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Educational Supervision

Finding the evidence for the Capability Rating Scales

What evidence do I use for the various Capabilities?

Before an ES review, both the trainee and the Ed Supervisor are required to rate the trainee against the 13 Professional Capabilities – and then one has to justify the rating with evidence.  This helps others, like ARCP panels, be reassured that the rating is grounded in evidence rather than ‘loose opinion’.    If it is written up poorly, then ARCP panels have to go searching for that evidence, and may not find it – because it buried deep within the ePortfolio somewhere – and as a result, the trainee gets an unsatisfactory grade.    So, the rating scales is an OPPORTUNITY to show case yourself – you know your ePortfolio like the back of your hand – so use that familiarity to prove that you are good enough and enable ARCP panels to sign you off effortlessly. 

The rating scale section is perhaps the most important area of Educational Supervision (and ARCPs pay particular attention to it).  It is also one of the hardest bits of Educational Supervision and a lot of people have difficulty with the write up.    This page will show both trainees and Educational Supervisors to write it up in the most optimal way – to make life easier for everyone!    If the ES and ARCP panel are impressed with your write up – how will that make you feel?

The Capability Evidence Table

Please click on a capability.  Items in blue provide greater evidence that those in black.  However, try and pack as much evidence as possible.

Fitness to practise is 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.

  1. CBD – under item (10) Fitness to practise: 
  2. CSR – under ‘Professionalism’ – With respect to the trainee’s conduct, performance and health CS says:  
  3. MSF – under ‘clinical performance’: ‘fitness to practise’ themes are…
  4. Log entries 
    Hopefully those marked for this capability will be automatically pulled in by the FourteenFish ePortfolio platform into the ES Capability Rating section. 
    In particular, look at: Clinical Case Reviews, LEAs/SEAs, Reflection on Feedback

Practising ethically with integrity and a respect for diversity.

  1. CBD – item (9) Maintaining an ethical approach
  2. CSR – under ‘Professionalism’  – With respect to an ‘ethical approach to practice’, the CS says:  
  3. MSF – under ‘professional behaviour’, “ethical approach” themes are:
  4. Learning Logs –
    Hopefully those marked for this capability will be automatically pulled in by the FourteenFish ePortfolio platform into the ES Capability Rating section.   
    In particular, look at: Clinical Case Reviews, LEAs/SEAs, Reflection on feedback (esp complaints), QIA, Leadership/Management/Professionalism 

This competence is about communication with patients, and the use of recognised consultation techniques.

  1. COT – in terms of ‘Overall Assessment of Performance’:
    (Note: 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”)
  2. AudioCOT – in terms of ‘Overall Assessment of Performance’:
    (Again, as most items in the audio-COT are about Communication Skills, rather than writing about each item, write in terms of the “Overall Assessment of Performance”.   Especially items (1), (2), (3), (4), (5), (6), (9), (10), (11), (12))
  3. PSQ – The following communication skills themes emerge from the latest patient feedback questionnaire: 
  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
  5. CEX – item 3: Communication skills
  6. CSR –under ‘Communication’ – The CS says the following about this trainee’s communication skills: 
  7. MSF – Under professional behaviour and/or clinical performance, the following communication skills themes emerge from the latest colleague feedback questionnaire:
  8. Learning Logs –  
    Hopefully those marked for this capability will be automatically pulled in by the FourteenFish ePortfolio platform into the ES Capability Rating section. 
    In particular, look at Clinical Case Reviews.

The gathering and use of data for clinical judgement, the choice of physical examination and investigations, and their interpretation.

