Benchmarking E portfolio

“NFD- Below expectations”

To explore the tricky area of trainees with borderline performance

To explore the use of IUP’s to help identify and address concerns

Consider the importance of documenting this in e-p

Aims

Important that trainees are aware there is a potential concern and are given the opportunity and support to address it as early as possible(ideally before it becomes a significant problem).

Essential to be able to demonstrate(by documenting in e-p) that the above has occurred and the issue has resolved (or not)

Important that trainees don’t come to final panel and get an unsatisfactory outcome having no idea that this is going to happen.

Essential to ensure those who aren’t fit to practice don’t get through WPBA and gain a CCT just by passing their exams.

Why does it matter?

Postgraduate school of primary care (PGSPC): 485 GP trainees across the whole HENE area (ECGPTP :35)

Outcome 4’s: Aug 11-12 3(0.6%) Aug 12-13 17(3.5%) ECGPTP:0 (3.5% =1 trainee)

Aug12-13 observed sig more trainees being referred to panel, sig more outcome 2 and 3 being given at earlier stage of training (though very few from EC )

ECGPTP currently: 2x outcome 3’s,last year 1x outcome 3 Increasing numbers of appeals so increasing importance of

robust evidence in e-p Appeals rarely lead to a change in the outcome where the

evidence is robust

Can WPBA be failed?

Increasing expectation for GPR to provide good quality evidence to support ES conclusion

Increasing confidence in use of WPBA as an evidence based tool to ensure that trainees unfit to practice do not achieve CCT simply by passing AKT and CSA

Increasing expectation of EP evidence that SMART feedback has been given to address issues

Increasing identification of struggling trainees earlier on Increasing expectation that lack of evidence ,poor quality of reflection or poor

engagement with e-p will lead to a “below expectations” conclusion in the relevant competency

Occasions at final panel where an ES has marked NFD for several competency areas but concluded satisfactory progress.

Occasions when several areas marked “below expectations” but no request for panel opinion(identified by random sampling)

Occasions where there is clear evidence of trainee being “below expectations” in a particular area but their ES marks them as NFD-meets expectations

Some ES’s not sure what to put if believe trainee if performing fine in WPBA but failing exams

Observations from panels:

Assessment: in the context of Supervised learning events(SLEs)is a key component of the clinical learning environment

Formative: Assessment for learning Key element-reflection on structured feedback in the

context of Supervised learning events(SLEs):helps trainee learn and develop

Summative: Assessment of learning(or performance(AoPs):Provides evidence for judgements on their progression in the competencies required

Key principles for the GMC:

Supervised Learning Events(SLEs) will use established tools should ideally be related to feedback from

previous SLE’s Indicating the level of performance is an

important part of feedback and supervisors should record levels of attainment using the anchor statements developed for this purpose(Competency Framework)

Key principles for GMC:

The purpose of the SLE is to: Act as a learning aid Highlight achievements and areas of

excellence Provide immediate feedback and suggest

areas for further development Demonstrate engagement with the

educational process

GMC guidance states :

Looking at underperformanceThe challenges: Difficult to know where certain behaviours fit and whether

they are important Evidence is difficult – not sure what to do/ how important it

is When does evidence of negative behaviour become

significant and how do we document it? How many times in poor performance do people say…’well

we already knew that…’

Indicators of potential underperformance “IPUs”

Trainees, and Behaviours we all recognise…

Is doctor-centred Doesn’t give the patient time and space when this is needed Can’t keep to time Fails to engage adequately with the portfolio e.g. the entries are scant,

reflection is poor, plans are made but not acted on or the PDP is not used effectively

Misses or ignores significant cues Informal feedback from colleagues raises concerns Uses stock phrases or inappropriate medical jargon rather than tailoring the

language to the patients’ needs and context Treats the disease, not the patient Approach is disorganised, chaotic, inflexible or inefficient Works in isolation (sits in their room most of the day working) ‘Dumps’ on colleagues Lets referrals pile up or fails to write up home visits that day Records show poor entries e.g. too short, too long, unfocused, failing to code

properly or respond to prompts Doesn’t think ahead, safety net appropriately or follow-through adequately Examination technique is poor Dogmatic or closed to other ideas

These behaviours are indicators of potential underperformance (we all exhibit such behaviours from time to time)

They will be common is ST1 They need to be seen repeatedly and in

differing contexts before professional judgements can be made as to their significance

Important note:

Identify behaviours that may cause concern (IPU’s)

Discuss with the trainee using the competence framework

Document if appropriate (use educators notes or a word document

depending on the level of concern)

First steps:

Being explicit with the trainee is important Discussing it together, you can see it and see where it fits. This

makes it much easier to have the discussion: -We all do this sometimes -This is normal at your stage -This is becoming an issue -Do you recognise this behaviour/concern?

These are the things that you need to do to improve this aspect Let's review this with an SLE to see if it's still a potential/real issue

for you/others Reflect and review progress using a variety of tools (and SLEs) Decide whether it's still an issue Document

Actions:

When do you reach this threshold? When do small things (IPU’s) become performance issues? When do you decide a cluster of issues in one competency area

represents “NFD-Below expectations” in an ESR? When do you decide that “NFD-Below expectations” in a number of

competency areas requires a panel opinion or represents unsatisfactory progress?

How do we decide whether this is important and what action to take?

(Highlight and reflect-is this a training issue or a performance issue that needs action?)

Educator’s notes - date stamp and gives you a timeline but when do you decide when to use this?

Essential that trainees are familiar with the competency framework, empowered to self-assess and work towards improvements

Things to consider: