Concerns and performanceDr Barry LewisDirector GP Education

Defining Clinical and Educational supervision

• Generic ‘supervision’ model– Normative

• Environment and ‘tools’

– Formative• Teaching, coaching, mentoring• Assessment

– Restorative• Recognising difficulty and responding• remediation

Task

• Take the model and agree where the 3 domains fall into the ‘trainer’ roles

• Agree ‘key’ roles for CS and ES

• Allow 15 mins for task

• Summary

Coaching

Clinical Coaching (JACSTAG)

• Demonstration of the full procedure

• talking through the procedure

• trainee talking through the procedure

• trainee undertaking the procedure

GROW• GOAL setting for the session

as well as short and long term

• REALITY checking to explore the current situation

• OPTIONS and alternative strategies or courses of action

• WHAT is to be done, WHEN, by WHOM and the WILL to do it.

Concerns about performance

• Task– Produce a list of performance parameters

that will allow ‘reporting’ of concerns

– e.g – poor punctuality– Include clinical and educational areas

• Allow 20 minutes

National Patient Safety Agency

• Low standard of work, mistakes.

• Inability to cope with work volume

• Unacceptable attitudes– To patients– To colleagues

• Punctuality and absence issues

• Specific skill deficiencies

National Patient Safety Agency

• Lack of awareness of standards required

• Failing to meet agreed objectives

• Acting outside competence limits

• Poor supervision of others when this is required

• Health problems that impact on work

ARCP Flow Chart

Meeting with educational supervisor – Initial PDP

Clinical supervisor appraisal 0, 3 & 6 months

e-portfolio evidence

Meeting with Educational supervisor 6 month appraisal

Satisfactory progress Produce PDP

Some concerns

Significant concerns

Feedback from PD and PCME

Produce PDP for next 6 months – copy to PD

Involve PD to produce PDP for next 6 months

Meeting with ES PD and AD to plan action including PDP

Meeting with Educational supervisor Educational appraisal – review of portfolio. NHS Appraisal Report to ARCP Panel

Satisfactory progress

Development needs – additional supervision or learning within normal training time. Produce provisional PDP

Development needs requiring additional training Produce statement of concerns and competencies to be developed

ARCP Review panel reviews report, portfolio and PDP

Outcome 1 Satisfactory progress PDP accepted or minor changes

Outcome 2 Additional learning or supervision needed No additional time PDP accepted or modified

Outcome 3 Additional training time required Action plan inc. PDP produced

WPBA

Educational and Clinical experience

WPBA Clinical supervisor appraisal 0, 3 & 6 months

e-portfolio evidence

Feedback from PD and PCME

Educational and Clinical experience

Continue as planned

Meet ES or PD to discuss plan

Meet with AD PD ES to implement plan

E-portfolio competence areas

• Communication/consultation skills

• Holistic practice• Data gathering,

interpretation• Making

diagnosis/decisions• Clinical management• Managing complexity

• Primary care admin• Working with

colleagues, teams• Community orientation• Performance, learning

and teaching• Ethical approach• Fitness to practice

Handling concerns – good practice

• Receiving information• Patient safety• Informing the trainee• Supporting the trainee• Dealing with concern

– Informally– ………………………………………….– formally

CS/ES

Examples

• Task– In groups of 3-4 choose a specific example

from experience, summarise it and decide how, in the new training environment, this should be recorded and handled.

– Allow 15-20 min

Handling concerns – good practice

• Gathering further information

• Deciding what to do

• Understanding contributory factors

• Interventions and remediation

• Review

• Aftermath and rehab.

PD >ARCP > AD