RANZCP (competency- based)Fellowship Program 2012 (CBFP) Dr Warren Ward April V0.3

FELLOWSHIP COMPETENCIES - CANMEDS 2

Which training program will my trainee be in? Trainees who enrol before Jan 2013 in Australia train under the current RANZCP Fellowship Regulations. New trainees commencing Fellowship training in New Zealand in December 2012 or in Australia in January 2013 will fall under the RANZCP Fellowship Regulations 2012, which moves Fellowship training to a competency-based training program. 3

RANZCP (competency-based) Fellowship Program 2012 (CBFP) Fellowship To be eligible for Fellowship to the RANZCP, trainees are typically required to complete 60 months full-time equivalent (FTE) training Stages of Training The training program is divided into three stages, as follows: Stage 1: 1 year FTE Stage 2: 2 years FTE Stage 3: 2 years FTE 4

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Transition from old to new training program Trainees who are registered in the current Fellowship training program will transition to the new Fellowship training program by The transition process will happen in a stepwise fashion, to coincide with the roll-out of the Stages of the competency-based Fellowship program. Generally, trainees may transition into Stage 1 from 2013; Stage 2 from 2014; and Stage 3 from

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RANZCP Assessment Stage 1 (1yr) Stage 2 (2 Years) Stage 3 (2 Years) CAP – child & adolescent; CL – consultation liaison; FP – forensic; POA – old age; AP – adult; ADD - addiction OCI WE OSCE WE = Written Examination; OCI = Observed Clinical Interview; OSCE= Observed Structure Clinical Examination SCHOLARLY PROJECT PSYCHOTHERAPY LONG CASE COMPETENCIES (supervisor assessment and EPAs) 11

Psychotherapies Assessment Long psychotherapy intervention (approx. 1 year or 40 sessions) and a number of briefer interventions. Trainees are encouraged to complete the psychotherapies requirement by the end of Stage 2, but must complete them to be eligible to apply for Fellowship. The details of the psychotherapies element will be available soon. 12

Scholarly Project A College-approved Scholarly Project must be successfully completed to be eligible for Fellowship. May include: a quality assurance project or clinical audit, a systematic and critical literature review, original and empirical research, a case series or other activities, as approved by the Scholarly Project Subcommittee, which oversees the projects. More information regarding the Scholarly Project and the Scholarly Project Subcommittee will be coming soon. 13

Workplace-based Assessments (WBAs) Used for formative assessment of competencies, NEVER used as a mechanism to ‘mark’ or ‘pass/fail’ – they are an indicator as to how the trainee is going. Organised by the trainee, and typically occur within the regular supervision time. WBAs are also used by the supervisor to inform their assessment of Entrustable Professional Activities (EPAs), with a minimum of 3 WBAs used to assess each EPA. The Fellowship training program uses 4 WBA tools: Observed Clinical Activity (OCA) Mini-Clinical Evaluation Exercise Professional Presentation Case-based Discussion (CbD) More information about WBAs, including the actual tools, forms and resources for trainees and supervisors will be coming soon. 14

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The trainee presents the relevant aspects of the case (15-20 minutes) The assessor prompts on further discussion points Feedback occurs immediately Followed by discussion and reflection CbD completed in one 60 minute supervision session or less Case-based Discussion (CbD) 16

Focused clinical interaction lasting between 5-25 minutes No longer than 30 minutes Mini-Clinical Evaluation Exercise 17

Some similarity to certain clinical OSCE stations but not the same Not the careful standardisation At the commencement rather than the end of training Generating a ‘mark’ is not the aim, - Aim is generating feedback and learning plan ‘Formative’ Mini-Clinical Evaluation Exercise vs ‘Summative’ OSCE: 18

Very similar to the Observed Clinical Interview (OCI) in general structure Formative, not summative assessment Observed Clinical Activity (OCA) 19

Entrustable Professional Activities (EPAs) Summative assessments used to assess competence of the trainee to perform specialised, professional activities or tasks with distant (reactive) supervision at the appropriate standard for the Stage of training. Assess and certify that trainees are attaining the necessary knowledge, skills and attitudes that are embedded in the Fellowship competencies and thus required for eligibility for Fellowship. 20

