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Educational Supervision

Finding the evidence for the Capability Rating Scales

The Capability Evidence Table

Please read this bit first - click on the tabs in order

The Capability Evidence Table

Instructions
Please click on a capability – cut and paste the contents (except the definition reminder) into the Capability Rating boxes in the ePortfolio.
Then… just fill in the blanks.   Train the trainee to do this.  By the way, items in blue provide greater evidence that those in black. 
Try and pack as much evidence as possible so that one can step back and make an overall opinion as to whether the trainee is meeting expectations or not.

Reminder: Fitness to Practise = the doctor’s awareness of when his/her own performance, conduct or health, or that of others, might put patients at risk and the action taken to protect patients.  The Fitness To Practice competency is rarely witnessed, but can be probed through CbD.

QUANTITATIVE

  1. CBD – item (10) Fitness to practise: 

QUALITATIVE

  1. CSR – under ‘Professionalism’ – with respect to the trainee’s conduct, performance and health, the CS says… 
  2. MSF – Themes around trainee’s conduct, performance and health are… 
  3. Log entries – select ones that show STRONG evidence.

Reminder: Practising Ethically = with integrity and a respect for diversity.

QUANTITATIVE

  1. CBD – item (9) Maintaining an ethical approach:

QUALITATIVE

  1. CSR – under ‘Professionalism’  – ethical themes are… 
  2. MSF – under ‘professional behaviour’, ethical themes are… 
  3. Log entries – select ones that show STRONG evidence.  In particular: Clinical Case Reviews, LEAs/SEAs, Reflection on feedback (esp complaints), QIA, Leadership/Management/Professionalism 

Reminder: Communication & Consultation Skills = communication with patients, and the use of recognised consultation techniques.

QUANTITATIVE

  1. COT – last item ‘Overall Assessment of Performance’:
  2. AudioCOT – last item ‘Overall Assessment of Performance’:
  3. CEX – item 3 Communication skills: 
  4. RCA/CSA – this trainee has passed which is a good indicator that a trainee’s communication skills were, on the whole, good enough.   The score for IPS was x out of  y

QUALITATIVE

  1. PSQ – communication skills themes are…  
  2. CSR –under ‘Communication’ – communication themes are…
  3. MSF – following communication skills themes emerge…
  4. Log entries – select ones that show STRONG evidence.  In particular, look at Clinical Case Reviews.

Note about COT: Most items in the COT are about Communication Skills – especially items  (1) patient contribution, (2) cues, (3) psycho-social context, (4) ICE, (8) explanations, (10) patient involved &  (11) shared understanding.   So look at these individual items – from the mapping sheet – and see how the trainee is doing.  But, rather than writing about each item, write in terms of the “Overall Assessment of Performance”.  If overall assessment has been marked as good in a COT, then surely the consultation skills must of been good enough.  Write something like “In terms of Overall Assessment of Performance: 7/9 COTs marked as at or above expected level and  2/9 below expected level”)

Note on AudioCOT: Again, as most items in the audio-COT are about Communication Skills, especially items (1), (2), (3), (4), (5), (6), (9), (10), (11), (12).  So, rather than writing about each item, write in terms of the “Overall Assessment of Performance”.   

Reminder: Data Gathering = the gathering and use of data for clinical judgement, the choice of physical examination and investigations, and their interpretation.  Clinical data rather than social data.

QUANTITATIVE

  1. CEX : item (1) history:            item (2) examination: 
  2. COT – item (5) Includes/excludes significant condition:          ; item (6) Examination:  
  3. Audio-COT:  – item (3) Identifies the reason for the call:       ; item (7) History Taking:
  4. CBD – item (2) data gathering & interpretation: 
  5. RCA/CSA – this trainee has passed which is a good indicator that a trainee’s Data Gathering skills were, on the whole, good enough.   The score for DG was x out of  y

QUALITATIVE

  1. CSR – under ‘Clinical Assessment’  the CS says….       The ‘Level of Supervision’ requires is reported as… 
  2. MSF – under Clinical Performance,  comments around data gathering are:
  3. Log entries – select ones that show STRONG evidence.  In particular, look at: Clinical Case Reviews, LEAS/SEAs & CEPs.

