Reminder: This is the doctor’s awareness of when his/her own performance, conduct or health, or that of others, might put patients at risk.  What actions did they take to protect patients?  The Fitness To Practice competency is rarely witnessed, but can be probed through CbD but a trainee can provide good evidence if they write up their thoughts and feelings around such matters in their LLEs.

QUANTITATIVE

1. CBD – item (1) Fitness to practise: 

QUALITATIVE

1. CSR – under ‘Professionalism’ – with respect to the trainee’s conduct, performance and health, the CS says… 
2. MSF – Themes around trainee’s conduct, performance and health are… 
3. Log entries – select ones that show STRONG evidence.
   

Reminder: To practise ethically is to practise with integrity and show a respect for diversity.   Use recognised ethical frameworks to aid your approach in helping patients.   Themes include honesty, integrity, trust and respect.  Others include autonomy, non-maleficience, non-malefeasence, beneficience, and justice.   Principles like morality, utility (doing greatest good for greatest number), rationing and human rights.

QUANTITATIVE

1. CBD – item (2) Maintaining an ethical approach:

QUALITATIVE

1. CSR – under ‘Professionalism’  – ethical themes are… 
2. MSF – under ‘professional behaviour’, ethical themes are… 
3. Log entries – select ones that show STRONG evidence.  In particular: Clinical Case Reviews, LEAs/SEAs, Reflection on feedback (esp complaints), QIA, Leadership/Management/Professionalism 

Reminder: This is about specific consultation and communication techniques you use and why you used them.   It also includes understanding and using consultation frameworks.

QUANTITATIVE

1. COT – last item ‘Overall Assessment of Performance’:
   
2. AudioCOT – last item ‘Overall Assessment of Performance’:
3. CEX – item 2 Communication skills: 
4. RCA/CSA – this trainee has passed which is a good indicator that a trainee’s communication skills were, on the whole, good enough.   The score for IPS was x out of  y

QUALITATIVE

1. PSQ – communication skills themes are…  
2. CSR –under ‘Communication’ – communication themes are…
3. MSF – following communication skills themes emerge…
4. Log entries – select ones that show STRONG evidence.  In particular, look at Clinical Case Reviews.

Note about COT: Most items in the COT are about Communication Skills – especially items  (1) patient contribution, (2) cues, (3) psycho-social context, (4) ICE, (8) explanations, (10) patient involved &  (11) shared understanding.   So look at these individual items – from the mapping sheet – and see how the trainee is doing.  But, rather than writing about each item, write in terms of the “Overall Assessment of Performance”.  If overall assessment has been marked as good in a COT, then surely the consultation skills must of been good enough.  Write something like “In terms of Overall Assessment of Performance: 7/9 COTs marked as at or above expected level and  2/9 below expected level”)

Note on AudioCOT: Again, as most items in the audio-COT are about Communication Skills, especially items (1), (2), (3), (4), (5), (6), (9), (10), (11), (12).  So, rather than writing about each item, write in terms of the “Overall Assessment of Performance”.   

Reminder: The gathering and use of data for clinical judgement, the choice of physical examination and investigations, and their interpretation.  This is mostly about clinical data rather than social data – salient features in the history and examination – outline them.

QUANTITATIVE

1. CBD – item (4) data gathering & interpretation: 
2. COT – item (5) Includes/excludes significant condition:          ; item (6) Examination:  
3. Audio-COT:  – item (3) Identifies the reason for the call:       ; item (7) History Taking:
4. CEX : item (3) Clinical Assessment (Hx & Ex)
5. RCA/CSA – this trainee has passed which is a good indicator that a trainee’s Data Gathering skills were, on the whole, good enough.   The score for DG was x out of  y

QUALITATIVE

1. CSR – under ‘Clinical Assessment’  the CS says….       The ‘Level of Supervision’ requires is reported as… 
2. MSF – under Clinical Performance,  comments around Data Gathering are:
3. Log entries – select ones that show STRONG evidence.  In particular, look at: Clinical Case Reviews, LEAS/SEAs & CEPs.

