Welcome to the latest CT visitor training update
Welcome to 2019, the start of the 2019.1 term for our registrars, and another round of Clinical Teaching Visits (CTVs). We have completed the process of placement allocations this term and hopefully you have been able to commence some of your visits.
This year we will have more educational activities specifically aimed at CTV visitors:
- CTV webinar – Wednesday 8 May 7.30pm - 8.30pm Random Case Analysis (RCA) – adding to the CTV.
- CTV webinar – Wednesday 20 November 7.30pm - 8.30pm Feedback Style – does one size fit all?
We are taking the opportunity to add RCA to CTVs and a new look form will be released later this year. The first webinar of the year is designed to upskill in RCA and how to add this into CTVs.
We would love to hear about topics you would like covered in webinars. We will be asking you about this in the evaluation of the first webinar and I am excited to hear your suggestions.
The survey for allocations of CTV visits will be with you in July this year for 2019.2 so please look out for this email in your inbox if you wish to be allocated visits.
You might recall in our last newsletter a new CTV visitor shared what she had learnt over her first few visits. Below, Dr Simon Young who has performed many CTV visits, shares his experience of CTVs and their value.
Some of you may be wondering what we do with the information that you provide us at GP Synergy. How do we use the information as part of the global view of the Registrars’ training?
Dr Jo Bruce | Deputy Regional Head of Education - Central, Eastern and South Western Sydney
CTVs are golden - Dr Simon Young
You would think that after doing over 300 CTVs in my career, across many training providers, that I’d be over them. In fact, I still look forward to getting in my vehicle and driving to experience another (often new) practice as well as meeting a colleague at the start of their GP career.
Entering another practice and a colleague’s room while patients are seen is a privilege. I believe that if one starts with this in mind, then it sets the right tone of the visit - that is, one of respect.
My role has to be clearly articulated before the CTV starts. I don’t want to drive the visit, I am a fortunate guest in the room. This is a learning experience for the GP registrar, and often serendipitously for me. The GP registrar doesn’t have to present the case to me, I want to be a fly on the wall while the registrar does a consult as normally as possible. When they are done and dusted then we can start Pendleton’s approach(1).
CTVs are a unique and undervalued part of apprenticeship learning. Often GP registrars see it as a ‘tick-the-box’ in their portfolio and these days hope they don't get any non-green flags. On the other hand, they can be overwhelmed by the amount that can be assessed and are not sure where to start. And in my opinion, the myriad sliding scales don’t really add to the process. The new box where the GP registrars reflects on three ‘take-homes’ is a step in the right direction. I believe it makes the visit more meaningful by getting the GP registrar to distil the visit, while at the same time provides feedback for the visitor, which I find informs my future visits. I always ask for specific feedback on my performance after this stage, as I hope this role-reversal ends the visit with the GP registrar feeling empowered.
In the spirit of a good ongoing educative experience I consider including websites, articles, and reference books in the report is essential to reinforce issues arising from the visit. Better still, email these to the trainee as well.
If I had to summarise my role as a CTV visitor, it is that of an insight facilitator.
To this end I ask for the GP registrar to give me their learning objectives for the visit at the date setting time. Many don't - already I have insight into their attention to detail /what they value. I’ll still start the CTV asking again what the trainee hopes to get out of the exercise.
The reason CTVs are golden is that a more experienced GP can help the GP registrar articulate what they have just done well and what they could have done differently, hopefully setting up a consult-by-consult reflective component, enabling guided curiosity about themselves and their performance, not just the patient or their condition(s).
A positive psychology maxim is to be your best possible self. CTVs should be helping GP registrars be their best possible professional selves.
Dr Simon Young | Clinical Teacher Visitor
Registrar formative assessments - Dr Vanessa Moran
Supervisor and CTV visitor assessments provide an important component of feedback to registrars. A registrar will be expected to have five CTVs and at least eight supervisor assessments during their GP terms. These formative assessments guide learning and promote reflection for the registrar but also provides the registrar's Medical Educator (ME) with a snapshot of how the registrar is progressing during training.
