Concerns and performance

Dr Barry Lewis Director 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 WPBA Educational and Clinical experience Clinical supervisor appraisal 0, 3 & 6 months e-portfolio evidence Feedback from PD and PCME Satisfactory progress Produce PDP for next 6 months – copy to PD Meeting with Educational supervisor 6 month appraisal Some concerns Involve PD to produce PDP for next 6 months Significant concerns Meeting with ES PD and AD to plan action including PDP WPBA Educational and Clinical experience Clinical supervisor appraisal 0, 3 & 6 months e-portfolio evidence Feedback from PD and PCME Satisfactory progress Produce PDP Meeting with Educational supervisor Educational appraisal – review of portfolio. NHS Appraisal Report to ARCP Panel 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 Continue as planned Outcome 2 Additional learning or supervision needed No additional time PDP accepted or modified Meet ES or PD to discuss plan Outcome 3 Additional training time required Action plan inc. PDP produced Meet with AD PD ES to implement plan

E-portfolio competence areas

• Communication/consult ation 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 CS/ES • Dealing with concern – Informally – ………………………………………….

– formally

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