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PVF 0001 External Clinical Teaching Visit (ECTV) Feedback

Registrar in Practice Experience InformationECT Visitor please complete

This page only will not be visible to Registrar, Practice or SupervisorDate: GP Registrar: Current Practice: Region: NW NE SW MWGP Supervisor: ECT Visitor:

Current Training Level:

GPT1 PRRT1 GPT2 PRRT2GPT3 PRRT3 GPT4 PRRT4 ES

Visit Number: Visit 1: Visit 2: Other : (For current training level)

You are given time at the beginning at the ECTV session to discuss the term with the GPR

The following should be discussed with the Registrar (GPR):Any issues identified by ECT visitor or that are raised by the GPR should be noted in the comments box below. (please note that these questions and responses form part of the Practice File and NOT the registrar’s file)

1. Are there adequate patient numbers? Yes No comments

2. Is there an adequate variety of consultations?

Yes No

3. Are there any concerns with teaching (eg. frequency, quality, amount)?

Yes No

4. Is the supervisor available appropriately to the registrar?

Yes No

5. Is the working environment conducive to training (eg. staff, colleagues, facilities, etc)?

Yes No

6. Was orientation conducted at the commencement of the term and was it satisfactory?

Yes No Not applicable

Do you have any concerns with the standard of training at this practice? Yes No Do you have any concerns with registrar wellbeing/competence at this practice? Yes No Note - If “yes” indicated above, the Regional Head of Education (RHE), Director of Medical Education and Training (DMET) and relevant portfolio medical educators (accreditation/registrar support) will be notified.

Comments:

PVF 0001 External Clinical Teaching Visit (ECTV) Feedback Version: 1.0Created: September 2017 Approval: Unit responsible: Medical Education Written by: Registrar Progression Portfolio ManagerReviewed: Next review: September 2018 of 16

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External Clinical Teaching Visit ReportReport once signed off will be visible to Registrar, Supervisor and Education team

Date: GP Registrar: Current Practice: Region: NW NE SW MWGP Supervisor: ECT Visitor:

Current Training Level:

GPT1 PRRT1 GPT2 PRRT2GPT3 PRRT3 GPT4 PRRT4 ES

Visit Number: Visit 1: Visit 2: Other: (For current training level)

Consultations observed at this visit:(gender, age, presentation, notes)

Level of ComplexityLow Med High

Patient 1: Patient 2: Patient 3: Patient 4: Patient 5: Patient 6:

Review of Educational Element of ECTV: (use patient examples where applicable)Areas or topics identified by you (the registrar) at beginning of the ECTV on which you desire feedback.

KEEP DOING: Skills displayed during the consultations that enhance your clinical performance

DO MORE: Skills discussed with you during the ECTV which, if utilised, may further enhance your clinical performance


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DO LESS/STOP DOING: Consultation techniques observed or discussed during the ECTV which may impede your consultation skills

Overall performance:Assess the GPR performance overall. If “unable to assess”, “below expected competence” or “well below expected competence” ticked then RHE will be notified.

Overall AssessmentAs an overall assessment, is the registrar at the competency level expected for their level of training?

Well below expected level of competence

Below expected level of competence

At expected levelof competence

Above expected level of competence

Unable to Assess (details must be provided)

Learning goals identified during this visit (eg. things to study/practice/review/trial) that the GPR should incorporate into their learning planner.

Review of GPR progression

Assess the GPR performance against RACGP/ACRRM competency benchmarking (see Appendix A).

(Note - If “well below competence” or “below competence” indicated, RHE will be notified.

At entry to GPT1/PRRT1, the registrar is expected to be at entry to GP competency (IA). Late GPT1/PRRT1, the registrar is expected to be between entry to GP and GP under

supervision competency. At start GPT2/PRRT2, the registrar is expected to be close to GP under supervision competency (FA). Late GPT2/PRRT2, the registrar is expected to be at GP under supervision competence. At GPT3/4, PRRT 3/4, the registrar is expected to be at or close to GP at point of fellowship competency.


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PVF 0001 External Clinical Teaching Visit (ECTV) FeedbackDomain: Communication Skills: Doctor-Patient and Doctor-Inter-professional Is the registrar at the competency level expected for their level of training?