  1. CEX : In terms of item (1) history:            In terms of item (2) examination: 
  2. COT – in terms of ‘Overall Assessment of Performance’:
    (Note: Many items in the COT are about Data Gathering.  Especially items:
    (1) Encourages pt’s contribution, (2) Responds cues, (3) Psychosocial context, (4) Pt’s health understanding, (5) Includes/excludes significant condition, (6) Examination.  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 Data Gathering 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”)
  3. Audio-COT:  – in terms of ‘Overall Assessment of Performance’:
    (Again, as most items in the audio-COT are about Data Gathering Skills, rather than writing about each item, write in terms of the “Overall Assessment of Performance”.  But do look at the mapping sheet at the folowing items to see how well the trainee is doing:
    Items (3) Identifies the reason for the call, (4) Encourages patient contribution, (5) Places complaint in PSO context, (6) explores ICE, (7) History Taking)
  4. CBD – In terms if item (2) data gathering & interpretation: 
  5. CSR – under ‘Clinical Assessment’ and ‘Level of Supervision’, the CS says…
  6. 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
  7. MSF – under clinical performance, the following theme emerge about this trainee in terms of Data Gathering:
  8. Log entries
    Hopefully those marked for this capability will be automatically pulled in by the FourteenFish ePortfolio platform into the ES Capability Rating section. 
    In particular, look at:
    Clinical Case Reviews, LEAS/SEAs & CEPs.

Any reference to the doctors’s ability to perform clinical examination and clinical procedures/investigations.

  1. CEPs – 
  2. COT –  In terms of item (6) appropriate physical or mental examination:
  3. Mini-CEX – In terms of item (2) physical examination skills:
  4. CSR – under ‘Clinical Assessment’ the CS says the following about examination skills:
  5. MSF – the following comments are made about examination skills: 
  6. Log entries –
    Hopefully those marked for this capability will be automatically pulled in by the FourteenFish ePortfolio platform into the ES Capability Rating section. 
    In particular, look at Clinical Case Reviews & CEPS.

This competence is about 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.

  1. CBD  In terms of item (3) Making diagnosis/decisions: 
  2. COT – In terms of items (6) Appropriate examination:           In terms of item (7) Appropriate working diagnosis:
  3. AudioCOT – In terms of item (8) appropriate working diagnosis:          In terms of item (9) creates an appropriate, effective treatment plan:        In terms of item (11) safety netting/FU:
  4. CEX In terms of item (4) clinical judgement:
  5. CSR – under ‘Clinical Assessment’, ‘Management of Patients’, ‘Context of Care’ and ‘Level of Supervision’, the CSR says the following about Decision & Diagnosis skills…
  6. MSF – under clinical performance,the following decision/diagnosis themes emerge from collegues:
  7. Log entries
    Hopefully those marked for this capability will be automatically pulled in by the FourteenFish ePortfolio platform into the ES Capability Rating section.   
    In particular, look at: Clin Case Reviews, LEAs/SEAs, Leadership/Management/Professionalism & Prescribing.

The recognition and management of common medical conditions in primary care.

  1. CEX In terms of item (7) overall clinical care:
  2. COT – In terms of item (10) Appropriate management plan & FU: 
  3. AudioCOT – In terms of item (9) creates an appropriate, effective mutually acceptable treatment plan:
  4. CBD – In terms of item (4) Clinical management
  5. CSR – Under  ‘Clinical Assessment’, ‘Management of Patients’, ‘Context of Care’ & ‘Level of Supervision’, the CS says…
  6. 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
  7. 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
  8. MSF – Under clinical performance, the following ‘clinical management’ themes emerge from colleagues:
  9. Log entries – 
    Hopefully those marked for this capability will be automatically pulled in by the FourteenFish ePortfolio platform into the ES Capability Rating section.

    Nearly all types of Learning Logs will often be about the management of a condition in primary care.

Aspects of care beyond managing straightforward problems, including the management of co-morbidity, uncertainty, risk and the approach to health rather than just illness.  

  1. CBD – In terms of item (5) Managing medical complexity
  2. Log entries
    Hopefully those marked for this capability will be automatically pulled in by the FourteenFish ePortfolio platform into the ES Capability Rating section.

