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SUPERVISION WORKSHOP

CBFP – PART 1

RANZCP Fellowship Regulations 2012 1

Contributors V0.3

Dr Felicity Plunkett

Director of Training, NZ Auckland

Dr Wayne de Beer

Deputy Chair Board of Education, NZ Hamilton

Dr Martin Cohen

Director of Training, NSW Newcastle

Dr Neil Port

Supervisor, NSW Newcastle 2

Workshop program

AM session 9.00 – 10.30am

10.30 – 10.45am

10.45 – 12.15pm

12.15 – 12.30pm

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Information about CBFP Discussion and questions Break Information and practical exercises: Workplace-based Assessments (WBAs) – Mini-CEX and Case-based Discussion Final discussion and questions 3

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Workshop program

PM session 1.30 – 3.00pm

Information about CBFP Discussion and questions 3.00 – 3.15pm

3.15 – 4.45pm

4.45 – 5.00pm

Break Information and practical exercises: Workplace-based Assessments (WBAs) – the Mini CEX and Case-based Discussion Final discussion and questions 4

Workshop Objectives

Following this session, you should be able to:

• Understand the key elements of the new CBFP training • Understand the main ways in which CBFP training will affect you as a supervisor • Understand the main ways in which CBFP training will affect your trainees • Understand the new Mini-CEX and Case-based Discussion (Workplace-based Assessments) • Undertake the new Mini-CEX and Case-based Discussion with your trainees V0.3

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Why change the curriculum?

• Reflects current learning and teaching trends • Regular timely (immediate) feedback during training • Clear expectations for Trainees and Supervisors • Enable Trainees to focus on competency as a goal V0.3

• Assessments in practice prepare Trainees for job readiness 6

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Modern educational trends

Miller’s triangle - hierarchies of competence

DOES

Performance

SHOW HOW

Demonstrates competence

KNOWS HOW

Applied knowledge

Workplace-based Assessments OCI, OSCE, Entrustable Professional Assessments Written Exam KNOWS

Factual knowledge 7

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Modern educational trends

Multi-dimensional competency framework The seven CanMEDS roles 8

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Educational pressures

• • • External regulation of medical education – AMC/NZMC accreditation, Government funding • Standard of psychiatrists graduating • Efficiency and effectiveness of training • Changed social contract and expectations of psychiatrists and mental health services Modern technology and ways of accessing and using information Generational changes in our Trainees 9

Changes to the assessments

Different drivers for these changes • Expert educationalist advice to improve exam fairness and reliability (

by Dr Gareth Holsgrove and Professor Brian Hodges)

• Too costly in time and resources to continue with separate trainee and exemptions exams • Coalescing them back into one sitting means the clinical exams are exit exams V0.3

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When does

CBFP

start?

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• The 1 st year Trainees will start under the new 2012 Training Regulations from December 2012 in NZ, and from January 2013 in Australia • • Current Trainees stay under the existing 2003 training regulations • Transition time line and conversion matrix now available on College website Trainees from overseas part-way through training start under the existing 2003 training regulations 11

Transition - Two parallel programs

New Zealand

Stage 1 December 2012 Stage 2 December 2013 Stage 3 December 2015

Australia

Stage 1 January 2013 Stage 2 January 2014 Stage 3 January 2016 • • Allows training & adjustment time for all involved Those under the current regulations will all be transitioned to CBFP by the end of 2015 • Will have case-by-case decisions, especially for 3 rd plus Trainees year V0.3

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Which parts are different?

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• • • 3 training stages – Stage 1, Stage 2, Stage 3 No longer 2 - Basic and Advanced Training Basic training is across 2 stages – Stage 1 is 1 st year – Stage 2 is 2 nd and 3 rd years •

Stage 3 is Advanced training – 4

th

and 5

th

years

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STAGE 1

Stages of training

STAGE 2 Proficient Basic STAGE 3 Advanced

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DEVELOPMENTAL TRAJECTORY

14

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Competency driven training

• Explicitly defined competencies and role of psychiatrist • Competencies are a combination of

knowledge

,

skills

and

attitudes

• Required competencies have to be achieved to become eligible to sit the written and clinical exams and to progress through the 3 Stages 15

Competency driven training

What are the Roles of a Psychiatrist?