Reminder: CEPS = Any reference to the doctor’s ability to perform clinical examination, clinical procedures and investigations.

QUANTITATIVE

1. CEPs – This trainee has done XXX out of the 5 mandatory examinations.  
2. COT –  item (6) appropriate physical or mental examination:
3. Mini-CEX – item (3) physical examination skills:

QUALITATIVE

1. CSR – under ‘Clinical Assessment’ – the CS says the following about examination skills…
2. MSF – the following comments are made about examination skills...
3. Log entries – select ones that show STRONG evidence.  In particular, look at Clinical Case Reviews & CEPS.

Reminder: This is not just about coming up with a diagnosis; it’s about any decision-making processes.  Write about the conscious, structured approach to decision making you take in order to protect patients.   Don’t just write about your decision, but also the thinking behind that decision.  How did you come up with that decision?  What was swaying you towards it and away from it?  How did you make the final decision?

QUANTITATIVE

1. CBD – item (6) Making diagnosis/decisions: 
2. COT – items (6) Appropriate examination:           item (7) Appropriate working diagnosis:
3. AudioCOT – item (8) appropriate working diagnosis:          item (9) creates an appropriate, effective treatment plan:        item (11) safety netting/FU:
4. CEX – item (7) clinical judgement:
5. RCA – This trainee has/has not passed the RCA which provides evidence of good Decision-making skills.

QUALITATIVE

1. CSR – under ‘Clinical Assessment’, ‘Management of Patients’, ‘Context of Care’ the CSR says the following about Decision & Diagnosis skills…          The ‘Level of Supervision’ required is reported as…
2. MSF – under Clinical Performance, themes around Diagnises/Decisions are… 
3. Log entries – select ones that show STRONG evidence.  In particular, look at: Clin Case Reviews, LEAs/SEAs, Leadership/Management/Professionalism & Prescribing.

Reminder: Clinical Management = the recognition and management of common medical conditions in primary care.

QUANTITATIVE

1. CBD – item (4) Clinical management
2. CEX – item (4) overall clinical care:
3. COT – item (10) Appropriate management plan & FU: 
4. AudioCOT – item (9) creates an appropriate, effective mutually acceptable treatment plan:
5. AKT – this trainee has passed which is a good indicator that a trainee’s clinical management skills are, on the whole, good enough.   The score for clinical questions was:  x  out of  y
6. RCA/CSA – this trainee has passed which is a good indicator that a trainee’s clinical management skills are, on the whole, good enough.   The score for CM was x out of  y

QUALITATIVE

1. CSR – Under  ‘Clinical Assessment’, ‘Management of Patients’, ‘Context of Care’  the following Clinical Management themes emerge…        The ‘Level of Supervision’ is reported as… 
2. MSF – Under Clinical Performance, the following ‘clinical management’ themes emerge…
3. Log entries – select ones that show STRONG evidence.  Nearly all types of Learning Logs will often be about the management of a condition in primary care.

Reminder: Aspects of care beyond managing straightforward problems.  It’s about the approach to health rather than just illness.  For example: managing co-morbidity, managing uncertainty, explaining risk. 

QUANTITATIVE

1. CBD – item (08) Managing medical complexity: 

QUALITATIVE

1. CSR –  Under ‘Management of Patients’ & ‘Context of Care’ the CS says…
2. Log entries – select the ones that show STRONG evidence.  In particular, look at : Clinical Case Reviews, LEAs/SEAs, Leadership/Management/Professionalism & QIA.

Reminder: Working effectively with other professionals to ensure good seamless patient care.  This includes the sharing of information with colleagues.  Seeking others for help and advice as well as providing help and advice for colleagues.  The ‘performance’ of working with colleagues is best reported by colleagues themselves i.e. through MSF.