These formative assessments provide four levels of feedback to the registrar and ME:
- how the registrar is working in the practice.
- how the registrar is achieving the competencies of the core skills in general practice
- assessment of key behaviours in the consultation (green/amber/red flags)
- specific feedback about individual consultations and areas of strength and improvements for the registrar.
The qualitative feedback, verbally and in the written report, is valuable for the registrar's reflection an learning. Supervisors and CTV visitors are encouraged to impart as much of this rich information as possible, in particular whilst they are in the room with the registrar.
The quantitative feedback is also very useful for the longitudinal tracking of the registrar. The 13 individual assessments over time with multiple assessors ensures this is a validated tool for assessment of the registrar. Like many assessments, when all is going well in a registrar's training the assessments can seem to be unnecessary, these assessments become particularly useful when things aren’t going so well, or when things change. For example, take a look at the two case studies below.
As a wise man once said “The whole is greater than the sum of its parts”.
So next time you are completing a CTV form please pay attention to the parts so that we can better look after the whole!
For more information about the competency assessment, please see the guide and resources on GPRime.
The assessments of the registrar (both supervisor and CTV) are constantly reviewed and evaluated. Further research is also in progress to see exactly which of the competencies are most valuable at predicting whether a registrar will require additional assistance or progress smoothly in training. We will provide updates on this research when it becomes available.
Thanks for all that you do in GP training. It really does make a difference.
Vanessa Moran | Director of Education and Training ACT and NSW
Case study 1: Registrar Helen
Helen has been a high performing registrar throughout training. She was an ED registrar for two years before joining the GP training program and settled well into a regional town with her family in her first GP term.
Helen received excellent reports from her supervisor and CTV visitors in her first two terms and was noted to be at, or above, all the competencies for the consultation core skills. Helen did not move practices between her second and third term and her supervisor had not had a chance to do any assessments in the beginning of her third term.
Her fifth and final CTV visit, performed by a new assessor, assessed her competencies at 'working towards the expected level' or 'at the expected level'. There were no red or amber flags and nothing in the text that indicated there was a particular problem with the consultations. The ME signing off on the report noted the drop in the competencies in the competency grid which prompted a conversation with the CTV visitor and the registrar. The registrar admitted that she didn’t want to say anything for fear of failure and disclosed that their partner was suffering from depression with the move. She was struggling with the conflicting pressures of the practice, the VMO roster, her family and studying for the exams and it was impacting her ability to do any (or all of them) well.
The ME helped facilitate a conversation between the registrar and the practice to reduce her hours, help her better prioritise the work conflicts, and encouraged her to see her own GP. Extra support was provided to the supervisor and an additional follow up CTV was arranged in three months time where Helen was found to be back on track.
Case study 2: Registrar Stanley
Stanley is in his second GP term. He has been doing his GP training part time as he also runs a business on the side. There have been concerns that Stanley doesn’t always prioritise his GP training and has been struggling to meet the competencies of general practice.
His first three CTVs and supervisor assessments have noted that he is either below, or working towards the expected level of training, and he has had a number of amber flags. The supervisor has been putting in extra effort to help him along. Stanley had his fourth CTV performed by a new visitor and the ME noted that this report contained lots of valuable written feedback with suggestions for improvement, however they noted that the competencies were all marked at the expected level of training, there were no red or amber flags.
The ME had recently had a conversation with the supervisor about Stanley’s progress and the supervisor had some serious concerns, the ME had a meeting booked with the registrar to discuss starting a Focused Learning Plan (FLP) to provide additional support.
The recent CTV report did not seem to make sense. This prompted the ME to get in contact with the CTV visitor who explained that they did have some concerns about the consultation but that they didn’t want to upset the registrar by giving them a 'low score' as they were not exactly sure what that would mean. The ME discussed the importance of the competencies and red/amber flagging behaviours and the process involved if this does occur. The CTV visitor was more aware of the importance of these tools and made adjustments moving forward.