Unable to assess



At expected level of competence


(specific examples required - mandatory field)

Domain: Providing Medical CareIs the registrar at the competency level expected for their level of training?

Unable to assess





(specific examples required- mandatory field)

Domain: Population Health and the Context of General PracticeIs the registrar at the competency level expected for their level of training?

Unable to assess






Domain: Professional, Intellectual and Ethical RoleIs the registrar at the competency level expected for their level of training?

Unable to assess







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PVF 0001 External Clinical Teaching Visit (ECTV) FeedbackDomain: Organisational and Legal DimensionsIs the registrar at the competency level expected for their level of training?

Unable to assess






Domain: Practicing Medicine in the Rural and Remote Context (ACRRM / Rural Registrars Only)

Is the registrar at the competency level expected for their level of training?

Unable to assess






Has this feedback been discussed with the supervisor?It is expected that if this does not occur at time of visit that it occurs later by phone

Yes No N/AHas the Learning Plan/Log Book been reviewed and discussed with the registrar?It is expected that this occurs at time of visit

Yes No N/A

ExamWhen is the GPR intending to sit the exam?Written: Clinical:Other:

ECT Visitor Authorisation (ensure you have completed the overall assessment)

ECT Visitor Name:

Signature:(May be electronic)

Date:


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Regional Head of Education Authorisation

Delegated Medical Educator Name:

Signature:

Date:Region:


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Registrar feedback on the ECTV

This Form will be sent to the Registrar after they receive a copy of the ECT Report.

Do you have any feedback for the Visitor who conducted your ECTV?

What have you gained from this ECTV?

Are there any learning needs you wish to put into your Learning Planner?


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APPENDIX A

Competency Expectations by Domain

Explanatory Information- competencies expected of registrars at each stage of training

This information will also assist you to complete this process.

The purpose of the supervisor reporting process is to collect information about the registrar’s areas of strength, learning needs and capacity to perform at an expected level through a range of relevant activities.

The information will be used by the education teams to guide the registrar’s learning journey, including the required level of supervision and support, and to assist in the registrar’s development of a relevant plan for learning. It will also help identify registrars who would benefit from further assessment and input from the PALS team.

The competencies below are a synopsis of expected competencies throughout general practice training, drawn directly from the RACGP Curriculum for Australian General Practice 2016 and the ACRRM Primary Curriculum.

Initial Assessment At the beginning of GPT1/PRRT1, it is expected that your registrar’s competencies will be at the “Entry to GPT1/PRRT1” level

Completion GPT1/PRRT1

It is expected that your registrar’s competencies would lie somewhere between “Entry to GPT1/PRRT1” and “General Practice Under Supervision”

Further Assessment At entry to GPT2/PRRT2, it is expected that your registrar’s competencies would lie somewhere between “Entry to GPT1/PRRT1” and “General Practice Under Supervision”

Completion GPT2/PRRT2

It is expected that your registrar’s competencies will be at the “General Practice Under Supervision” level.

During GPT3/PRRT3 It is expected that your registrar’s competencies would lie somewhere between “General Practice Under Supervision” and “At Time of Fellowship”.

During GPT4/PRRT4 It is expected that your registrar’s competencies would lie at or close to “At Time of Fellowship”.

For more detail please refer to the following links: https://www.racgp.org.au/Education/Curriculum/CS16/home/ http://www.acrrm.org.au/PrimaryCurriculum/Default.htm


http://www.acrrm.org.au/PrimaryCurriculum/Default.htm

https://www.racgp.org.au/Education/Curriculum/CS16/home/

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Entry to GPT1/PRRT1General Practice Under

Supervision: GPT2/PRRT2

At Time of Fellowship: GPT3-4/PRRT3-4

Communication Skills: doctor –patient and doctor inter-professional

Has effective communication skills and uses language that is easy to understand; is warm and sympathetic, establishes rapport and listens and responds to verbal cues

Communicates effectively in written word (clinical notes and referral letters)

Identifies and manages patients who are angry, distressed; has a framework for appropriately breaking bad news

Identifies patients whose care may be enhanced or undermined by involvement of family members; can manage confidentiality and informed consent

Recognises patients who benefit from health promotion, self-care and counselling and appreciates barriers to implementing these strategies

Identifies culturally appropriate communication with both Aboriginal and Torres Strait Islander peoples and those from culturally diverse backgrounds and the

