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Professional Capabilties Cheat Sheet

and how to use them to write up a learning log entry and CBDs

Section 1: The Capability Cheat Sheet

Why use this Cheat Sheet?

A quick guide on what sorts of specific things to write about in a Learning Log Entry or a CBD for each Professional Capability.  Write to me if you have any other hot tips and advice that you think should be included here:  rameshmehay@googlemail.com

  1. Using this Cheat Sheet will make your writing more focused 
  2. Because of that focus, it will take less time to write up (20 mins not 1 hour)
  3. You will get unexpected learning insights 
  4. The more you do this, the easier it becomes.  Persevere if it feels hard at first.
  5. Your clinical brain will automatically start thinking in this way in the future – handle anything GP throws at you!

Provide a Justification

  • Keep your learning log introductory brief short
  • For each PC – don’t just describe what you did – provide a justification (incredibly impt) The detail should be in the justification.  
  • We don’t just want to see what you did, we want see the intelligence behind it. 
  • Instead of “I decided to not admit her”, write “According to guidelines, she should have been admitted, but I decided not to admit her BECAUSE…”
  • Many trainees find it easier to write about the PCs BEFORE the description of the case.  Why?  Becasuse they end up writing about things that will “score marks”.  It makes them write more about the stuff that matters than writing a lengthy description.  In this way, the description is kept brief. 

Fitness to practise is about YOU and/or OTHERS AROUND YOU.  In other words,it’s about turning the “reflective eye” onto yourself or others to see what might reduce or prevent patient harm. It’s not about whether you are clinically good enough to be fit as a doctor but rather other factors in your life that might reduce your effectiveness as a doctor.  Think GMC Duties of a Doctor (see below).

  • Safety & Quality
      • Reflecting on a mistake you made.
      • Reflecting on mistakes you’ve identified that others have made.  Significant Event?
      • Methods to look after or protect yourself.   For example, when staff constantly interrupt you (and hence the risk of mistakes).
      • Exploring your work-life balance – it is the unbalanced who are more likely to make a mistake.
      • Feeling stressed
      • Health difficulties
  • Knowledge, Skills & Performance
      • Where you’ve gone the extra mile to make the care of your patient your first concern.  e.g. staying on a home visit.
      • Not going beyond the limits of your competence & seeking help 
      • Describe methods to perform better .  For example: how do you use to handle the pressure of on-call?   If you run badly over time in all consultations, what do you plan to do?
  • Communication, Partnership & Teamwork
      • Looking at other significant events – that you or others raised
      • Examining and reflecting on an argument with a patient.  Seeing both sides of the story.
  • Maintaining Trust
      • Going the extra mile to ensure patient trust 
      • Going the extra mile to maintain public’s trust in the profession

In order to truly understand ethics, you need to understand some of the medical ethical frameworks. It is really important It’s really important that you understand the theory, because it then helps you understand what you are doing and whether or not you need to move to a different position. In your write-ups about an ethical approach, don’t just say what you did – instead, relate what you did in relation to the theory. Use the theory to justify what you did. Show that you understand what you are doing from an ethical perspective.

  • Consent issues
  • Confidentiality issues
  • Capacity assessment (functional) – lack of any ONE of these areas represents a lack of capacity
      1. Understands information about a decision, and is then able to…
      2. Retain/Remember/Recall information around the decision, long enough to…
      3. Weigh up the pros and cons of a decision or the various options available, and then they can…
      4. Communicate their wishes by talking, sign-language or any other means. 
        (NOTE: just because a patient can speak doesn’t mean they can’t communicate – perhaps they can write or indicate or nod).
  • Autonomy, Non-Maleficience, Beneficence & Justice
  • Malfeasance vs Maleficence
  • Aristotle’s principle of Morality (Good people do good things)
  • Rationing: Utility vs Rights-based ethics
      • utility = doing the greatest good for the greatest number
      • individual rights = every individual and has an equal right to any other

In their book “Communicating with Patients”, Silverman, Kurtz and Draper outline 72 communication skills. So don’t be vague by saying “I explained x, y and z to the patient”. Instead, describe HOW you explained things. Why did you explain in that particular way? Focus on both the content and the process of each communication skill like EXPLANATIONS. Show the ” intelligence” behind the “doing”.

