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THE MOST
OF GP
TRAINING
New AiTs Handbook
Welcome
Congratulations on gaining a place on the
GP Specialty Training Programme, the largest
community of specialty trainees in the UK.
1
training based on
full time working and
starting in August
November January:
have your CSR and ESR completed
in good time for your ARCP in
January / February
You can apply for academic
May July:
fellowship posts that are
have your CSR and ESR completed
advertised in your region
during your training (e.g. in good time for your ARCP in July
ST2). For this you will need Most GP training schemes
include 18 months in May June:
to find additional time during
your training to pursue hospital specialties and if GP is your 1st ST2 rotation, make
research or other training 18 months in general sure you get your Performers List
opportunities. practice. The absolute application sorted in good time
minimum is 12 months in
general practice at the end
of the programme.
6/7
Year Year
2 3
August 2017 August 2018 August 2018 August 2019
1 5
Its training to become a GP Ask for help
Sometimes its easy to forget that being a GPST is Your trainer has your best interests high on their
all about training to become a GP, as each job and priority list and is just a phone call or email away.
training scheme is so varied. It is helpful to consider It is helpful to get to know them early on in your
how you can apply each specialty to general practice, training, particularly before your first Educational
particularly for your ePortfolio. Supervisor Review, so drop them a line shortly
into your first post.
2
Dont ignore the Trainee ePortfolio
6
When you first start the Trainee ePortfolio can seem Keep on top of the admin
daunting BUT if you take some time to write at least Paperwork is never a highlight but if you dont
one or two good quality entries a week you will be do it, it can seriously impact your training. Find out
on the right track. Try to keep on top of it as you go when you need to submit important documents such
along and remember your ePortfolio represents you as Performers List applications, DBS applications
so make it shine. and Form R (for the ARCP) so you can keep on
top of it all.
3
The final year can be tough
7
The number of things to complete in the final year is Enjoy this amazing experience
significant so try to do the audits and Significant Event GP training is an enjoyable learning experience.
Analyses etc as early as possible. If you fancy doing The difficult times are part of the job and will pass.
a diploma consider doing it earlier in your training. Keep the end goal in mind and celebrate the
achievements along the way.
4
Dont bite off more than you can chew
It might seem a good idea to undertake complex
self-improvement projects and diplomas but trying
to do too much can leave you feeling stressed,
so keep your workload as manageable as possible.
8/9
Looking after yourself
as a trainee
As a GP trainee, help is always at hand. The RCGP, along with
many other organisations, are here to support you.
THE
a diseased organ, more
even than the whole
man - he must view the
man in his world.
MRCGP
Harvey Cushing
The MRCGP is an integrated training and assessment programme that is made up of three
components; an Applied Knowledge Test (AKT), a Clinical Skills Assessment (CSA) and
Workplace Based Assessment (WPBA). It relates to the training curriculum and tests the
wide-ranging knowledge, clinical and communication skills required in general practice.
All GP trainees must complete the Colleges assessment (MRCGP) to practise as a GP.
In this chapter youll find out about the different aspects of the MRCGP and how collectively
its components will demonstrate that you are ready to enter independent practice:
WPBA Workplace Based Assessment and its tools
AKT Applied Knowledge Test
CSA Clinical Skills Assessment
Less Than Full-Time Training
Taking maternity and paternity leave
10/11
WPBA
Workplace Based Assessment
Workplace Based Assessment (WPBA) is one of the three components of the
MRCGP. There are different WBPA tools that demonstrate you have covered the
13 areas of professional competence. Each tool has a different aim. You have to
complete a certain number of each in every six-month review period.
