Yes, there is!  The curriculum covers the knowledge and skills that all GP trainees need to learn in order to deliver the highest quality standards of patient care.  It won’t surprise you to hear that it’s a large document – after all, General Practice is a broad specialty which encompasses a number of other specialties.  To make the GP curriculum easier to understand, it is divided into a number of Curriculum Statement Headings.   There’s a section which focuses on the GP consultation (which is at the heart of being a GP).  Others focus on the day to day aspects of being a GP and organisational management.   And finally, others concentrate of various clinical specialties.  Click here to see the curriculum section for your particular specialty and what GP trainees need to familiarise themselves with.

• https://www.rcgp.org.uk/training-exams/training/gp-curriculum-overview/online-curriculum.aspx

There’s quite a number of different types of assessments for the MRCGP.   They all have acronyms which can make it look more complicated than it really is.  As GP Trainers, we have had extensive training on how to do these assessments.  We’ve had repeated opportunities for practising them and for benchmarking ourselves against our colleagues.   It is really unfortunate that most hospital consultants have not been given the same level and depth of training we have had from our HEE Deanery.   We hope to pass on some of what we have learnt to you through these pages.  For simplicity’s sake, we’ll only cover the assessments YOU will be involved in.  You’ll be glad to know that of the 12+ types of WPBA assessments, you only need to really get to grips with a handful (about 5) of them which are listed below.

It’s really important to grasp a good understanding of what each of these assessments is about because if you carry them out the way they are meant to be done, you will be able to define more precisely and reliably what bits a trainee is good at and what areas they need to focus and develop.  And the good thing is that it is very likely that specialty trainees for your own clinical specialty will have to do these assessments too – if not now, in the near future!   So – by covering them in some detail here, you’ll not only be training yourself up for doing assessments for GP training, but also for doing assessments for your own specialty.   And let’s not forget the Foundation Year docs who already have to do them.  The skills you will learn here are transferable!

Click on an assessment below to read more about it.   Each has it’s own web page on which you will find some really useful forms and practical guidance..

1. Case-Based Discussion (CBD) 
2. Mini-Clinical Evaluation Exercise (Mini-CEX) 
3. Clinical Examination & Procedural Skills (CEPS) 
4. Multi-Source Feedback (MSF) 
5. Clinical Supervision & the Report (CSR) 

Other Useful things

• The ePortfolio 
• The 13 Professional Capabilities
• CBD question maker for Hospital Consultants 

Some of the Work-Place Based Assessments are graded in slightly different ways.   

• Insufficient Evidence (IE) means you are unable to grade.  This might be because you actively decided not to concentrate on a particular competency because you wanted to concentrate on some of the others.   Or perhaps the material being assessed wasn’t ‘the best’ for this particular competency.   Clearly, if there are repeatedly ‘Insufficient Evidence’ grades for a particular competency for a particular set of assessments, then the trainees needs to be encouraged to actively find material that will demonstrate it.
• Below Expectations (BE) means that the trainee (for a particular competency) has performed below what you would have expected from a trainee at similar stage of training.  Therefore, they Need Further Development (NFD).   If in your opinion they are borderline, still choose BE or NFD.
• Meets Expectations (ME) means that the trainee (for a particular competency) has performed on par with what you would have expected from a trainee at similar stage of training.  This is not to say they are competent for licensing or independent practice – they will still have needs for further development until they get to that stage that most certified doctors are at.   All you are saying is that they are doing okay and progressing at the expected rate.
• Above Expectations (AE) or Excellent (E) means that the trainee (for a particular competency) has performed above what you would have expected from a trainee at similar stage of training.  They may have gaps in other areas, but for the particular area you are assessing, they have performed exceptionally well.

One thing we see a lot of hospital consultants do that we do not like as GP Educators and Assessors is giving out “Excellent” grades with a low threshold.   Excellent or Above Expectation grades should be given sparingly – when they are well deserved!   When we see that a hospital consultant has marked everthing on a CBD (bar one or two things) as Excellent, we end up thinking that those CBD marks are no longer reliable because the grades are given out in a way that is against recommended guidance.   We then end up ignoring that CBD which you have clearly made time to do with your trainee!

So, in summary, only give Above Expectation and Excellent grades occaisionally – only when they are well deserved.   

