Competencies in practice A curriculum for internal medicine
Drivers for Change Shape of Training • Increased generalism • Changing demography etc • Published 2013 Generic Professional Capabilities (GMC) • To be embedded in all curricula from 2017 • 9 domains Enhancing (General) Internal Medicine Burden of assessment
Internal Medicine Curriculum
The ultimate goal The aim of medical training is to prepare learners for unsupervised practice As level of performance increases, level of supervision decreases
Swinging pendulum Between • Old view … “we just know that this a good trainee and are happy that they are fully competent…” • Atomised, individual tick-box competencies » “this trainee can look after a patient with fever and a rash” » “this trainee can look after a patient with fever and diarrhoea ”
Assessment – the challenges Too many Ticks in all the boxes but assessments everyone knows they are weak We have to assess everything Not integrated into routine practice No feedback given Some domains are difficult to assess
Priority Assessment strategy needs to drive learning and provide reassurance BUT needs to be practical and feasible for: • Trainers • Trainees • Patients • Service delivery
Competencies in Practice (CiPs) “a unit of professional practice identified as a task or responsibility to be entrusted to a learner to execute unsupervised once sufficient competence has been demonstrated ” AKA “ Entrustable Professional Activities” (EPAs)
Levels of trust Presumptive trust • based entirely on qualifications/state of training Initial trust • “Swift/thin” trust. Based on first impressions. Obvious limitations Grounded trust • Based on prolonged experience with trainee and specific assessment data (exams, WBAs etc)
CiPs • Focus on what happens in clinical practice • Translate competencies into clinical practice • Requires demonstration of multiple competencies simultaneously and specific knowledge, skills, attitudes and behaviours • Acquired through training • Observable and measurable • Are being developed in The Netherlands, Canada, US, Australia, New Zealand, UK
Competencies or CiPs – what’s the difference? Competencies CiPs Descriptors of physicians Descriptors of tasks Knowledge, skills, Essential parts of professional practice attitudes, values • • Content expertise Discharge patients • • Communication ability Design treatment plans • • Management ability Manage patients in an outpatient clinic
Role of the supervisor Clinical supervisor • Familiar with day to day practice of the trainee. Observing them and interacting with them on a regular basis. Providing feedback and making informal entrustment decisions within context on a regular basis. Will make advisory/formative CiP recommendations.
Role of the supervisor Educational supervisor • May have personal clinical experience of trainee but has overall supervision of programme and will receive feedback from clinical supervisors and others that are integrated into a summative CiP recommendation
Trainee attributes that support entrustment • Competence • Integrity/honesty • Conscientiousness/reliability • Insight (aware of limitations)
Information/evidence to inform and support an entrustment decision • Personal knowledge of/experience with trainee • Informal “intelligence” from medical and non -medical colleagues • Workplace based assessments • ACAT, DOPS, mini-CEX, CbD, MSF, TO, QIPAT, Patient survey etc. • Specific courses/qualifications • MRCP, SCE, ALS, etc • Specific feedback/reports • CS Report
CiP example
CiPs There are 14 CiPs split into two categories: • Clinical • Non-clinical
CiPs - Clinical 1. Managing an acute unselected take 2. Managing an acute specialty-related take 3. Providing continuity of care to medical in-patients, including management of comorbidities and cognitive impairment 4. Managing patients in an outpatient clinic, ambulatory or community setting, including management of long term conditions 5. Managing medical problems in patients in other specialties and special cases 6. Managing a multi-disciplinary team including effective discharge planning 7. Delivering effective resuscitation and managing the acutely deteriorating patient 8. Managing end of life and palliative care skills 9. Achieving procedural skills
Entrustment level descriptors, Clinical Level 1: Observations of the activity – no execution Level 2: Trusted to act with close supervision Level 3: Trusted to act with supervision available quickly Level 4: Trusted to act unsupervised (with clinical oversight within training)
CiPs – Non-Clinical 10. Is focused on patient safety and delivers effective quality improvement in patient care 11. Carrying out research and managing data appropriately 12. Acting as a clinical teacher and clinical supervisor 13. Dealing with ethical and legal issues related to specialty clinical practice 14. The ability to successfully function within NHS organisational and management systems
Entrustment level descriptors, non-clinical Level 1 : No or limited knowledge or experience Level 2 : Knowledge but limited experience, trusted to act with close supervision Level 3 : Knowledge and experience, trusted to act with guidance available Level 4 : Experienced and trusted to level of independent practice
What is expected of you in the CiP study? • Trainee • Clinical Supervisor • Educational Supervisor
Trainee • Ensure your clinical supervisor has completed an assessment of your performance using the CiP Study Clinical Supervisor Report by Friday 15 July • Consider what evidence you need to provide to inform the decisions made about your performance at each CiP • You will need to complete a self-assessment of all 14 CiPs on the e-portfolio before the meeting with your educational supervisor • Complete an evaluation questionnaire
Clinical Supervisor • Review the trainee’s e -portfolio and consider your personal experience of the trainee • Complete a CiP Study Clinical Supervisor Report to indicate what level the trainee is performing for each CiP by Friday 15 July • Complete an evaluation questionnaire
Educational Supervisor • Review your trainee’s e -portfolio and consider the Clinical Supervisor Report(s) and trainee self assessment report • Meet with your trainee to discuss progress and performance and agree and document a level of performance for each CiP on the CiP Study Educational Supervisor Report by Friday 29 July • Complete an evaluation questionnaire
Accessing the documentation through the ePortfolio • Trainees have been assigned new programme and post location: CiP Study Programme/Hospital – CiP • Ensure you are logged on in correct role (CS, ES) • Supervisor reports for the study can be accessed via the Progression tab • Trainee self-assessment form accessed via Assessment - Generic
Guidance and support • Webpage • Participant guide • ePortfolio user guides • Webinar • curriculum@jrcptb.org.uk
Summary, evaluation and close
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