Reminder: CEPS = sny reference to the doctor’s ability to perform clinical examination and clinical procedures/investigations.

QUANTITATIVE

  1. CEPs – 
  2. COT –  item (6) appropriate physical or mental examination:
  3. Mini-CEX – item (2) physical examination skills:

QUALITATIVE

  1. CSR – under ‘Clinical Assessment’ – the CS says the following about examination skills…
  2. MSF – the following comments are made about examination skills…
  3. Log entries – select ones that show STRONG evidence.  In particular, look at Clinical Case Reviews & CEPS.

Reminder: Making Decisions =  a conscious, structured approach to decision making. taken to protect patients.   The trainee must show not only his or her decision, but the thinking behind that decision.  Including diagnosis.

QUANTITATIVE

  1. CBD  item (3) Making diagnosis/decisions: 
  2. COT – items (6) Appropriate examination:           item (7) Appropriate working diagnosis:
  3. AudioCOT – item (8) appropriate working diagnosis:          item (9) creates an appropriate, effective treatment plan:        item (11) safety netting/FU:
  4. CEX item (4) clinical judgement:

QUALITATIVE

  1. CSR – under ‘Clinical Assessment’, ‘Management of Patients’, ‘Context of Care’ the CSR says the following about Decision & Diagnosis skills…          The ‘Level of Supervision’ required is reported as…
  2. MSF – under Clinical Performance, themes around Diagnoises/Decisions are… 
  3. Log entries – select ones that show STRONG evidence.  In particular, look at: Clin Case Reviews, LEAs/SEAs, Leadership/Management/Professionalism & Prescribing.

Reminder: Clinical Management = the recognition and management of common medical conditions in primary care.

QUANTITATIVE

  1. CEX item (7) overall clinical care:
  2. COTitem (10) Appropriate management plan & FU: 
  3. AudioCOT – item (9) creates an appropriate, effective mutually acceptable treatment plan:
  4. CBD – item (4) Clinical management
  5. RCA/CSA – this trainee has passed which is a good indicator that a trainee’s clinical management skills are, on the whole, good enough.   The score for CM was x out of  y
  6. AKTthis trainee has passed which is a good indicator that a trainee’s clinical management skills are, on the whole, good enough.   The score for clinical questions was:  x  out of  y

QUALITATIVE

  1. CSR – Under  ‘Clinical Assessment’, ‘Management of Patients’, ‘Context of Care’  the following Clinical Management themes emerge…        The ‘Level of Supervision’ is reported as… 
  2. MSF – Under Clinical Performance, the following ‘clinical management’ themes emerge…
  3. Log entries – select ones that show STRONG evidence.  Nearly all types of Learning Logs will often be about the management of a condition in primary care.

Reminder: Managing Medical Complexity = aspects of care beyond managing straightforward problems, including the management of co-morbidity, uncertainty, risk and the approach to health rather than just illness.  

QUANTITATIVE

  1. CBD item (5) Managing medical complexity: 

QUALITATIVE

  1. Log entries – select the ones that show STRONG evidence.  In particular, look at : Clinical Case Reviews, LEAs/SEAs, Leadership/Management/Professionalism & QIA.
  2. CSR  Under ‘Management of Patients’ & ‘Context of Care’ the CS says…

Reminder: Working with Colleagues = working effectively with other professionals to ensure patient care, including the sharing of information with colleagues.  The ‘performance’ of working with colleagues is best reported by colleagues themselves i.e. through MSF.

QUANTITATIVE

  1. CBD – item (7) Working with colleagues in teams: 

QUALITATIVE

  1. MSF – Under Professional Behaviour , ‘working with colleagues’ themes are… 
  2. CSR – under ‘Working with colleagues and in teams’, the CS says…
  3. Log entries – select ones that show STRONG evidence.  In particular, look at: Clinical Case Reviews, Reflection on Feedback, Leadership/Mx and Professionalism & QIA.

Reminder: Performance, Learning & Teaching = maintaining the performance and effective continuing professional development of oneself and others.

