4

Personal details
Name

Phone

Address

GMC number

Acknowledgement This portfolio, which is to be used across the United Kingdom for doctors in the Foundation Programme, is the result of a collaboration of many individuals and organisations across the United Kingdom. This collaboration has relied on close working between Deaneries, their educational advisers, researchers and most importantly trainers and trainees. The portfolio, based on the curriculum for the foundation years in postgraduate education and training, is designed to help the trainee by pulling together data, evidence and information including assessment and monitoring, demonstrating progress through the Foundation Programme. Thank you to all who have contributed to the Foundation Programme Portfolio, in particular, the Portfolio Management Group, Professor David Graham, Professor Derek Gallen, Ida Ryland, plus many more.
July 2007

Contents
Welcome to the Foundation Programme How to use the Learning Portfolio 5 6

Section 1: Planning your Personal Development Programme Self-appraisal and guidance forms 1.1 1.2 1.3 1.4 Completing your self-appraisal Completing your Personal Development Plan (PDP) Career management Educational agreement

8 9 9 12 15 17 18 19 20 21 22 24 25 26 27

Section 2: Structured meetings and reviews 2.1 2.2 2.3 2.4 2.5 2.6 2.7 2.8 Structured meetings and review forms Programme timetable and documents Preparing for your review what will you need? Overview of meetings in each placement Induction meeting Mid-point review End of placement final review Mid-year review of progress

Section 3: Reflective practice learning from experience 3.1 3.2 Reflective practice Self-appraisal of training

28 29 31

Section 4: Assessment of competence 4.1 4.2 Guidance on assessment and presentation of evidence Assessment tools Ai. Mini-PAT (Peer Assessment Tool) Aii. Team Assessment of Behaviour (TAB) Bi. Mini-Clinical Evaluation Exercise (Mini-CEX) Bii. Direct Observation of Procedural Skills (DOPS) C. Case-based Discussion (CbD) 4.3 4.4 Summary of evidence presented Statement of health and probity

32 33 34 36 42 43 45 47 49 55

Section 5: Sign off 5.1 5.2 Attainment of F1 competency Foundation Achievement of Competency Document (FACD)

58 59 60

Section 6: Additional evidence 6.1 6.2 6.3 6.4 Curriculum Vitae Formal educational activity and certificates Audit/research project Log book of procedures

61 62 63 64 65

Section 7: Appendices Appendix 1: Clinical Supervisors feedback report Appendix 2: Trainee-written training for assessment tools Appendix 3: Rater/assessor-written training for assessment tools Appendix 4: GMC guidance to probity and health Appendix 5: Important links

66 67 68 72 79 81

Welcome to the Foundation Programme

This portfolio is designed to help you draw together the information that will help you on the path to becoming a good doctor. With the assistance of your educational supervisor, it will help you to plan your skills development and allow you to demonstrate the attainment of the attitudes, skills and knowledge that you need to complete the Foundation Programme.

The portfolio is based on the Foundation Programme Curriculum (www.mmc.nhs.uk). We would suggest that you read this Curriculum carefully as it will help you to understand the areas that you will need to cover during your Foundation Programme, and the standards that will be expected of you.

You should also become familiar with the latest version of The New Doctor (GMC 2007), and fully understand Good Medical Practice (GMC 2006). These documents, produced by the General Medical Council, define the standards expected of all doctors during their years of training and throughout their professional life, and they form the basis of both the portfolio and the Foundation Programme Curriculum.

Although this portfolio will provide a record of your progress through Foundation, its principle purpose is to encourage the development of good practice and to this end it should be thought of as a Learning Portfolio. It provides a structure that will help you to prepare for meetings with your educational/clinical supervisors, to develop the habits of reflective learning, and to assist you in managing the process of presenting the evidence of your competence at the end of the Foundation Programme.

You have a responsibility to demonstrate that you are not only fit to practice, but that you maintain your fitness to practice through continuing professional development. This portfolio will help you do that over the next two years of your Foundation Programme.

Whilst the primary purpose of the Foundation Learning Portfolio is to assist you in recording and reflecting on your progress and achievements throughout the Foundation Programme the contents of your portfolio may also be used as part of the selection process.

How to use the Learning Portfolio

The purpose of the portfolio is to assist and document your progress through a learning programme, which your educational supervisor will help you develop. The portfolio is presented in six parts, each designed to help you complete and organise different aspects of your learning and assessment.

Section 1: Planning and managing your Foundation Programme Youll find everything you need to plan the development of your portfolio in this section; including an opportunity for self evaluation, a discussion with your educational supervisor incorporating career management, and your Personal Development Plan. This section also includes an educational agreement that must be signed by both yourself and your educational supervisor and retained within the portfolio.

Section 2: Structured meetings and review forms Here you will find the forms that mark progress through each placement; including an explanation of the formal process by which your training and learning is structured. The forms in this section of the portfolio must be completed and signed, may not be changed or adapted and should be retained within the portfolio.

Section 3: Reflective practice This section offers some examples of how you might use the experience gained during each placement to aid your learning. It must be stressed that the portfolio is not designed to be a prescriptive model that must be followed, but offers suggestions and models to assist you in developing your own approach to reflective learning.

Section 4: Presentation of evidence and assessment of competence Youll be shown the means by which you will demonstrate your progress as a doctor during, and at the end of, the Foundation Programme. It includes the formal assessments that must be completed, along with guidance as to what else you might consider submitting as evidence of your developing competence.

Section 5: Sign off There are two parts to the sign off process. Having successfully completed the first year of the Foundation Programme (F1 year) you will need to ensure that the Attainment of F1 competency is completed. This will satisfy GMC registration requirements for the issuing of the Certificate of Experience.

On the successful completion of your second year in the Foundation Programme (F2), you should ensure that the Foundation Achievement of Competency Document (FACD) is completed. This document represents formal certification of attainment of foundation competences. This will be an important part of your clinical credentials for the future.

Section 6: Additional evidence of achievement In this section you will be able to keep an up-to-date curriculum vitae, log of procedures, examples of audits you have undertaken providing a brief outline of the audit with outcome, certificates of achievement such as ALS, and also details of any presentations you have given.

