Assessment in situ

Milan Mehta offers some tips on the third component of the MRCGP exam – Workplace Based Assessment

THE MRCGP is designed to be an “integrated” assessment system. Summative assessments such as the Applied Knowledge Test (AKT) and Clinical Skills Assessment (CSA) evaluate candidates in the pressured and unavoidably artificial setting of an exam. But some areas of professional practice are best tested on the job and this is where Workplace Based Assessment (WPBA) comes in.

Preparation and planning are just as important with WPBA. Below are some tips and common pitfalls to avoid. More specific requirements for each type of WPBA can be found on the RCGP website (www.rcgp.org.uk).

Case-based Discussion (CBD)

CBDs are mainly done in primary care and it is your responsibility to select cases, so choose them carefully as your ePortfolio must include a balanced variety of patients (e.g. children, elderly, mental health, palliative care). The cases must also reflect a variety of settings (e.g. hospital, GP surgery, home visits, out of hours). It is impossible for one CBD to provide evidence for every competence, so make sure you select cases that will enable your supervisor to cover as many competences as possible during the discussions. One way of achieving this is to ask your supervisor at the start of the discussion which competences they are expecting to look at.

Some trainees make the mistake of not planning ahead, which causes unnecessary anxiety closer to the time of their six-monthly and final reviews. Identify which competences were covered during your last CBD, think ahead which competences are still outstanding and then select subsequent cases to cover them.

Consultation Observation Tool (COT)

Your GP trainer will observe some of your consultations (either directly or by video recording) in order to make holistic judgements about your consultation skills. The discussion that follows, and the feedback your trainer gives you, will be used as evidence in your ePortfolio.

Record several of your consultations on video and select one to be assessed and discussed, or ask your trainer to sit in with you during them. Remember, the more complex your consultations are, the more evidence they will probably generate. Try not to let your consultations exceed 15 minutes, since effective use of time is a positive attribute your trainer will be looking out for. Again, make sure you select a balance of cases and include at least one involving children (aged 10 or younger), older adults (aged 75 or over) and mental health. Don’t be afraid to select videos where you think you’ve performed well, since being able to tell the difference between good and bad consultations is a marker of your professional development.

Multi-Source Feedback (MSF)

This tool collates feedback from colleagues about your professional behaviour and clinical performance which can then be reflected on, used for self-evaluation and included in your ePortfolio. The number of colleagues you need to provide feedback will differ depending on whether you are in a primary or secondary care post. Colleagues you select for MSFs will need to have observed you in the workplace.

Try to ask different colleagues to provide feedback across the MSF cycles. It is sensible to select colleagues that you have a good working relationship with, as they are more likely to give you positive feedback!

However, if a single colleague gives you some minor negative feedback then this is okay as long as it is balanced out by overall positive feedback from everyone else. Your Educational Supervisor will give you the MSF feedback and make sure you try to address any problems that colleagues raise.

Patient Satisfaction Questionnaire (PSQ)

This will provide valuable feedback on your empathy and relationship-building skills during consultations. This is a chance to display your warm, caring side as a GP trainee, and make sure you address every patient’s ideas, concerns and expectations, as this will undoubtedly make them leave your consultation with a sense of satisfaction.

Direct Observation of Procedural Skills (DOPS)

There are eight mandatory skills that you need DOPS for, and the rest are optional. Start completing DOPS as early as possible as it is often hard trying to find someone to observe you at the relevant time. The observers should not be other GP trainees or specialty trainees at a similar stage in training to you.

Clinical Evaluation Exercise (MiniCEX)

This is the secondary care equivalent of COTs. Again, try to cover a range of clinical problems. Clinical Supervisor’s Report (CSR) This is usually for hospital posts only and is a structured report from your Clinical Supervisor based on evidence relating to your post (e.g. WPBA tools, ePortfolio entries and feedback from colleagues). At the start of your post, try to identify educational objectives and learning opportunities with your supervisor. Ask your supervisor before the CSR is completed if there are any concerns, so there is enough time to address them. Every six months you are expected to meet with your educational supervisor and review the evidence collected and plan for the next six months. Just as with anything the trick with WPBA is to keep on top of it. Good luck.

Dr Milan Mehta is a GP and co-author of Succeeding in the MRCGP CSA: Common scenarios and revision notes for the Clinical Skills Assessment which is part of the MediPass Series published by BPP Learning Media

In the next issue: Learning Logs and Personal Development Plans