MRCGP & GP Training
Section 1: How to use the capabilities to your advantage in Learning Logs & CBDs
Things to write about in your learning log entries & CBDs...
If you are new to GP training, firstly – welcome! This page is divided into 3 sections.
- The first section which follows below is guidance that jumps straight into using the Professional Capabilities to help you write up your Learning Log Entries or Case Based Discussion. No doubt you will come back to this page again and again – and this is the reason why we have put it first.
- However, if you are new to all of this, please read section 2 first. Section 2 provides an intro to what Capabilities are, how they differ from Competencies and this thing called RDMp.
- Section 3 is where you will find additional Downloads and Weblinks.
During training, you have to pay attention to two things over the 3 years.
- Cover the curriculum – building your knowledge, skills and attitudes.
- 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.
Provided below is a quick guide on what sorts of specific things to write about in a Learning Log Entry or a CBD when writing about a particular Professional Capability heading. Trust me, if you do this…
- it will make your writing more focused and…
- because your writing is more focused, it will take less time to write up (20 minutes rather than 1 hour) and…
- by doing it again and again, your clinical brain will automatically start thinking in this way in the future. This means that you will be able to handle any situation General Practice throws at you by simply thinking about it in terms of the relevant capability areas.
Provide a Justification
- Keep your learning log introductory brief short
- For each Professional Capability – do not just describe what you did…. Provide justification for what you did (incredibly important)
- The detail should be in the justification. The description should be short and sweet.
- In other words, we don’t just want to see what you did, we want see the intelligence behind what you did.
- So instead of “I decided to not admit her” you should write “According to guidelines, she should have been admitted, but I decided not to admit her BECAUSE…”
- Many trainees find it easier just to pick the Professional Capability headings first – (i.e. the areas they want to write about). Then – write about them! And only after this is finished, write the description of the case. In this way, they end up writing about things that will “score marks”. It also makes them write more about the stuff that matters than writing a lengthy description. In this way, the description is kept brief.
Communication Skills (CS)
- 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
Practising Holistically, Promoting Health & Safeguarding (PH)
- Looking at the psycho, social, occupational effects of an illness on a patient’s life
- How did that change your management?
- Promoting Health (Opportunistic Health Promotion)
- Safeguarding patients (adults, children, the vulnerable etc).
Data Gathering & Interpretation (DG)
- History & Examination
- Write it like a medical records write up
- 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!!!
Clinical Examination & Procedural Skills (CEPS)
- Write up the examination you made in detail
- e.g. 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
Making Diagnoses & Decisions (MD)
- Not just about diagnosis
- Treat or not – I decided not to treated BECAUSE
- Investigate or not – I decided to do the following BECAUSE
- Admit or not admit – I decided to admit BECAUSE
- What was the justification behind your decision? (the intelligence)
- 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.
- Dual Process Theory – system 1 vs system 2 thinking = fast/slow thinking – see this resource
- Cognitive biases – see this powerpoint
- How Doctors Think
Clinical Management (CM)
- Outline the clinical plan
- For example for an asthma flare up: Started steroids for 5d, given abx for 7d, push up blue inhaler qds for 7d, checked inhaler technique, FU 2w.
Managing Medical Complexity (MMC)
- Explaining risk is a very special skill, it’s a hard thing to do right.
- Risk – how did you explain risk of something: e.g. getting pregnant on contraception, QRISK explanation
- Uncertainty – how did you handle this?
- Safety netting * bringing people back to reduce risk or to handle uncertainty
- Complexity – is where there are lots of problems to juggle at the same time. How did you do it?
Working with Colleagues (WWC)
- Involving other health professionals in the management e.g. community matrons, referrals, virtual ward
- Second opinion from a colleague
- Passing on information to relevant colleagues – updating them about a patient
- Reading and complying with what others have written e.g. management plan
- Referring patients and the information in the letter
- Admitting patients and the information you pass to the admitting doctor
Performance, Learning & Teaching (PLT)
- Teaching others
- Loooking things up – don’t put too much “reading” stuff down.
- Doing modules and courses.
- 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.
Organisation, Management & Leadership (OML)
- How you organise yourself – doing results, paperwork, managing your time and workload
- How to manage other – staff, the practice etc
- Leadership – leading on mini-projects and things, chairing meetings
Community Orientation (CO)
- 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.
Ethical Approach (Eth)
- Consent & Confidentiality
- Autonomy, Non-Maleficience, Beneficience & Justice
- Malfeasance vs Maleficence
- Aristotle’s principle of Morality (Good people do good things)
- Rationing: Utility vs Individual rights
- utility = doing the greatest good for the greatest number
- individual rights = every individual and has an equal right to any other
Fitness to Practise (FTP)
- Mistake you made.
- Mistake others made – did you raise it as a Significant Event?
- Other Significant Events – that you or others raised
- Looking after yourself – for example
- running over time,
- patient argument,
- staff constantly interrupting you,
- the pressure of on-call, how you coped,
- what measures to protect yourself,
- how will you handle things better in the future etc.
Section 2: THE BASICS - Capabilities, Competencies & RDMp
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
- take effective and appropriate action,
- explain what they are about,
- live and work effectively with others and
- 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….
- Diagnostics (or Decision Making)
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.
Section 3: Downloads and Weblinks
- 00 Becoming_a_GP v 10.9 open ith publisher 2003.pub
- 00 Becoming_a_GP_FINAL_V10.9.pdf
- 01 seeing the bigger picture.pdf
- 02 relationship.pdf
- 03 communication and consultation skills.pdf
- 04 practising holistically.pdf
- 05 working with colleagues.pdf
- 06 diagnostics.pdf
- 07 data gathering and interpretation.pdf
- 08 making diagnoses and decisions.pdf
- 09 clinical management.pdf
- 10 managing medical complexity.pdf
- 11 management.pdf
- 12 primary care admin and IMT.pdf
- 13 community orientation.pdf
- 14 maintaining performance learning and teaching.pdf
- 15 professionalism.pdf
- 16 ethical approach.pdf
- 17 fitness to practise.pdf
- 18 index.pdf
- professional competencies rcgp with descriptors.pdf
Amar has dedicated most of his working life to the education of GPs and development of GP training.
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