CanMEDS roles What Competencies are needed for these?

Fellowship Competencies and Developmental Descriptors What are the Learning Outcomes for these Competencies?

Detailed Learning Outcomes for each Stage

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Competency driven training V0.3

• • Defined syllabus for each stage of training Assessments mapped to syllabus and learning outcomes • Formative assessment o formal and informal assessment procedures o involves qualitative feedback (rather than scores) • Summative assessment o Tests the knowledge and understanding of information, skills, concepts or processes o Final evaluation 17

Which parts are the same?

• Still a 5 year program • Stage 1 – General Adult Psychiatry, 6 months Acute • Commence a College accredited Formal Education Course • Stage 2 - mandatory rotations: • Consultation-Liaison (6 months) • Child & Adolescent (6 months) V0.3

• 2 optional rotations 18

Which parts are the same?

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• Stage 2 competencies: o Addiction o o o Old Age ECT Several psychotherapy modalities • Stage 3 can still be Generalist or in a Certificate program – advanced level competencies • Certificate programs – the same 7 as before (Addiction, Adult, Child, C-L, Forensic, Old Age, Psychotherapy) 19

Which parts are the same?

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• The structure of the Written, OCI and OSCE exams remains the same (the timing and standard has changed) • Written exam - still 2 x 3 hour exam papers (in late Stage 2, set at junior consultant standard) • OCIs - still must pass 2 of 3 OCIs (in Stage 3, at advanced standard) • OSCE – 12 stations, 8 short cases, 2 long cases, 2 byes (at advanced standard) 20

What about supervision?

Business as usual in many ways

Same time requirements for supervision One 1:1 hour and 3 clinical supervision hours per week Across min. 40 weeks of the year Similar training and accreditation requirements for supervisors

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What about supervision?

Aspects of supervision that are

different WORKPLACE-BASED ASSESSMENTS FEEDBACK AND GRADING ARE MORE FORMALISED CLEARER STANDARDS

• Structured workplace based assessments • Written feedback • More training resources for supervisors • More guidance about the standards expected in each Stage of training V0.3

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Which parts are different?

• The 1 st Episode Case History has been removed • Professional writing tasks are required in some WBAs • The Psychotherapy long case will be restructured • The Scholarly Project is a new mandatory requirement and can be commenced at any stage V0.3

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Which parts are different?

• The OCI and OSCE exams will be set at exit level and will be sat closer to the end of training (Stage 3) • OCI and OSCE exams will be sat in 4 th during certificate training) and 5 th year (some time • Entrustable Professional Assessments (EPAs) are new • EPAs are summative assessments V0.3

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NEW

- Workplace-based Assessments (WBAs) V0.3

CbD

Case-based Discussion

PP

Professional Presentation

Mini-CEX OCA

Mini Clinical Evaluation Exercise Observed Clinical Activity • Highly recommended that trainees experience all of these tools early in their training 25

Range of WBAs You can choose:

Mini-CEX

Briefly observed clinical tasks

CbD D

etailed case discussions with supervisor

PP

Case Presentations

OCA

A full 50 minutes assessment with structured feedback and clear standards At least

3

of these will determine whether an EPA has been achieved. V0.3

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Why Workplace-based Assessments (WBAs)?

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• On the job assessment (efficient use of supervision time) • Relevant tools to assess key clinical activities • Feedback is ensured and structured • Clearer standards and guidelines for the supervisor • A clearer paper trail to document trainee’s performance 27

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WBA in the first month

• The initial formative WBA is to be scheduled in the first month of the rotation • Aim to do it within the first 4 weeks that the trainee and supervisor have worked together • To help the supervisor assess the trainee’s strengths and weaknesses, and alert them to any significant problems 28

Entrustable Professional Activities (EPAs) V0.3

• Relate to activities identified as core to the profession • Complex, whole tasks (requires knowledge, skills, professional behaviours and attitudes) • Involve more than one learning outcome • Relate to more than one of the seven CanMEDs roles 29

Entrustable Professional Activities (EPAs)

• 2 summative EPAs per 6 month rotation • Mandatory EPAs in each of the 3 Stages • Despite signing off an activity as “entrustable”, the supervisor remains responsible to oversee the trainee’s clinical performance V0.3