Consolidates and refines communication skills; engenders confidence and trust, appropriately uses closed and open questions, shows sympathy and empathy and interest in patients

Begins to manage more difficult patients; mental health problems, heart-sink patients, patient complaints, breaking bad news, carer distress and end-of-life decisions

Addresses barriers to patients implementing health promotion and prevention strategies; motivates and assists patients and recognises opportunity for health education

Identifies Aboriginal and Torres Strait Islander patients as well as those from other culturally diverse groups and addresses barriers to care and communication; communicates in a culturally safe manner; optimizes patient empowerment

Communication style is respectful, clear and adaptive; adjusts communication to suit age, gender, cultural background, emotional state and physical state of the patient

Involves the patient in decision-making; provides appropriate explanations, discusses diagnostic and management possibilities, negotiates courses of action, encourages feedback and input from patients and carers.

Coordinates care that is continuous and meets the needs of patients in their context; offers advice on health options and communicates with family members and practitioners involved in the patient’s care

Uses a patient-centered, whole person approach that builds mutual confidence; understands the impact a patient’s culture, history, gender and background impacts on their experience of health; seeks to promote health and wellbeing

Aboriginal and Torres Strait Islander patients are identified. Culturally safe communication is practiced with all culturally diverse groups; historical and cultural influences


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PVF 0001 External Clinical Teaching Visit (ECTV) Feedbackrole of Aboriginal and Torres Strait Islander cultural educators and mentors; appreciates impact cultural beliefs, behaviours and intergenerational trauma have on Aboriginal and Torres Strait Islander peoples’ health

are appreciated and incorporated in to the consultation.Uses interpreters, key community contacts and networks as appropriate

Providing medical care History

Takes a history of the presenting complaint with an appropriate review of systems, using a bio-psychosocial model

Identifies the ideas, concerns and expectations of the patient and describes strategies to manage unrealistic patient or carer expectations

Recognises the impact sociocultural factors have on presentations, compliance and patient engagement

Elicits a good history; incorporates the bio-psychosocial approach and patient preferences where possible; appreciates the impact diagnoses have on the patient’s family and context

Elicits the patient agenda (ICE) and reconciles this with the doctor agenda; creates a mutually agreed problem list

Takes a comprehensive, structured and biopsychosocial history from the patient and documents this clearly; interprets symptoms in their socio-cultural and medical context

Examination Conducts an appropriate and focused examination with consent

Conducts an appropriate and focused examination with consent and demonstrates correct technique and use of clinical tools

Performs a respectful, appropriate and competently executed examination, with consent

Investigations Identifies patients in whom investigations are required to make a diagnosis or create a management plan, outlining the factors to consider when choosing the most appropriate investigation

Effectively communicates results to the patient

Judiciously orders investigations and is aware of public health costs; describes the risks and benefits of investigations

Develops recall and reminder strategies for handling results

Rational investigations are ordered and explained; a structured framework for following results up is in place


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PVF 0001 External Clinical Teaching Visit (ECTV) FeedbackDiagnosis Identifies and manages

the acutely unwell patient

Synthesises clinical information to create an appropriate list of differential diagnoses; can discriminate between the possible differential diagnoses relevant to the presenting complaint

Develops a diagnosis and executes a management plan for acute serious illness and trauma

Refines diagnostic powers; fewer diagnostic dilemmas, differential diagnoses are risk stratified, differential list is better prioritized and defended

Differential diagnoses are rational and defensible; uncertainty and undifferentiated illness is managed

Management(Including response to medical emergencies)

Takes appropriate steps to manage serious illness; manages acute emergencies: asthma, anaphylaxis, seizures, chest pain/AMI, shock, poisoning, overdose, envenomation, haemorrhage

Identifies evidence-based guidelines and key factors to consider when prescribing medication; can communicate evidence and medication management plan to patients

Identifies which patients will benefit from procedures; can obtain informed consent and determine which procedures can be safely done in general practice and those that require referral

Appreciates the risk associated with managing patients with undifferentiated illness

Understands the role of

Effectively communicates with and counsels patients about management options including use of safety net

Uses unbiased and appropriate patient and guideline resources when prescribing, managing and referring for procedures; discussed side effects and risks with patients

