Planning your Registrar Planning your Registrar YearYear

Louise WillcocksLouise Willcocks

Swindon/Bath GP Registrar Swindon/Bath GP Registrar DRCDRC

March 2007March 2007

AIMSAIMS

• Starting outStarting out

• ExamsExams

• Certification and paperworkCertification and paperwork

• Top TipsTop Tips

Starting outStarting out

• EMISEMIS

• A-Z map for home visits.A-Z map for home visits.

• Doctor’s bag and stuffDoctor’s bag and stuff

• Remembering everyone’s names.Remembering everyone’s names.

• Who/what/ how and when to refer?Who/what/ how and when to refer?

• Half day for study (shopping).Half day for study (shopping).

• DRC once a week.DRC once a week.

• No weekendsNo weekends

• No nights/eveningsNo nights/evenings

• No bleepsNo bleeps

The YearThe Year

• Goes really fastGoes really fast

Exams – Summative Exams – Summative AssessmentAssessment

• COGPED MCQCOGPED MCQ

• VideoVideo

• AuditAudit

• Trainer’s reportTrainer’s report

• CPR certificateCPR certificate

COGPED MCQCOGPED MCQ

• May 2007.May 2007.

• FreeFree

• Can resit up to 5 timesCan resit up to 5 times

• 3 hrs long3 hrs long

• Quite random questions e.g. Quite random questions e.g. DVLA/sick certs/fitness to fly/dandruff.DVLA/sick certs/fitness to fly/dandruff.

• Don’t read into questions too much.Don’t read into questions too much.

COGPED MCQCOGPED MCQ

• If you pass the MRCGP MCQ If you pass the MRCGP MCQ automatically pass the summative.automatically pass the summative.

• Questions are of a different standard Questions are of a different standard in the two exams.in the two exams.

• Final COGPED MCQ is May 07. If you Final COGPED MCQ is May 07. If you fail- fail- which you won’t-which you won’t- will do AKT. will do AKT.

VIDEOVIDEO

• Can submit to SA or “single route” Can submit to SA or “single route” for MRCGP.for MRCGP.

• Criteria for SA and MRCGP different. Criteria for SA and MRCGP different. NOSA and RCGP websites give NOSA and RCGP websites give information on this.information on this.

• 2 hours long. No consultation longer 2 hours long. No consultation longer than 20 mins.than 20 mins.

“ “Single Route” VideoSingle Route” Video

• Logbook on RCGP website.Logbook on RCGP website.

• 7 consultations, at least 1 child under 7 consultations, at least 1 child under 10 yrs and one psychosocial.10 yrs and one psychosocial.

• 15 mins maximum for each 15 mins maximum for each consultation.consultation.

• Judged by 14 criteria (10 pass and 4 Judged by 14 criteria (10 pass and 4 merit). Need 4/7 for each pass criteria merit). Need 4/7 for each pass criteria to pass.to pass.

• Need to send logbook with videoNeed to send logbook with video

• Need to keep consent forms and all Need to keep consent forms and all patients must be consented.patients must be consented.

COGPED video route not available COGPED video route not available from August 2007. ?Submit videos from August 2007. ?Submit videos Oct 2007.Oct 2007.

Tips for videoTips for video

• Start early onStart early on

• The more you do the easier it gets.The more you do the easier it gets.

• You can have a printout of the MRCGP You can have a printout of the MRCGP criteria in front of you as long as not in criteria in front of you as long as not in camera shot.camera shot.

• Check sound quality, position of camera, Check sound quality, position of camera, date/time on tape recording.date/time on tape recording.

• Make sure patients not exposed on camera. Make sure patients not exposed on camera.

AuditAudit

• Keep it simpleKeep it simple

• Start asapStart asap

• Discuss with Discuss with Trainer/practice/colleagues for ideas.Trainer/practice/colleagues for ideas.

• Relate to recent guideline Relate to recent guideline changes/QOF/hot topics.changes/QOF/hot topics.

AuditAudit

• Tips on Bath web site.Tips on Bath web site.

• 8 proforma8 proforma

• 3000 words double spaced and 3000 words double spaced and anonymised.anonymised.

• Send 3 copies and keep one for Send 3 copies and keep one for yourself.yourself.

Trainer’s report.Trainer’s report.

• Do as you go alongDo as you go along

• Familarise yourself with it. Generally Familarise yourself with it. Generally trainer fills it in.trainer fills it in.

• Send it into deanery approx 6 weeks Send it into deanery approx 6 weeks before reg year finishes with VTR1.before reg year finishes with VTR1.

Exams- MRCGPExams- MRCGP

• MCQ MCQ

• Written paper Written paper

• VideoVideo

• Oral Oral

Each module costs ₤340. Closing date Each module costs ₤340. Closing date for applications 9/2/07.for applications 9/2/07.

Syllabus available on RCGP website Syllabus available on RCGP website which is invaluable.which is invaluable.

For MCQ preparation PEP CD’S and For MCQ preparation PEP CD’S and onexamination.com are fantastic onexamination.com are fantastic resources.resources.