  • Rapport, Allowing the patient to speak, Active Listening, Agenda Setting, Screening, ICE, PSO, Verbal & Non-Verbal Cues
  • Clarifies, Summarises, Catharcism: therapeutic expression of feelings, Shows empathy, Deals sensitively
  • Shared thinking, explains diagnosis, Relates explanation to patient’s perspective
  • Explanation skills: chunks & checks, patient’s starting point, organising the explanation, simple language, signposting, repetition & summarising, check understanding, 
  • Negotiation skills, encourages patient to contribute, elicits feelings, involving the patient, shared decision making, shared planning, mutually acceptable plan, forward planning, safety netting, summarises
  • Any of the Calgary-Cambridge 71 skills
  • 3-way consultations, remote consultation skills, telephone consultation skills
  • Describe comprehensively BUT concisely – History & Examination & Test Results – write it like a medical records write up
  • Cover the red flags 
  • Detail other sources of patient information (other than the patient) – e.g. medical records, clinical letters, a relative, other health professionals
  • May need to add a bit of narrative to contexturalise and tie things together.
  • For example… for chest pain:   
    Chest pain, left-sided, tight and radiating up neck & arm.
    Sweating +++, no palpitations, no SOB, smoker 35/day, FH of IHD – father had MI age 38!!!   
    Has had this before – was admitted but according to discharge letter he self-discharged and did not attend any follow-up appointments or tests (including an exercise ECG).

We want to see that you can do a competent examination. Therefore, just spell out the OUTCOMES of the examinations you made. We can tell from that whether you did a good enough examination or not. Don’t be too verbose: don’t write things like “I then proceeded to measure the respiratory rate which was 32 and with a pulse-oximeter i was surprised to see that his oxygen saturation was 95%” Be concise. Be direct. Be comprehensive but to the point. Write in a similar fashion to how you would write up examination findings in the hospital medical notes when you were an FY doctor. For example, you might write….

  • Write up the examination outcomes
  • Write as you would in the medical notes
  • For example, for Respiratory: Good chest movements, no resp distress (no ic/sc recession), no cyanosis; RR= xx, O2 sats = xx, HR = xx; BS vesicular, no added sounds, Percussion normal 

Try and link your decision-making theoretical concepts and frameworks. You can find more on www.bradfordvts.co.uk/clinical-skills/decisions-diagnoses-uncertainty. If you don’t do this now, you will never learn about them.  We want to understand what was going on in your brain.  We want to understand what you were thinking.  We want to see you weigh up the pros and cons.

  • Not just about diagnosis.  Any decision making in the consultation.
  • The process of coming to a working diagnoses
  • The differentials you considered
  • What investigations you decided to do.  Why those?
  • What treatments you decided upon – why those?  Pros and cons.
  • Did you decide to admit the patient? Why?  On what grounds?   Pros and cons of admission.
  • Always details the justification behind your decisions (i.e. the intelligence).
  • Decision making theory/concepts
      • Dual Process Theory – System 1 & 2 thinking (fast/slow) –  see this resource
      • Cognitive Biases – see this powerpoint
      • Using Time as a Diagnostic Tool
      • Managing/Reducing Uncertainty
      • Complexity Theory
      • Pattern recognition
      • Prioritisation
      • Six Category Intervention analysis
      • SWOT analysis
      • How Doctors Think
  • Remember – detail the intelligence behind your decision-making – i.e. the justification behind it.

This one is pretty straightforward. Just write out your management plan as you would do in the medical records. We want to see whether your management plan is medically “sound”. As experienced GPs we can tell. Often, it is obvious to us why you decided on a particular management plan (i.e. because it is standard practice). But other times, you may need to provide a reason or justification for your chosen plan – especially if you decide to do something against the standard. In your write-up, try not to be unnecessarily verbose. Be concise, perhaps even using bullet points. Oh, and don’t forget, SAFETY NETTING is always part of the management plan – so include it WHERE IT IS APPROPRIATE and   REALISTIC to do so. Not everything needs safety-netting.

