the fact that they demonstrate so many competencies well especially if they include examples  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 AND PROJECTS

Involvement in Audit or project work allows a clear demonstration of several competencies.

  • 07  Primary Care administration and IMT: for which the summary description is “about the appropriate use of primary care administration systems effective record keeping 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.
  • 08 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…”
  • 09 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 THE POST

  • Please file your entry for this under Courses & Certificates.
  • The expectations for Y&H deanery can be found here.
  • The trainee should 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

  • Please file your case study or presentation under Lecture/Seminar in your ePortfolio.
  • The case study/presentation mainly covers competency domain 10: Learning and teaching.  It is important to ensure that the GMC expectation that doctors 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.
  • Question from a recent Trainer: Does the presentation have to be at Half-Day Release to peers?  Can it be to members of our PHCT?  Can it even be a presentation to our medical students?  
    Answer: To answer this question, one has to think about the purpose of the presentation. The purpose behind the presentation is to help the trainee acquire some teaching and planning skills.   Therefore, a presentation to any of these groups (including medical students) is simply fine.  But the GP trainee should have given some thought to it rather than a quick and dirty presentation. In other words: a) identifying the audience’s learning needs b) setting some aims and objectives c) thinking about the method of delivery/presentation and if they’re super duper trainees d) evaluating the session.

THE SUMMARY OF LEAVE

  • Please 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.

THE SUMMARY FOR ATTENDANCE AT TEACHING EVENTS

  • Please 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 (SUIs)

  • Please 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?