• During their ST1 years, most trainees should be scoring at Borderline, Meets Expectations or Needs Further Development levels most of the time.  
• During the ST2 year, trainees should be scoring at the Meets Expectations, Needs Further Development and occasionally Competent levels as they gradually acquire the necessary knowledge, skills and attitudes for the various professional competencies.  
• And during ST3, they should mostly be hitting Competent levels with the occasional Excellent here and there.
• Don’t be afraid of giving out NFD or BE grades – especially in the early years as people early on in their careers need training – after all, that is why they are on a Specialty Training Programme!
• Do you want your assessments to be taken seriously?  Then don’t give out Excellent or Above Expectation grades willy nilly.   Only when you are in awe of the trainee’s performance.
• Equally though, you do not want to be a complete hawk by marking everything as NFD!   Giving an NFD for nearly everything is rather demotivating.   If you find that nearly every grade you have awarded is an NFD – ask yourself, “is the trainee really so bad, or am I being to hard with the marking?”
• It is okay to give ST1s and 2s the occaisional Excellent grade – but remember the operative word – occaisional.  Only when you are truly impressed (or “wowed!”) and thus well-deserved.  
• The overall principle is that your grades need to provide the right balance.  Your grades should portray an accurate picture of where the trainee is currently at.  

Trainees may expect you to award a Competent or Excellent because this is probably what they’ve been usually given in the Foundation Years of their training.   They may well be disappointed with a Needs Further Development or Below Expectation grade.  Please take a moment to explain things to them.   Explain that Needs Further Development or Below Expectations is NOT a failure or fail grade.    It simply means that they need to work on a particular area to become stronger in it.    This is what the assessment system is designed to do, so that further training experiences can be directed toward their developmental needs.  

Say to them..

• Early on in your career, you cannot possibly be the finished article. Would you agree? 
• Would you agree that if everything was good, there would no need for you to be on a Specialty Training Programme?
• Educational Supervisors and ARCP panels know this.  So how would it looked if everything was marked as excellent so early on in your career?  If you were on the assessing panel, would you think the trainee was perfect and no need to be on a training programme or would you think the assessor has not done their job properly?
• Therefore, I do need you to allow me to do the role that I am trained and qualified to do – which is to assess you.  I don’t mind you having a discussion with me about it as long as there is also a respect for the freedom to make my qualified judgement.
• All of us, as human beings, have ‘needs further development’ in all aspects of our lives.   Even I do as a hospital consulant.  Therefore, it is good practise for us to start learning to be open and honest about these like us consultants and GPs have to do in our appraisals.

Do take a moment to have this discussion.    Doing it in this way will help get you both onto the same wavelength early on.  Otherwise, the trainee will always be a little “miffed” after every assessment and whilst they may not overtly vocalise this, it will be quietly eating away at them and eating away at your consultant-trainee educational relationship.  Get things open and cleared early on.  Both minds have to be on the same wavelength.  

First of all, be thankful that they do!   These assessments are mandatory and if they don’t get them done, it is they that suffer, not you.    And the Royal College of GPs says it is the trainees responsibility to get them done, not the assessors.   Don’t you think that is a good rule?  Or would you rather the RCGP says the assessor needs to make sure the trainee has them all done?  Which would you prefer.  I know for me, it is the former.  Hence, TPDs will ask our trainees to badger you because they have to be done in a timely way.  You cannot just do all of them towards the end of the placement.  They have to be done progressively throughout.  We realise that Hospital Consultants lead very busy lives and assessments like the CBDs need time.  But also bear in mind that by having a GP trainee, the specialty departments gets a pair of free clinical hands to help out with both the day to day and on-call workload.    Surely the least we can do as supervisors is to MAKE TIME in our professional working lives to do the supervising and assessing in return.   It’s a heck of a lot less than the work they give us in return.  And after all, why did we sign up to training if we can’t afford time or space to dedicate a bit of ourselves to it?   So, if a trainee says “Dr XXX, I really do need to get another CBD done with you”, say “Thank you for the reminder, I really appreciate it.   Let’s make a time and date to get it doen.  Looking at my diary, shall we plug it in for next week on Tuesday morning… say 8.30 before the ward round starts at 9.30?”

Yes, but only if you have trained them how to do it properly.  At the moment, we are seeing too many GP trainees being assessed by specialist registrars who have not been trained in what the competencies mean or how to carry out the assessments. The Royal College would deem this unacceptable and it is against the rules.  No surgeon in their right mind would consider allowing their trainee to do say an appendectomy without training them up first……the same applies to these assessments for General Practice training. They are important assessments which dictate whether a trainee is safe with patients and we must not forget that.    We would suggest that a specialist registrar can do things like CEPS (Clincial Examination & Procedural Skills) but perhaps, until they are trained up, the CBDs are done by the consultant.   The Clinical Supervisor’s Report has to be done by the consultant.

There are these 13 things which define what good GPs are good at.   For example, one of these is “Making Diagnosis and Decision” – not surprising.   Another few unsurprising ones are “Communication Skills” and “Working With Colleagues and in Teams”.  And then there are ones that aren’t so obvious until you read up and understand what they are about – like “Managing Medical Complexity” and “Fitness to Practice”.  We call these 13 things THE 13 PROFESSIONAL CAPABILITIES.    Anyway, they are listed below with a brief description of what they mean.

