ST3 Introduction

Programme Directors:Dr Christine MarshallDr Richard de FerrarsDr Andrew Cochrane

Introduces self

Clarifies roles

Name the Musical and Song…

Greets patient

Demonstrates interest & respect

Daft Diversion...

Greets patient

Demonstrates interest & respect

Watch the

bottom right...

Meaning and

relevance to

follow

What Would YOU Like To Know About?

We have several

areas to run through

but what is on your

mind?

Opening question

Identifies the reason for the consultation

Agenda setting

ST3 Introduction

• Enhanced ST3• MRCGP Exam Overview• Year Planning• KSS Policies• Overview of the VTS• E-Portfolio & Learning Log• OOH Training• Local Training Agreement.

Provides structure to the consultation

Sequencing

ST3 Representative

• Dr Hannah Pedley expressed interest

• Deputy please?

• VTS Rep at KSS Trainee’s Committee– Vicky Goodall.

Encourages the patient to contribute

Enhanced ST3

• First real step towards ST4

• Additional 3 months as ST3

• Details TBC…

• Last year - AKT score over 70%

CSA early (Dec/ Jan)

• Develop further skills– CCG work– Stage 1 Educators Pathway.

Sequencing

Timing

MRCGP Overview

Provides Rationale

AKT

Hurrah - Majority have negotiated this challenge If not: 2-3 attempts left? = please take it in October

final attempt? = take it May 2016

(focus on CSA first)

AKT Failed Twice?If you had problems with written exams at medical school,

consider a dyslexia assessment

Costs about £300

Gain additional time in exam (30 or 45min).

Sharing of thought

CSA – Lots of Choice!

Now held monthly from October to May

KSS and VTS set a pace aimed at Jan / Feb / Mar

- November: Cumberland Lodge

- December: KSS day at the RCGP exam centre

- January: Thursday pm sessions

Enhanced ST3 – need to work ahead of the pace.

Provides rationale

Examination

CSA – Lots of Choice!

Nov/ Dec - risk wasting £1700 (and one of your 4 attempts)- needed by some (maternity, enhanced ST3)- results come out mid December

Jan/ Mar - Makes sense for most- Allows Apr/ May re-sit without extension- But result is not out until early March…

May - Will need extension to re-sit

VTS teaching is aimed at January - March date

Take your trainer’s advice!.

Offers choice

WPBA AssessmentsPortfolio close will be end of May

– Get ES review 1 done by mid JanuaryHalf the assessments before review 1

– Get ES review 2 done by mid MayHalf the assessments before review 2

Full year = CBD x12

COT x12 (some kept on video please)

MSF x2 (Need 10 back: 5 clinical, 5 non-clinical)

PSQ x1 (Feb/ March/ April)

DOPS replaced by CEPS.Clarification

CEPS

Clinical Examination & Procedural Skills

•Now 13th DoC replacing skills log

•Evidence tagging includes COT, CSR, log, MSF

•CEPS form more flexible than DOPS

•Should still have a “form” for intimate exams

Planning the Year

The tube map - looks complex at first glance but is very useful…..

Uses visual methods of conveying information

  Consulting OOH CSATutorials / Learning Work-place Based Assessments Other MRCGP   Formative Assessment

Aug   Sitting-in       VTS - Intro Session                 Introduction to WPBA

1           Survival skills, computer training   Start              Knowledge Checklist

(25)   20 min appts       Educational framework   Video  COT1  CBD1          Initial Plan

Sept           Communication Skills                    

2   15 min appts   Session 1                        

(26)                   COT2 CBD2          

Oct     Session 2   VTS - Telephone Triage                  

3   12-15 min appts                     CSA AKT    

(27)   (if CSA early)   Session 3   VTS – EBM & critical appraisal        COT3 CBD3        

Nov       Session 4                        

4            VTS – CSA simulation (actors)             CSA       

(28)       Session 5           COT4 CBD4          

Dec       Session 6                    

5           Deanery CSA study day     MSF COT5 CBD5   CSA       

(29)       Session 7                        

Jan    Confident with   Session 8                

6    10-12 min appts                COT6 CBD6   CSA   AKT   ES Review

(30)       Session 9                    

Feb     Session 10                    

7                 COT7 CBD7   CSA    

(31)       Session 11         PSQ              

Mar       Session 12           COT8 CBD8          

8                 MSF       CSA       

(32)       Session 13         PSQ COT9 CBD9          

Apr   All   Session 14                        

9   10 min appts       Finding a practice     PSQ COT10 CBD10   CSA AKT    

(33)       Session 15   Working as a locum                     

May       Session 16           COT11 CBD11          

10           Practice finance & admin              CSA   ES Final Review

(34)       Session 17           COT12 CBD12        

Jun       Session 18                       NHS Appraisal

11                                

(35)       Session …                        

Jul                                

12                                

VTS Website – ST3 MRCGP Page

MRCGP Summary

AKT - well done if passed in ST2

- others, please take in October

- delay any final attempt until May

CSA - Nov & Dec for some

- Jan Feb Mar for most

WPBA - use the planner and keep to speed.Chunks & checks

Uses repitition & summary

Offers choices

KSS Policies & Plans

• Chaperone policy

• Dress code

• Car allowance

Contracting

Chaperone Policy

Sensitivity

Assesses patient’s starting point

Encourages patient to contribute

Dress Code

Sensitivity

Assesses patient’s starting point

Encourages patient to contribute

“Conventionally in the UK, formal professional practice between doctors and patients is appropriately marked by a certain formality of dress. It is, therefore, legitimate to require trainees to dress in this fashion.”