REMEMBER: Your progress through the Foundation Programme will be recorded in your portfolio. The portfolio will help you plan and manage your learning; it will also demonstrate your achievements. It is your responsibility to ensure that your portfolio is up to date and contains the evidence demonstrating your achievements.

Self-appraisal and guidance forms

The forms or templates in this section of the portfolio are designed to help you identify what you need to learn during the Foundation Programme and to plan a constructive discussion with your educational supervisor. Although they will play an important part in many of the formal review meetings, none of the forms in this section are strictly compulsory or prescriptive. In fact, you are encouraged to adapt them to suit your particular educational needs, with the agreement of your educational/clinical supervisor. The exception to this rule is the Educational Agreement which must be signed by yourself and your educational supervisor and retained within your portfolio.

Within this section are templates for the: Self-appraisal tool Personal development plan Career management discussion Educational agreement.

1.1 Completing your self-appraisal

The aims of the self-appraisal are: i) To provide the means for reflection and evaluation of your current practice. ii) To inform a discussion with your educational supervisor to help you both gain insight into your understanding of your current abilities.

This self-appraisal tool is designed to assess how confident you feel when asked to perform the tasks of a Foundation Programme doctor. The information given will help to identify your strengths as a doctor and will assist you, with the help of your educational/clinical supervisor, to agree what you need to learn. You may choose to revisit the self-appraisal throughout the programme.

This self-appraisal tool will be treated as confidential and will not be part of the formal assessment of your competence. The personal development plan that you produce will be based on this and will enable the planning of how you will learn what you need to know. This need not be confidential.

It is essential for your own development that you complete this form honestly, identifying the areas where you feel your weaknesses lie and how confident you feel about undertaking the tasks required of you at this time.

Instructions for completion of the self-appraisal tool:

Look at the relevant section in the Foundation Programme Curriculum (for example section 4 Syllabus and competences 1.0 Good clinical care; 1.1 History taking, examination and record keeping skills).

Read the standards expected at F1/F2 level do you understand what is expected of you? Have you had the opportunity to practise the skills? Do you feel ready to undertake the tasks?

For each section of the curriculum headings on the form, tick the score that most reflects your feelings of confidence (for example demonstrates clear history taking and communication with patients).

Be prepared to add comments on any areas that concern you, or for which you feel you are not ready or adequately prepared. Use examples from your experience to date, where appropriate.

Take the completed document to your meeting with your educational/clinical supervisor for discussion.

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The self-appraisal
For each statement in the right hand column, tick the score that most reflects how you feel about performing each of the tasks. Scoring system: 1. Little or no experience in this area yet 2. Some experience, but not yet at the level required in the curriculum 3. Experienced and confident in demonstrating competence

Criterion
1. Good clinical care: History, examination, diagnosis, record keeping, safe prescribing and reflective practice Time management and decision making Patient safety Infection control Clinical governance Nutritional care Health promotion, patient education and public health Ethical and legal issues 2. Maintaining good medical practice: Life long learning Research, evidence and guidelines Audit 3. Teaching and training

Comments

4. Relationship with patients and communication skills 5. Working with colleagues

6. Probity, professional behaviour and personal health 7. Recognition & management of the acutely ill Clinical Resuscitation Take management Discharge planning

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1.2 Completing your Personal Development Plan (PDP)

The Personal Development Plan (PDP) is your chance to set out what you expect to achieve during each placement and throughout the year. You should develop it with your supervisor and it should be updated as often as is necessary, accepting of course that you must be able to refer back to the goals that you set yourself at the beginning.

The template provided in the portfolio is a good example to start with, but if in agreement with your educational supervisor you want to develop or adapt the form, then you are encouraged to do so. Guidance on developing and using your PDP is available in the Rough Guide to the Foundation Programme, but a very simple explanation is set out here.

What do you need to learn? The Foundation Programme Curriculum covers a very wide range of core skills, both clinical and non-clinical. Everyone will have their own strong and weak points and it is important to begin to identify what you should focus on initially. What you need to learn will change as you develop through the Foundation Programme and your experience grows, so your PDP should be updated as you make progress.

Similarly, although broad in nature, placements may offer different opportunities to gain Curriculum competences. As you consider the opportunities available to you in each placement, you should plan how you intend to make the most of them.

How was this identified? As you progress through the Foundation Programme, self evaluation, reflective practice, multisource feedback and direct assessment will all provide different perspectives on your performance and development. It is important to be aware of what information you are using when setting your learning needs, and to ensure you are not missing important feedback that may be available to you. For example, if all your learning needs originate from one feedback source it may be worth re-examining what other information is available to you.

How will this be addressed and by when? Your plan should identify what you intend to do during the year or placement, how you will develop your learning and, most importantly, how and when you will be assessed. While reflective practice is extremely important, one of the key goals of the programme is to show, through your portfolio, a series of assessments that demonstrate development against the curriculum, and progression towards competence.

12

Setting yourself a target is always a good way to ensure progress. Discuss and agree realistic and achievable targets for demonstrating progress with your educational/clinical supervisor and record them here.

Date completed If you want to use the Personal Development Plan as evidence in the assessment section of the portfolio, signature blocks have been included for your educational/clinical supervisor to sign off the fact that you have set yourself goals and seen them through. How you present your evidence of competence is up to you, but your educational/clinical supervisors will be able to help you.

13

The Personal Development Plan

Name GMC number Educational supervisor What specific development needs do I have? How will these objectives be addressed? Evaluation and outcome
(show how you have achieved your objectives)

Year Placement

F1/F2 (circle)

Date

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1.3 Career management

Effective career planning and career management support are integral parts of postgraduate medical training.

You will already be thinking about your future career pathway. There is a chance that you may not be able to enter your first choice career option and you should discuss other career opportunities with your educational supervisor, and take every opportunity to get a taste of other specialities.

Careers information may be obtained from the Postgraduate Deaneries and Medical Royal Colleges (whose websites are good sources of information), and from publications available in Postgraduate Medical Libraries (for example, BMJ Careers).

Information about specialty training, for example, higher specialist training in medicine is available from the Joint Committee on Higher Medical Training (www.jchmt.org.uk) and, for surgical specialties, from the Joint Committee on Higher Surgical Training (www.jchst.org). Contact details for the Medical Royal Colleges and specialty training bodies can be found on the website of the Postgraduate Medical Education and Training Board (www.pmetb.org.uk).

If you need impartial or confidential personal advice your local director of postgraduate education, clinical tutor or foundation programme director should be able to help. Postgraduate Deaneries will ensure that people with specific training in career management available locally. College tutors within the hospital can provide advice on careers within their own specialty.

Doctors who require guidance on training for general practice should contact the local GP course organiser, GP tutor, or director of postgraduate general practice education, who will be a member of the Postgraduate Deans department.

When you are seeking careers advice you should ensure that your portfolio is up to date as it will form the basis of any discussion about future careers. It is advisable to keep a record of discussions relating to career management to ensure that advice and recommendations are followed.

The proforma in this section will assist you in preparing for your meeting with your supervisor.

Further careers advice is available on the MMC website (www.mmc.nhs.uk).

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Reflective summary sheet on careers

A summary sheet should be completed for every post you have held. Complete sections 1 and 2 before meeting with your educational supervisor. 1. What have I learnt about myself/my career aspirations during this post? For example, which aspects of the post did you particularly enjoy? What potential specialties or subspecialties have you identified?

2. Careers information sources that I have used For example websites, postgraduate careers advisors, specialty meetings and any career planning tools such as Sci59.

3. Further action needed to confirm my specialty choice(s) or subspecialty choice This part is to be completed with the educational supervisor at after career discussion.

Signed by trainee supervisor Signature: Name (print): Date:

Signed by educational/clinical Signature: Name (print): Date:

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1.4 Educational agreement

Name of trainee: Training period From: Trust: GMC number: To: Department:

At the first meeting the foundation doctor and educational/clinical supervisor should read and sign the following educational agreement. The foundation doctor will: Take an active part in ongoing supervision and subsequent appraisal including negotiating learning outcomes and the development of a Personal Development Plan (PDP). Endeavour to achieve learning outcomes by: o regularly reviewing their PDP o utilising the opportunities for learning provided in everyday practice o attending all prescribed teaching sessions o undertaking appropriate personal study o utilising locally provided educational resources such as libraries and skills centres o using designated study leave appropriately. Developing as a life long learner through o reflecting and building upon their learning experiences o identifying their learning needs o being involved in planning their education and training o evaluating their learning experiences. The educational/clinical supervisor will: be available to, and take an active part in, the ongoing supervision and subsequent appraisal. process including negotiating educational outcomes in a Personal Development Plan. ensure that the negotiated outcomes are realistic, achievable and within the scope of available learning opportunities. ensure that the foundation doctors are made aware of sources of help and advice. promote a supportive climate for learning. ensure that an individual doctors commitments allow attendance at prescribed teaching sessions, are appropriate for their learning needs and offer an appropriate balance of education and service in their placements. We have read and understood the requirements of our roles as set out above. Signed by foundation doctor Signature: Name (print): Date: Signed by educational/clinical supervisor Signature: Name (print): Date:

17

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2.1 Structured meetings and review forms

Although the portfolio is important for your own learning, there is also a formal process that is essential for ensuring that all involved have fulfilled their responsibilities. It is considered good practice that all formal review meetings are documented, although much of the feedback and supervision will be informal. A record of progress provides important continuity between placements and supervisors. The forms in this section of the portfolio must be completed and signed, may not be changed or adapted, and should be retained within the portfolio.

The formal review process is based around the concept of one educational supervisor providing ongoing supervision for all training placements in a foundation year or even the whole Foundation Programme. Clinical supervisors will provide supervision during a specific placement.

The precise arrangements will vary widely in foundation schools in different parts of the country. As a result, these roles may not always be distinct, or they may change with each placement. For example, the educational and clinical supervisors may be the same person and may change with each placement. The important part is that whatever structure is in place in your foundation school, and regardless of how many informal or ad hoc discussions take place with your supervisor, the formal review intervals set out in this section should take place and be carefully documented.

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2.2 Programme timetable and documents

The training programme follows a cycle that is repeated in each placement. All the documents from each placement will be presented to a panel of assessors for review. Foundation year Doctor in training
Educational supervisor and learner

Educational agreement signed. First week in placement Review curriculum and complete. self-appraisal material. Summary of educational review completed. Development plan completed. Continue reflective practice Thereafter and gathering evidence for competency assessment. Portfolio reviewed. Development plan amended. Mid point review form completed.

Mid-point of placement

Continue reflective practice and Thereafter gathering evidence for competency assessment. Final week in placement End of self-evaluation of training. Progress reviewed. Final placement review form completed.

Portfolio reviewed. Progress discussed with educational Mid-year review supervisor. Mid year review of progress form completed.

Completion of year

F1 competency or FACD form completed.

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2.3 Preparing for your review what will you need?

Initial meeting with the educational supervisor Foundation Programme Portfolio Diary and rota (to arrange subsequent appointments) Educational agreement form Self-appraisal Form Personal Development Plan Careers summary sheet

Induction meeting with clinical supervisor* Diary and rota (to arrange subsequent appointments) Personal Development Plan Self-appraisal form (completed)
*Where the educational and clinical supervisors are the same, this need not be a separate meeting.

Mid-point review* Foundation Programme Portfolio Diary and Rota (to arrange subsequent appointments) Personal Development Plan Structured Appraisal Form Careers Summary Sheet
*The mid-point review is not mandatory but strongly encouraged, particularly if you or your supervisor have concerns.

End of placement review Foundation Programme Portfolio Personal Development Plan Careers summary sheet End of placement self-appraisal of training Self-appraisal form Final review form Mid-year review of progress* Foundation Programme Portfolio Personal Development Plan Structured appraisal form
The mid-year review of progress is not mandatory but strongly advised to review satisfactory progression through the programme. This review is undertaken by your educational supervisor.

End of year review Foundation Programme Portfolio (complete and up to date) Assessment panel report

An explanation of the role of each of these meetings and some guidance as to how to approach them is set out overleaf, followed by examples of each form required.

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2.4 Overview of meetings in each placement

A. Initial meeting with your educational supervisor The educational supervisor is the consultant or general practitioner supervisor who will have overall responsibility for supervising all your placements during either F1 or F2 year, or both. You should aim to meet with your educational supervisor at the beginning of each placement to review your progress and update your Personal Development Plan. It is your responsibility to arrange this meeting. The initial meeting with the educational supervisor will be your first chance to identify the opportunities presented by your F1 or F2 placements for helping you progress in your training. The completed self-appraisal form will provide insight into which areas of the curriculum you feel either confident or uncertain. This may help to indicate the areas you need to concentrate on at the start of the placement. The meeting should culminate in the agreement of a Personal Development Plan that sets out how you will approach your learning during the next placement and the year ahead. It should be an exploration of your progress in the Foundation Programme so far and determine what specifically needs to be learned in this placement and how it will occur. It may be recorded in the Personal Development Plan documentation provided in the portfolio, or a development of it as agreed with the educational supervisor. Discussion should also touch on career management and guidance, and should consider what your initial needs may be, your possible career intentions, and what you want to get out of the Foundation Programme to help you understand your future career choices. Both trainee and educational/clinical supervisors should complete and sign the educational agreement form (example on page 17).

B. The placement induction meeting This should be conducted by the educational/clinical supervisors within one week of you taking up your placement (or as soon as possible). Where the educational and clinical supervisor is the same person, there need not be a separate meeting. It will consist of a review of your Personal Development Plan including the self-appraisal. It should focus on the opportunities that exist in the particular placement and how they will be tackled.

Both trainee and trainer should complete and sign the induction meeting form (example on page 24).

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C. The mid-point review not compulsory but strongly advised This should be conducted by the educational/clinical supervisors approximately half way through the placement. It will briefly review progress to ensure your training is on course, that an appropriate number and range of assessments have been undertaken and that you have attended adequate educational opportunities.

The mid-point review is not mandatory but strongly encouraged, particularly if you or your supervisor have concerns. Both trainee and trainer should sign the mid-point review form provided (example on page 28). D. The final review of each four-month placement This should be conducted by the Educational/Clinical Supervisor, at the end of each four or six month placement. This review should examine the assessments undertaken and the reflective practice recorded, and compare it against the objectives that you agreed in the Personal Development Plan at the beginning of the placement. Additionally you may want to revisit the self-appraisal form to see how your estimation of competence has developed.

This review may highlight concerns that have emerged, either through the placement, or where assessments have identified specific areas for development. The review form should outline what additional work and assessment are required to address shortcomings in performance during the next placement, including additional assessments where necessary to substantiate an improvement in performance.

If significant concerns have been highlighted in the final review form, the Foundation Programme training director should be informed. E. The mid-year review of progress The mid-year review of progress is not mandatory but strongly advised to review satisfactory progression through the programme. This meeting is conducted by your educational supervisor who will review your portfolio and review your progress in the Foundation Programme. This is also an opportunity for discussions relating to your personal development and future career planning.

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2.5 Induction meeting

Induction meeting (to take place within two weeks of starting the placement) Name of trainee: Training period From: Trust: GMC number: To: Department:

Give a brief description of the placement: for example general practice in rural setting; haematology in university teaching hospital 1. Are there any induction considerations to be taken into account? Such as duties of the placement(s), arrangements for clinical supervision, academic and welfare support, learning resources and facilities available.

2. Are there any specific competences the trainee has set out in their Personal Development Plan to develop during this placement?

3. What learning methods will be used and how will these be assessed? (See Section Four: Assessment of Competences

Signed by trainee Signature: Name (print): Date:

Signed by educational/clinical supervisor Signature: Name (print): Date:

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2.6 Mid-point review

The mid-point review is not mandatory but strongly encouraged, particularly if you or your supervisor have concerns. Name of trainee: Training period From: Trust: GMC number: To: Department:

1. What evidence is there that the trainee is making progress in line with their Personal Development Plan (PDP)/induction meeting discussion (for example assessments)?

2. What areas still need to be addressed?

3. Has any assessment or aspect of performance highlighted any concerns which should be addressed within the PDP?

Further explanatory comments:

Signed by trainee Signature: Name (print): Date:

Signed by educational/clinical supervisor Signature: Name (print): Date:

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2.7 End of placement final review

Final review to take place at least two weeks before end of placement
Name of trainee: Training period From: Trust: GMC Number: To: Department:

Please check that you have completed the following (delete as appropriate): Trainees Portfolio has been reviewed Induction meeting took place Date: Induction meeting was recorded Midpoint assessment took place Date: Midpoint assessment was recorded Attendance records are available for Foundation Education Programmes in Trust and Department? Assessment of competences 1. Has the trainee completed competence assessments in line with the Curriculum guidelines? (delete as appropriate) Mini-CEX Yes / No Case-based discussions (CbD) Yes / No DOPS Yes / No Multi-source feedback mini PAT, TAB Yes / No 2. Has any assessment or aspect of performance highlighted areas of concern during the placement and how has this been addressed? Yes / No Yes / No Yes / No Yes / No Yes / No Yes / No

3. If these have not been addressed, please detail the specific action(s) to be taken in the next placement:

4.

Are additional assessments required to substantiate improvement? If so, please specify:

Signed by trainee Signature: Name (print): Date:

Signed by educational/clinical supervisor Signature: Name (print): Date:

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2.8 Mid-year review of progress

The mid-year review of progress is not mandatory but strongly recommended

Name of foundation doctor: Training period From: Trust:

GMC number: To: Department:

1. What evidence is there that the foundation doctor is making satisfactory progress in line with the requirements of the Foundation Programme?

2. What areas still need to be addressed?

3. Have any assessments or aspects of performance highlighted any concerns which should be addressed?

Further comments/recommendations:

Signed by Foundation doctor Signature: Name (print): Date:

Signed by educational supervisor Signature: Name (print): Date:

27

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3.1 Reflective practice: learning from experience

Good reflective practice is a core part of any learning programme. Being able to identify your challenges and discuss them with your supervisor will help you define future learning opportunities and apply what youre learning in the work environment.

There is no requirement for any of your reflective practice material to be included in your evidence of competency, but you can include it as an example of learning development if you wish.

There are two templates set out in this section: The first has been designed to help you think about your experience in the work place in a structured way, capturing the elements of that experience most pertinent to learning and development. The second has been designed to help you think about your last placement, what you learned in that placement, how it may have differed from your expectations and if/how it has affected your thoughts for career direction.

Neither of the templates are meant to be prescriptive. The key is to find a method that works for you which can be easily managed in the workplace. Consider the templates a prompt for the kinds of things you should be thinking about dont feel constrained by them.

Be mindful of the confidential nature of what you may be recording and who may have access to it if left unattended in a busy workplace environment. Most of all, however, ensure you make the most of this important learning opportunity.

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Reflective practice
Name of foundation doctor: Training period From: Trust: GMC number: To: Department:

Try to put time aside each day to reflect on the days learning opportunities and identify any further learning needs. You can use this template to record a variety of situations, including, for example, educational, clinical, ethical, legal, or personal experiences. Use the list of questions to aid your reflective writing. You can download a copy of this form from the CD, or from the website, www.mmc.nhs.uk. Describe interesting, difficult or uncomfortable experiences. Try to record both positive and negative elements. 1. What made the experience memorable? 2. How did it affect you? 3. How did it affect the patient? 4. How did it affect the team? 5. What did you learn from the experience and what (if anything) would you do differently next time?

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3.2 Self-appraisal of training

Evaluating your learning experience
1. What did you find the most valuable learning experiences and how did they match your needs? What areas did you find the most challenging?

2. What feedback did you get from your supervisors to help you meet your objectives?

3. Has your placement differed from your expectations? Has it changed your ideas or thoughts on a career direction? If so, how?

4. In light of your experiences, how will you adapt your PDP?

5. What (if any) study/formal education did you undertake during the Foundation Programme? What were some of the key things you got from the training?

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4.1 Guidance on assessment and presentation of evidence

Learning during the Foundation Programme should be trainee led and evidence based. You must be able to collect all the evidence you need to demonstrate to your supervisors and the assessment panel that you have developed your learning against the competencies set out in the Foundation Programme Curriculum.

There are currently four types of Foundation Programme Assessment that you are required to undertake. You may, however, also want to consider submitting project work, course certificates, personal references, or excerpts from reflective practice.

You should ensure you are familiar with the education and assessment section of the Curriculum (Section 3). This provides guidance as to how many assessment forms should be completed.

Some individuals may need to submit additional assessments to satisfy their supervisors of competence in a specific area: for example, a trainee struggling with safe prescribing may choose to submit additional CbD forms to substantiate their improvement in performance, and eventual achievement of F2 competence. Doing more than the recommended guidelines is fine; doing less may well raise questions from your educational/clinical supervisors and may jeopardise your ability to present a sound case of competence at the end of your Foundation Programme.

Also in this section is the GMCs statement of health and probity. As well as being an important part of the Curriculum, this form is an ongoing requirement for all doctors to keep in their portfolio. You can get advice on completing this form from your educational supervisor, or from the GMC website.

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4.2 Assessment tools

The Foundation Programme Curriculum sets out the requirement to use a series of assessment tools. There will be some variation as to exactly which tools will be used in your foundation school, but you will be advised accordingly.

Extensive guidance is available in the Curriculum and in the Foundation Programme Rough Guide, but a brief summary of the tools and how they are to be used is set out below. Further information on the tools is also available on the HCat (Healthcare Assessment and Training) website - www.hcat.nhs.uk.

Additional guidance for those conducting the assessments is set out in the appendices of this portfolio.

A.

Multi-Source Feedback (MSF)

i) mini-Peer Assessment Tool (mini-PAT) or ii) Team Assessment of Behaviour (TAB) Previously described as 360 assessment, these are collated views from a range of co-workers. Multi-source feedback (MSF) should usually take place once a year, unless concerns are identified. The foundation doctor should nominate 12 raters/assessors for mini-PAT or ten for TAB. Most raters/assessors should be supervising consultants, GP principals, specialist registrars and experienced nursing or allied health professional (AHP) colleagues. Raters may also carry out unscheduled assessments. If using mini-PAT the foundation doctor will also complete a mini-PAT Self assessment form.

mini-PAT or TAB, or indeed both forms of multi-source feedback, may be used in your foundation school. Guidance as to which is appropriate for you to use and the exact process by which they are operated will be available locally.

B.

Direct observation of doctorpatient encounters

i) mini Clinical Evaluation Exercise (mini-CEX) This is an assessment of an observed clinical encounter with immediate developmental feedback. A minimum of six observed encounters suggested in both F1 and F2. mini-CEX is one form of observed clinical encounter.

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A different observer/assessor should be used for each mini-CEX, wherever possible. Observers/assessors may be experienced SpRs, consultants or GP principals and should include the educational supervisor. Each mini-CEX represents a different clinical problem, sampling each of the acute care categories listed in Section 4 of the Curriculum. The foundation doctor chooses the timing, problem and observer/assessor.

ii) Direct Observation of Procedural Skills (DOPS) This is a structured checklist for assessing practical procedures. DOPS is another doctor-patient observed encounter and could replace, or run parallel to, mini-CEX. Two observed procedures are suggested per placement. Different observers/assessors should be used for each encounter, wherever possible Observers/assessors may be consultants, GPs, SpRs, suitable nurses or allied health professionals. Each DOPS should represent a different procedure, sampling from the acute care skills listed in Section 3 of the Curriculum, or from procedures specific to the specialty. The foundation doctor chooses the timing, procedure and observer/assessor. Observers/assessors may also carry out unscheduled assessments.