QUANTITATIVE

1. CBD – item (09) Working with colleagues in teams: 

QUALITATIVE

1. MSF – Under Professional Behaviour , ‘working with colleagues’ themes are… 
2. Log entries – select ones that show STRONG evidence.  In particular, look at: Clinical Case Reviews, Reflection on Feedback, Leadership/Mx and Professionalism & QIA.
3. CSR – under ‘Working with colleagues and in teams’, the CS says…

Reminder: Maintaining the performance and effective continuing professional development of oneself and others.   It’s about the trainee’s goes about meeting the needs of their own learning AND about how they aid in the teaching of others.

QUANTITATIVE

—-

QUALITATIVE

1. CSR – under ‘Professionalism’ the CS says the following things about this trainee as a learner…
2. MSF – under ‘professional behaviour’ and/or ‘clinical performance’, the following themes emerge about this trainee as a learner… 
3. Learning Logs: Select log entries which show how you went about to educate yourself after seeing particular patients. LEAs & SEAs as a result of seeing patients.   Reflection on feedback from others e.g. on particular patients or from the trainer after CBDs, COTs etc.
4. Other Log entries – Link log entries about –  attending courses/CPD, , Academic Activity, Audit, PDSAs, Projects & QIA projects.  Anything you have done in terms of Prescribing?  Or Leadership?

Reminder: This is about taking responsibility for organising yourself and developing systems to manage your workload.  It also includes taking initiative (=leadership) in managing others and making everyone’s life easier and safer.   For example, looking at systems beyond what would be  routinely expected from you.  Bettering systems of care.  Engaging with and improving IT systems.

QUANTITATIVE

1. CBD – item (11) Organisation, Management, Leadership: 

QUALITATIVE

1. Log entries – select ones that show STRONG evidence. In particular, look at: Clinical Case Reviews, LEAs/SEAs, Leadership/Management/Professionalism & QIA.

Reminder: This is the ability of the doctor to operate in physical, psychological, socioeconomic and cultural dimensions.  It involves taking into account feelings as well as thoughts – both patient’s and doctor’s.  This item also includes promoting health at opportunistic moments rather than just treating disease.  And of course, the wider need to always survey and protect patients – i.e. safeguarding. 

QUANTITATIVE

1. CBD – item (13) Practising holistically: 
2. COT – item (3) psychosocial context:          ;item (5) Pt’s health understanding: 
3. AudioCOT – item (5)  Places complaint in psycho-social contexts:           ;item (6): Explores ICE: 
4. PSQ – item (4) Interested in you as a whole person:            ;item (5) Fully understanding your concerns: 
5. RCA/CSA – this trainee has passed which is a good indicator that a trainee’s ‘practising holistically’ skills are, on the whole, good enough.    The score for IPS was x out of  y

QUALITATIVE

1. CSR – under ‘Context of Care’ the CS says the following about this trainee’s “practising holistically” skills…
2. Learning Logs – select ones that show STRONG evidence. In particular, look at: Clinical Case Reviews, LEAs, SEAs, Safeguarding entries.

Reminder: Community orientation is the management of the health and social care of the practice population and local community.   So – it is more about the health of the population or a particular patient community or group than a particular individual.   Community orientation only comes to life when we look at the impact of disease/provision of health care in the wider patient context. This is where audit work or engaging in a project that looks at the patient population becomes invaluable. Incidentally, these are often the best ways of learning about this element of the curriculum.

QUANTITATIVE

1. CBD – item (8) Community orientation: 

QUALITATIVE

1. Learning Logs – Use learning logs where you talk about particular patient groups.   Or where an encounter with a specific patient stimulates you into thinking about a patient group with the same characteristic e.g. diabetics, Bengali-speaking patients, new mums, teenagers etc.
2. Other Learning Logs – Think about other types of logs where you are looking at patient groups rather than individual patients.  For example, in audits and projects.  Leadership work and activities.
3. CSR – under ‘Context of Care’  the following themes around Community Orientation emerge…