Action Points: Making a Diagnosis/Decisions.

Action Points for the Competency Rating Scales

  • You should consider a retrospective review of a series of clinical encounters to look at whether your initial diagnosis was correct (based on any subsequent contact regarding the same problem) and to reflect on the outcome/value of any investigations undertaken. This can be a useful activity and would be an example of ‘quality improvement activity’ for revalidation.
  • Reflect in 1-2 log entries on the prevalence and incidence of conditions and how this helped you to recognise their pattern.
  • You need to demonstrate this (making diagnosis) effectively through your choice of CbD cases and you need to choose better log entries for this area to provide clear evidence.
  • Differential diagnosis is important so practice after each new presentation both medical school style and thinking about likelihood for this patient. You can do this with friends. A patient comes to you with xx, yy, and z what are your differentials. They are now 80 not 30 how does the differential change  does the differential change if their sex is different – or class?
  • You need to provide evidence of you coping with undifferentiated conditions and how you cope with uncertainty. (think CbD choices , choice of LLE and how you write these up).
  • It would be really helpful to see clinical encounter entries where you have seen a patient presenting early in an illness/disease process and how over time you made decisions and come to a diagnosis.
  • Continue to provide evidence from COTs and CbDs and learning log entries that you can consider appropriate differential diagnoses in the wide range of patients you will see as a GP. Separately you may also want to consider when you used time to make the diagnosis.
  • You should be demonstrating that you can make decisions that are appropriate for the individual patient. Evidence needs to demonstrate you can think laterally and broadly and appropriately (in relation to risk, etc.) when considering differential diagnoses and making decisions.
  • Need to concentrate on reflecting on this competency when doing log diary entries consultants seem happy with your competence on this  but it is easier to demonstrate in GP – Looking at the word statements helps clarity. Integration of previous info… how did you use this…. then choose  examples of  when you used time, etc.
  • At the moment it is unclear to me whether your  difficulties in this area are primarily due to your knowledge base or whether you have specific additional development needs related to decision making per se. As a priority you needs to develop your knowledge base particularly in General Medicine, and demonstrate this on e-P and thorough CbD and mini CEX.
  • Ask yourself what is most likely, but also  what is the one not to miss? Reflect on using these questions in your e-P.
  • More of the CBDs you choose from now on should try and include positive proof of this as what you are doing when observed in joint surgeries and videos is clearly fine.
  • Try to gain confidence in diagnosing and managing conditions you have explored, but as you say, coping with uncertainty and making appropriate decisions are the mainstay of good independent practice, so reflect on when you do this well in entries (as well as when it has been difficult!).
  • Need to try and link some log entries and not just rely on WPBA, look at the word pictures for competent and excellent and reflect on some patient encounters using these.
  • When reflecting, try and show you’re ‘working’ how and why did you make decisions the way you did and reflect on how you could have done it better.
  • Pick a patient who comes in acutely and you  have seen over time as their diagnosis becomes apparent- write up showing how your differentials changed.
  • Document cases that have been a challenge to diagnose, ideally also covering curriculum statements that need more evidence.

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