C. Case-based Discussion (CbD) This is a structured discussion of clinical cases managed by the foundation doctor. Its strength is assessment and discussion of clinical reasoning. A structured discussion takes place of real cases in which the foundation doctor has been involved. Decision-making and reasoning can be explored in detail.

D. Clinical Supervisor Feedback Report In addition to the assessment tools above, your Foundation Programme assessment process may well include a clinical supervisor feedback report. This is available in Section 7, Appendix 1.

Feedback and debriefing A key component of the assessment process is the provision of feedback and debriefing. This is required to outline the views of observers and assessors to doctors in the Foundation Programme. Giving and receiving feedback, which highlight both success and difficulty, are a vital part of and will enhance your learning and development.

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Aii) MULTI-SOURCE FEEDBACK: 360 Team Assessment of Behaviour (TAB)

Name of doctor in training Current post GMC number Date started current post

Please use the comments boxes to commend good behaviour and to describe any behaviour which is causing you concern. Give specific examples. This form will be sent to the foundation doctors educational supervisor, who may ask you privately to enlarge on any concern behaviour you report. At least nine other forms will also be considered. The foundation doctor will receive private feedback, but you will not be identified in person without advance discussion with you. No concern You have some concern You have a major concern COMMENTS: Anything especially good? If you cannot give an opinion due to lack of knowledge of the foundation doctor say so here. You must specifically comment on any concern behaviour and this should reflect the trainees behaviour reflect trainees behaviour over time not usually just a single incident.

Attitude and/or behaviour

Maintaining trust/professional relationship with patients Listens. Is polite and caring. Shows respect for patients' opinions, privacy, dignity, and is unprejudiced. Verbal communication skills Gives understandable information. Speaks good English, at the appropriate level for the patient. Team-working/working with colleagues Respects others roles, and works constructively in the team. Hands over effectively, and communicates well. Is unprejudiced, supportive and fair. Accessibility Accessible. Takes proper responsibility. Only delegates appropriately. Does not shirk duty. Responds when called. Arranges cover for absence. Name of assessor: Post/designation:

Signature:

Date:

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4.3 Summary of evidence presented

You will be assessed in the areas of competence listed in the table below. You can choose how you wish to demonstrate that you have achieved this competence, but we have suggested some assessment tools below that may help you to prove you have achieved that level of competence. For a full explanation of the competencies listed below, refer to Section 4 in the Foundation Programme Curriculum. The Curriculum structure mirrors the GMCs Good Medical Practice (2007).

You need to start planning how you will present your competences. Indicate what evidence you have included in your portfolio to support your learning and in the right hand column indicate the date when the competence was achieved.

1. Good clinical care

Competence 1.1 Demonstrates the knowledge, attitudes, behaviours, skills and competences to be able to take a history and examine patients, prescribe safely and keep an accurate and relevant medical record. (i) History taking (ii) Examination (iii) Diagnosis and clinical decisionmaking (iv) Safe prescribing (v) Medical record-keeping, letters, etc 1.2 Demonstrates appropriate time management and organisational decision-making. 1.3 Understands and applies the basis of maintaining good quality care and ensuring and promoting patient safety. (i) The patient as centre of care (ii) Makes patient safety a priority in own clinical practice. (iii) Understands the importance of good team working for patient safety (see 5.0) (iv) Understands the principles of quality and safety improvement.
Examples of suggested assessment tools What evidence will you present to support your development in this area of competence? Date achieved

Mini-CEX CbD Mini-CEX CbD CbD CbD CbD MSF CbD

Mini-CEX CbD CbD MSF MSF CbD CbD MSF

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(v) Understands the needs of patients who have been subject to medical harm or errors. 1.4 Demonstrates the knowledge, skills, attitudes and behaviours to reduce the risk of cross-infection. 1.5 Understands that clinical governance is the over-arching framework that unites a range of quality improvement activities. This safeguards high standards of care and facilitates the development of improved clinical services. 1.6 Demonstrates the knowledge, skills, attitudes and behaviours to ensure basic nutritional care. 1.7 Demonstrates the knowledge, skills, attitudes and behaviours to be able to educate patients effectively. (i) Educating patients about: disease prevention, investigations and therapy (ii) Environmental, biological and lifestyle risk factors (iii) Smoking (iv) Alcohol (v) Epidemiology and screening 1.8 Demonstrates the knowledge and skills to cope with ethical and legal issues which occur during the management of patients with general medical problems. (i) Medical ethical principles and confidentiality (ii) Valid consent (iii) Legal framework of medical practice

CbD

DOPS Mini-CEX MSF CbD Reflective content of portfolio

Mini-CEX CbD

Mini-CEX CbD Mini-CEX CbD Mini-CEX CbD Mini-CEX CbD Mini-CEX CbD

CbD, MSF CbD CbD DOPS

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2. Maintaining good medical practice

(i) Demonstrates the knowledge, attitudes, behaviours, skills and competences needed to start self-directed life-long learning (ii) Demonstrates knowledge, skills, attitudes and behaviours to use evidence and guidelines that will benefit patient care. (iii) Demonstrates the knowledge, skills, attitudes and behaviours to use audit to improve patient care MSF Reflective content of portfolio MSF CbD

Involvement in audit (report should be included in Foundation Learning Portfolio)

3. Teaching and training

Demonstrates the knowledge, skills, attitudes and behaviours to undertake a teaching role (i) Teaching (i) Presentations Demonstrates the knowledge, skills, attitudes and behaviours to be able to communicate effectively with patients, relatives and colleagues in the circumstances outlined below (i) Within a consultation (ii) Breaking bad news (iii) Complaints

MSF MSF

4. Relationships with patients and communications skills

Mini-CEX MSF Mini-CEX MSF Mini-CEX CbD MSF

5. Working with colleagues

Demonstrates effective teamwork skills within the clinical team and in the larger medical context. (i) Communication with colleagues and teamwork (ii) Interface with different specialties, and with other professionals, including: members of a team, clinical team and support services, hospital and GP, hospital and other agencies, e.g. social services, police (ii) Relevance of outside bodies

MSF CbD

CbD

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6. Professional behaviour and probity