Summative Assessments: Entrusted Professional Activities (EPAs) Summative assessments used to assess competence of the trainee to perform specialised, professional activities or tasks with distant (reactive) supervision at the appropriate standard for the Stage of training. Progression through training requires trainees to be entrusted to perform specific EPAs to an appropriate standard for the stage of training A minimum of 2 EPAs should be assessed and achieved for every 6 month FTE rotation A minimum of 3 WBAs will be used by Supervisors to inform assessment of each EPA 21

Fellowship EPAs In Stages 1 and 2, trainees must complete a number of General Psychiatry EPAs in addition to those required for mandatory and elective Area of Practice EPAs. Stage 1 General Psychiatry EPAs 1. Producing discharge summaries and organising appropriate transfer of care 2. Initiating an antipsychotic in a patient with schizophrenia 3. Active contribution to the multidisciplinary team meeting 4. Providing an explanation to a family about a young adult’s major mental illness. Stage 2 General Psychiatry EPAs 1. Demonstrating proficiency in all the expected tasks associated with prescription, administration and monitoring of ECT 2. The application and use of the Mental Health Act 3. Assessment and management of risk of harm to self and others 4. The safe and effective use of clozapine in psychiatry 5. Cultural competence. 22

Supervisor In-Training Assessment Forms and Reports In development – coming soon. 23

Written Exam Summative assessment task that trainees sit at the threshold of Stage 2 and 3 (end of year 3 to the beginning of year 4 (FTE)). Trainees may sit the written exam at any point from early in Stage 2, but this is not recommended. The Written Exam is set at the junior consultant standard. The first Written Exam will be held in

Clinical Exams There are two Clinical Exams held in Stage 3: Observed Clinical Interview (OCI) Objective Structured Clinical Examination (OSCE) The first Clinical Exams will be held in

Learning in the Competency Based Fellowship Program Learning Outcomes Fellowship Competencies 26

Assessment in the CBFP Workplace-based assessments (Formative - elective) Learning Outcomes Fellowship Competencies 27

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The CbD assesses: clinical reasoning decision making the integration of medical knowledge within case management and the trainee’s ability to document this Case-based Discussion (CbD) 29

Mental health legislation Acute management / Psychiatric emergency Safe Prescribing Multicultural skills Consumer / Carer/ NGO Risk assessment Examples of Stage 1 CbD’s: 30

Patient new to the trainee with regard to the clinical skill being assessed. Supervisor has some familiarity with the patient Selection 31

Usually arranged by the trainee in advance Occurs during individual or clinical supervision Trainee keeps a record Organisation 32

Focused on a specific aspect of clinical work: Mental state examination, cognitive assessment Risk assessment Relevant Physical examination Side-effect assessment Talking to carer/family Consent to treatment Interpret laboratory tests 33

9 point scale Midpoint “the standard to be achieved” (by the end of period of training) Trainee should have performance deficits, measured relative to what is expected by the end of period of training! Assessment 34

The trainee : Plans in consultation with the assessor to carry out the OCA Nominates a suitable clinical case, ideally new to the trainee Is responsible for all organisation plus consent Protocol 35

The OCA will be split into two sessions Session 1 The interview will run for up to 50 minutes, with a 10 minute feedback session Followed by self reflection in own time Protocol – Session 1 36

Present the Case (up to 20 minutes) Summary of the salient features of the case An assessment of gaps in the history plus other essential information required A formulation, diagnosis and differential diagnosis, Present a detailed management plan (up to 20 minutes) Protocol : Session 2 37

Protocol : session 2 Feedback – 10 minutes) Once the discussion is complete the assessor provides detailed feedback Ample time for feedback is to be allowed Feedback is to be restricted to the OCA The trainee is responsible for retaining the OCA form within their portfolio 38

History taking Mental state examination Creating a therapeutic relationship Clinical judgment/Formulation Organisation/Efficiency Physical Examination skills Overall clinical care Assessment headings 39