• More detailed guidance on each one can be found by clicking this link: competency descriptors in detail

So, what is capability progression?

So, to recap, these are the things that a good GP is pretty good at.  Therefore, it makes sense that a GP trainee needs to become really good at these 13 things if they want to become and practise as a quilified good GP.  But they can’t possibly develop all these things all in one go.   As they progress through training, they will become more competent at somethings earlier than others.  As a trainee moves through training, they will gradually accrue more and more knowledge, skills and attitudes for the 13 Professional Capabilities (each one has its own unique set of knowledge, skills and attitudes).  Others will take time.   And for different trainees, the pattern of development will be different.   Some will develop communication skills early (because they are natural), others much later.  But hopefully by the end of ST3, most will be good at all 13 things.    But in all cases, it will be incremental.  This gradual development of becoming competent in these 13 capabilties over the 3 year GP training period is what is called Capability Progression.  As everything is kept in the ePortfolio, the ePortfolio is the place where you will see evidence of this Capability Progression and GP trainees need to make sure the evidence is uploaded and is there – especially in time for ES meetings and ARCP panels who will be continuously revisiting this at each meeting/panel.  By the end of GP training, there should be good evidence for all 13 Professional Capabilties.

GP trainees thesmelves need to be able to identify their strengths and weaknesses so that they can build on their weaknesses and provide a broader and richer evidence set in their ePortfolios.   The trainee will hopefully be able to identify their strengths and weaknesses simply by reviewing whatever is in their ePortfolio.  Clearly, for this to be reliable depends on them actively (and regularly) engaging with the ePortfolio and capturing their learning experiences within it.  They also need to review the GP curriculum and seek out areas in which they feel they are less well versed.   

And then there is you, the Clinical Supervisor who can help them identify gaps in the specialty you are supervising them for and help them bridge these gaps.  You will pick up areas from simply observing them in their day-to-day work (Clinical Supervision).  You will also obtain information about their strengths and weaknesses from your colleagues – so do listen to them and actively seek out this information.  And of course, hopefully you will identify strengths and weaknesses through the various assessments you will do with them.

And finally, they will be aided in this analysis through their Educational Supervision meetings.  Their Educational Supervisor will meet at least once during every post and together the structured evidence in the ePortfolio will be considered against the Professional Capability framework in order to identify strengths and weaknesses; this will help  them develop a learning plan designed to enable the trainee to collect more evidence of competence and to build up a richer picture of readiness for practice. 

A record of personal development and experience is becoming mandatory for all doctors. It provides evidence that training has taken place and allows the doctor to reflect on a range of learning opportunities.  By making use of the full capability of electronic systems, the ePortfolio can be used to record, monitor and manage a GP trainee’s learning all in one place.  By providing a structure for documenting the evidence harvested through Work-Place Based Assessment (WPBA) tools, the ePortfolio helps to ensure that judgements about the GP trainee’s progress and achievement are based on a clear, systematically recorded picture of competence.  Above all else the ePortfolio is where the GP trainee records their learning in all its forms and settings. Its prime function is to be an educational tool that will record and facilitate the management of the journey of clinical and personal development through learning.

At the beginning of specialty training, when a GP trainee registers with the Royal College of GPs (RCGP),  they will be given access to the RCGP Trainee ePortfolio which will be used throughout the training period, in both hospital posts and primary care. It is accessed and updated through the internet.  Although the ePortfolio belongs to the GP trainee, key parts of it are accessible to the GP Trainer, Hospital Consultant, Educational Supervisor and deanery administrators through a permissions system. 

The trainee will use it to record their learning experiences and reflections.  The trainee’s Educators (like  the Clinical Supervisor, Educational Supervisor, Training Programme Director and so on) will use it to record things like the trainee’s assessments, progress and reviews.  It must be used at all stages of training to document the assessments.  The assessments recorded in the Trainee ePortfolio will be drawn from performance and evaluation taking place in the real situations in which doctors work.  The Trainee ePortfolio should also be used to record and validate naturally occurring evidence against the competence framework. This is evidence which occurs in the course of practice and which illustrates the GP trainee’s competence. For example, the trainee may do an evidence review on a specific topic and present it to a practice meeting. This might be taken as evidence of data gathering and interpretation, or communication skills. Evidence that a trainee is late for ward rounds on a regular basis might be discussed with the them and recorded under teamwork. 

