Education Posters 543 – 550

Education Posters 543 – 550

543 Assessing Interpersonal Skills in UK Postgraduate Examinations: A consensus view

Pauline Foreman

Aims/Objectives Good interpersonal skills are a core competence for doctors in postgraduate specialty training in the UK; but what does ‘good’ really look like and how should we best assess these skills in postgraduate medical examinations.

Content of Presentation A cross-speciality seminar was held at the RCGP with a wide range of stakeholders present including patients and trainees, to explore through appreciative inquiry whether current approaches to the assessment of interpersonal skills are still valid. A literature review was undertaken prior to the seminar and the format of the day included a combination of expert presentations and small group work.

Relevance/Impact This work has relevance to patients and carers, educators and all Colleges and Faculties responsible for the delivery of postgraduate medical examinations in the UK. This work has contributed to the new GMC Generic Professional Capabilities Framework.

Outcomes A consensus definition of interpersonal skills was developed.The strengths and weaknesses of current approaches to the assessment of interpersonal skills were discussedRecommendations were made for all Colleges and Faculties to improve the assessment of interpersonal skills in postgraduate medical examinations.

Discussions Good interpersonal skills are essential for all doctors and must be assessed in postgraduate examinations. A combined formative and summative approach is necessary, with increased focus on assessment in the workplace. Assessments should be dynamic and develop in line with changes in clinical pracice and research.Fairness remains a high priority, particularly in relation to candidates with protected characteristics. All specialities have similar issues with assessing interpersonal skills, and sharing good practice is helpful.

544 Suspected cancer recognition and referral, a symptom based approach – CRUK/RCGP faculty workshops

Karen Llewellyn-Date

NICE guidance for suspected cancer recognition and referral (NG 12) implementation is dependent on general practitioner knowledge, understanding and translation into clinical practice. CRUK recognised the pivotal role general practitioners have in early cancer diagnosis and supported faculty workshops in 2015/16 to address knowledge and understanding of NG12, and provide support. In total 221 general practitioners attended CRUK sponsored faculty workshops.

The impact of which is summarised below: Attendees rating their knowledge and awareness of the expanding role of primary care in cancer control as high or very high increased by 72.5% (pre and post evaluation scores). 95% of attendees rated the workshop as being very or extremely relevant to their role and only 1.2% thought that it had little relevance to their role. 89% of attendees believed that attending the workshop will improve their practice. Only 1.1% thought that it would have little impact.

Key learning identified which has impacted on clinical practice: Significance of lowered PPV of 3%. Relevance of raised thrombocytosis (raised platelets) and cancer risk. Relevance of haematuria as a symptom of both urological and endometrial cancer. Relevance of a full blood count for patients with haematuria. Importance of using a weighted 7 point score for pigmented lesions. Awareness and use of educational tools to support clinical decision making. Opportunity of a negative cancer diagnosis as a ‘teachable moment’ to prompt patient behaviour change.

Cancer Research UK has evidenced that 42% of cancers are preventable and closely associated to lifestyle factors. In 2016-17 CRUK-sponsored general practititioner workshops and e-learning will support the important role of general practice in primary care cancer control.

545 Addressing the success-satisfaction paradox amongst Defence Medical Services GP Specialty Trainees

Richard Withnall

Aims/Objectives Defence Medical Services (DMS) GP Specialty Trainees (DMS GPSTs) are successful in the MRCGP, the UK GP licensing examination. First attempt pass rates usually exceed 76% in the Applied Knowledge Test and are commonly 100% in the Clinical Skills Assessment. Despite this, the GMC National Training Survey reveals low levels of DMS GPST satisfaction. To address this paradox, DMS GPSTs’ training experiences were explored to inform training innovation to enhance Learner satisfaction.

Content of Presentation Themes identified within three focus groups involving 18 DMS GPSTs at all stages in training included a ‘Defence Dilemma’ (the national GP curriculum is understandably orientated towards NHS General Practice, but may not fully prepare a DMS GPST for independent military General Practice, especially overseas). This dilemma was further explored within semi-structured interviews with 12 final-year DMS GPSTs and newly-qualified military GPs. Saturation was reached. Thematic analysis was applied within a framework of social constructionist epistemology.

Relevance/Impact DMS GPSTs are recruited from the same pool as NHS GPSTs. National GP Training applications have dropped by 15% since 2013/14. Satisfaction with GP training and perceived preparedness for independent military practice are important influences upon DMS GPST recruitment and retention.