  • Outline the clinical plan
  • Be concise yet comprehensive
  • For example for an asthma flare up:  
    1. Start antibiotics (Amoxicillin as per guidelines
    2. Prednisolone 40mg od 5 days
    3. Take blue inhaler qds
    4. Safety netted – worsening of SOB or feeling unwell or rigors/chills… go to A&E/999
    5. I will review next week (try and use motivational interviewing to stop smoking and enagage with pulm. rehab and review inhaler use)

Trainees often struggle with this capability. Trainees think that if a condition is complicated, it is complex – BUT IT IS NOT! For example, the CKD management pathway is rather complicated, but when you slow down, it’s quite straight-forward to follow. It is not complex. Complicated and Complex mean different things. Complicated is something that might have lots of parts to it but everything follows a logical order and is therefore quite easy to follow or fix. An non-functioning electrical device might look COMPLICATED by having loads of components, but because everything has a logical placement, it should be easy for most technicians to fix. The weather is an example of something that is COMPLEX – where one little change can have a massive and sometimes unpredictable effect elsewhere. Do you see the difference between complex and complicated?  Trainees think that if they manage 2 or 3 problems together – it demonstrated Managing Medical Complexity – but IT DOES NOT! If they are four simple things (let’s say sticky eye, sore throat, a mole and a fungal toenail infection – yes having four things COMPLICATES matters but does not make the consultation COMPLEX. Yet someone who has both hypertension and CKD – is complex because drug management of the BP might have an adverse effect on the renal function.

I see that the RCGP have include Health Promotion in this capability, but there is a separate capability for this! So, if you want to focus on this, I suggest writing it within that capability. However, if the health promotion is part of a bigger picture of medical complexity, then you may wish to write about it here. You decide.

Think medical complexity when…

  • 2 or more COMPLEX medical problems to juggle (acute or chronic) – how did you do it?
  • where you’re stepping in to improve health care co-ordination (e.g. too many specialists involved and the patient is confused)
  • where you’re stepping in because of Collusion of Anonymity (look it up – coined by Balint) 
  • there is uncertainty – describe methods to handle uncertainty.  (One example is by safety-netting)
  • explaining risk – because is a very special skill, it’s a hard thing to do right.  How did you explain risk of something: e.g. risk of getting pregnant on contraception, QRISK explanation

How you work with others. Remember, this is not about you being the “superhero” but how you work other others in a team. Remember: “there is no I in teams”. If you want to write about a team which you felt you led well (perhaps on a crash call in hospital or say
a project in GP), then write this under the Leadership capability in OML(Organisation, Management & Leadership).

Examples of Working With Teams

  • Seeking a 2nd opinion or advice from a colleague
  • Involving other health professionals in the management  – not just hospitals e.g. community matrons, referrals, virtual ward, HVs, Midwives, DNs, Crisis teams, Mental Health, The Labs – microbiology, haematology etc.  Why did you involve them?  For advice or help with patient care?  Team-based approach to patient care?
  • Coordinating existing specialist involvement in a more team-based approach to enhance patient care, rather than silo working or preventing a Collusion of Anonymity.
  • Acute admissions – liaising with on-call team, handing over, information in the letter.
  • Passing on information to relevant colleagues – updating them about a patient
  • Reading and complying with what others have written e.g. management plan
  • Team dynamics – e.g. in meetings, in general, the ethos of the practice.
  • Working on a project with others – QoF/DES/LES/Audit work
  • Teaching colleagues – perhaps a workshop or teaching event you ran

Teamwork Principles You Can Write About…

  1. Understand how teams work (Tuckman & Group Dynamics)
  2. Facilitation skills (including how to encourage participation & managing conflict)
  3. Defining clear Goals
  4. Being Organised – Clear Roles & Tasks (read about Belbin’s Teams Roles), Delegation
  5. Communicating well (SBAR, handover, referral letters, discharge letters)
  6. Listening well (including allowing people to express feelings)
  7. Making good decisions together
  8. Mutual Trust, Respect
  9. Being Flexible
  10. Providing Skills training & Support
  11. Enjoying the process & Celebrating Success
  12. Communities of Practice (Wenger)- look it up.

