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ST1 and ST2 - Survival Guide

Purpose

  • Outline essential components of GP training for the MRCGP
  • Provide advice to help you through your ST journey
  • Encourage you to take responsibility for ongoing learning and development
  • Indentify resources which may be of use

Please also refer to the deanery trainee induction pack which is a more comprehensive document full of relevant information:

http://primarycare.severndeanery.org/SevernDeanery

MRCGP

As you will be aware, the MRCGP qualification is composed of different assessments which all need to be completed / passed. These are essentially work place based assessments (WPBA) and 2 exams – Applied Knowledge Test (AKT) and the Clinical Skills Assessment (CSA). In order to complete your certificate of specialist training (CCT) at the end of ST3 year you will also need to have an eportfolio demonstrating wide curriculum coverage, you must also have satisfied the out of hours (OOH) component of GP placements and be certified to be up to date with resuscitation skills.

During the first 2 years of training you need to focus your attention on the WPBAs. You will also have to complete the specified OOH part of any GP placements. You may also take the AKT if you wish to.

The college website is actually full of info about all aspects of training and I would certainly recommend a good look through the curriculum/training website
www.rcgp-curriculum.org.uk/ - if you click on the MRCP link from the left side menu you can then access detailed info about all aspects of it, including comprehensive coverage of each WPBA.

A summary of what you need to complete and when is listed below; every 6 months you will have a review with your educational supervisor by which stage you should have completed at least the minimums listed. You will see that what is required does vary a bit each year.

Specialty Training Year 1
Minimums prior to 6 month review
  • 3 x COT or mini-CEX
  • 3 x CbD
  • 1 x MSF, 5 clinicians only
  • DOPS – as appropriate
  • Clinical supervisors’ reports
Minimums prior to 12 month review
  • 3 x COT or mini-CEX
  • 3 x CbD
  • 1 x MSF, 5 clinicians only
  • 1 x PSQ, if in primary care
  • DOPS – as appropriate
  • Clinical supervisors’ reports care
Specialty Training Year 2
 
 
Minimums prior to 18 month review
  • 3 x COT or mini-CEX
  • 3 x CbD
  • PSQ, if not completed in ST1
  • DOPS – as appropriate
  • Clinical supervisors’ reports
Minimums prior to 24 month review
  • 3 x COT
  • 3 x CbD
  • PSQ, if not completed in ST1
Specialty Training Year 3
 
 
Minimums prior to 30 month review 
  • 6 x CbD
  • 6 x COT
  • 1 x MSF
Minimums prior to 34 month review
  • 6 x CbD
  • 6 x COT
  • 1 x MSF
  • 1 x PSQ

You should be familiar with case based discussions(CBDs), and Mini-CEX assessments.
A COT (consultation observation tool) is the equivalent in a general practice setting. Multi source feedback (MSF) needs to be fitted in for ST1s – usually towards the end of a post – you need to give colleagues a special code from the eportfolio, and allow some time for completion
Patient satisfaction questionnaires (PSQ) need to be downloaded from the eportfolio and then the data re-entered online (may need a kindly secretary to do this!)

You can start to complete the directly observed procedures (DOPS) straight away (hopefully you are all familiar with these). There are only 6 essential DOPS to complete and the sooner you get these recorded the better. In fact you are often better placed in hospitals (depending on your job) to get senior colleagues / senior nurses to sign you off for PRs/genital exams/smears than you would otherwise be in General Practice. There is scope to then complete many other procedures listed on the eportfolio or others you can add.

Clinical supervisor reports (CSR) are completed by your supervising departmental consultant at the end of that particular post. (GP supervisors are also able to complete these for GP placements in ST1/ST2).

EPORTFOLIO

Your main tool for collating all of the evidence of your assessments as well as logging all relevant learning experiences is the rcgp eportfolio. This has only been running for 2 years and has undergone several improvements since its creation. It may take a bit of time to familiarise yourself with it but don’t be too put off – it can be a helpful method of recording what you have done, and charting your progress, as well as ensuring comprehensive coverage of the main curriculum topics in preparation for your 6 monthly reviews.

The main problem is keeping up the discipline of recording relevant information. You will initially need to establish a personal development plan (PDP) – setting yourself some measurable achievable goals with a timeline for completion. It makes sense to prioritise some specific things you really need to learn rather than more obscure/small print stuff. Sometimes these can be confidence in handling certain cases or developing certain skills rather than simply acquiring knowledge.

It has been suggested that you should aim to log at least one entry into the learning log each week – and again, the more meaningful / useful the better – after all it is your log demonstrating what you are learning, and in that way the eportfolio should be a help rather than a hindrance. It is fairly easy to record tutorials / teaching seminars not so easy to comment on cases / situations that you have learnt from - but these can be important to reflect upon. It is a good idea to record a variety of experiences – clinical encounters/professional conversations/reading/significant event analysis.