    In particular, look at : Clinical Case Reviews, LEAs/SEAs, Leadership/Management/Professionalism & QIA.
  3. CSR  Under ‘Management of Patients’, ‘Context of Care’ the CS says…
  4. CEX In terms of item (7) overall care:        (Remember to also look at the ‘complexity of the case’ drop down box)

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.

  1. MSF – Under professional behaviour , the following ‘working with colleagues’ themes emerge from colleagues:
  2. Log entries – 
    Hopefully those marked for this capability will be automatically pulled in by the FourteenFish ePortfolio platform into the ES Capability Rating section
    In particular, look at: Clinical Case Reviews, Reflection on Feedback, Leadership/Mx and Professionalism & QIA.
  3. CSR – under ‘Working with colleagues and in teams’, the CS says…
  4. CBD – In terms of item (7) Working with colleagues in teams: 

Maintaining the performance and effective continuing professional development of oneself and others.

  1. Learning Logs: Academic Activity– Audit, Projects, PDSAs etc. 
  2. Log entries 
    Hopefully those marked for this capability will be automatically pulled in by the FourteenFish ePortfolio platform into the ES Capability Rating section
    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 from colleagues: 

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.

  1. CBD – In terms of item (6) Organisation, Management, Leadership: 
  2. Log entries
    Hopefully those marked for this capability will be automatically pulled in by the FourteenFish ePortfolio platform into the ES Capability Rating section.
    In particular, look at: Clinical Case Reviews, LEAs/SEAs, Leadership/Management/Professionalism & QIA.

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. 

  1. COT – In terms of item (3) psychosocial context:          In terms of item (5) Pt’s health understanding:
  2. AudioCOT – In terms of item (5)  Places complaint in appropriate psycho-social contexts          In terms of item (6): Explores ICE
  3. CBD – In terms of item (1) Practising holistically: 
  4. PSQ – In terms of item (4) Interested in you as a whole person:            In terms of item (5) Fully understanding your concerns: 
  5. RCA/CSAthis trainee has passed which is a good indicator that a trainee’s ‘practising holistally’ skills are, on the whole, good enough.    The score for IPS was x out of  y
  6. CSR – under ‘Context of Care’ the CS says the following about this trainees “practising holistically” skills: 
  7. Learning Logs
    Hopefully those marked for this capability will be automatically pulled in by the FourteenFish ePortfolio platform into the ES Capability Rating section.
    In particular, look at: Clinical Case Reviews & LEAs/SEAs.   
    Also look at 
    Supporting Documentation/CPD – in particular for Safeguarding entries /Courses

Community orientation is 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.

  1. Learning Logs Academic Activity: like audits, projects, PDSA cycles, gap analysis etc
  2. CBD – In terms of item (8) Community orientation: 
  3. CSR – under ‘Context of Care’ the CS says the following about this trainee in terms of Community Orientation: 
  4. Other Learning Logs –
    Hopefully those marked for this capability will be automatically pulled in by the FourteenFish ePortfolio platform into the ES Capability Rating section.
    In particular, look at: Clinical Case Reviews, LEAS/SEAs, Leaderhip/Management/Professionalism & QIA 
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            

How to write it up

Remember the purpose of this rating scale: for you to provide evidence of performance in the 13 Professional Capabilities –  nothing more and nothing less.  Now, if we focus on the term evidence, there are two types of evidence that you can provide – quantitative and qualitative.   Both are different ways of providing a measure on the same thing – one is NOT better than the other.   It’s like looking at different windows into a particular room to get a good feeling of what it is really like.   It’s great if the view from each window tallys up with one another (a process called triangulation).    And one window might provide little bits of “extra information” that the other room failed to provide.     By looking at BOTH windows (the quantitative and the qualitative) – you get a picture that is far more comprehensive, inclusive complete and reliable that just looking at one window in isolation.    It is richer, deeper and more meaningful.    That’s all that ARCPs want – a true, deep and meaningful picture of how you are progressing in terms of your training.

The numbers don't tell you the whole story. For that, you need the narrative as well.

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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