Remember to be specific when you write about what you have or are planning to learn. For example, when writing about your learning needs, don’t just write “I will read up more about facet joint arthritis”. Be specific to show us that you have thought about it and are definately planning to do it. For example, you might write “I plan to read more about facet joint arthritis – great health professional article on patient.info”. Likewise, instead of “a course on Motivational Interviewing”, write “a course on Motivational Interviewing – one in Manchester run by xxx in Dec 21”.  Oh and don’t cut and paste things from online learning material. That will not help you learn and it also does NOT show us that you are learning. We are more  interested in what exactly is new for you and is going to change the way you do things in the future. What are the key take-home messages for you.

Also, when writing about teaching you have delivered, don’t just write about what you did (i.e. don’t just be descriptive). Tell us did it that particular way and try and relate it to (i) educational theory and (ii) faciliation theory – plenty of www.bradfordvts.co.uk (click on TEACHING). In other words, tell us “the intelligence behind your doing”. Don’t forget to evaluate your teaching – it’s the only way to get insight & improve!

  • Teaching others
  • What things have you looked up?   Care – don’t put too much “reading” stuff down.
  • What modules and courses have you done?  Detail what you learned that you are going to put in practice.  Tonnes of learning detail is not necessary.  We are interested in the most important points for YOU.  
  • Have you been involved in teaching others?   What did you do?  Why did you do it that way?  What teaching/facilitation methods did you use?  Relate what you did to the educational theory.

This capability actually covers lots of things! So best to think in terms of the 3 things – (1) Organisation (2) Management (3) Leadership

ORGANISATION:

  • Understanding primary & secondary care organisational systems.
  • Computerised medical records – how you use them to facilitate patient care; your medical notes – organised, comprehensive, logical?  
  • Using other medical/non-medical IT systems – to manage the patient, to keep clinically up to date, other uses

MANAGEMENT:

  • This is about managing yourself and/or others.
  • Methods to help you keep on top of things – your blood results, letters and other admin work amongst the daily duties of a GP.
  • Methods to help make you/organisation be more productive
  • Time management
  • Please detail what you are doing rather than being vague with words like “I am being more productive and efficient”. We want to know how. If you can’t tell us how, then it’s likely you don’t know what you are doing. So please tell us how. Again, it is about “the intelligence behind the doing”. 

LEADERSHIP:

  • Don’t think of leadership as that top person in an organisation that leads the others below.  That’s a leader, not leadership. Leadership is broader than that. 
  • Chairing a meeting
  • Helping to manage staff or team-building activities
  • You may have led a team or project or a change in the way of working in the practice you are working in.
  • You can even show leadership qualities when managing a complex patient – let’s say where lots of specialists are involved but doing their own thing (silo working) – and you step in to coordinate the care in order to provide optimal patient care.
  • If you are going to talk about leadership, you should relate what you are doing (the description) to the theory (i.e. “the intelligence”).

Leadership theory/principles include:

  1. believing in the purpose/committing to the project/taking responsibility – developing a vision
  2. (developing or enhancing skills that you may need for the job,
  3. making sound & timely decisions,
  4. communicating well,
  5. leading by example (& showing humility),
  6. knowing your people, valuing them & looking out for their welfare (& being forgiving)
  7. skills – delegation, motivation, prioritisation, facilitation, influencing others,negotiation, empathy
  8. learning agility – learning to be curious – being innovative,
  9. showing self-awareness,
  10. O-HIT core values – Openness, Honesty, Integrity & Trust.

There are 3 parts of this capability. You can write about any one of them.

PRACTISING HOLISTICALLY

  • Looking at the problem in a wider context rather than just a medical one.  Why do we encourage this? Because the management of the problem in many instances needs more than just the quick “plaster” fix of a drug. So – write about these additional measures you have put in place to help – e.g. daycare, nursing support, referral to counselling.
  • How is it affecting the patient’s life, their family’s, their work, their mental sanity.
  • Explore ICE (Ideas, Concerns, Expectations) – how did this change your management?   Did you challenge any unhelpful health beliefs?
  • Explore the PSO (Psycho, Social, Occupational) aspects of the problem on a patient’s life (or on his or her family) – how did this change your management?   Did you advise on any workplace adjustments?
  • Understanding the problem in relation to the patients cultural and socio-economic background.

