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Training Map for ST3s in a GP Post

things to achieve before the end of your 12 month GP placement

The ST3 training map (GP post)

Broad things to achieve by end of the final GP post

These are good for the Placement Planning Meeting...

Everything we do as doctors and every part of our job  (whether in hospital or GP) can be group into three areas which are all underpinned by PROFESSIONALISM.   Those three areas are RELATIONSHIPS (which includes communication skills), DECISION-MAKING (which includes decisions on all sorts of things, including diagnosis-making) and MANAGEMENT (by management – we do not mean clinical management – we mean management in the broad sense – how we manage our work, ourselves, our sanity, our health, our personal systems, our work-personal life balance).   The latter is important because happy and well-grounded doctors generally make good decisions and less mistakes.   For your Placement Planning Meeting, it can be helpful to think what the trainee might want to develop in their new post in terms of these 4 areas.   Click to open the items below for further clarification on each of these.

What:  At the end of this placement, the trainee will

  • have developed good rapport with most patients.  The trainee will be well on their way to developing good communication/consultation skills for face to face and telephone consultations.   Should be good enough for RCA/CSA standard.
  • have developed and shown good working relationships with a wide variety of staff, not just the doctors.  

How

  • Reading or revisit reading a communication skills book  – as early as possible – Skills for Communicating with Patients by Silverman or The Naked Consultation by Liz Moulton.
  • Reading a telephone consultation book.
  • Practise through face-to-face consultations with patients.
  • Practising telephone consultation skills.
  • Tutorials and professional conversations with trainer and other colleagues.
  • Relationship with colleagues: through day-to-day interaction with them.   Showing genuine interest in other people.  Demonstration in informal and formal conversations.

Output Measure:

  • Face-to-Face Consultations
      • Deals with the main consulting issues in face to face consultations within 10 minutes on average.
      • In other words, a gradual move from 15 to 10 minute consultations.
  • Adequate telephone consultations observed
      • Coves the main issue and giving good advice. 
      • At least one Audio-COT to assess more objectively (compulsory).
  • Practice Meetings
      • Contributes to practice meetings rather than just sitting back and listening.
      • Demonstrates a respect for other differing opinions.
      • Does not think  he or she is always right.
  • COTs:
      • Achieving all COT capabilities relating to RELATIONSHIPS to a ‘competent for licensing’ level.
      • These areas are: (i) Hx (ii) Ex (iii) Diagnosis (iv) Mx and (v) Patient Contribution. (vi) FU plans in place.  PLUS (vii) Picking Cues, (viii) Exploring ICE & (ix) PSO and (x) Explanations.   
  • CBDs:
      • Achieving all CBD capabilities relating to RELATIONSHIPS to a ‘competent for licensing’ level.
      • These areas are: (i) Working with Colleagues and in Teams (ii) Practising Holistically and (iii) Fitness to Practise.
  • MSF
      • Multi-Source Feedback (MSF) comments about good relationships  and working with clinical, non-clinical staff and patients.
  • PSQ
      • Patient Satisfaction Questionnaire (PSQ) details evidence of good communication skills, relationships and rapport.
  • ePortfolio
      • Log entries demonstrate thinking and reflection on specific communication micro-skills, like ICE, PSO, Signposting, Screening., Setting Agendas, Summarising, Explanations and so on.
      • Log entries show good levels of reflection on feelings – of self and others. 
      • Log entries show an appreciation for others.

NOTE:
Achieving means trainee is achieving competence or near competence.
Progressing means although trainee might not be competent, they are progressively developing well in this area.

What:  At the end of this placement, the trainee will

  • be able to deal with (i.e. make decisions on) most consultations adequately by themselves.   Only occaisionally needs to seek advice (like qualified GPs).  
  • generally make good working diagnoses most of the time. 
  • be good at thinking about differential diagnoses.
  • know where to look for information when they don’t know it (not just default to asking a senior).
  • develop reasonable management plans.
  • know their own limits – clinically.
  • know their own limits – when they are too unwell to practise safely.

