1. West Herts GP Specialist Training Programme ST1 Induction Meeting 5 th August 2009

2. Programme Directors ST1 Group –Paul Heatley & Bruce Covell ST3 Group –Pauline & Nick Foreman VTS Administrator –Maria Parry-Price Postgraduate Centre Manager –Kim Hull

3. West Herts VTS – a very brief history NW Herts VTS (Hemel/St Albans/Radlett/Kings Langley/Berkhamsted) Programme Directors: Paul Heatley & Bruce Covell Watford VTS Programme Directors: Pauline & Nick Foreman Merged August 2007 Trainers workshops remain separate

4. VTS Teaching Programme ST1 and ST3 groups have a weekly half day meeting at Watford Hospital Postgraduate Centre from 2.15 to 5pm. Broadly follows school terms Both groups have a residential course in the summer ST2 group have three study days per year but no weekly programme.

5. Content of VTS Programme Guided by GP Curriculum –See RCGP website www.rcgp-curriculum.org.ukwww.rcgp-curriculum.org.uk –Condensed curriculum guide External speakers Case discussion E-portfolio Journal Club Preparation for nMRCGP Your views are important and will be sought

6. Plus…..

7. Visit to Nice – July 2009

8. VTS Rotation(s) 18 months in general practice and 18 months in a variety of secondary care posts The local trusts have four month posts (some have a six month cycle) We have two rotations A.18 entrants per year established in 2007 B. 4 entrants per year established in August 2009

9. Rotation A – ST1 year 4/12 full time general practice 4/12 medicine/geriatrics/A&E 4/12 part-time GP and part-time GU/Derm/Palliative Care/Community Geriatrics Allocation process

10. Rotation A – ST2 & ST3 ST2 –4/12 Paediatrics –4/12 Obstetrics and Gynaecology –4/12 Psychiatry ST3 –12/12 full time General Practice

11. Rotation B Part of national drive to increase training capacity 18 months secondary care in other Trusts (currently QEII, Welwyn and the Lister, Stevenage). August 2011 posts to be confirmed. 18 months in local training practice

12. Working week in GP attachments (Deanery Guidelines) 40 hours Ten sessions –Seven sessions consulting with patients –One session of formal teaching –One session at the VTS –One session of private study Plus Out of Hours experience (108 hours over the three years ie 1 session per month) Experience of extended hours

13. Specimen timetable for full time GP attachment MondayTuesdayWedsThursFri Surgery & visits Tutorial & visits Surgery & visits Surgery & visits Surgery & visits Surgery Private Study VTSSurgery

14. Relationships GP based posts – you will be employed by your trainer Secondary care posts - You will be employed by a hospital or community trust Educational Supervisor - You will be attached to a trainer or PD for the duration of the three year course but there is some flexibility.

15. If you have a problem… Do talk to ……….. –Other members of the group –Consultant or Trainer –Programme Director –Patch Director (Dr Keith Cockburn) –Deanery Director of Postgraduate General Practice (Dr Arthur Hibble) Don’t…

16. Exams!

17. nMRCGP Applied Knowledge Test (AKT) Clinical Skills Assessment (CSA) Workplace Based Assessment (WPBA) New rule: from August 2010 candidates can attempt the CSA and AKT a maximum of four times.

18. Applied Knowledge Test (AKT) Can be done at any time in the ST2 or ST3 year Held at one of 150 Pearson Vue testing centres; Oct, Jan & April each year 200 multiple choice questions in 3 hours 80% clinical medicine, 10% critical appraisal and EBM, 10% health informatics & administration Sample questions on rcgp web site NMRCGP Practice Papers: Applied Knowledge Test by Rob Daniels (PasTest)Rob Daniels

19. Things that come up in the AKT Legal aspects, e.g. DVLA Professional regulation, e.g. GMC Business aspects, e.g. GP contract Prescribing, e.g. Controlled drugs Appropriate use of resources, e.g. drugs Health & Safety, e.g. needlestick injury Ethical, e.g. Mental capacity, consent

