The Milton Keynes Traffic Light System A structured mechanism for identifying trainees in difficulty From: Greg Simons

Overview of Presentation Introduction RDMp Model Reflection/ Insight Traffic Light system Implications of the traffic light Expectations

Introduction GP GP Trainer National Clinical Lead GP access and responsiveness Associate GP Dean PD support Trainer Support Trainee Support Executive rep at Deanery Board level Faculty Development

The RDM-p Model Tim Norfolk – Quality in Primary Care 2009 17 (1), pp37-49 Unifying theory of clinical practice Links Relationship, Diagnostics, Management and Professionalism Overarching model, provides a framework that can incorporates criteria and competencies across the range of assessments of a GP's work

Adapted from Tim Norfolk; Quality in Primary Care 2009 RDMp Relationships descriptor R=relationships Negative positive Holistic Consulting skills Communicating Working with colleagues Lacks warmth in voice/manner uses too many closed questions Unable to adapt language Unclear when communicating Gives little support confrontational (+p) Authoritarian (+p) Good non verbal behaviour Uses open questions Adjusts questioning Expresses ideas clearly Encourages contribution Delegates appropriately Non-judgemental Adapted from Tim Norfolk; Quality in Primary Care 2009

Adapted from Tim Norfolk, Quality in Primary Care 2009 RDMp Diagnostics descriptor D=Diagnostics negative positive Data gathering Data interpretation Making diagnoses Making decisions Clinical Management Managing complexity Can’t find a way of resolving the problem (D+M) Makes immediate assumptions Dogmatic Overlooks important information Options too limited Positive when dealing with problems Thinks around issues Open to new ideas Shows interest and understanding Identifies key points Aware of options Adapted from Tim Norfolk, Quality in Primary Care 2009

adapted from Tim Norfolk, Quality in primary care 2009 RDMp Management descriptor M= management negative positive Community orientation Practice Management IMT Maintaining performance Learning and teaching Unsystematic Fails to apply lessons Disorganised Doesn't keep up to date Poor prioritisation Misses reasonable deadlines Doesn't think ahead Doesn't cope well with unexpected Becomes agitated Sound systematic judgement Admits to and learns from mistakes Organised Regularly updates job related skills Prioritises effectively Coordinates activity Thinks ahead Delivers on time Stays calm under pressure adapted from Tim Norfolk, Quality in primary care 2009

Adapted from Tim Norfolk, Quality in primary care 2009 RDMp professionalism descriptor P= professionalism negative positive Ethics Fitness to practice Defensive (M+P) Critical Shows favouritism Narrow perspective Fails to take responsibility for poor actions Treat issues as problems Disrespectful to colleagues, staff or patients Finds it difficult to seek help when appropriate Receptive Gives constructive feedback and support Collaborates Sees bigger picture Takes responsibility appropriately Recognises limitations Shows respect Seeks help when necessary Adapted from Tim Norfolk, Quality in primary care 2009

© Tim Norfolk Tim Norfolk Quality in Primary Care 2009, 17 (1), pp37–49

RDMp and Good Medical Practice Tim Norfolk 2009

Amar Rughani’s Insight Table Insight/ Reflection Amar Rughani’s Insight Table Performance Insight Reflect What do you think?? Good Ideal Poor Unconsciously competent doctors may not adapt to changing situations as they don't understand why they are (currently) competent. They may also engage in risky practices through lack of insight regarding the connection between action and effects. Consciously incompetent doctors might be difficult because they have low motivation to improve. The causes of low motivation, such as stress need to be looked for. Unconsciously incompetent doctors may be the most difficult to remediate because despite regular exposure to deficiencies in performance, they may lack the capacity to change

Using the Traffic Light System Look at descriptors for RDMp domains Apply the grading in each domain using your knowledge of the trainee, experience and evidence e.g. eportfolio, feedback

Grading (Milton Keynes) 1 = clearly failing 2 = concerns 3 = expected stage 4 = above expectation for stage 5 = ready for independent practice Add in insight/lack insight (-/+)

Using the Traffic Light System Look at descriptors for RDMp domains Apply the grading in each domain using your knowledge of the trainee, experience and evidence e.g. eportfolio, feedback Decide whether the trainee demonstrates insight with reflective ability with + or - Categorise Green/ Amber/ Red

Traffic Light System for MKVTS- Tables colour concern eportfolio ES PD/AD Green none Sufficient number and quality of entries. Progression in PDP and skills log Satisfactory coverage curriculum Satisfactory completion Assessments Continue regular review eportfolio Continue 6/12ly reviews RDMp3+ in all areas Monitor eportfolio

Traffic light system for MKVTS colour concern ePortfolio ES PD/AD Amber Some Consistently poor quality/ number of entries Poor PDP Poor coverage of curriculum Inadequate number of mandatory assessments RDMp2 in any one area One area may be (-) for insight PD interviews trainee + ES

Traffic light system for MKVTS colour concern ePortfolio ES PD/AD Red Significant Failure to engage ePortfolio Unsatisfactory progress signalled by ES or CS RDMp1/2 in more than one area poor insight (-) in multiple domains Interview with PD/AD with ES with a view to referral to ARCP

Implications of Traffic Light Feedback monthly for those in GP, Quarterly for those in Hospital (more freq if problems) Early referral to ARCP Reflective Skills very important Early, Frequent and open discussion with Ed Supervisor

Expectations Full engagement Professionalism Self Directed