KSS Policies & Plans

• Chaperone policy

• Dress code

• Car allowance– Mileage for home visits, travel to teaching– Up to 20 miles to & from home when NEED car…– NEED car if you do a visit or travel to teaching…– Must keep daily record to complete a claim

Contracting

VTS Overview

Much mystery surrounds the activities of the GP trainees on Thursday afternoons…..

Elicits patient’s health beliefs

VTS Overview

How can we all get the most out of the VTS?• Time-keeping• Participation• Cumberland Lodge

Cumberland Lodge dates:

November

March

June

PASS THESE DATES TO PMs

Ideas & concerns

The Learning Log/ PDP

Shares own thoughts

Picks up verbal & non-verbal cues

Categories of Log EntriesHow should Trainees use the learning log?

1) Simple list of useful information from teaching:CURB scoringCauses of amenorrhoea

2) Recording of a “required event”Audit project Child protection Statement of LeaveOOH session Leadership CPR/ AED

3) Genuine educational activityTutorials, VTS sessionsInteresting cases, followed by reading up

4) “Domains of competence” eventReflection from a competency, not a clinical, perspective

Organises explanation

Categories of Log EntriesHow should Trainees use the learning log?

1) Simple list of useful information from teaching:OK to record but don’t bother sharing(unless you want to see how sarcastic your ES can be)

2) Recording of a “required event”As and when appropriateDo count towards 2-per-week target

3) Genuine educational activityTutorials, VTS sessions, interesting cases & readingNo more than 1-per-week about a teaching session

4) “Domains of competence” eventReflection from a competency, not a clinical, perspectiveSuperb for ES Reviews – try and write 2-3 per month

Required/ Mandatory EventsLevel 3 Child Protection

VTS session, e-modules if on leave

ST3 GP AuditOne 8-stage audit cycle – see website

Leadership event See VTS website for optionsForm to complete is on KSS website

CPR/ AED certificateUsually done in term 3

Two Significant Events[Complaints], near misses, cancer diagnoses

All of these MUST be shared. Uses explicit categorisation

Audit & Leadership

• Move away from 8-point audit

• Move towards CCG project work (QIP)

• Mandatory move if doing enhanced ST3

Offers choices

E-Portfolio

Non-verbal behaviour

Practice Swaps

• We encourage ST3s to try another practice for 1 week

• W/C June 2nd 2016

• Avoid A/L that week please.

Offers choices

Out-of-Hours• You all hate it• Hard work for supervisors• Look at the VTS website

25% pay supplement

£50 supervision fee

72 hours is mandatory (may increase)

Good preparation for CSA so NO GAPS PLEASE

Log-entry at end of each shift

OOH sheet from supervisor IF NOT YOUR TRAINER

Ask your supervisor to work through the FPCS Induction Forms with you – on the VTS website

PROFESSIONALISMBooked shift = be there (unless you have died) Empathy & support

Out-of-HoursTraffic Light – PLEASE DISCUSS WITH YOUR ES

• Red = ST1/2 (observe only)• Amber = first few ST3 months.

Avoid phone triage until after training

Can see patients at base from the start

Supervisor can go on a visit with you

If left at base, must have phone or alternative• Green = last 5 shifts

You take a slot on the rota

Do everything including solo visits

Supervisor could be by phone.Empathy & support

Admin Required for OOH

• Medical Indemnity Insurance

• GMC Number

• BLS certificate

• Safeguarding Level 3 Certificate

• Information Governance Certificate

• DBS certificate

• Hep B status

OOH – Key Points

• New shift e-booking system to try out

• Must compete admin checklist

• Must complete clinical induction checklist with supervisor

• Must discuss RAG with trainer/ ES

• Must keep back FIVE green shifts for last 3 months of training

Local Trainers Agreement

Use of notes

Local Trainers Agreement

• The Working Week

• Annual Leave

• VTS & Educational Activities

• Study Leave

• Private Study (Flexible Education Session)

• Out-of-Hours Training

• Read through NOW. Any questions?

Checks patient’s understanding of information

Daft Diversion...

Greets patient

Demonstrates interest & respect

Any answers?

Daft Diversion...

Calgary-Cambridge consultation model

Doctor-patient relationship and patient-centred consulting

Does NOT mean doing what the patient wants

Facilitating them to reach agreement on what is best for them

Trainer-trainee relationship and adult learning

Does NOT mean doing what the trainee wants

Facilitating them to reach agreement on what is best for them.

Trainer-Trainee Relationship

Consider the analogy to the doctor-patient relationship?

Develop relationship & rapport – chat time!

What can go wrong at the start?

What happens over time?

What happens when Dr & patients disagree?

GPs can have a bad day and take it out on patients

Trainers can have bad days…

ST3 Introduction

• Enhanced ST3• MRCGP Exam Overview• Year Planning• Chaperones• Overview of the VTS• E-Portfolio& Learning Log• OOH Training• Local Training Agreement

Checks with patient

End summary

The EndSafety netting

Final checking