How: 

  • Through a combination of face-to-face consultations, telephone consultations, debriefs, tutorials and professional conversations.
  • Develops their own “flow diagram” of where to look for information when they don’t know it.

Output Measure:  

  • Debriefs
      • There is confidence in the trainees data gathering, diagnostic, prescribing and management behaviour. 
      • As the trainee progresses through ST3, the confidence in their abilities grows to a level where the trainer/supervisor feels that not all consultations need debriefing.
  • During surgeries
      • Is gradually calling less and less for help from others as their confidence and independence grows. 
      • [Note – trainer/supervisor must watch out for trainees who are over-confident.]
  • Other clinical practice activities
      • Deals with  results and letters safely.
      • Can do home visits safely and independently.
  • COTs
      • Achieving all COT capabilities relating to DECISION-MAKING to a ‘competent for licensing’ level
      • These are  (i) Makes appropriate working diagnosis, (ii) Appropriate Management Plan, iii) Involving patient in decisions, and (iv) Effective use of Resources.
  • CBDs
      • Achieving all CBD capabilities relating to DECISION-MAKING to a ‘competent for licensing’ level
      • These are (i) Data Gathering & Interpretation, (ii) Making diagnosis & decisions, (iii) Clinical Mx,  (iv) An Ethical Approach and (v) Fitness to Practice.
  • MSF
      • Feedback from colleagues says clinical acumen is good. 
      • Comments about clinical management being sound.
  • ePortfolio
      • Log entries show good decision making skills.     
      • Links learning logs appropriately to Clinical Experience Groups e.g. “infants, children and young people.”   
      • Entries demonstrate clear evidence of learning.
  • Other WPBA
      • Completes a Prescribing Review Assessment  – and there are no significant concerns.

NOTE:
Achieving means trainee is achieving competence or near competence.
Progressing means although trainee might not be competent, they are progressively developing well in this area.

What:  At the end of this placement, the trainee will

  • understand many of the different systems in General Practice.
  • be able to prioritise own daily workload (both clinical and educational).
  • do their admin work on time (prescriptions, referrals, letters, test results).
  • be engaged in their own learning and development.
  • be able to show a progression in problem-solving skills for both clinical and non-clinical problems.   
  • be able to recognise when they are stressed too unwell to perform.   

How: 

  • Engages fluently with systems like others do in the practice (clinical, non-clinical, including IT).
  • Develops their own system for their daily routine work – ensuring things like test results, letters, prescriptions are done in a timely way.  [Discuss with Trainer/Other GPs.]
  • Dialogue with others about practice systems, safety, personal management systems and resilience.  For example,  in debriefs, through professional conversations and from tutorials in General Practice.
  • Discussions at HDR and other workshops – on practice systems, safety, personal management systems, resilience.
  • Attendance at mandatory course – BLS, ALS, Defibrillator Training, Child Safeguarding, Adult Safeguarding.
  • Attendance at self-management courses.

Output Measure: 

  • Observed surgeries
      • Uses the computer effectively in consultations.
      • Uses other IT systems (e.g. ICE, pathlinks, referrals) effective in consultations.
  • MSF
      • No concerns over paperwork, managing tasks etc.   
      • Others say committed learner. 
      • No negative comments like shirking responsibilities.
  • Educational Activities
      • Prepares adequately for tutorials.
      • Prepares for HDR, esp when running a session.
      • Prepares for practice presentations that they may be leading on.
      • Attendance at mandatory course – BLS, ALS, Defibrillator Training, Child Safeguarding, Adult Safeguarding.
      • Engages in Quality Improvement activities.
      • Completes a Leadership Project to demonstrate their leadership skills
  • CBDs
      • Achieving all CBD capabilities relating to MANAGEMENT to a ‘competent for licensing’ level.
      • These are (i) OML, (ii) Managing Medical Complexity, (iii) Working with Colleagues (e.g. delegation, teamwork) and (iv) Fitness to Practise.
  • WPBA
      • Does not leave assessments until the last minute.
  • ePortfolio
      • Good engagement.   
      • Log entries entered in a timely way (not last minute). 
      • Log entries demonstrate evidence of learning.   
      • Log entries: periodically reflects on work and life to maintain a good balance.
      • Most PDP items achieved.
  • No concerns over sick leave taken
      • Not too much and not too little. 
      • [Note: both too little or too much can indicate self-management problems.]