The WPBA
tools explained CbD COT Mini-CEX
Case-based Consultation Clinical Evaluation
Discussion Observation Tool Exercise
A structured interview The observation The observation and
with your supervisor and assessment of assessment of your
about a selection of your primary care hospital consultations
your cases consultations
The Mini-CEX is a
Used in both hospital and COTs are used in 15-minute snapshot of
general practice posts the primary care where your your patient interaction,
CbD is a focussed way to trainer observes your which is overseen by the
discuss cases and explore consultation, either by clinical supervisor or trainer
your clinical judgment. Youll sitting in or by video, or educational supervisor
need a variety of cases and then discusses it (depending on deanery
that cover a balance of the with you. You should arrangements). It might
curriculum. Each discussion include different types of also be observed by a
lasts about 30 minutes. consultation, including staff grade doctor, nurse
In ST1 and ST2, you children, older adults and practitioner, clinical nurse
select two cases, present mental health, and must specialist, an experienced
them to the assessor and get written patient consent specialty registrar (ST4
then they will choose one - the reception staff can or above) or consultant.
to discuss. usually help you with this. The Mini-CEX is used
Theres a form on the in hospital posts and
In ST3, you present four
RCGP website too: assesses clinical skills,
cases and they choose
www.rcgp.org.uk/wpba attitudes and behaviours.
one or two for discussion.
12/13
MSF PSQ CEPS CSR
Multi-Source Patient Satisfaction Clinical Examination Clinical Supervisors
Feedback Questionnaire and Procedural Skills Report
A feedback A feedback Personal log entries and A short structured report
questionnaire on your questionnaire on your supervisor assessment on your performance in
performance by your consultation style by using a range of each hospital post
colleagues your patients evidence to demonstrate
good clinical practice Used in secondary care
MSF is similar to the The PSQ provides patient settings the Clinical
Team Assessment of feedback on your empathy CEPS demonstrates Supervisors Report
Behaviour (TAB) from the and relationship-building progress towards ideally demonstrates how
foundation curriculum. skills during consultations. competence in basic you have achieved your
The questionnaire collects The questionnaire is clinical skills and can be learning objectives. At the
colleagues opinions about taken from the ePortfolio performed with or without end of each placement
your clinical performance and given to patients by an observer. You add your Clinical Supervisor
and professional behaviour. the reception staff for these to the ePortfolio as rates you in several
Typically you email out completing after their an assessment under the areas, adding comments
ticket requests to five consultation. Evidence section or create to inform the Educational
clinicians in secondary The feedback is added to a personal learning log. Supervisors Review.
care placements or five the ePortfolio (usually by Examinations that have to
clinicians and five non- one of the practice staff) be included and observed
clinicians in primary care. and you discuss the results to a satisfactory standard
Once their responses are with your trainer. Youll are breast examinations,
in, the anonymised results need 40 responses; keep rectal and prostate
are summarised and them beyond your training examinations and the
discussed with you by your for auditing or in case of examinations of male and
Educational Supervisor. any technical issues. female genitalia. Other than
that, the choice of CEPS is
based on your needs.
Learning Logs...
14/15
... even more learning log tips
Logs can be saved before completion and can Respect patient confidentiality in your logs and
only be seen by your supervisor when you remember what you write can be accessed by
share them. a court of law.
You could make notes on your smartphone Keep a note of which out-of-hours session you
as you come across a learning point while are on and the running total.
working; this can be a great reminder later on.
You dont need to use all the Learning Log
Use everyday learning experiences or the categories. Clinical encounters should be used
topics you are reading up on as entry material. most often.
The earlier you do a log the easier it is Reflect on a significant event analysis (SEA)
plus you avoid end of placement panic and every six months, remember, these can also
concerns from your trainer. be good events.
BE PREPARED
Like everything else involving the
ePortfolio, consistency and planning
ahead is the name of the game.
16/17
Quick guide to
CCT requirements
The minimum evidence requirements described below are based on a standard three-
year specialty training programme, with 18 months of hospital posts and
18 months in general practice.
x mini-CEX
6 x mini-CEX
6 12 x CbD
(if in secondary care) / COT (if in secondary care) / COT
(if in primary care) (if in primary care) 12 x COT
x PSQ
1
clinical supervisors report
(if in primary care) from each hospital post
CEPS as appropriate
The ARCP evaluates evidence presented ARCPs are performed at least annually but can be
in your Trainee ePortfolio to formally more frequent for trainees who havent progressed
at a sufficient level and for those whose training has
assess your progress before moving on
been affected due to factors such as maternity leave
to the next training stage. The outcomes or ill health.
are recorded in your ePortfolio under
The ARCP process can seem daunting, and appear
Progress to Certification.
stressful. However, the focus really is how to ensure
It is a quantitative and qualitative assessment of trainees get the most out of their training, to prepare
professional competence and a display of reflective them to be a GP. So, although you will have to
practice and learning cycles. prepare for several throughout your training journey,
do try not to let the process worry you.
