Setting a Direction

Setting a Direction

Clinical Examination and Procedural Skills The Introduction of CEPS The assessment of psychomotor skills in WPBA for the MRCGP examination MRCGP WPBA Core Group Integrated DOPS The proposal for change from mandatory to Integrated DOPS : 1. The assessment of DOPS will no longer be recorded as a single test on a mandatory list. 2. DOPS will be integrated within the existing framework of the Trainee ePortfolio and become Clinical Examination and Procedural skills (CEPS). Recording Integrated DOPS in the ePortfolio 1. New professional competence also called Clinical Examination and Procedural Skills 2. New Learning Log category called Clinical Examination and Procedural Skills 3. Included as part of the COT (criterion 6) 4. Specifically addressed by 3 questions for the ES as a

summary of progress in the ESR. 5. Changes to MSF 6. Changes to CSR 7. New evidence form for assessor to document observations 1. New professional competence also called Clinical Examination and Procedural Skills Clinical Examination and Procedural Skills becomes a new and additional competency to be completed by trainees in the same manner as the current twelve competencies. New Competence: Clinical Examination and Procedural Skills 13 Clinical Examination and Procedural Skills Insufficient Evidence Needs Further Development From the available evidence, the doctors performance cannot be assessed. [placed on a higher point of this

developmental scale] Competent Excellent Chooses examinations broadly in line with the patients problem(s) Chooses examinations appropriately targeted to the patients problem(s) Proficiently identifies and performs the scope of examination necessary to investigate the patients problem(s) Identifies abnormal signs but fails to recognise their significance Has a systematic approach to clinical examination and able to interpret physical signs accurately

Uses an incremental approach to examination, basing further examinations on what is known already and is later discovered Suggests appropriate procedures related to the patients problem(s) Varies options of procedures Demonstrates a wide range of according to circumstances and the procedural skills to a high standard preferences of the patient Demonstrates limited fine motor skills when carrying out simple preocedures Observes the professional codes of practice including the use of chaperones Refers on appropriately when a procedure is outside their level of skill Identifies and discusses ethical issues with regard to examination

and procedural skills Performs procedures and examinations with the patients consent and with a clinically justifiable reason to do so Shows awareness of the medicolegal background to informed consent, mental capacity and the best interests of the patient Actively promotes safe practice with regard to examination and procedural skills Engages with audit quality improvement initiatives with regard to examination and procedural skills Helps to develop systems that reduce risk in clinical examination and procedural skills IPUs Indicators of Potential Underperformance: Fails to examine when the history suggests

conditions that might be confirmed or excluded by examination Patient appears unnecessarily upset by the examination Inappropriate over examination Fails to obtain informed consent for the procedure Patient or trainee shows no understanding as to the purpose of examination. New Competence: Clinical Examination and Procedural Skills Genital and Intimate Examinations Insufficient evidence By the end of training the trainee must have demonstrated competence in breast examination and in the full range of male and female genital examinations Needs further development

The intimate examination is conducted in a way that does not allow a full assessment by inspection or palpation. The doctor proceeds without due attention to the patient perspective and feelings Competent Excellent Ensures that the patient understands the purpose of an intimate examination, describes what will happen and explains the role of the chaperone. Arranges the place of examination to give the

patient privacy and to Recognises the verbal and non-verbal clues that the patient is not comfortable with an intrusion into their personal space especially the prospect or conduct of intimate examinations. Is able to help the patient to accept and feel safe during the examination. respect their dignity. Inspection and palpation is appropriate and clinically effective. 2. New Learning Log Category Clinical Examination or Procedural Skill performed (please specify, if a genital or intimate examination)

Reason for physical examination and physical signs elicited (was this the expected finding?) Reflect on any communication or cultural difficulties encountered Reflect on any ethical difficulties encountered, (to include consent) Self assessment of performance (to include overall ability and confidence in this type of examination) Learning needs identified How and when are these learning needs going to be addressed ? 3. Included as part of the COT / MiniCex

New wording in italics Consultation Observation Tool Criterion 6 This competence will be about both the appropriate choice of examination, and performance when directly observed . A mental state examination would be appropriate in a number of cases. Intimate examination should not be recorded (on video), but directly observed. The observer may also choose to write an assessment form. 5. Three Questions in the ESR 1. Are there any concerns about the trainees clinical examination or procedural skills? If the answer is, yes please expand on the concerns and give an outline of a plan to rectify the issues. 2. What evidence of progress is there in the conduct of genital and other intimate examinations (at this stage of training)? Please refer to specific evidence since the last review including Learning Log entries, COTs and CBDs etc. 3. What does the trainee now need to do to improve their clinical examination and procedural skills?

Discussion Assessment of progress Longitudinal approach v. cross-sectional Workplace based Learning Expert judgements of experienced trainers The intimate examination and the invasion of personal space Integrated needs based agenda for learning v. Disjointed prescribed tick box lists. CEPS - Implementation Time constraints Assessment of intimate examinations Gold standard for GP Contractual requirements Video v. direct

observation Trainers as DOPS assessors Managing the change Guidance and training for trainers The full physical examination Communication skills during examination The skills lab Rational examination Rational procedural skills

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