Guide to the ESR By Carol and Barry

Why is the ESR important? An Educational Supervisors Review (ESR) is conducted every six calendar months for all GP trainees, as prescribed by the Gold Guide. The ESR format draws together information from many sources in order to provide regular, formative feedback to the trainee, and to inform the decision making of the ARCP panel

At the end of training the final two ESRs will automatically get carried over to the doctor’s RCGP Revalidation ePortfolio ESRs are important as they can flag up a learner in difficulty. Educational supervision is not about disciplinary procedures but more about helping the trainee overcome or see them through the difficulties.

ARCP Annual Review of Competence Progression 4 stages Screening Panel members Face to Face Appeal 6 outcomes (actually there are 9!)

ARCP outcomes Outcome 1 – satisfactory progress Outcome 2 – unsatisfactory progress. Development of specific competences required – additional training time not required Outcome 3 - Inadequate progress by the trainee – additional training time required. Outcome 4 - Released from the training programme with or without specified competences Outcome 5 - Incomplete evidence presented – additional training time may be required Outcome 6 - Gained all required competences !! Finished

Principles of the ESR A review of the evidence on the portfolio “It is the trainee’s responsibility as an adult learner to demonstrate their progression” To generate a learning plan for the next 6 months

Problems that your ES has “educational supervisors tell us that they are currently spending significant amounts of time evidencing their judgements rather than critiquing the trainee’s assessment of their progression and the evidence trainees offer in support of this” Solution: you need to rate and reference your evidence

Your ES needs adequate time to read, check and validate your evidence. This needs to be done in a timely fashion for the ARCP Solution : closing dates for submitting evidence ST1 9 th November and 10 th May ST2 16 th November and 17 th May ST3 23 rd November and 24 th May

What evidence do I need? Reflective log entries 2 log entries per week, linked to the competences/curriculum WPBA – COTS/CBDS/mini-CEX Minimum requirements a SMART PDP Appropriate DOPS Who should assess your DOPS? MSF PSQ CSR

WPBA I need

ST1 Minimums prior to 6 month review: 3 x COT or mini-CEX 3 x CbD 1 x MSF DOPS Clinical supervisors’ reports Minimums prior to 12 month review: 3 x COT or mini-CEX 3 x CbD 1 x MSF, 1 x PSQ, if in primary care DOPS Clinical supervisors’ reports

ST2 Minimums prior to 18 month review: 3 x COT or mini-CEX 3 x CbD PSQ, if not completed in ST1 DOPS Clinical supervisors’ reports Minimums prior to 24 month review: 3 x COT 3 x CbD PSQ, if not completed in ST1

ST3 Minimums prior to 30 month review: 6 x CbD 6 x COT 1 x MSF Minimums prior to 34 month review: 6 x CbD 6 x COT 1 x MSF 1 x PSQ

A word on log entries Vs Be general and specific, reflect on feedback and don’t forget your PDP when a learning need is identified. Describe your feelings. Write entries in a natural way A record of OOH Professional conversations Audit SEAs Target what you need to check the box for curriculum and try and think about the cases/events in different perspectives Validating – clicking on the competences/curriculum statements

Where do I find the appropriate evidence for self-rating? n.b log entries not included in this example!

 Communication and consultation skills. This competence is about communication with patients, and the use of recognised consultation techniques.  Practising holistically: the ability of the doctor to operate in physical, psychological, socioeconomic and cultural dimensions, taking into account feelings as well as thoughts.  Data gathering and interpretation: the gathering and use of data for clinical judgement, the choice of physical examination and investigations, and their interpretation.  Making a diagnosis / making decisions. This competence is about a conscious, structured approach to decision making.  Clinical management: the recognition and management of common medical conditions in primary care.  Managing medical complexity and promoting health: aspects of care beyond managing straightforward problems, including the management of co-morbidity, uncertainty, risk and the approach to health rather than just illness.  Primary care administration and IMT: the appropriate use of primary care administration systems, effective recordkeeping and information technology for the benefit of patient care.  Working with colleagues and in teams: working effectively with other professionals to ensure patient care, including the sharing of information with colleagues.  Community orientation: the management of the health and social care of the practice population and local community.  Maintaining performance, learning and teaching: maintaining the performance and effective continuing professional development of oneself and others.  Maintaining an ethical approach to practice: practising ethically with integrity and a respect for diversity. Fitness to Practice: the doctor’s awareness of when his/her own performance, conduct or health, or that of others, might put patients at risk and the action taken to protect patients  Fitness to practice: the doctor's awareness of when his/her own performance, conduct or health, or that of others, might put patients at risk and the action taken to protect patients

Log entry examples, correctly referenced or not?

Preparation for ESR, a summary Contact your ES regarding your appointment Preparation to be completed by deadline date Think about your previous educational plan (previous ESR) if appropriate; did I address issues raised? Log entries. Enough, general and specific, reflective, feelings. Quality. Am I over/under linking DOPS. Am I on track? CSR/ENs. Are there any common themes/problems arising? PDP. SMART, generated by learning need PSQ/MSF. Can I see these? Ask ES to release them. Common themes/needs WPBA. Enough. What do I do well, how can I improve. Are there gaps emerging?

Review Preparation Make sure you complete your self rating in the correct review period! Sign the declarations Have 2 screens open when writing the self rating For your self ratings you have to demonstrate the evidence. You need examples from several sources, dates and can cut and paste highlights/comments. Think about how you can improve even if you are doing well in a particular competency. Competent for licensing only at last review

And finally…… Think about what you need to achieve over the next six months. Be prepared to discuss with your ES Discuss any problems you may have at the ES meeting. Your ES is there to help and guide you