Formative assessment - Barnsley VTS

Confidence rating scales

You score yourself on 'level of confidence' for a list of topics which aim to cover the content of general practice. These scales are useful at the beginning of a training post to identify potentially weak areas and allow planning of learning. They are less useful as 'outcome measures' of education because in some areas confidence in dealing with a particular problem may remain the same despite acquiring considerable knowledge and skills: the more we learn, the more we realise there is to learn!

Learning needs elicited by direct patient contact - 'Capturing the Moment'

A powerful method of generating learning needs for registrars and established GPs alike, because they arise in a context of immediate, practical relevance. Twenty to thirty patients per day provide abundant insights into your 'need to learn' areas; the trick is to capture those needs as they arise and not let the moment pass without action.

A model designed to make use of educational needs arising from consulting was developed by Dr Richard Eve, using the acronyms PUNS & DENS. Many of our clinical encounters result in patient's needs not being met (Patient Unmet Needs); some of these PUNS are the direct result of the doctor's lack of knowledge or skill (Doctors Educational Needs). The PUNS & DENS method centres around a log of patient contacts (written or held electronically), where you reflect on why the patient's needs went unmet, consider deficiencies identified in your knowledge/skills repertoire and write down an action plan to remedy the situation; it has been further expounded locally by Dr Amar Rhughani.

Problem case analysis

Perhaps bearing PUNS & DENS in mind, you and the trainer jointly review records, and/or your own log, of case-histories that are interesting, challenging or causing difficulties: an opportunity to discuss the learning needs that arose and how to deal with them. The 'Problem-based Learning' approach means the original perceived problem may be a 'springboard' for covering areas of need far distant, as the discussions are frequently wide-ranging.

Random case analysis

A complete surgery, or random cases within it, are reviewed. Early on in training this enables the trainer to keep track of how you are coping. Later, it is useful to ensure that an adequate case mix is being experienced. Giving learning activity a practical and relevant context; i.e. real case-histories, supports 'Adult Learning' principles (Knowles);

Adults motivated to learn when they perceive learning to be relevant to their current situation
When they can acquire skills/knowledge for immediate/practical use
When they have active involvement in the process.

In Tutorials, topics identified from case analysis can be addressed in more depth, and cross-linking with actual cases 'keeps it real' in accord with these principles.

Significant event analysis

We can all make mistakes, but can we show that we learn from them? You, your trainer or other member of the practice team raises a significant incident such as a missed diagnosis, adverse patient event or a practice complaint (SEA can also be used where something has gone right, perhaps unexpectedly!). All the parties involved discuss why the event is considered significant and explore the facts of the case. The important issues raised by the event are teased out. Those things that went well are highlighted together with those that went badly. Feasible areas for improvement are identified and an action plan drawn up. The SEA can then be written up and filed in the learning log or Personal Development Plan.

The key features of success of SEA are (i) that it should be a positive experience for all involved (ii) that it should result in some improvement in patient care (iii) that it is about improvement and development - not blame.

Feedback from patients, staff and colleagues

During your training year you work closely with the trainer, practice nurses, receptionists and so on as part of a team delivering Primary Health Care. Observations from members of the team can be fed back from time to time by the trainer: ideally, this will involve giving positive feedback where it is due and striving to achieve mutual agreement when offering constructive criticism. When things aren't going so well, it is helpful for the trainer to know if there are any external factors, e.g. domestic problems, that might be affecting performance at work.

Consultation analysis

Reviewing yourself on video tape can be an sobering but illuminating experience, and there are ways of enhancing the process including consultation mapping, consultation modelling and use of a predetermined assessment "grid". With the shift in emphasis to video as an endpoint assessment, e.g. in Summative Assessment and the MRCGP examination, it is easy to forget the unique educational value of video work. Mutual exploration of the issues generated by a single videoed consultation is a compelling formative tool in GP training.

Joint surgeries

Joint surgeries are a fruitful source of noting learning needs, but having your trainer sitting in the corner may be daunting and can affect both process and outcome of the consultation. Patients also find it hard to ignore the fact that a more familiar doctor is in the room and may begin to address their enquiries in that direction.

Audit

Audit compares our performance against a set of criteria and standards; it is revealing in that it is about what we actually do, not what we say we know. The Summative Assessment process requires you to produce a written submission of practical work, usually a completed audit cycle. Conducting small-scale focused audits on a regular basis is a good habit to get into, and is a sure-fire way of identifying weaknesses to improve quality of care delivered.

Personality profiles and self-perception tools

Some attributes of an aspiring GP can have a huge impact on how a particular individual learns and works within the practice setting, but may not be directly linked to the clinical care of patients. Validated self-assessment questionnaires are useful in beginning to understand more about yourself, without prolonged umbilicus-gazing, and can be used to look at such diverse attributes as team role, learning styles and personality type.

Logbooks, diaries and personal development plans

With all these learning points it's a good idea to keep records. Apart from anything else, you'll forget what it was that was so important to learn last week when confronted by this week's agenda! Noting down learning (a log) and action points arising (a plan) keeps the process on track and will provide you with a basis for discussion when you undertake appraisals during the training year and afterwards. Preparing a personal development plan is a good habit to get into, as sooner or later every GP will be expected to have one.

Appraisals

An appraisal is a formative assessment process culminating in an interview performed by a peer, trainer, course organiser or another. It gives you an opportunity to feedback on the educational experience as well an providing a forum to review what has been accomplished and plan for future learning/development.

An appraisal should end with a mutually agreed statement of where future energies should be directed and an action plan. Objectives should be SMART; specific, measurable, attainable, resourced (or relevant) and time bounded.

FORMS (Forms 2 & 3 in use as at June 2006) (Click here)

PLP (Personal Learning Plan form) (Click here)

Heathers_GPR_appraisal_doc (Click here)

Appraisal Folder VTS Exit appraisal 10 (Click here)

Appraisal Folder VTS hospital post 10 (click here)