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EPAs in Stage 1

Stage 1: 4 mandatory EPAs • Active participation in multidisciplinary team meeting / ward round • Produce succinct, organised and informative discharge summaries in a timely manner • Initiating an antipsychotic in a patient known to have schizophrenia V0.3

• Provide an explanation to a family about a young adult’s major mental illness 31

EPAs in Stage 2

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Stage 2: 5 mandatory EPAs • Demonstrate proficiency in all the expected tasks associated with prescription, administration and monitoring of

ECT

• The application and use of the

Mental Health Act

• Assessment and management of

risk

others of harm to self and • The safe and effective use of

clozapine

in psychiatry •

Cultural

Competence 32

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How it all fits together? An example 33

Tasks in Stage 1 training

ROTATION 1 ROTATION 2

WBA Formative

First 4 weeks

WBA Formative WBA Formative WBA Formative Formative

mid rotation

Supervisor assessment WBA Formative WBA Formative Supervisor assessment Summative WBA Formative V0.3

EPA 1 Summative EPA 2 Summative

Minimum of 3 WBAs for 1 EPA WBA Formative

First 4 weeks

WBA Formative Formative

mid rotation

Supervisor assessment WBA Formative WBA Formative Supervisor assessment Summative WBA Formative

EPA 3 Summative EPA 4 Summative

Minimum of 3 WBAs for 1 EPA 34

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Summative assessments

STAGE 1

BASIC

STAGE 2

PROFICIENT WRITTEN OCI OSCE EPAs and SUPERVISOR ASSESSMENTS PSYCHOTHERAPY LONG CASE SCHOLARLY PROJECT ADVANCED STAGE 3

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BREAK

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Reconvene in 15 minutes

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Plan - Second Half of Workshop • Mini-CEX – information and practical exercises • Case-based Discussion (CbD) – information and practical exercises • Final discussion and wrap-up V0.3

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Mini Clinical Evaluation Exercise (Mini-CEX)

• • • • • Yes, the name’s hilarious, but get over it A brief, defined clinical task Takes about 20 min Done in the usual hour of 1:1 supervision time Task is negotiated between Trainee and Supervisor beforehand V0.3

• • • Both trainee and supervisor fill in the mark-sheet Structured written feedback immediately after Formative assessment to shape their practice 38

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WBAs: Mini-CEX

Mini-CEX can be used for: • • • • • • • • Mental state examination Detailed cognitive testing A specific aspect of history-taking (like addictions & gambling history or family history) Risk assessment EPSE or other physical assessment Medication/side-effects review Talking to a family Getting consent to treatment 39

Mini-CEX DVD examples

30 minutes • Watch DVD – 2 examples • Samples of mark-sheets • Practice marking • Discuss and questions Choose areas to mark : • History taking process • History taking content • Mental state exam • Physical exam skills • Communication skills • Data synthesis • Organisation/efficiency V0.3

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Case-based Discussion (CbD)

• • • • • Done in the usual hour of 1:1 supervision time Trainee selects 4 cases they are managing Supervisor chooses 1 of the cases • • Choose cases from usual clinical work, or an on-call assessment Cases can be focused on a specific diagnosis or issue if that’s best for trainee’s learning Structured written feedback immediately after Formative assessment to shape their practice V0.3

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Case-based Discussion (CbD)

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• • Trainee briefly presents the case Supervisor then asks questions to explore the trainee’s knowledge and how they approached the case • Presentation and discussion - 30 minutes • • Trainee and supervisor complete the mark-sheet Feedback - marking is discussed and explained at the end • Can be some teaching or suggestions for further reading 42

DVD for Case-based Discussion (CbD)

30 minutes • Watch DVD – 4 brief clips • Samples of mark-sheets • Practice marking • Discuss and compare the examples Choose areas to mark: • Clinical record keeping • Clinical assessment • Risk assessment & management • Medical treatment • Referral • Investigation • Follow-up, care planning & transfer of care • Professionalism • Clinical reasoning 43 V0.3

Final Wrap-up • Questions?

• Final Discussion V0.3

• Part 2 of this Workshop • Certificates of Attendance 44