Develops the knowledge, skills, attitudes and behaviours to always act in a professional manner (i) Doctor-patient relationships

(ii) Health and handling stress 7.1 Core skills in relation to acute illness (i) Promptly assesses the acutely ill or collapsed patient (ii) Identifies and responds to acutely abnormal physiology (iii) Where appropriate, delivers a fluid challenge safely to an acutely ill patient (iv) Reassesses ill patients appropriately after starting treatment (v) Requests senior or more experienced help when appropriate (vi) Undertakes a secondary survey to establish differential diagnosis (vii) Obtains an arterial blood gas sample safely, and interprets results correctly (viii) Manages patients with impaired consciousness, including convulsions (ix) Uses common analgesic drugs safely and effectively (x) Understands and applies the principles of managing a patient following self-harm (xi) Understands and applies the principles of management of a patient with an acute confusional state or psychosis (xii) Ensures safe continuing care of patients on handover between shifts, on call staff or with hospital at night team by meticulous attention to detail and reflection on performance (xiii) Considers appropriateness of interventions according to patients wishes, severity of illness and chronic or co-morbid diseases

mini-CEX DOPs CbD MSF MSF

7. Recognition and management of the acutely ill

mini-CEX CbD mini-CEX CbD mini-CEX DOPS mini-CEX CbD mini-CEX MSF mini-CEX CbD DOPS CbD mini-CEX CbD mini-CEX CbD mini-CEX CbD mini-CEX CbD

mini-CEX CbD

mini-CEX CbDs

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7.2 Demonstrates the knowledge, competences and skills to be able to recognise critically ill patients, take part in advanced life support, feel confident to initiate resuscitation, lead the team where necessary and use the local protocol for deciding when not to resuscitate patients (i) Resuscitation Certificates of completion of Intermediate Life Support Course or Advanced Life Support (or equivalents) mini-CEX CbD CbD MSF

(ii) Discusses Do Not Attempt Resuscitation (DNAR) 7.3 Demonstrates the knowledge, competences and skills to be able to function safely in an acute take team 7.4 Demonstrates the knowledge and skills to be able to plan discharge for patients, starting from the point of admission and taking into account the effects of any chronic disease 7.5 Demonstrates the knowledge and skills to be able to select, appropriately request and accurately interpret reports of the frequently used investigations listed below. For all investigations it is vital that foundation doctors recognise abnormalities which need immediate action. (i) Full blood count Urea and electrolytes Blood glucose Cardiac markers Liver function tests Amylase Calcium and phosphate Coagulation studies Arterial blood gases Inflammatory markers (ii) 12 lead ECG (iii) Peak flow, spirometry (iv) Chest X-ray Abdominal X-ray Trauma radiography Ultrasound, CT and MRI (v) Microbiological samples

MSF

CbD

CbD CbD CbD

CbD

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8. Practical procedures
F1 Procedures that F1 doctors should be competent and confident to do and teach to undergraduates Procedure Venepuncture and IV cannulation Local anaesthetics Arterial puncture in an adult Blood cultures from peripheral and central sites Subcutaneous, intradermal, intramuscular and intravenous injections IV medications Intravenous infusions, including the prescription of fluids, blood and blood products ECG Spirometry and peak flow Urethral catheterisation Airway care, including simple adjuncts Nasogastric tube insertion
Competent and confident to do with or without supervision (please specify): Comment:

Date achieved

F2
During F2, doctors are expected to maintain and improve their skills in the above procedures. By the end of the year, they should be able to help others with difficult procedures and guide F1 doctors in teaching others. Foundation doctors will be able to extend the range of procedures they can do. Each specialty will specify an appropriate range of procedures in which foundation doctors will be expected to become proficient, e.g. Competent and confident to do with or Date achieved Procedure
without supervision (please specify): Comment:

Aspiration of pleural fluid or air Skin suturing Lumbar puncture Insertion of a central venous pressure line Aspiration of a joint effusion

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4.4 Statement of health and probity

The General Medical Council (GMC) introduced legislation in 2003 that requires all medical doctors who wish to remain on the GMC Medical Register to be revalidated every five years. This means that every five years the GMC will assess your fitness to practise, and in doing so will consider whether to renew your licence to practise as a medical doctor in your current field of medicine.

In your Foundation Programme training you will learn the importance of maintaining evidence that will help you understand the future requirements laid down by the General Medical Council to maintain an up-to-date revalidation folder in the years following foundation studies.

All doctors, including those in training, must have integrity and honesty, and must take care of their own health and well-being so as to not put patients at risk. This is clearly laid out in Good Medical Practice (GMP). You must read the relevant sections of GMP before completing the self-declaration forms for health and probity below.

Good Medical Practice can be found on the General Medical Council's (GMC) website (www.gmc-uk.org) and copies of the relevant extracts can be found in Section 7, Appendix 4. Help on completing the form is also available on the GMC website.

Probity
Procedure 1. For revalidation purposes, it is sufficient to provide a self-declaration about how effectively you are meeting good practice standards of probity in matters which might affect your fitness to practice medicine. You must disclose information that relates to events within the whole of your current appraisal/revalidation cycle.

2. You are not obliged to use any of these pro-forma products as a revalidation self-declaration. You may, if you wish, present evidence of your probity in some other way. However, the GMC have tested the forms and know that they are suitable tools to use. As the GMC have not been able to test or verify the other products or formats that may be used, using them could increase the chance that you will be asked for additional information and/or evidence. This could mean that your revalidation may take more time.

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Guidance Paragraphs 56 to 76 of Good Medical Practice (see Section 7, Appendix 4) provides a list of professional obligations that you should consider when signing a declaration on probity. There are, of course, other types of obligations/information that you should also consider, for example, any form of disciplinary, regulatory or criminal procedures that have been applied to you, or which you know are in progress or pending.

Health
Procedure 1. For revalidation purposes, it is sufficient to provide a self-declaration about how effectively you are ensuring that your personal health does not affect your fitness to practice medicine. You must disclose information that relates to your health over the whole of your current appraisal/revalidation cycle.