QUANTITATIVE

—-

QUALITATIVE

  1. Learning Logs: Academic Activity– Audit, Projects, PDSAs etc. 
  2. Other Log entries – select ones that show STRONG evidence.  In particular, look at: Supporting Documentation/CPD, LEAs/SEAs, Reflection on Feedback, Leadership/Management/Professionalism, QIA & Prescribing.
  3. CSR – under ‘Professionalism’ the CS says the following things about this trainee as a learner…
  4. MSF – under ‘professional behaviour’ and/or ‘clinical performance’, the following themes emerge about this trainee as a learner… 

Reminder: Organisation, Management & Leadership = taking responsibility for organising oneself, developing systems to manage one’s workload, taking leadership in managing others or particular areas, bettering systems of care, engaging with IT systems beyond what is routinely expected.

QUANTITATIVE

  1. CBD – item (6) Organisation, Management, Leadership: 

QUALITATIVE

  1. Log entries – select ones that show STRONG evidence. In particular, look at: Clinical Case Reviews, LEAs/SEAs, Leadership/Management/Professionalism & QIA.

Reminder: Practising Holistically = the ability of the doctor to operate in physical, psychological, socioeconomic and cultural dimensions, taking into account feelings as well as thoughts.  Don’t forget, this item now includes promoting health at opportunistic moments.  It also includes a wider need to always survey and protect patients – safeguarding. 

QUANTITATIVE

  1. COT – item (3) psychosocial context:          ;item (5) Pt’s health understanding: 
  2. AudioCOT – item (5)  Places complaint in psycho-social contexts:           ;item (6): Explores ICE: 
  3. CBD – item (1) Practising holistically: 
  4. PSQ – item (4) Interested in you as a whole person:            ;item (5) Fully understanding your concerns: 
  5. RCA/CSAthis trainee has passed which is a good indicator that a trainee’s ‘practising holistically’ skills are, on the whole, good enough.    The score for IPS was x out of  y

QUALITATIVE

  1. CSR – under ‘Context of Care’ the CS says the following about this trainee’s “practising holistically” skills…
  2. Learning Logs – select ones that show STRONG evidence. In particular, look at: Clinical Case Reviews & LEAs/SEAs.   Safeguarding entries/courses.

Reminder: Community orientation = the management of the health and social care of the practice population and local community.  Community orientation only comes to life when we look at the impact of disease/provision of health care in the wider patient context. This is where the NOE of audit work or engaging in a project that looks at the patient population becomes invaluable. Incidentally, these are often the best ways of learning about this element of the curriculum.

QUANTITATIVE

  1. CBD – item (8) Community orientation: 

QUALITATIVE

  1. Learning Logs Academic Activity: like audits, projects, PDSA cycles, gap analysis etc
  2. Other Learning Logs -select ones that show STRONG evidence.  In particular, look at: Clinical Case Reviews, LEAS/SEAs, Leaderhip/Management/Professionalism & QIA 
  3. CSR – under ‘Context of Care’  the following themes around Community Orientation emerge…
Competence Area MSF PSQ AudioCOT/COT  CbD CEX CSR
Communication and consultation skills            
Practising holistically

 

         
Data gathering and interpretation            
Making a diagnosis/decisions            
Clinical management            
Managing medical complexity  

 

       
Primary care admin and IMT  

 

     

 

Working with colleagues and in teams            
Community orientation    

 

     
Maintaining performance, learning and teaching            
Maintaining an ethical approach            
Fitness to practise            

The numbers on their own don't tell you the whole story - you need the narrative as well.

What evidence do I use for the various capabilties?

Write-up examples

Here are two Professional Capability write ups from one of our trainee’s ePortfolio which I was incredibly impressed with.  Have a read and compare it with what you currently do.  Is there anything you can learn from it to make yours even better?   Remember, when you are providing evidence for the Capability Rating Scales, you are meant to be “showing yourself off” to panel members who do not know you!   A bit like in a job interview – where you are selling and proving your worth.   This is the same – so why would you want to do it quickly and undersell yourself?  Spend time and write it up with care, thought and consideration.   Impress the many people who will be reading it (some of whom you will not know – but will be making a decision about you as to whether you move up an ST grade or not in your GP training).