Most ePortfolio entries will be  tagged to one or more of the 13 Profesional Capabilities – so that an overall picture of Capability Progression is easily accessed.  Doing this allows capability in areas such as team-working to be appraised in a manner which cannot be done through examinations like the AKT and CSA. The Educational Supervisor and Clinical Supervisor are responsble for doing this.  If you don’t know how to tag ePortoflio entries to the Professional Capability labels, please ask your local Training Programme Director to do some training perhaps with a group of Hospital Consultants.

A few other bits about the ePortfolio.  The ePortfolio will detail achievements in the various MRCGP exams – namely, AKT and CSA.  It also has a diary and a mailbox.  It also contain links to learning resources that are being developed by the RCGP and has a personal area where individuals can save files, documents, certificates of learning and other digital materials.  In general, the ePortfolio might be described as the “glue” which holds the curriculum learning and assessment together.

• Click here to read more about the ePortfolio: www.bradfordvts.co.uk/mrcgp/eportfolio

Throughout training, the GP trainee will have one Educational Supervisor and several Clinical Supervisors. They will have regular reviews with both. However, don’t confuse the two. Each aims to do different things as illustrated in the table below.  Clinical Supervisors are qualified specialists who have responsibility for the day-to-day supervision, training and assessment of trainees who are doing a placement in their specialty. In a GP post, the Clinical Supervisor is the GP Trainer.  In a hospital post, the Clinical Supervisor is the Hospital Consultant.  In an integrated post (e.g. combined Eyes & ENT job), then they will have a clinical supervisor for each specialty.  Each trainee should have a named Clinical Supervisor for each placement, usually a senior doctor, who is responsible for ensuring that appropriate clinical supervision of the trainee’s day-to-day clinical performance occurs at all times, with regular feedback.

All clinical supervisors should:

• Clinical supervisors oversee the day-to-day work of the trainee during that placement.
• Understand their responsibilities for patient safety.
• Be fully trained in the specific area of clinical care.
• Offer a level of supervision necessary to the competences and experience of the trainee and tailored for the individual trainee.
• Ensure that no trainee is required to assume responsibility for or perform clinical, operative or other techniques in which they have insufficient experience and expertise.
• Ensure that trainees only perform tasks without direct supervision when the clinical supervisor is satisfied that they are competent so to do; both trainee and clinical supervisor should at all times be aware of their direct responsibilities for the safety of patients in their care.
• Consider whether it is appropriate (particularly out of hours) to delegate the role of clinical supervisor to another senior member of the healthcare team. In these circumstances the individual must be clearly identified to both parties and understand the role of the clinical supervisor. The named clinical supervisor remains responsible and accountable for the care of the patient and the trainee.
• Clinical Supervisors are are expected to hold formative meetings with their trainee at the beginning, middle and end of their placement.  They should use the WPBA assessment tools as learning opportunities, formative assessments and to provide evidence towards the record of competence progression collected in the trainee’s eportfolio.
• Clinical Supervisors are expected to complete a Clinical Supervisors Report (CSR) at the end of the placement. If a trainee is in an integrated post working concurrently in more than one specialty, then each clinical supervisor will complete a CSR.
• Be appropriately trained to teach, provide feedback and undertake competence assessment of the trainees in the specialty.
• And finally, Clinical Supervisors should be trained in equality and diversity and human rights best practice.

Educational attendance requirements for GP trainees:  It is an absolute requirement for them to attend the equivalent of 70% of possible half-day release sessions.  (This means 70% of the total number of sessions, not 70% of those which do not fall while they are on annual leave, working nights etc.)
We know that hospital rotas make it impossible for all hospital trainees to attend the Half Day Release programme every Tuesday afternoon (for example).  But you must make your system work so that the trainee can attend at least 70% of the time.  As I said earlier, you get a free pair of clinical hands which also help take the burden from on-call workload too.  Don’t we owe it to these trainees to give something back in terms of their education, learning and development?  After all, why did the department want to take on and get involved in GP training?  Was it to purely lighten the workload of the department?  Was it because of your enthusiasm for teaching and training others?  Was it because you love seeing young little wonderful beings develop?   Or was it a combination of these?  So – is it right to take and no give?   Also, imagine life in your department with the trainee status being taken away.  In that situation, it wouldn’t be just the half day of absence you’d be worried about – it would be every day!

You might think that there is no solution to being able to release our trainees just ONE HALF DAY a week because the rota for your department looks impossible.  But if your open your mind to the art of possibility, you’ll find a way.  This educational attendance requirement is recorded for each post in the Form B which is the equivalent of an educational contract.  If your post fails to meet this requirement, there is a good chance that your post may well be removed for GP training.  Is that worth the risk?  Again, I would urge you to rexamine why you and your department signed up for GP training.   Always, speak to your friendly local Training Programme Directors for GP training.