Courses like hot topics and revision Courses like hot topics and revision course (Portsmouth or Taunton.)course (Portsmouth or Taunton.)

Study GroupStudy Group

• Essential preparation for written Essential preparation for written paper.paper.

• Past papers on line RCGP website. Past papers on line RCGP website.

• Look at past examiners comments. If Look at past examiners comments. If question done badly topic may come question done badly topic may come up again.up again.

Good gossip session.Good gossip session.

Food and wine essential!Food and wine essential!

Exams- nMRCGPExams- nMRCGP

From August 2007 single training From August 2007 single training route and new assessment process.route and new assessment process.

• AKT- applied knowledge testAKT- applied knowledge test

• CSA- clinical skills assessmentCSA- clinical skills assessment

• Enhanced trainer’s reportEnhanced trainer’s report

AKTAKT

• 200 questions200 questions

• Machine markedMachine marked

• Extended matching questions and Extended matching questions and single best answers.single best answers.

• 3 times a year Feb/May/Oct3 times a year Feb/May/Oct

CSACSA

• OSCE formatOSCE format

• Assesses clinical, professional, Assesses clinical, professional, communication and practical skills.communication and practical skills.

• ? To be held 3 times a year.? To be held 3 times a year.

Enhanced Trainer’s reportEnhanced Trainer’s report

• Similar to current Trainer’s report but Similar to current Trainer’s report but more in depth.more in depth.

• Requires evidence as proof of Requires evidence as proof of reaching a certain standard. reaching a certain standard.

Out of HoursOut of Hours

• Minimum 72 hours.Minimum 72 hours.

• Log book to be completedLog book to be completed

• Should be supervised.Should be supervised.

• Shifts short 3-5 hrs so start soon.Shifts short 3-5 hrs so start soon.

• Variety of shifts weekends/evenings, Variety of shifts weekends/evenings, base or visiting.base or visiting.

• Often good funOften good fun

• Might want to do more of it when you Might want to do more of it when you finish GPR year.finish GPR year.

• Log book doesn’t need to be sent Log book doesn’t need to be sent anywhere.anywhere.

• Keep a log of interesting patients for Keep a log of interesting patients for PDP.PDP.

Certification and paperworkCertification and paperwork

• Join RCGP costs ₤350 in order to Join RCGP costs ₤350 in order to complete CCT.complete CCT.

• Submit your VTR2 forms once you Submit your VTR2 forms once you have done this to RCGP certification have done this to RCGP certification unit. Make sure all the dates are unit. Make sure all the dates are correct, stamped and filled in correct, stamped and filled in correctly. They will get sent back if correctly. They will get sent back if not.not.

• Do this as soon as possible. Dull but Do this as soon as possible. Dull but essential and will save lots of hassle essential and will save lots of hassle later.later.

• Then known as an associate member Then known as an associate member and in theory get BJGP.and in theory get BJGP.

• Before the end of the job need to Before the end of the job need to register with PMETB.register with PMETB.

• Submit VTR1 form with ₤500 and Submit VTR1 form with ₤500 and should then receive CCT. Can’t do should then receive CCT. Can’t do this till 6 weeks prior to finishing.this till 6 weeks prior to finishing.

• Look at NOSA website and RCGP for Look at NOSA website and RCGP for guidelines and application forms.guidelines and application forms.

Top TipsTop Tips

• PDP keep a record of your tutorial PDP keep a record of your tutorial topics, list of education meetings, topics, list of education meetings, interesting patients, referrals e.t.c. interesting patients, referrals e.t.c. Do as you go along, it’ll be a lot less Do as you go along, it’ll be a lot less tedious and easier in the long run.tedious and easier in the long run.

• Keep electronically or paper.Keep electronically or paper.

JournalsJournals

• BMJBMJ

• BJGPBJGP

• Pulse/Doctor/GPPulse/Doctor/GP

• BMJ careersBMJ careers

• Internet up dates e.g. doctors.netInternet up dates e.g. doctors.net

CoursesCourses

• Exam related- revision coursesExam related- revision courses

• Hot TopicsHot Topics

• Others- DFFP, DRCOG. Minor surgery.Others- DFFP, DRCOG. Minor surgery.

No study budget so can get expensive.No study budget so can get expensive.