Outcomes Bespoke ‘Preparing for military GP life post-CCT’ training (including pre-hospital emergency care, tropical medicine, environmental health, medical planning and occupational medicine) has been introduced within the DMS GPST (Residential) Course, a quarterly one-week programme complementing DMS GPSTs’ NHS vocational training scheme attendance.

Discussion Military-specific training has been introduced to help address DMS GPSTs’ success-satisfaction paradox.

546 Back to reality: GP attachment days

Rachael Imrie

Aims: GP trainees in South East Scotland arrange study days in their base GP practice whilst undertaking hospital placements. Little is known about what activities trainees undertake during these days and how the days benefit trainee development. This study aimed to confirm how attachment days are used in South East Scotland and to gain knowledge about how trainees and educational supervisors feel about attachment days.

Content and outcomes: The surveys received response rates of 45%, 50% and 52% for ST1/2, ST3 and Educational Supervisors respectively. 96.7% of supervisors and 84.4% of trainees felt that attachment days are either “somewhat useful” or “very useful” to trainees’ overall development as a GP. There is significant variation in what an attachment day consists of. Only 11% of trainees got to plan the content of their attachment days. Qualitative comments reflect the importance of attachment days for team-building, refocusing on primary care and orientation to workplace-based assessment and the e-Portfolio.

Impact: This work permits an insight into how attachment days are being used in practice in South-East Scotland and demonstrates some ways in which the educational benefits of the days could be maximised.

Discussion: In South East Scotland, attachment days are felt to be useful to the trainees’ overall development as a GP. Results indicate that there may be benefit in suggesting that trainees have more involvement in the planning of these days, to maximise educational benefit, and in offering templates for attachment days in order to broaden the range of educational options available.

546 Attitudes towards Family Medicine of Spanish medical students who completed the final of the degree in the academic year 2014-15

María Candelaria Ayuso

Objectives: To determine the relationship between knowledge of and attitudes towards Family Medicine (FM) of medical students and the specialties they choose.

Content of Presentation: Cohort study, with 350 students from 13 Spanish medical schools. They answered the brief CAMF (Spanish acronym for “knowledge of and attitudes toward FM”) at the end of the degree (2014-2015 academic year). They also gave their consent and provided information that allowed to know the specialty choice in the 2016 MIR (Spanish acronym for Specialist registrar) exam.

Relevance/Impact: A cold climate towards FM within medical academia could constitute a barrier against choosing this discipline as career.

Outcomes: The average age was 24.3 years (SD:3.2); 68% were women; 77.2% took a course in primary care/FM. 57.2% of them (95%CI:51.6-62.5) “would like to become a family doctor” and 15.0% (95%CI:11.4-19.4) considered FM as their first choice. 86 students were not registered for the examination and 30 of those examined did not choose specialty. FM was preferred by 52 (22.2%;95%CI:17.1-28.2), without statistically significant differences by the study of a FM/Primary Care subject. The brief CAMF score ranged 3-38 (median:24; interquartile range (IQR):19-28). The median for who chose FM was 26 (IQR:22-31.25), significantly higher than 24 (IQR:19-28) of those who chose another specialty (p=0.022).

Discussion: Spanish medical graduates have a little interest by FM. Medical students who took a course in FM/Primary Care did not show more interest. Who chose FM showed higher score on the questionnaire CAMF, so this could be a predictor of choice of specialty.

547 TPD forums – setting up local educator groups to improve consistency in the quality of the educational environment of gp training posts

Amjad Khan, MeiLing Denney,

Background Within the GP setting, there is variation in the educational experience, with GP trainees reporting that they have different workload commitments and educational time compared to their peers. TPDs face challenges in delivering consistent guidance to supervising practices as to what is expected and achievable.

Summary of work At an organizational level the Scotland deanery is bringing together four regions of Scotland to try to achieve consistency through Quality Management of its training programs. We wanted to develop practical sessions where TPDs could discuss potentially contentious issues and achieve consensus of opinion as to the advice they should be giving educational supervisors and practices. A quarterly TPD forum was therefore set up to address some of these issues.

Summary results Meetings were set up to receive information and concerns from TPDs regarding potential areas of inconsistency. A list of topics was prioritized for discussion including: acceptable workload volume; content of tutorials and other teaching within the surgery.

Conclusions A series of guidance documents developed from these fora for TPDs and practices to help achieve consistency and manage expectations of both trainees and educational supervisors. We hope that this serves to enhance the GP training experience further and reduce complaints from trainees.