PROMOTING HEALTH

Please don’t try and squeeze in health promotion just for trying to impress us. Health Promotion has to be appropriate and realistic. Of course, if someone smokes you want to explore if they are open to smoking cessation, but give it the time and space it deserves and only do it when appropriate to do so. So, if a patient comes in with depression and you spend a good time on their low mood and suicidal ideation, talking about smoking cessation is not the right thing to do here – best left for another day, when the patient is in a happier part of their life (and more likely of success too).

  • What tools you used if any, to promote health (e.g. Cates’ plots, decision-aids, health promo leaflets, SWOT analysis).
  • What skills did you use to engage in positive health?   Motivational Interviewing skills for example.  Risk explaining skills.    Challenging unhelpful health beliefs.

SAFEGUARDING

A patient may come in with a problem that actually necessitates an enquiry into safeguarding, even though that might not have been part of their agenda. But doctors have to make doctoring decisions and if someone is at risk of harm – that has to become part of the agenda. So, if a lady comes in and reveals Domestic Violence, and this occurs in the presence of young children, safeguarding has to be part of the discussion and management plan.

So detail…

  • what you did,
  • why you did it,
  • show that you have an understanding of safeguarding systems and
  • detail how you did it to try and minimise an angry response.

Another capability trainees struggle with and what they write about often fails to “hit the mark”. So please re-read this capability to get the true definition of what it means firmly grounded into your head. Many trainees think referring a patient to a service in the community is a demonstration of this capability. IT IS NOT. This capability is about THE COMMUNITY rather than individuals, hence the term COMMUNITY orientation. It’s about populations rather than individual patients. It’s about population medicine and health rather than individual medicine and health.

In dealing with an individual patient many of us come across issues that apply more widely to other patients who share a similar characteristic. For example, you may have a poorly controlled diabetic in front of you and you realise he know nothing about diabetes or dietary management because all of your leaflets are in English and not in Punjabi – his mother tongue. You then realise you have a significant Punjabi community and thus the notion that this issue might be a wider problem. So,you source some leaflets in Punjabi and by doing that, you are being COMMUNITY ORIENTATED.

HOSPITAL POSTS: It is often difficult to show evidence for this capability when in a secondary care (hospital) post. But it is not impossible! Just remember, it has to relate to the community at large. For instance. you decide to join a hospital diabetic team that are trying to improve education in the community.Or perhaps the department is doing a campaign to encourage breastfeeding to new mothers. Or your General Medicine department wants your help on how to write more effective discharge letters that will help GPs (and thus ultimately patients) better.

Examples:

  • You decide not to prescribe an expensive branded version of a drug (that a consultant wants you to prescribe) but a generic one because the money saved could provide more NHS services to the population at large.
  • You have a patient in front of you who you feel could do with some Mindfulness therapy but not sure if this is available – in your research, you find something available on the NHS and you let other doctors and patients know.
  • A patient wants an MRI of their back (no red flags); you decide to follow the local guidelines on MRI (developed because GPs are ordering MRIs unnecessarily) – you decide not to refer because one has to be protective of the NHS budget so that the greater population can be served better.
  • You get involved with the CCG lead on sexual health to help deliver a better service.
  • You notice that chlamydia is rife in your practice population but the uptake of screening is low – so you work with one of the partners to develop a “Get Tested” campaign.
  • You attend a patient participation group because you want to hear what patients want.
  • You attend LMC meetings because you want to help shape health at a population level.

Things to write about

  • What did you learn from this patient that you are going to apply to all other patients with a similar characteristic?
  • Have you made any changes to services to other patients as a result of this case?
  • Have you developed a resource or something for other patients as a result of this case? e.g. back pain leaflet for patients who speak Latvian because there are quite a number of Latvian speaking patients.
  • Have you reviewed any community services and how to make best use of them?
  • Did you get involved in developing a new service?
  • Have you helped shape the practice to encompass the variety of cultures and diversity within its practice population?
  • Have you attended meetings to shape future health e.g. CCG/Primary Care Networks/Patient Participation Group meetings
  • Have you been involved with voluntary groups and offered your help?
  • Any natural moments where you have explored individual vs population health care?

