Education Posters 536 – 542
536 Consistency and reliability of judgements by assessors of Case based Discussions in General Practice Specialty Training Programmes in the UK
RCGP WPBA Core Group
Aims/Objectives: Judgements arising from Case based Discussions (CbDs) are made by a variety of assessors. This poster compares how CbD assessments support Annual Review of Competence Panel (ARCP) decisions.
Content of Presentation: Trainees identified at ARCP as needing extra training time (Outcome 3) at the end of their first year of General Practice (GP) training, were included (n=37). CbDs were chosen as both hospital and GP supervisors complete them, enabling an appropriate comparison. Results showed 6.8% Staff and Specialist Grades (SASGs)/ Consultants rated trainees as needing further development compared to 78% of GPs despite the trainee being given an Outcome 3 at ARCP. 23% of the assessments completed by SASG /Specialist Registrars rated these trainees globally as excellent. These results suggest the CbD when used in hospital does not reliably identify trainees in difficulty.
Relevance/Impact: Work Place Based Assessments (WPBAs) contribute collectively to demonstrate the competence progression of an individual by recording their skills, knowledge and behaviours against those identified in the MRCGP curriculum. It is imperative that WPBAs are completed appropriately to inform fair and defensible ARCP decisions about trainee progression.
Outcomes: The results raise concern with regard to the consistency of judgements made by different groups of assessors, with significant variance between assessors of different status and seniority.
Discussion: Further work is required to determine whether the CbD is fit for purpose as a mandatory WPBA for GP trainees during their hospital placements. There is a need to improve the inter-rater reliability of CbDs to ensure a consistent contribution to subsequent decisions about trainees’ overall progress.
537 “Front door, back door … revolving door” Managing patients with long term conditions – evaluation of a multi-professional study day
Background Primary Care manages the majority of long term conditions (LTC) with a considerable amount by nurses working in practice. This is leading to a change in practice team skill mix complicated by medical and nursing recruitment issues. The RCGP Ten Point Plan is encouraging multi-professional working and learning.
Aim Our local trainer group in collaboration with nurse educators aimed to organise and evaluate a multi professional study day to share learning and encourage teamworking in primary care based around management of LTC.
Methods A multi-professional group of clinician educators developed a relevant agenda around LTC and reducing hospital admissions and readmissions. This included a mix of presentations and workshops based on multimorbidity, admissions avoidance, communication skills and interprofessional learning. These were grounded clinically around COPD, diabetes, frailty and dementia. Evaluation is on going.
Outcomes Immediate evaluation of the 47 delegates (5 professional groups) was positive across multi professional boundaries 95% indicating increased understanding of other professional roles and 81% indicated improved confidence in LTC management. Other evaluations to date have been positive (more practices expressing interest in nurse and other clinician training, better links between educators).
Conclusions The success of a multiprofessional learning event requires involvement of educators from different professionals and careful structuring. The methods for multiprofessional learning and evaluation will need to be considered more as primary care becomes more integrated.
538 Losing the stabilisers: what trainees and trainers can learn from the experiences of Newly Qualified General Practitioners (NQGPs) in their first year of work
Aims To explore how NQGPs found the transition from trainee to General Practitioner (GP) with the aim of discovering if there are any perceived needs or wants for further support, either in training or once qualified.Relevance Recruitment and retention of GPs is a priority to avert the GP workforce crisis. Understanding push and pull factors throughout a GP’s career is important. This evaluation focuses on the experience during the first year of becoming a GP.
Methods A survey was circulated to all NQGP who completed training from a single Deanery in August 2015. 50/126 (39%) responses subsequently informed two geographically distant focus groups and 2 semi-structured interviews which explored emerging themes further.
Results The majority of NQGPs feel comfortable in their jobs but 44% have considered leaving general practice in the UK. The most challenging aspects are managing workload and taking on the increased responsibility and independence associated with being a GP, as well as grappling with new geography and systems. Clinical aspects of the job plus the flexibility it offers are the most rewarding factors. Clinical experience and taking on the workload of a GP prior to qualification are considered to be helpful in preparing for the transition and NQGPs shared pearls of wisdom about the transition for future trainees. NQGPs feel exposure to a variety of practices and teaching on practical business aspects of being a GP and resilience would be beneficial.
Recommendations Trainees should be made aware early in ST3 and encouraged by their trainers to increase their level of responsibility and workload prior to qualification to help them ‘lose the stabilisers’ by the time they qualify.
539 Patient simulation in the MRCGP CSA exam: the bare bones
Aims/Objectives MRCGP is the UK’s national GP licensing exam. It comprises a tripos of Workplace Based Assessment, an Applied Knowledge Test and a Clinical Skills Assessment (CSA). Professional Role-Players (RPs) simulate patients in the CSA. The new Skeleton Model aims to help RPs learn their characters, assist standardisation of RP performance by CSA Examiners and support consistent CSA Examiner marking.
Content of Presentation The Skeleton Model pictorially represents a RP’s opening statement (skull), secondary statement (spine), information a RP can only give in response to a candidate question (legs), information the RP may give freely (arms), and details the RP may ad-lib (skin). Information about the required RP demeanour and non-verbal communication is also provided (thought cloud).
