nMRCGP Assessments on the

e portfolioA summary for hospital clinical

supervisorsMaggie Eisner

June 2009

Components of nMRCGP

Applied Knowledge Test (machine marked test) – done in ST2 or ST3

Clinical Skills Assessment (simulated GP surgery) – done in ST3 in GP post

Workplace Based Assessment - mini CEX (COT in GP posts), CBD, CSR, MSF, DOPS

Learning log - including clinical encounters, tutorials and seminars, significant incidents, professional conversations (etc)

All components matched to curriculum headings and to competency framework

The e portfolio

Is the only record used in assessing trainee’s progress

Trainee responsible for keeping it up to date – but may need encouraging and reminding

Logon provided for Clinical Supervisor – sometimes the wrong name, e g specialty’s educational lead. Can be changed on e portfolio via VTS administrator Vicky at Field House

Clinical supervisor can view e portfolio (most of it)

Other health professionals can enter assessments via their GMC number or with electronic ‘ticket’ from trainee

Educational supervisor is GP educational supervisor for the 3 years

Assessment of progress

Educational Supervisor (GP trainer or Programme Director) meets trainee twice every 6m (month 2 and 4)

At 2nd meeting, ES evaluates evidence on e portfolio and enters Educational Review

ARCP once a year (in month 10) to agree to progression from ST1 to ST2, ST2 to ST3, or grant CCT

Number of assessments required before ES mtg in month 4

DOPS – any time in training – Mandatory (there are others) : breast exam, Cx smears,

female genital exam, male genital exam, prostate exam, rectal exam, bld gluc testing, simple dressings

Observers may be SpR, staff grade, nurses, consultants

miniCEX – at least 3 per 6m 15-min snapshot of doc-pt interaction Observers may be staff grades, experienced SpR,

consultant

MSF – 1 set of 5 per 6m in ST1, none in ST2

CSR – at least 1 per 6m, before ES mtg in month 4

CBD – at least 3 per 6m, preferably by experienced educator

Case based discussion – what and how?

Formal, structured exercise with preparation by trainee and assessor

Developed from the old MRCGP oral exam (designed to test whether trainees could consider scenarios and issues in breadth and depth)

Intended to find evidence of specific competencies, not test knowledge

Trainee selects 2 cases, gives copies of records to assessor in advance

Assessor selects one and decides which competencies to look at frames questions around the actual case, not exploring

hypothetical events

Practising holistically

Data gathering and interpretation

Making a diagnosis/decisions

Clinical management

Managing medical complexity

Primary care admin and IMT

Working with colleagues and in teams

Community orientation

Maintaining an ethical approach

Fitness to practise

Case based discussion – the competencies

Case based discussion – rating

Expect progress from NFD to competent – ‘excellent’ is a description of a mature practitioner

Insufficient evidence – if you haven’t looked at that competency, or the case doesn’t address it

Needs further devel – rigid adherence to rules, superficial grasp of facts, can’t apply knowledge, little judgement

Competent – accesses and applies knowledge, sees things in context, conscious planning, ability to prioritise

Excellent – intuitive grasp of situations, doesn’t have to rely on rules, identifies underlying principles, understands context for applying knowledge

Case based discussion – making it useful

Prepare in advance

Get trainee to self rate and discuss whether you agree and why

Record a few details of the case (e portfolio has no specific slot for this, put in Feedback section) to help educational supervisor to assesshelp trainee to reflect

Encourage trainee to select case for next time which reflects the competencies they need evidence for

Further information

www.bradfordvts.co.uk: nMRCGP for Consultants – Elderly medicine

www.rcgp.org.uk: GP curriculum

Appendix

Detailed descriptions of the 12 competency areas and the criteria for the 4 grades

NB Each kind of assessment tests a different selection of competencies – e g CBD doesn’t include nos 1 (communication) and 9 (maintaining performance, learning and teaching)