548 GPs teaching new surgical trainees at a regional bootcamp – how to write a clinic letter

James Seddon

Clinic letter-writing is an important communication tool in the hospital outpatient setting, serving as a record of the consultation for the hospital, confirming the shared outcome with the patient and communicating progress to the GP. It is a skill and is often poorly performed. There has traditionally been a paucity of formal teaching on the subject. Surgical ‘bootcamps’ have been developed to induct new core trainee year one doctors (CT1s) by providing training in practical skills, both technical and non-technical, that they will need in their new jobs. As part of this, a senior GP trainee delivered teaching on how to write a clinic letter.

The poster will describe the teaching method, which centred around pairs of CT1s critquing letters of varying quality from the perspective of the GP, the patient and the next surgeon to see the patient. Based on the cognitive approach of Zygotsky’s ‘zone of proximal development’, the CT1s were presumed to be able to derive the important qualities of a letter with a little guidance from someone who had both written outpatient letters and received them.

Feedback from the first group of 27 students confirmed that this was an unknown unmet need and that the teaching was valued. Significant improvements in self rating scales on clinic letter writing were shown. 95% of students valued having teaching from other specialties and particularly highlighted having a GP teach the clinic letter session.

The poster will include feedback from a second session running in 2017.The implications include the consideration of including clinic letter writing training for all doctors who work in outpatients and the use of a GP to provide it.

Download the poster

549 Difficult and deprived areas: energising the primary care workforce

Cathy Williamson

The NHS Five Year Forward View (2014) seeks to develop innovative service models such as multispeciality community teams in order to improve health outcomes, increase access to care and reduce health-related inequalities. General Practice “Forward view” (NHS England 2016) recommends increasing the number of Primary Care health providers in training, with new options to retain staff working in primary care and new models to integrate general practice services with community and wider health care services.

The Difficult and Deprived Areas Programme (DDAP) began in 2013. It offers senior medical students a longitudinal 14 week placement within a teaching General Practice, alongside bespoke local community health care experience working with underserved or marginalised groups. A weekly teaching session tackles complex health-related issues now presenting in modern primary care such as substance misuse, poverty, safeguarding, mental health, asylum seekers and homelessness; workshops teach relevant skills such as conflict management, unconscious bias and motivational interviewing.

Student satisfaction has been consistently high, including strengthening student commitment to future working in primary and community settings and fostering interest in working with marginalised groups. More interesting is the high satisfaction from GP teachers about the programme but also as a vehicle for practice and practitioner development: “This was a useful experience … focusing on deprivation which I see commonly and perhaps become desensitised to.”

The poster will explore potential for tailored experience in such “Difficult and Deprived” areas of primary care as a vehicle for energising the primary care workforce and promoting recruitment and retention.

550 What’s Happening in the GP Trainee-Trainer Supervisory Relationship?

Dawn Jackson

This study was an initial stage of PhD research. Semi-structured interviews were undertaken with 4 experienced GP educators to address the perceptions regarding: The training needs of GP trainees? The methods which GP trainers should use to identify and address these needs? A further aim: Are there particular theories or models of supervision which relate to General Practice supervision?

Methods Participants were purposively sampled from a population of experienced GP educators in the West Midlands, for geographical area, educator title and gender. Participants included training programme directors, advanced trainers and area directors. Interviews were conducted by a single researcher and recorded. They were transcribed verbatim and analysed by the researcher using content and coding methods. Emergent themes were later related to theories of clinical supervision.

Results Difficulties in supervision appeared to be associated with a lack of “agreeement” between trainee and trainer. Trainees in these instances were perceived to demonstrate “lack of engagement” with the educators’ expectations of behaviour and attitude. This relates to Bordin’s (1983) model of the supervisory working alliance, where “agreement” in goals and tasks is seen as fundamental. The educators had variable expectations of supervision, which may relate to perceived “tensions” in the trainer role e.g. whether the trainee or trainer should act as “guide” for the supervisory interaction. This relates to both “role theory” (Biddle, 1986) and “locus of control” within social learning theory (Rotter, 1954).

Relevance With variability in the views of experienced educators with regards to “roles”, “expectations” and “locus” in GP supervision, it follows that variability could also exist between trainees and trainers. Mismatch in expectations in the supervisory alliance could effect “agreement”, “alliance” and potentially trainee progression.