COMMUNICATION & CONSULTATION SKILLS

Evidence

  • COTs  – 8 out of 9 COTs have been marked as “Competent for Licensing”.
  • My PSQ was very good in all areas.  Patients thought I allowed them to speak, tried to really understand their problem and left satisfied.  Mean score generally 5 for most items and Median score generally 6. 
  • CSR – under “Communication” says I regularly explore a patient’s ideas, concerns and expectations.    Also comments “excellent at recognising the impact of  problem on a patient’s life”.  And “generally makes good management plans in partnership with the patient”.
  • MSF themes – ‘good communicator’, ‘explains things well’, ‘good at communicating treatment plan’.   

Tagged Evidence

  • 06/05/2019 Learning log: Taught medical students consultation models
  • 30/01/2019 Learning log: Antibiotics wrongly prescribed by another GP
  • 10/05/2019 Learning log: Gentleman with unexplained back pain and lots of worries

Suggested Action Before Next Review

  • Maybe now try and look at difficult consultations and advanced consultation techniques.   Start by finding a course on handling difficult consultations – and then put that into practise?

MAKING A DIAGNOSIS/DECISIONS

Evidence

  • CBDs: for item Making Diagnosis/Decisions = 9/11 C, 2/11 NFD, 1/11 IE
  • COTs: (9 done in total)
    item 6 appropriate examination = 6/9 C,  2 E, 1 NFD. 
    item 7 Appropriate working diagnosis: 9/9 C
  • Previous CSR suggested to try and work more independently and to balance when to seek reassurance from others. Current CSR comments are that I meet expectations for diagnostics items, appropriate differential diagnosis and refers appropriately with specific comments stating “clinically very good”, and “does not over or under investigate” and “more self-confident and less reliant on others”. 
  • MSF themes around having good clinical knowledge, explores differential diagnosis very well, good at knowing when to ask for help, thinks laterally when needed

Tagged Evidence

  • 30/04/2019 Learning log: The girl who was taking the pill incorrectly
  • 20/03/2019 Learning log: Home visit man with haematuria – what next?
  • 25/04/2019 Learning log: Training in telephone triage

Suggested Action Before Next Review

  • I feel I have made incredible progress in terms of coping with uncertainty over the last 12 months. I would like to build on this further – perhaps read Tim Crossley’s book on ‘I Don’t Know What It Is But I Don’t Think It’s Serious’ (confidence and decisiveness in primary care).

REFLECT
Can you see that…

  • These write-ups are concise and specific.    As a result, they are not particularly long.   Long write-ups usually indicate vagueness or waffle!
  • There is both quantitative and qualitative evidence within this write-up.
  • At the end, the trainee is quite specific about how they plan to build on each competency in the near future.

Can you do something similar?  I’m sure you can.   Speak to your Educational Supervisor or GP Trainer if there is anything here that confuses you or if there is something you want more help with.

Action Points for each Capability

All trainees need to write up reasonable action points for each capability.  They must not be woolly or vague like ‘continue to build on this skill’.  This is another area which both trainees and supervisors struggle with – why? – because the points generated are simply too woolly and vague.     And even if you are an ST3 who is completing to CCT, YOU STILL HAVE TO write action points for each of the Professional Competencies – because some of these will form the basis of your PDP for your very first GP appraisal.   In the case of ST3s who are completing, the ‘suggested action before next review’ box should be interpreted as ‘suggested action before first appraisal’.

  • In summary, you need to write objectives which are SMART.  The easiest way to do this is to simply think what next practical step the trainee needs to take which will help progress him or her in this competency.
  • Feeling stuck?   Click on the button below to some top ideas from our “Formulating Action Points for each Capability” page.

Please leave a comment

Got any advice or suggestions?  Anything we’ve missed or is inaccurate?  Then leave a message below.   Got a resource to share? Contact rameshmehay@googlemail.com.  Make GP Training Better Together’

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