Theoretical concepts you can write about

***** Items with five stars are capabilities that trainees often struggle with.  So, please read and re-read these several times. 

Section 2: Understanding the Basics

If you are new to GP training (trainer or trainee), please read this section.   You may also want to dip into some of the downloadable resources in the DOWNLOADS box above.

Capabilities are abilities or attributes, described in terms of behaviour, key to effective performance within a particular job.  They provide a common language for describing performance and the abilities/attributes displayed by individuals. Currently the RCGP defines 13 capabilities.   

Put another way, everything any qualified and capable GP does can be mapped out into one or more of these 13 broad areas (capabilities).    Therefore, if by the end of training a trainee can demonstrate that they are good (i.e. capable) at all 13 areas, then it makes logical sense that they are also capable at being an independent GP.

The definition of ‘skills’ and ‘capabilities’ is, on the face of it, very similar. They both relate to the ability to do something well.  But capabilities are not skills, although they are similar.

A skill focuses on the ability to do a particular thing.  If you are good at a skill or even a set of skills, that does not automatically mean that you will be good at a job.   That’s where capabilities come in.    Capabilities focus on behaviours rather than abilities and tend to be based on broad things rather than the specific things that skills focus on.  Capabilities specify how the individual carries out the skills they have in the context of their working environment (s).  

For example, lets say you have 5 window cleaners who are really good at cleaning windows.   Clearly all 5 have the skill!    But if I told you two of them always turn up late and make a right mess whilst a third one is always rude and lies about the number of windows that have been cleaned – that only leaves two who have the capabilities expected of a good window cleaner.  Those capabilities might be punctuality, communicates well with clients, is ethically minded, and is honest.

So basically, capabilities tell us what success looks like.   They combine ABILITY with the knowledge and skills required.  

What’s the difference between Competence and Capability?

When we say an individual is competent, we are implying that actual state that has been reached and that there is nothing further to do.   When we say someone is competent, it’s like saying they have reached a ‘defined’ state and there is nothing further.  All learning has been achieved.  There is no further learning.    Capability does not have this limitation.  Capability not only refers to whether a minimum ability exists in an individual but also provides space for further improvement.  

Here are some examples…

  • A student may be getting average grades in their A-levels.   But with more intense revision and educational input, they are capable of achieving significantly better grades.
  • A runner can finish a marathon in 3 hours and that might be pretty good.    However, with further training, they may have the capability to complete it in less than 2.5 hours.

Competence is another word describing the ‘know-how’ or ‘skill’ of an individual whereas capability is the word that describes how good they are at applying it in a variety of situations and circumstances.   Capability incorporates an individual’s competence PLUS their attitudes, values, and flex their style.   Capability is therefore a higher and more “real” indication of a trainee’s ability than competence. Capability is not just about the possession of skills (unlike competence).

This might help you understand it better…

(Taken from: Quality in Learning, edited by John Stephenson and Susan Weil, published by Kogan Page, London in 1992.  CHAPTER ONE CAPABILITY AND QUALITY IN HIGHER EDUCATION John Stephenson )

Capability: a working definition Capability does not easily lend itself to detailed definition. It is easier to recognize it than to measure it with any precision. It is an integration of confidence in one’s knowledge, skills, self-esteem and values. We have found widespread support for our resistance to the temptation to define capability in reductionist terms, seeking ever more separately measurable competences. Capability depends much more on our confidence that we can effectively use and develop our skills in complex and changing circumstances than on our mere possession of those skills. 

The following definition of capability, however, has been useful in exploring the essence of capability with academics: Capable people have confidence in their ability to

  1. take effective and appropriate action,
  2. explain what they are about,
  3. live and work effectively with others and
  4. continue to learn from their experiences as individuals and in association with others, in a diverse and changing society.