20. Clinical Skills Assessment - CSA Can only be done in the ST3 year Simulated surgery with actors and trained assessors 13 patients, 10 minutes each, 2 minute break The three domains on which you will be marked are: DATA-GATHERING, TECHNICAL & ASSESSMENT SKILLS: Gathering & using data for clinical judgement, choice of examination, investigations & their interpretation. Demonstrating proficiency in performing physical examinations & using diagnostic and therapeutic instruments

21. CLINICAL MANAGEMENT SKILLS: Recognition & management of common medical conditions in primary care. Demonstrating a structured & flexible approach to decision- making. Demonstrating the ability to deal with multiple complaints and co-morbidity. Demonstrating the ability to promote a positive approach to health INTERPERSONAL SKILLS: Demonstrating the use of recognised communication techniques to gain understanding of the patient's illness experience and develop a shared approach to managing problems. Practising ethically with respect for equality & diversity issues, in line with the accepted codes of professional conduct.

22. CSA – III – new scoring Each domain is marked separately to give an overall score In addition the examiner grades each consultation as: Clear Pass, Marginal Pass, Marginal Fail, Clear Fail A “cut score” is calculated each day to allow for any variation in the difficulty of the cases and is used to define the pass mark Held at assessment centre in Croydon four times per year (will eventually move to new RCGP in Euston) Cases and Concepts for the New MRCGP: CSA and CbD for the NMRCGP by Naidoo, P. CSA Courses in Rickmansworth run by CSA examiners

23. Workplace Based Assessment (WPBA) E-portfolio – starts now and you must register with the RCGP to get access Curriculum www.rcgp-curriculum.org.uk Case Based Discussions (CBD) Consultation Observation Tool (COT) Multi-Source Feedback (MSF) Patient Satisfaction Questionnaire (PSQ)

24. WPBA – Timetable for ST1 Year Prior to review at 4 months (November 2010) –CBD x3 –COT or mini CEX x3 –MSF 5 clinicians –Clinical supervisors report (secondary care only) –PSQ (primary care only) –DOPS (opportunistic) Prior to review at 10 months (May 2011) –CBD x3 –COT or mini CEX x3 –MSF (5 clinicians) –Clinical supervisors report (secondary care only) –PSQ (primary care only) –DOPS (opportunistic)

25. Educational Supervision - timing Your 4 month review will take place in November 2010 – time is tight! Your 10 month review will take place in May 2011 The “Annual Review of Competence Progression” ARCP Panel meets in June and December

26. E-portfolio Shared Learning Log: regular reflective recording of at least three entries per week –Clinical encounters –Tutorial –VTS Personal Development Plan (PDP) –Regular entries and review Trainee Self-Rating

27. Associate in Training (AiT) Cost AiT joining fee £145 AiT annual fee £218 (each April) AKT £430 (£478 non-AiT) CSA £1445 (£1606 non-AiT) CCT (PMetB)£805 (costs as published on 17.7.10)

28. What I wish I’d known when I started….. E-portfolio – what to put in and what is meant by reflective learning The AiT journal “InnovAit” is excellent Make a learning plan at each stage Get to know the other members of the group early on – valuable resource Learn about consultation models early on

29. What I wish I’d known continued.. What to expect from your trainer –Contract –Learning needs analysis –One to one teaching –Supervision and support Inform MPS/MDU when you are in a GP post. Higher cost but you can claim reimbursement

30. Useful web sites Royal College of General Practitioners –rcgp.org.uk East of England Deanery –Easterngp.co.uk Bradford VTS –www.bradfordvts.co.uk Postgraduate Medical and Education Board (PMeTB) –www.pmetb.co.uk

31. Useful Web Sites RCGP Curriculum www.rcgp- curriculum.org.ukwww.rcgp- curriculum.org.uk www.gpnotebook.co.uk - quick,concise clinical guidancewww.gpnotebook.co.uk www.patient.co.uk - leaflets & support groupswww.patient.co.uk www.doctors.net.uk - e-mail address, discussion fora and clinical advicewww.doctors.net.uk www.bmjlearning.com - excellent learning modules; £70 if not a BMA memberwww.bmjlearning.com