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MRCGP WPBA Core Group

Clinical Examination and Procedural Skills The Introduction of Integrated DOPS The assessment of psychomotor skills in WPBA for the MRCGP examination. MRCGP WPBA Core Group. Background. Anecdotal evidence suggested that Mandatory DOPS were not fit for purpose.

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MRCGP WPBA Core Group

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  1. Clinical Examination and Procedural SkillsThe Introduction of Integrated DOPSThe assessment of psychomotor skills in WPBA for the MRCGP examination MRCGP WPBA Core Group

  2. Background • Anecdotal evidence suggested that Mandatory DOPS were not fit for purpose. • Concern from the GMC that trainees were not being assessed in clinical examination skills • The WPBA core group undertook a consultation exercise to seek a consensus and to find a way forward. • A 5 stage modified Delphi approach was followed over 18 months

  3. Consultation Findings • General consensus that Mandatory DOPS were not fit for purpose • Learning needs differ for different trainees and different communities • All trainees should be competent to conduct intimate examinations • Supervisors are able to recognise incompetence in examination and procedural skills • Assessment of DOPS should be integrated in assessment just as clinical examination is integral to clinical care

  4. ‘Integrated DOPS’ The proposal for Change from mandatory to Integrated DOPS : • 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.

  5. The transition to integrated DOPS • November 2014 new framework for recording DOPS will be included in the ePortfolio • Integrated DOPS (as the new competence of Clinical examination and procedural skills) tobe used in parallel with mandatory DOPS until August 2015 • Rules for the Mandatory DOPS screen will continue until end of July 2015 • June /July 2015 evaluation of integrated DOPS • Mandatory DOPS to be removed from WPBA from August 2015

  6. Recording Integrated DOPS in the ePortfolio • New professional competence also called Clinical Examination and Procedural Skills (after Data Gathering) • New Learning Log category called ‘Clinical Examination and Procedural Skills’ • Included as part of the COT (criterion 6) • Can be also Self – assessed in ESR review within competences for Data gathering, Clinical management and Maintaining an ethical approach • Specifically addressed by 3 questions for the as a summary of progress in the ESR. • Changes to MSF • New evidence form for assessor to document observations

  7. 1. New professional competence also called Clinical Examination and Procedural Skills ‘Clinical Examination and Procedural Skills’ will become a new and additional competency to be completed by trainees in the same manner as the current twelve competencies.

  8. New Competence: Clinical examination and procedural skills [1]

  9. New Competence: Clinical examination and procedural skills [2] Genital and Intimate Examinations

  10. 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 shows no understanding as to the purpose of examination.

  11. 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 ?

  12. 3. Included as part of the COT / MiniCex New wording in italics

  13. 5. Three Questions in the ESR 1. Are there any concerns about the trainee’s 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?

  14. FAQ - Conceptual 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.

  15. FAQ - 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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