Trainee Assessment Behavioural attitudes and professionalism

What do we learn about trainee: Information Input Daily reviews of notes/ debriefs Tutorial discussions, CBDs, COTs, videos, observed consulting, role plays Prescribing, referrals, clinical audit, case reviews, SEAs PSQs, complaints, informal feedback Colleagues, staff, MSFs, observed behaviours, time keeping, sickness e-Portfolio logs, reflections, detail, insights

Why trainees don’t make progress Low starting point – poor foundation, not met foundation standards: communication, clinical knowledge skills and experience. Failure to build on and progress during GP training due to: – External pressures – long travel times, external pressures/ commitments, stress, illness – Low value/priority attached to learning. Not self directed learner. – Unable to overcome/improve specific/more global issues: communication/ knowledge base/ application of knowledge/ attitudinal issues.

Formative assessment of issues Before they arrive – progress within e- portfolio, exams taken, Early in attachment- informally assess their starting point in four areas: – Communication skills – Knowledge base – GP curriculum – Application of knowledge to clinical situations – Attitudes

Formative assessment tools Traditionally.. – COTs, observed, videos, knowledge tests/ self assessments – Manchester self assessment, nPEP, etc, debriefs, feedback tools and use of e-portfolio Other areas – Managing attitudinal/ workplace issues – What to do with a trainee who doesn’t accept feedback/ wont do videos.

Professional attitudes Altruism (giving priority to patient interests rather than self-interests); accountability (being answerable to patients, society and profession) Excellence (conscientious effort to perform beyond ordinary expectation) Commitment to life-long learning

Professional attitudes Duty (free acceptance of commitment to service – i.e. undergoing inconvenience to achieve a high standard of patient care) Honour and integrity (being fair, truthful, straightforward, and keeping to one’s word) Respect for others (respect for patients and families, colleagues, other healthcare professionals, and students and trainees).

Teaching Professionalism

Detecting un-professional behaviour Seven broad categories of ‘signs and symptoms’ Abuse of power Greed Misrepresentation Fraud Impairment Lack of conscientiousness Conflicts of interest ·

Abuse of power abuse while interacting with patients and colleagues bias and sexual harassment breach of confidentiality

Arrogance -Offensive display of superiority and self- importance -Can be subtle/ missed in mild/ situational cases

Greed When money becomes the driving force Not common in GP trainees Beware trainee who is doing lots of locum shifts in A&E/ hospital at weekends and evenings

Misrepresentation Lying, which is consciously failing to tell the truth – ie also includes lies by omission You may need to look for objective evidence that disproves the lie.

Fraud Conscious misrepresentation of material fact with the intent to mislead, usually for personal gain. May include stealing from the practice e.g. equipment.

Impairment Any disability that may prevent the physician from discharging his/her duties. In this context this is where this is self induced and/or undisclosed e.g. impairment due to drug or alcohol misuse, untreated bipolar affective disorder, not declaring an infectious illness without taking precautions, etc.

Lack of Conscientiousness Failure to fulfil basic professional responsibilities, e.g. timely referrals and managing workload/ paperwork/ path results to the extent that this does/ could compromise patient care.

Conflicts of interest Self- promotion/advertising Unethical collaboration with industry Less common in trainees

Acceptance of gifts; and misuse of services Inappropriate treatments

Case Studies