The key is to ensure you have adequate curriculum coverage – regular ‘hits’ on all the curriculum statement headings when you log an entry (you can have several curriculum headings per entry) and to also make sure – in discussion with your trainer - that you are demonstrating the 12 core competencies as well. (the competencies are recorded by your trainer (via his/her access to your eportfolio) who should regularly review your learning log; the competencies are commonly demonstrated by your CBDs and COTs / CEXs; but can also stem from other log entries; if you ‘share’ your entries your trainer has a chance to provide further feedback/questions).

The college website again provides a very thorough guide about how to use it / navigate around etc:
http://www.rcgp-curriculum.org.uk/PDF
The deanery induction pack mentioned above also contains a helpful review.

HOSPITAL PLACEMENTS

Make the most of the opportunities you have. When spending time in a specialty dept try to focus on a few key areas of the curriculum and a few skills that you need to take away with you which would be useful in primary care. Use the brief statement headings in the Condensed Curriculum Guide to clarify your learning needs and re-evaluate them towards the end of your post. Try and get to clinics and think about the ongoing care of patients, chronic disease management issues, how you would handle the cases in general practice. Enjoy the opportunity to be involved with colleagues – keep asking questions; get involved with teaching sessions etc.

Please be understanding, patient, and sensible with your approach to your specialty departments and the hospital trust as a whole. Over the last 2 years since ST training and GP training were introduced to the GWH trust vast improvements have been made to the departmental posts and the ST programmes generally. Following a lot of feedback locally and after PMETB reviews some posts were deselected and others better staffed so that GP trainees have more opportunities to learn what they need to learn.

It is not a perfect system by any means. As a junior doctor your skills are needed by the hospital to be on the job, providing an appropriate service to your patients and your department. Rotas are hard to devise and manage. Having said that the departments are more than aware of your training needs and should be reasonable in granting you time off for Weds afternoon tutorials / practice visits / other relevant courses – you are entitled to an average of ½ day study leave per week, but this does still remain at the discretion of the department to enable you to be away for that particular time requested. So be reasonable and expect the departments to also be reasonable. There may be difficulties with fixed rotas /nights /annual leave etc, so give plenty of notice and think of how you may be able to help to resolve any problems that may ensue.

PRACTICE VISITS

During your hospital placements you are expected to visit your eventual training practice for an average of ½ day each month. This needs to be planned with plenty of notice to the practice / your trainer, and your hospital department. It may be practically easier to spend 1 day every 2 months.

The idea of these visits is to continue to have a foot in General Practice and to start developing a relationship with your trainer. You will have the opportunity to feed back about your training, as well as familiarising yourself with the practice and the GP working day. It is useful to get a grip with the computer system, and to get to know other doctors, the practice manager and other staff. It makes sense to plan a tutorial in advance, and possibly complete a CBD or two.

Worth noting – Gp trainers will be much more realistic in their assessments. Hospital consultants may well state that you are competent, or even excellent from their perspective - whereas from a Gp perspective it is almost to be expected that your marks will be ‘needs further development’ for most competencies for most of your time as a trainee, as they are looking at what a Gp should be like in practice; i.e. what you are aiming for by the end of ST3. Basically don’t be disheartened by such feedback as you will gradually improve over time.

WEDNESDAY SMALL GROUPS

These are fantastic opportunities to have a break from busy hospital jobs and be amongst friends. It is the perfect environment to unwind a bit, but also refocus on being GPs and learn about various other clinical issues / skills tailored to your needs. Ask questions; support each other; teach each other; share issues. Use the experience of your educator to discuss whatever issues you want to. To some extent you can set the agenda for your learning and shape the direction of the group.

You are expected to be there for as many sessions as possible. If you can’t make one week, then you could opt to join another group on another Wednesday to make up for it. A 70%+ attendance is required.

COURSES / RESOURCES

The local Severn region of the RCGP runs FREE courses for AKT and CSA x3 yearly across the region, but book early to guarantee your place. You may have to send a £50 deposit which is returned to you on attendance.
(go to RCGP website then follow links for – faculties – England – South England – Severn – Events for an up to date timetable)

Join in the CPD GP teaching programme for local GPs – teaching is held on Wednesday afternoons; occ evenings, and occ. whole day teaching – see timetable on the website

There are many online learning providers – BMJ learning; Drs.net modules; gpnotebook gems; RCGP e-learning to name a few

The RCGP Innovait monthly journal which you receive as an associate in training is a very well written and useful tool covering a wide range of topics in appropriate detail – surprisingly readable. It deals with clinical issues + guidelines as well as providing exam questions and explanations. It also has other sections on the non clinical aspects of practice.

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