ContactsContacts

• Summative assessmentSummative assessment– http://www.nosa.org.ukhttp://www.nosa.org.uk– Moira Linden; 01962 893 813Moira Linden; 01962 893 813– moira.lindenl@sevwesdeanery.nhs.ukmoira.lindenl@sevwesdeanery.nhs.uk

• RCGP certificationRCGP certification– 020 7930 7228020 7930 7228– certification@rcgp.org.ukcertification@rcgp.org.uk

• PMETBPMETB– 0871 220 3070 0871 220 3070 – info@pmetb.org.ukinfo@pmetb.org.uk– article11@pmetb.org.ukarticle11@pmetb.org.uk

• HOT Topics courseHOT Topics course– 0191 489 0555 0191 489 0555 – www.nbmedical.co.ukwww.nbmedical.co.uk

• MRCGP courseMRCGP course– Carol White; 01264 355 005Carol White; 01264 355 005– cwhite@rcgp.org.ukcwhite@rcgp.org.uk

Audit criteriaAudit criteria

1.Reason for choice of audit1.Reason for choice of auditPotential for changePotential for changeRelevant to the practiceRelevant to the practice

2.Criterion/Criteria Chosen2.Criterion/Criteria ChosenRelevant to audit subject and justifiable, eg. Current literatureRelevant to audit subject and justifiable, eg. Current literature

3.Standards set3.Standards setTargets towards a standard with a suitable timescaleTargets towards a standard with a suitable timescale

4.Preparation and Planning4.Preparation and PlanningEvidence of teamwork and adequate discussion where appropriateEvidence of teamwork and adequate discussion where appropriate

5.Data Collection (1)5.Data Collection (1)Results compared against standardResults compared against standard

6.Change(s) to be evaluated6.Change(s) to be evaluatedActual example describedActual example described

7.Data Collection (2)7.Data Collection (2)Comparison with Data collection (1) and standardComparison with Data collection (1) and standard

8.Conclusions8.ConclusionsSummary of main issues learnedSummary of main issues learned

Video criteriaVideo criteriaPC1PC1 the doctor is seen to encourage the patient's contribution at appropriate points the doctor is seen to encourage the patient's contribution at appropriate points

in the consultationin the consultationPC2 (M)PC2 (M) the doctor is seen to respond to signals (cues) that lead to a deeper the doctor is seen to respond to signals (cues) that lead to a deeper

understanding of the problemunderstanding of the problemPC3PC3 the doctor uses appropriate psychological and social information to place the the doctor uses appropriate psychological and social information to place the

complaint(s) in contextcomplaint(s) in contextPC4PC4 the doctor explores the patient's health understandingthe doctor explores the patient's health understanding PC5PC5 the doctor obtains sufficient information to include or exclude likely relevant the doctor obtains sufficient information to include or exclude likely relevant

significant conditionssignificant conditionsPC6PC6 the physical/mental examination chosen is likely to confirm or disprove the physical/mental examination chosen is likely to confirm or disprove

hypotheses that could reasonably have been formed OR is designed to address a patient's hypotheses that could reasonably have been formed OR is designed to address a patient's concernconcern

PC7PC7 the doctor appears to make a clinically appropriate working diagnosisthe doctor appears to make a clinically appropriate working diagnosisPC8PC8 the doctor explains the problem or diagnosis in appropriate languagethe doctor explains the problem or diagnosis in appropriate languagePC9 (M)PC9 (M) the doctor's explanation incorporates some or all of the patient's the doctor's explanation incorporates some or all of the patient's

health beliefshealth beliefsPC10 (M)PC10 (M) thethe doctor specifically seeks to confirm the patient's understanding of doctor specifically seeks to confirm the patient's understanding of

the diagnosisthe diagnosisPC11PC11 the management plan (including any prescription) is appropriate for the working the management plan (including any prescription) is appropriate for the working

diagnosis, reflecting a good understanding of modern accepted medical practicediagnosis, reflecting a good understanding of modern accepted medical practicePC12PC12 the patient is given the opportunity to be involved in significant management the patient is given the opportunity to be involved in significant management

decisionsdecisionsPC13 (M) PC13 (M) the doctor takes steps to enhance concordance, by exploring and the doctor takes steps to enhance concordance, by exploring and

responding to the patient’s understanding of the treatmentresponding to the patient’s understanding of the treatmentPC14PC14 the doctor specifies the appropriate conditions and interval for follow-up or the doctor specifies the appropriate conditions and interval for follow-up or

reviewreview

ConstructsConstructs

ClinicalClinical

PatientPatientSSelf-managementelf-managementAAgendagendaDDecision Aidsecision Aids

BBenefitsenefitsEEducationducationDDeatheath & D & DrivingrivingSSupport Groupsupport GroupsIIdeas, concerns & expectationdeas, concerns & expectationTTransculturalranscultural

DoctorDoctorRRisk managementisk managementUUp to datep to dateDDEN’sEN’sEEvidence-basedvidence-based

CConfidentiality/onfidentiality/CConsentonsentHHealth promotionealth promotionOOpen questionspen questionsPPrejudicerejudicePPrescribingrescribingEEmpathympathyRRecord-keeping/ecord-keeping/RReferralseferrals

PracticePracticePProtocolrotocolRRegisteregisterAAudituditCChange managementhange managementTTrainingrainingIITTCContract/clinicsontract/clinicsEEasease

WiderWiderGGoldberg & Huxley’s filters to careoldberg & Huxley’s filters to careRRationingationingIInverse care lawnverse care lawMMedicilisationedicilisation

SScreeningcreeningHHealthealthIInequalitiesnequalitiesTTeamworkeamwork

EthicalEthical

ConsultationConsultation

PrescribingPrescribing

Any Questions?Any Questions?