Educational Supervisor Review

Having recently had a supervisor review there are some really important features of how to use the RCGP ePortfolio that I wished I had been more mindful of. One of the GP ST2 had mentioned these in our induction lectures but some where along the line I must have taken my eye of the ball.

So what is the aim of the ESR? It is to evidence the trainee has covered the breadth of the curricullum as well as evidence the attainment of particular competencies. It isn't looking at the clinical skills (which the clinical supervisor looks at in terms of the particular rotation) but more about how a trainee applies themselves to the situation.

For example I had a palliative care patient which referenced nicely to the curricullum statment for palliative care. However it was also used as evidence for working in teams (with McMillan/Marie Curie), communication skills, and practicing holistically. So the first thing to remember is to make sure that each entry has an easy reference "HEADLINE" e.g. "22.6.12A Palliative Care *Comm skills *holistic practice" implying the date, this is Case A on that date, and that it is evidence towards those competencies aplying reflective practice as talked of before in order to generate a learning need to add to the personal development plan (PDP) - of which 1 or 2 should be met a month bearining in mind that the closer you complete them to the learning event the more chance of the experience cementing the knowledge being assimilated. The aim is for about three cases a week like this.

One of the mistakes I made was listing a whole bunch of cases e.g. a morning theatre list or a ward round and this really made it hard to use these entries as evidence as it was laborious to identify clearly the specific evidence used to meet a competency. A further mistake was that sometimes in my entries it was unclear who had made "the decision" e.g. a senior or myslef which is useful in order for the evidence to be considered robust enough. One tip was that when discussing a case e.g. in a professional conversation I could have highlighted the medical complexity of the case and been clear what my plans had been and how the senior colleuges had felt about/engaged with them. A further mistake I made was simply recording subtely different cases with the view that it was their subtle differences which implied complexity but actually medical complexity relates only to one particular patients management. Including this, there were 4 competency areas that really shocked me as to what they had been trying to ask for and what I had delivered so it is vital to really get to know these different competencies.

So when evidencing medical complexity one must look to the competency definition which includes managing co-morbidity, uncertainty and risk as well as having an approach to health and not just illness. At a basic level this means being positive about a patients health, prioritising managment based on risk, and drawing conclusions managing health problems seperately. The competency begins to be met when the trainee identifies the implications of co-morbidity, managing both acute and chronic conditions of a patient, explaining risk to the patient to enable them to engage in its managment, and finally encourages recovery and rehabilitation as well as health promotion and disease prevention strategy. To excell on this one, the trainee has to be able to manage the acute and chronic issues over time, co-ordinating a team based approach to rehabilitation, care, cure, palliation or health promotion, and finally anticipates and uses strategies to manage risk/uncertainty  such as monitoring, outcomes assessment and feedback to minimise risk. Interestingly the way GP's are being paid is changing to reflect this ability to create health through quality.

The second interesting competency was practicing holistically - which I thought meant taking into accoun their social and psychological situations. However it also means more than this in the sense that it is important to utilise other community services and supports and not just yourself. It also means recognising how the condition will impact carers and family and hence involving them in the discussions and plans (not just informing them of the outcomes of plans) and then organising this care recognising the doctors limited ability to intervene in these matters. When making plans it is key to understand the influence of the cultural and socio-economic backgrounds and use this to generate practical solutions to the problems.

Ethics shows us the difference between a curriculumm (a broad scope of an educational programme including content, processes and experiences) and a syllabus (a list of topics to cover). The reason it shows this is because of the tension in that there is inherent conflict e.g. in providing a person centred approach i.e. a consultation looking at treament vs. a community approach i.e. telephone triaging at the time. Social expectation and political influence challenges the curricullum and creates tension by changing how refferals could be authorised to happen, aiming to prescibe cheaper generic medications, and serving different agendas. In my own competency assesment I noted how in one situation I felt something was wrong but did not have the skill and knowledge to affirm the feeling and expertly debate the case with a senior. In the competency itself it suggests not only identifying the conflict - which I sort of recognised inmyself but also take action to discuss them.

The fourth and final competency area of interest was communication skills which I will address later.

Suffisive to say that the competency are the core of the eportfolio which shouldn't just be seen as a way of revising for the AKT/CSA - IT IS a different beast!

THe Best way of seeing how the curriculum relates to the competencies is http://www.rcgp.org.uk/GP-training-and-exams/~/media/Files/GP-training-and-exams/Curriculum-2012/RCGP-Curriculum-Introduction-and-User-Guide-2012.ashx