Relevance/Impact To ensure fairness to candidates, RPs’ CSA portrayals must accurately and consistently reflect what patients do and say in ‘real-life’ consulting rooms. The Skeleton Model reduces RP variability in verbal and non-verbal communication and clinical examination findings, thus standardising how, what and when information is passed to candidates.
Outcomes The same case is usually run on three CSA examination circuits simultaneously using three different RP/Examiner pairings. Using the Skeleton Model in preparation helps ensure all candidates receive the same level of challenge irrespective of their allocated circuit or examination room.
Discussion Launched at the RCGP Examiners’ Conference, the Skeleton Model helps to ensure a high quality, fair and consistent assessment by supporting RPs and Examiners, and standardising how, what and when information is passed to all CSA candidates.
540 Exploring the value of patient-centred care and diversity issues at the start of training helps IMG’s apply these concepts in clinical settings
Background GP specialty trainees who are international medical graduates [IMG] have been identified as performing poorly group in the Clinical Skills Assessment [CSA]. There is evidence that part of the problem for IMGs is related to a difficulty with the patient-centred approach. This course was designed to introduce IMGs to the concept of patient-centred care and the impact of diversity on healthcare interactions, as a first step to developing patient-centred consultation skills.
Aim To support IMGs at the start of their training to make the transition to a patient-centred approach.
Method The course takes place over two days separated by two weeks. Participant numbers are restricted to 12 with two facilitators. The first day focuses on patient-centred care, it’s relevance to UK general practice, how this impacts on the consultation and how to respond to the challenges of cultural distance. At the start of the second day a focus group takes place to explore the impact of the first day on their clinical interactions in the intervening two weeks.
Results Thematic analysis of the feedback demonstrates that doctors were able to apply patient-centred skills in their consultations. They describe skills in the following areas: Active listening and empathy, exploring patient concerns and self-awareness.
Discussion Some IMGs are unaware of the concept of patient-centred care and after the workshop were able to describe applying a patient-centred approach to their clinical interactions prior to receiving consultation skills training. This suggests that exploring the concept of patient-centred care has a value independent of consultation skills training.
541 The use of ‘Making every contact count’ by registrars in general practice vocational training
Making Every Contact Count (MECC) is the evidence-based approach to deliver very brief opportunistic interventions supported by the NHS and partner organisations. GPs have an important role in delivering brief advice and interventions. This study investigates the use of MECC by GP registrars.
An online questionnaire was completed by a sample of GP registrars in their second or third year of training (10 and 5 participants respectively). Response rate was 50%.Participants agreed preventative medicine was important in their role. On-line materials were available at induction. Only 2 participants knew about MECC. 10 identified receiving training on giving lifestyle advice, in 9 cases by a physical activity GP champion, one informally from their trainer. Only one had received feedback on interventions delivered.
Eleven registrars asked fewer than half of patients about their lifestyle, 4 more than half. Interventions were less likely depending on patient’s presenting problem, uncertainty about reception of intervention, and time. Several requested more training.Following discussion of these results a “Training the Trainer” session was organised. Feedback was positive and constructive.
The CCG are now organising further training for MECC’s wider dissemination into primary care. A focus group with trainees is planned to identify specific training needs.Registrars are positive about their role in disease prevention and health promotion but need training, support and feedback from trainers to deliver this routinely to their patients. This would be assisted by more widespread adoption of the MECC approach in primary care.
542 Simulated Emergencies – Training of Practice Team
Dr Olivia O’Connell
AIMS A training exercise was developed to improve competence of a whole practice staff team in managing emergencies. Low fidelity manikins and patient actors were used for simulations within a practice premises, with their own resuscitation equipment.
CONTENT Initially, management of a simulated emergency scenario was demonstrated by an Emergency Medicine consultant, using their practice resuscitation equipment. Challenges of managing emergencies in a general practice setting were discussed. Groups (containing a mix of clinical and non-clinical staff) then rotated through different emergency simulations, engaging with enthusiasm. Scenarios ranged from a fitting adult in the waiting room, to paediatric meningococcal sepsis. An update on CPR and AED use was included and expanded into a simulation of acute MI and cardiac arrest. Facilitators used manikins and patient ‘actors’ (volunteers from the patient participation group) to run the scenarios. Informal debrief followed simulations.The session closed with discussion and reflection as a whole practice team.
OUTCOME Feedback was obtained verbally and via anonymous form. Participants felt that the session had raised awareness of equipment, practice environment, and the importance of communication. Comments included that scenarios were ‘realistic and relevant’, with a useful aspect being ‘practical involvement in normal role’.
RELEVANCE A key comment; the session ‘helped understand how we can work as a team to achieve a better result’.In subsequent real situations, non-clinical staff have demonstrated increased understanding of the valuable role they have in emergency situations. An ‘observations template’ and stethoscope were added to resuscitation equipment.
DISCUSSION The value of simulation training is well established.This type of session had value in team building, and feedback suggests it could potentially improve patient outcome.