Its performed by an ARCP panel with at least three
members including regional directors, Training
Programme Directors and administrative staff.
For academic trainees an academic representative
Quality assuring the ARCP process
should be present.
RCGP External Advisors also review a random
Ultimately it is the ARCP panel that will decide 10% sample of trainee ePortfolios with a
whether you are ready to apply for a CCT at the end Satisfactory ARCP outcome as well as every
of your GP training so it should be treated seriously. ePortfolio with an Unsatisfactory outcome.
This external review ensures the panel process
is fair and in line with national guidelines.
18/19
ARCP Preparation
Before each ARCP you should ensure the following have been completed or uploaded:
Enhanced Form R A new form needs to be submitted with every ARCP Panel.
This must be completed no earlier than eight weeks before the ARCP and submitted no later than
Educational
two weeks before your ARCP date. However for administrative reasons, some deaneries and
Supervisors Report
LETBs ask for the ES Report to be submitted even earlier.
There is no minimum number of assessments required but you will be expected to discuss your learning
needs during placement planning meetings and to record your plans in the Learning Log and PDP.
CEPS
The range of examinations and procedures and the number of observations will depend on your
particular needs and the professional judgement of your Clinical and Educational Supervisors.
Summary of Review Mandatory number of completed assessments: Mini-CEXs/COTs, CbDs, MSF and PSQ.
PDPs Evidence of engagement in learning cycle.
Educators Notes Any concerns about performance as well as positive comments too.
Revalidation Any concerns raised.
Number of hours done.
Type of sessions.
Out of Hours
Learning evidence.
(OOH)
Certificate of Completion of each session uploaded and attached to a reflective learning log entry
about each of your OOH sessions.
Out of Hours (OOH) progress.
Uploaded evidence of Cardio-Pulmonary Resuscitation (CPR) and Automated External Defibrillation
(AED) update training. Minimum is once within the three years before the end of your GP training.
Advanced Life Support in Foundation Training does not count.
CSA - number of attempts, outcome.
Other
AKT - number of attempts, outcome.
Completion of compulsory local forms including trainee surveys.
Audit demonstrating completion of audit loop.
Quality Improvement Projects.
Significant Event Analysis (at least two per year).
Applied Knowledge Clinical Skills
Test (AKT) Assessment (CSA)
You can take the AKT in GPST2 or GPST3. Its three hours The CSA is designed to test your ability to appropriately
10 minutes long and has 200 multiple choice questions gather information and apply learned understanding
covering clinical medicine (80%), clinical appraisal (10%) of disease processes and person-centred care in a
and health informatics and administrative issues (10%). standardised context.
It takes place at Pearson Vue centres and you have up to four There are 13 ten-minute consultations during which you stay
attempts. The exam is available three times a year and the in a room and specifically trained and calibrated role players
dates are published on the RCGP website in the training and come in and out as your patients. The cases used in the
exams section. You must make your application during the exams are written and assessed by working GPs.
booking period approximately six weeks before the exam.
You have 10 to 15 minutes before the simulated surgery starts
Useful resources for revision to read your patient list and notes (presented on an iPad). You
GMC Good medical practice guidance: also get two minutes between each case. Copies of BNF and
www.gmc-uk.org/guidance BNFc are allowed as are sticky bookmarks to mark essential
pages beforehand. You can write the topic on your sticky
RCGP website AKT section: www.rcgp.org.uk/akt
bookmarks but nothing else.
