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Update on Supervised Learning Events In Foundation Sonia Panchal Clinical Fellow HEE / Academy of Medical Royal Colleges David Kessel Chair AoMRC Foundation Programme Committee Sharing Good Practice Sharing Good Practice Collins Report • “We have found that the Foundation Programme has many strengths.” • But …… Sharing Good Practice Assessments - Issues • Excessive • Onerous • Not valued Sharing Good Practice WorkPlace Based Assessments Sharing Good Practice WPBA Sharing Good Practice WPBA Sharing Good Practice WPBA Sharing Good Practice WPBA Purpose • Interaction • To give feedback Summative • Record of progress Sharing Good Practice Assessments - Issues • WPBA Poorly Understood – Too few – Too late – Too easy – Kind assessors – Poor feedback – Pass / fail • Tick box Sharing Good Practice 2012 Outcome Based Sharing Good Practice Supervised Learning Events • • • • Familiar tools DOPS Mini-CEX CBD DCT Sharing Good Practice What is an SLE? Sharing Good Practice What Subjects? Sharing Good Practice Quality not Quantity Sharing Good Practice Do Something Challenging Sharing Good Practice Sharing Good Practice Sharing Good Practice Evaluation Of Supervised Learning Events In Foundation Training Background 1. http://hee.nhs.uk/wp-content/uploads/sites/321/2012/08/Foundation-for-excellence-report.pdf 2. http://www.foundationprogramme.nhs.uk/pages/foundation-doctors/training-and-assessment/fpcurriculum2012 Background • Work based assessments • Supervised learning events Sharing Good Practice Aims Evaluation the use of SLE in foundation training in the first year of introduction: • SLE received & perceived by trainers and trainees • Suggestions to enhance the value and improve uptake of SLE Sharing Good Practice Methodology Three separate evaluations: • Dundee University – Qualitative assessment • GMC National Training Survey – Additional questions • NHS E-portfolio – Quantitative analysis Sharing Good Practice Dundee University • Semi-structured individual and group interviews • 110 participants • FY1, FY2 and trainers • England Scotland and Wales • Quantitative thematic, discourse analysis & narrative analysis Sharing Good Practice GMC NTS FY1 and FY2 trainees: • How easy or difficult did you find recording each tool in the e-portfolio? • How useful or not useful have you found the feedback received in this post for each tool in the e-portfolio? • Have SLE led to me reflecting on my practice? • Have SLE helped me to learn? • Have SLE helped me to identify areas in which I need to develop? • What are the most common barriers to attaining curriculum outcomes? Sharing Good Practice GMC NTS FY2 trainees: • How useful or not useful have you found each of the following? – Supervised learning events – Work-placed based assessments • How much do you agree or disagree? – It has been more difficult to get trainers to complete SLE than it was for WBA – There is no real difference between WBA and SLE – SLE are more useful to my training than WBA were – SLE allow me to have more contact time with senior Sharing Good Practice NHS e-portfolio • • • • Total numbers of WBA and SLE Numbers of each type of WBA and SLE Timing of WBA and SLE Focus of WBA and SLE within the curriculum • Clinical problem category • Perceived complexity of topic chosen for the WBA/SLE Sharing Good Practice RESULTS Sharing Good Practice Foundation Doctors Year FY1 FY2 Total 2011-12 (WBA) 7369 7111 14480 2012-13 (SLE) 7389 7586 14978 GMC NTS: (2013) Dundee: 97.7% response rate 55 individual interviews 19 group interviews Sharing Good Practice Understanding SLE Sharing Good Practice Understanding SLE GMC NTS FY2: SLE are more useful to my training than WBA were No Difference SLE vs. WBA GMC NTS FY2: No real difference WBA vs. SLE Narrative “I don’t really understand what they [SLE] meant ((laughs)) to be honest errm” (FY1 doctor) “So my u-my understanding of SLEs- assuming, as I said, that they’re the same as workplace-based assessment- because my, my understanding until today was that they were exactly the same thing” (Trainer) Almost exclusively perceive WBA as “assessments” Sharing Good Practice Uptake of SLE compared with WBA Sharing Good Practice Recording • Recording SLE tools in e-portfolio – No significant ease or difficulty • Form submission WBA SLE NES 92% 92% Horus 7.9% 7.8% • No difference in submission of FY1 vs FY2 • No difference in form types Sharing Good Practice Minimum forms WBA & SLE: 8) WBA: SLE: 3 DOPs 3 Mini-Cex 2 CBDs (min Average 25 forms per year 8 forms per placement Average 24 forms per year 8 forms per placement No difference between FY1 & FY2 doctors Sharing Good Practice Minimum forms 2011-12 cohort: Reduction from 8 WBA to 7 SLE Average 3 less forms complete Scotland WBA: 6 forms per placement SLE: 6 forms per placement Sharing Good Practice Timing of forms NES WBA Forms Submissions 2011-12 NES SLE Form Submissions 2012-13 18000 30000 14000 12000 10000 8000 CbD Clin Teach DOPS 6000 4000 Mini-CEX No. of Completed Forms No. of Completed Forms 16000 25000 20000 CbD 15000 DOPS 10000 5000 2000 0 Clin Teach 0 Sharing Good Practice Mini-CEX Clinical problem “New patient” dominating the responses rather than the other more specific clinical problems Sharing Good Practice Barriers to performing SLE Sharing Good Practice Barriers Process of learning • Individual: – Trainer and trainee enthusiasm • Interpersonal: – Quality of the trainee-trainer relationship • Culture: – Tensions between service provision and education • Technological: – Difficulty of access to e-portfolio Sharing Good Practice Feedback • Feedback helps trainee’s improvement and progression • >40% did not find the feedback to be valuable • CBD found to be the most useful for feedback Sharing Good Practice Conclusion Overall few trainees and trainers appreciate the differences between SLE and WBAs The findings may be attributed to: • Lack of training and understanding by trainee and trainers on how to use SLE tools • Nature of form filling during training in a work environment is, be its nature going to result in trainees leaving completion of WBAs or SLEs until late into a placement • Challenges with service and education provision • Support good trainees to develop as well as identifying struggling trainees Sharing Good Practice Recommendations Understanding of SLEs must be improved • SLEs should be retained in the Foundation Programme Curriculum • Foundation School Directors will promote education / understanding of SLE within their schools. Sharing Good Practice Recommendations Development of Educational Materials Specific to SLE • Development of software to simplify recording the SLE for trainer and trainee e.g. an app for a smartphone / tablet to allow secure access to record SLE within the e-portfolio Sharing Good Practice Recommendations Improved Access to the e-portfolio for recording SLEs • A set of webpages about SLE for trainers and trainees to be developed and hosted under the aegis of AoMRC Sharing Good Practice Recommendations Trainer Evidence • Trainers should be provided automatically with data regarding the quality and quantity of work related to SLEs via linkage with the e-portfolio Sharing Good Practice Recommendations Curriculum Mapping • UKFPO should consider revising how the subject of each SLE is recorded in the eportfolio Sharing Good Practice "The SLEs are a big step forward in gaining value from observation and feedback. I have learned how valuable this process can be. With the SLE the Junior has to complete reflection before submitting the ticket. At least this means I can get some insight into what is happening inside their heads!" Sharing Good Practice Thank You Sharing Good Practice