Understand principles of restricted medications and off-label prescribing, manages medication misuse and withdrawal; has a framework for managing compliance issues

Manages diagnostic uncertainty and undifferentiated illness with greater skill; appreciates mental health conditions that confound presentations of undifferentiated illness

Effectively communicates with health professionals, provides hand-overs; implements strategies to reduce fragmentation of

Manages a wide variety of patients and problems comprehensively and in a cost-effective and evidence-based manner; works within limits of own expertise and coordinates the involvement of appropriate health practitioners


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PVF 0001 External Clinical Teaching Visit (ECTV) Feedbackgeneral practice in coordinating patient care to minimize fragmentation; identifies the role of the multidisciplinary team in patient care and makes timely, appropriate referrals

care

Procedural Skills

Is able to do: CPR, ECG, IM injections, suture lacerations

See also: Skills and Procedures

Able to do: vaccinations, blood glucose testing, cervical cytology, simple dressings

Optional skills may include: proctoscopy, cryotherapy, curettage and shave excision, punch biopsy, excision of simple skin lesions, cautery, incision and drainage of abscess, drainage of joint effusion, joint injections, insertion of hormonal implants, spirometry

See also: Skills and Procedures

May be developing an interest and proficiency in a procedural field

Cognitive Skills Synthesises information and problem solves at level of simple complexity; uses hypothetico-deductive method for problem solving

Demonstrates a willingness to learn and improve; is reflective and self-aware

Can adapt to different work and clinical situations

Synthesises information and problem solves at level of moderate complexity; uses pattern matching when problem solving

Conducts a structured consultation and competently manages common presentations

Synthesises information and problem solves at level of increased complexity; draws on various resources and skills in doing so. Is critical and discriminating

Has honed reflective abilities and insight


http://curriculum.cpmec.org.au/skillsprocedures.cfm




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Addressing health needs of Aboriginal and Torres Strait Islander, other culturally diverse groups and disadvantaged communities

Describes conditions and health risks prevalent in Aboriginal and Torres Strait Islander and other culturally diverse populations and barriers to delivering care; identifies local resources that assist in addressing these communities’ needs

Manages diagnostic uncertainty related to cultural beliefs and uses strategies & resources to enhance health outcomes.

Begins to apply principles of partnership, community ownership, consultation, capacity building, reciprocity and respect to health care delivery to disadvantaged groups

The conduct of the consultation is appropriate to the need of the Aboriginal and Torres Strait Islander person and their sociocultural context.

Works with culturally diverse and disadvantaged groups to address barriers in access to health services and improve the determinants of health

Population Health & the Context of General Practice

Has a patient-centered approach; considers the psychosocial and cultural determinants of health and recognises vulnerable groups in the community

Understands public health roles relevant to general practice and public health risks addressed in general practice

Describes the MBS and PBS systems

Begins engaging with the community

Describes differences in morbidity and mortality in Aboriginal and Torres Strait Islander populations and the doctor’s role in promoting health equality in all culturally diverse and disadvantaged populations

Implements individual and national population based screening activities in the consultation; motivates patients to participate

Advocates for vulnerable groups and appropriately accesses government funded programs

Understands requirements for public health notification; can manage public health risks and communicable disease outbreaks

Uses evidence and healthcare delivery strategies (including MBS programs, health promotion & community education) to reduce health inequality in Aboriginal and Torres Strait Islander populations and other disadvantaged groups

Promotes holistic health and preventative care to individuals and to groups, appreciating the individual, contextual and epidemiological determinants of health and disease

Advocates for patients, identifies and manages barriers to care

Practices in a cost-conscious manner; has a deeper understanding of the Australian healthcare system

Promotes screening and management decisions based on an understanding of Aboriginal and Torres Strait Islander person health needs as well as those of other culturally diverse and disadvantaged groups


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Professional, Intellectual & Ethical Role

Behaves professionally at all times; respect, duty of care, boundaries, confidentiality, safety and privacy principles are understood and practised

Is committed to general practice; understand the principles of self-care and advocacy for patients

Is willing to learn and extend; identifies learning needs and takes responsibility for learning, identifies and commits to quality improvement strategies

Describes the role research plays in reducing health inequality in Aboriginal and Torres Strait Islander populations and other culturally diverse groups. Reflects on own assumptions, cultural beliefs and emotional reactions in providing culturally safe care