Capability is a necessary part of specialist expertise, not separate from it. Capable people not only know about their specialisms; they also have the confidence to apply their knowledge and skills within varied and changing situations and to continue to develop their specialist knowledge and skills long after they have left formal education. 

Capability is not just about skills and knowledge: it incorporates values, self-esteem and a commitment to learning.

Taking effective and appropriate action within unfamiliar and changing circumstances involves judgments, values, the self-confidence to take risks and a commitment to learn from the experience. Involving students in the decisions which directly affect what they learn and how they learn it develops a sense of ownership and a high level of motivation. 

Many academics find the emphasis on confidence, esteem and personal values as well as on knowledge and skills relevant to their perception of an educated person and the role of higher education. Each of the four ‘abilities’ is itself an integration of many component skills and qualities, and each ‘ability’ relates to the others. For instance, one’s ability to take appropriate action is related to our specialist expertise which in turn is enhanced by one’s learning from one’s experiences of earlier actions taken. ‘Explaining what one is about’ involves much more than the possession of oral and written communication skills; it requires self-awareness and confidence in one’s specialist knowledge and skills and how they relate to the circumstances in hand. 

Educating for capability through higher education 
Capability, we argue, is developed as much by the way students learn as by what they learn. If students have experience of being responsible and accountable for their own learning, within a rigourous and interactive environment, they will develop confidence in their ability to take effective and appropriate action, to explain what they are about, to live and work effectively with other people, and to continue to learn from their own experiences. The medium, as they say, is the message. The Higher Education for Capability approach is a total approach. Confidence in one’s personal qualities and specialist expertise is developed through successfully taking responsibility and accounting for the reflective application of specialist knowledge and skills. 

Every part of a GP’s job can be catergorised into one or more 4 broad areas.  These are….

  1. Relationship
  2. Diagnostics (or Decision Making)
  3. Management
  4. Professionalism

So, if we can define several capabilities within each of these four areas then it should make sense that if a GP trainee can demonstrate “good enough” performance in each of these capabilities by the end of their training, then they should be “good enough” to become a qualified GP.  These capabilities are called The Professional Capabilities.   Before we go onto exploring the capabilities (previously called competencies), click below to read more about one or more of the RDMP domains. RDMp was developed by the occupational psychologist Dr Tim Norfolk (ref: Quality in Primary Care 2009; 17, 37-47).

In summary, the 13 Professional Capabilities can be grouped into one of the four RDMp areas above.

  1. Introduction: Seeing the Bigger Picture
  2. Relationship
  3. Diagnostics/Decision-Making
  4. Management
  5. Professionalism

During training, you have to pay attention to two things over the 3 years. 

  1. Cover the 9 Clinical Experience Groups – building your knowledge, skills and attitudes.   
  2. Show evidence that you are capable in all the 13 RCGP Professional Capability areas.  

You should focus on these two things at all times – constantly providing evidence for them.   The context of a Learning Log Entry or a CBD will automatically cover the curriculum BUT what you write in it should be focused on the Professional Capabilities.   This is where a lot of trainees go wrong – they provide so much detailed clinical information and detailed clinical management plan, that they exhaust themselves and provide evidence mainly for the curriculum but not the Professional Capability Areas.   

So, for example, if I choose to write about a man with a frozen shoulder, then automatically, I am covering the curriculum about MSK problems.    Yes, I can write up about what history I took, what examination I made and even the management plan.   But that alone will only cover the capability areas of Data Gathering, CEPS and Clinical Management.  BUT THERE ARE 10 OTHER PROFESSIONAL CAPABILITY AREAS THAT I WILL BE IGNORING.  And by ignoring them, not only do I miss the opportunity to provide evidence for these areas, but I also limit my own professional development through a lack of reflective learning in these areas.   So, don’t forget to focus on the Capability Areas.  For example, for PRACTISING HOLISTICALLY – I might look at how this man’s frozen shoulder is interfering with his job as a bricklayer.   For MAKING DECISIONS  – I might write how I came to the DIAGNOSIS of a frozen shoulder.  I might also describe how we DECIDED on a management plan.   I hope this example provides a clearer picture for you.  

Got any suggestions or advice?

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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