NOTE:
Achieving means trainee is achieving competence or near competence.
Progressing means although trainee might not be competent, they are progressively developing well in this area.

What:  At the end of this placement, the trainee will

  • demonstrate a genuine respect for other people
  • demonstrate a genuine respect for their contractual responsibilities

How

  • Through everyday interactions with other people – both patients and colleagues
  • Engaging with both the ePortfolio and WPBA
  • Commitment to professional duties demonstrated at work.

Output Measure:

  • Respect for patients
      • Attends to patients in distress and discomfort.
      • Nice comments from patients made to GP Trainer and others.   This might be document in the MSF and CSR.  Also, trainee may get thank you cards from patients for the respect and kindness they have shown.
      • Shows respect for patients as individual fellow beings – in face-to-face  and telephone consultations – either directly observed or recorded ones.
  • Respect for work colleagues
      • MSF – positive comments about the trainee’s professionalism (attitude to work, turning up on time, not shirking responsibilities, going the extra mile for patients and colleagues). 
      • Helps trainer/other doctors/practice during times of struggle.
      • Trainee responds constructively to negative feedback from MSFs, colleagues and elsewhere.
  • Shows respect for Learning Activities by planning for them.
      • Prepares adequately for tutorials.
      • Engages with prep for other learning activities e.g. at HDR.
  • Shows respect for GP Training Requirements
      • Does not belittle the ePortfolio or WPBA.    
      • Engages well with ePortfolio.  
      • Gets WPBA done and treats them with respect.
      • Log entries written in a way to show evidence of learning (as opposed to non-focussed ‘waffle’ just to ‘tick a box’)
  • Shows respect for the Computerised Medical Record
      • by recording adequate amounts of information rather than one-liners!
      • consultations added in a timely way (including home visits).
      • does not falsely alter records.
      • [Note to trainees: all medical systems -both hospital and GP- have an audit trail.   They can tell if you have altered a medical record word by word and the exact timing!   They can tell exactly what you have changed and when.   So do not alter records retrospectively.  Instead, add an additional note in a timely way.]
  • COTs:
      • Reviews own recordings and selectively tells you which consultation to look at (rather than saying “any”).    This shows a respect for the assessment.
      • Achieving all COT capabilities relating to PROFESSIONALISM to a ‘competent for licensing’ level.
      • These are (i) Involving the patient, (ii) Shared decision-making and (iii) Making effective use of resources.
  • CBDs
      • CBD prep sheet prepared with care (as opposed to last minute quick rough-and-ready write ups).  Preparation shows a respect for the assessment.
      • Achieving all CBD capabilities relating to PROFESSIONALISM to a ‘competent for licensing’ level.
      • These are (i) Working with Colleagues and in Teams, (ii) An Ethical Approach and (iii) Fitness to Practise.
  • Understands the need to ration care and protect the NHS.
      • Progressively developing in this area – i.e. not over referring in a willy-nilly way, not treating every ill with a pill, and not ordering every investigation under the sun!  
      • Considers costs and effectiveness, of tests and medication, and takes this into account in his or her clinical management plans.
NOTE:
Achieving means trainee is achieving competence or near competence.
Progressing means although trainee might not be competent, they are progressively developing well in this area.

Within the 1 month - revisiting the basics

The next 2 months

The second 3 months

The third 3 months

The last 3 months

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