RCGP Essential Knowledge Updates and Challenges:
Useful resources for revision
www.elearning.rcgp.org.uk
RCGP website CSA section:
NICE guidance: www.nice.org.uk/guidance
www.rcgp.org.uk/csa
SIGN guidance: www.sign.ac.uk/guidelines
( )
BNF opening chapters: www.bnf.org/products/bnf-online
The CSA fee in 2016/2017 was 1663
20/21
Less Than Taking maternity
Full-Time Training or paternity leave
Less Than Full-Time Training (LTFTT) is an option to help If you are pregnant or become pregnant as a GP trainee
those with child-caring or other responsibilities or health you should tell your programme director about it as
problems, to continue training. soon as possible as they can help you plan your
training accordingly.
Most trainees in a substantive approved post can apply for
LTFTT if they meet the eligibility criteria. However, LTFTT You should also notify RCGP Member Services as a 50%
is deanery specific and therefore not guaranteed. If you reduction from the standard AiT subscription fee can be
would like to be considered for LTFTT you have to apply applied on the next renewal, due on 1 April each year.
to your deanery programme director (Head of School,
You can suspend your AiT membership during your maternity
or Postgraduate Dean) and have a justifiable reason for
leave, though this will affect your access to trainee support
your application. Guidance on the process as well as what
such as the ePortfolio.
reasons are considered should be available from your local
training body website. At the time of writing, GP trainees are entitled to two weeks
paid paternity leave. As with maternity leave this only applies
If deemed eligible, LTFTT arrangements will be accommodated
to eligible GP trainees who have had 12 months continuous
as soon as practically possible.
NHS experience.
Assessment as an LTFTT
The timescale of the WPBA minimum evidence requirements Top Tip - The BMA website
is different for trainees who are working less than full time. has up-to-date information
about maternity and paternity benefits
LTFTTs normally take WPBA assessments on a pro rata for GP trainees at www.bma.org.uk
basis, according to the number of hours worked. However,
it may be more than the pro rata equivalent; this will depend
on your performance, progress and recommendations from
your previous review.
Youll have an Educational Supervisors Review every six
months and a review of competence progression at least
once a year.
RCGP
that there are physicians for
the body and physicians for
the soul, although the two
cannot be separated.
AND ME
Plato
The Royal College of General Practitioners (RCGP) is the membership body for general
practice and represents over 51,000 members across the UK, and overseas. It is here to
support you throughout your GP career and offers continuing professional development,
peer support and involvement in developing the profession.
While we are a national membership body we do most of our work at a local level. The
College is split into six regions, which are made up of smaller groups called faculties. The
faculties provide a forum for sharing ideas, offering mutual support and run educational
meetings and networking events.
In this chapter you can read about what the RCGP means to other trainees and the support and
opportunities available to you via your national and local AiT Committees:
Your Committee
What your membership means
22/23
Your Committee
Welcome to the start Throughout your training youll
work among many teams. One
We are aware there is still much work
to be done to support AiTs to the full
of the best job you unique team that will be with you and you have our promise that we
throughout your training is the will continue to champion the AiT
could ever have: being incredible AiT Committee. Together, perspective.
your AiT Committee has achieved a
a GP. There may be tremendous amount for the lives of
If you would like more information on
the AiT Committee or need to get in
tough times ahead but AiTs year on year. Every region has
touch with your local representative
a representative so if you ever need
please visit
we are confident that to bend an ear, seek a bit of info, or
www.rgcp.org.uk/aitcommittee
can see a way something can be done
the rewards of general better, we are here to listen and make Very best wishes,
practice will captivate positive changes. Laura and Duncan
It is genuinely a real privilege to
you and renew your represent such an amazing body Dr Laura Armitage GPST3
passion when the of professionals and we take the AiT Committee Chair (2015-2016)
responsibility of representing our Dr Duncan Shrewsbury GPST3
going gets tough. 11,000 strong AiT community seriously. AiT Committee Chair (2016-2017)
24/25
As a member of
your College:
26/27
The good physician
treats the disease;
the great physician
treats the patient
who has the disease.
William Osler
Acknowledgements
This AiT Handbook was the inspiration of the national RCGP AiT Committee in 2014. The committee wanted to ensure new GP trainees
were fully aware of the support available to them and the processes they have to follow to successfully complete their training. Crucially
the guide contains lots of tips the committee members wish they had known when starting training. [link]