Behaves professionally at all times; respect, duty of care, boundaries, confidentiality, safety and privacy principles are understood, practiced and evaluated

Is committed to general practice; practices the principles of self-care and advocacy for patients and coordinates patient care

Is willing to learn and extend; identifies learning needs and takes responsibility for learning, identifies and commits to quality improvement strategies including reporting and managing critical incidents; seeks to learn alongside others

Understands mandatory reporting and has a framework for supporting a colleague in difficulty

Describes ethical approaches to research in Aboriginal and Torres Strait Islander health and other culturally diverse groups

Practices professionally and adheres to the code of professional conduct; justice, beneficence, non-maleficence, autonomy and confidentiality

Engages in self-care and maintains a balance between involvement and applying appropriate boundaries

Is committed to lifelong learning, actively and independently seeking out educational opportunities; engages in the education of others

Takes a leadership role in arenas outside of patient care (organisations, community groups, practice meetings)

Identifies opportunities for research and teaching in Aboriginal and Torres Strait Islander health and other disadvantaged groups

Organisational & Legal Dimensions

Maintains appropriate medical records; identifying what information must be recorded, principles of record storage and legalities of use of patient data

Understands legal requirements; reportable deaths, medico-legal report

Effectively uses practice systems (including IT systems) for patient care; reviews, recalls, handling of abnormal test results, managing failures to attend

Identifies and manages occasions when duty of care clashes with confidentiality requirements;

Manages the systems of General Practice: (data management, documentation, certificates, insurance matters, billing, care plans and practice management)

Understands and works within statutory and regulatory requirements; manages medico-legal


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PVF 0001 External Clinical Teaching Visit (ECTV) Feedbackwriting, confidentiality and informed consent

May have difficulty with time management but is organised and has a good work ethic

Identifies models of care and policies relevant to Aboriginal and Torres Strait Islander health as well as other culturally diverse groups

understands when MDO advice is required

Demonstrates an understanding of patient competency and shared decision making; appreciate legalities of caring for patients who cannot give consent

Understands certification; WorkCover, Centrelink, care plans, billing rules, notification requirements, involuntary admission legislation

Understands Aboriginal community controlled health services; uses government programs and policies to enhance care delivery to Aboriginal and Torres Strait Islander peoples

responsibilities, recalls and reminders and confidentiality

Manages time effectively

Is aware of strategies that promote culturally safe practices; uses policies and initiatives to promote equality in care of all culturally diverse groups

Practicing medicine in the rural & remote context(rural registrars only)

Participates in the provision of care away from other medical services; respects local community values; commits to the acquisition of knowledge required to care for the local population

Provides effective clinical care when distant from medical services; demonstrates resourcefulness when working in isolation; arranges appropriate referral to distant services, is becoming confident in the use of information and communication technology in provision of care

Practices independently in isolation; provides supervision to healthcare personnel; uses information and communication technology to manage patients and communicate with colleagues

Provides care in the hospital setting

Participates in the admission of patients to hospital; applies relevant protocols; communicates with healthcare personnel and provides appropriate handovers

Develops and implements management plans for hospitalised patients including the management of fluids and blood products; monitors clinical progress; manages the deteriorating patient; arranges transfer to other facilities; engages in discharge planning

Provides supervision to healthcare personnel; manages adverse events; participates in quality improvement initiatives; contributes to the medical expertise of the hospital team


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PVF 0001 External Clinical Teaching Visit (ECTV) FeedbackResponse to medical emergencies

Arranges evacuation; communicates with receiving clinical personnel; performs an initial assessment of the critically ill patient

Provides definitive emergency care, resuscitation and performs procedures across all patient ages

Leads an inter-professional team in delivering emergency care; participates in disaster planning; stabilizes critically ill patients, providing both primary and secondary care; performs required emergency procedures

Useful Links:

1. Australian Curriculum framework for junior doctors2. RACGP Curriculum for Australian General Practice 2016: Core skills unit & Aboriginal & Torres

Strait Islander Health Unit3. ACRRM Primary Curriculum 4th Edition


http://www.acrrm.org.au/PrimaryCurriculum/Default.htm

http://www.cpmec.org.au/Page/acfjd-project

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