2. You are not obliged to use any of these pro-forma products as a revalidation self-declaration. You may, if you wish, present evidence of your health in some other way. However, the GMC have tested the forms and know that they are suitable tools to use. As the GMC have not been able to test or verify the other products or formats that may be used, using them could increase the chance that you will be asked for additional information and/or evidence. This could mean that your revalidation may take more time.

Guidance Paragraphs 77 to 79 of Good Medical Practice (see Section 7, Appendix 4) set out some of the health obligations that you should consider when signing a declaration. There are other types of obligations/information that you should also consider, for example, your own assessment of your health and whether there are any formal or voluntary restrictions to your practice because of illness or a physical condition. This would include any conditions imposed by an employer or contractor of your services, any proceedings under the GMCs Health Procedures or Health Committee or similar proceedings of other professional regulatory or licensing bodies within the UK or abroad.

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Probity declaration
Professional obligations
I accept the professional obligations placed upon me in paragraphs 59 to 76 of Good Medical Practice. Signature Date Name in capitals.

Convictions, findings against you and disciplinary action

Since my last appraisal/revalidation I have not, in the UK or outside: Been convicted of a criminal offence nor do I have proceedings pending against me. Had any cases considered by the GMC, other professional regulatory body, or other licensing body nor do I have any such cases pending against me. Had any disciplinary actions taken against me by an employer or contractor, or have had any contract terminated or suspended on grounds relating to my fitness to practise.

Signature Date Name in capitals.

IMPORTANT NOTE: If you are unable to sign both of the above declarations then you must complete the rest of the form which is available on the GMC website.

Health declaration
Professional obligations
I accept the professional obligations placed upon me in paragraphs 77 to 79 of Good Medical Practice. Signature Date Name in capitals.

Regulatory and voluntary proceedings

Since my last appraisal/revalidation I have not, in the UK or outside: Been the subject of any health proceedings pending against me by the GMC, other professional regulatory body, or other licensing body Been the subject of medical supervision or restrictions (whether voluntary or otherwise) imposed by an employer or contractor resulting from any illness or physical condition.

Signature Date Name in capitals.

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5.1 Attainment of F1 competency

(To satisfy GMC requirements for registration for issuing of Certificate of Experience)
Name of foundation doctor Trust Placement 1 specialty Placement 2 specialty Placement 3 specialty *Placement 4 specialty GMC number Start date Educational/clinical supervisor Educational/clinical supervisor Educational/clinical supervisor Educational/clinical supervisor

(* if required) Documentation to be considered: a) Portfolio b) Attendance at formal teaching sessions c) Record of study leave d) Record of sickness 1. Has the trainee developed an up-to-date portfolio? 2. Has the trainee completed the required assessments in each of the three posts? 3. Has the trainee met the requirements laid down by the GMC, The New Doctor and the Foundation Programme Curriculum for F1?
Additional comments from educational supervisor:

YES/NO YES/NO YES/NO

Additional comments from foundation doctor:

I confirm that Dr competences required of F1 foundation training. Signed: Date:

has satisfactorily demonstrated the

(educational supervisor/assessment panel/external assessor) (Delete as appropriate)

Final decision by foundation school director

Dr
Delete as applicable has ACHIEVED

(foundation doctor) the requirements of the Foundation Programme

Comments:

has FAILED TO ACHIEVE

the requirements of the Foundation Programme

Further training agreed/action taken (this should include referral to the Deanery):

Name: Name:

Signature: Signature:

(Foundation School Director) Date: (Foundation Doctor)

Date:

This document should be sent to your Deanery/foundation school and a copy placed in your Learning Portfolio.

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5.2 Foundation Achievement of Competency Document (FACD)

Name of foundation doctor Trust Placement 1 specialty Placement 2 specialty Placement 3 specialty *Placement 4 specialty GMC number Start date Educational/clinical supervisor Educational/clinical supervisor Educational/clinical supervisor Educational/clinical supervisor

(* if required) Documentation to be considered: a) Portfolio b) Attendance at formal teaching sessions c) Record of study leave d) Record of sickness 1. Has the trainee developed an up-to-date portfolio? 2. Has the trainee completed the required assessments in each of the three posts? 3. Has the trainee met the requirements laid down by the GMC, The New Doctor and the Foundation Programme Curriculum?
Additional comments from educational supervisor:

YES/NO YES/NO YES/NO

Additional comments from foundation doctor:

I confirm that Dr competences required of foundation training. Signed: Date:

has satisfactorily demonstrated the

(educational supervisor/assessment panel/external assessor) (Delete as appropriate)

Final decision by foundation school director

Dr
Delete as applicable has ACHIEVED

(foundation doctor) the requirements of the Foundation Programme

Comments:

has FAILED TO ACHIEVE

the requirements of the Foundation Programme

Further training agreed/action taken (this should include referral to the Deanery):

Name: Name:

Signature: Signature:

(Foundation School Director) Date: (Foundation Doctor)

Date:

This document should be sent to your Deanery/foundation school and a copy placed in your Learning Portfolio.

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Additional evidence of achievement

In this section you will be able to keep an up-to-date curriculum vitae, certificates of achievement such as ALS, log of procedures, examples of audits you have undertaken (providing a brief outline of the audit with outcome), details of any presentations you have given, attendance at educational activities and meeting/conference attendance.

You may wish to use the forms in this section to provide evidence of your educational activites or develop your own with your supervisor.

6.1 Curriculum vitae

Develop and maintain an up-to-date structured curriculum vitae keeping a shortened version containing relevant bullet points in your portfolio.

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6.2 Formal educational activity and certificates

Formal educational activity may include things like: formal training sessions, lectures, study leave courses, conferences, work based projects, audits, open learning activities, and other areas of excellence/leadership/teamwork. Keep copies of important certificates in this section. Remember that original copies are often requested for verification purposes. Date(s) Title/subject Nature of the activity

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6.3 Audit/research project

Name of trainee: Training period From: Trust: GMC Number: To: Department:

This form should be completed for each audit/research project that you undertake, whether the project is completed or not.

What was the audit/research topic and why did you choose it?

What were the major findings and what changes to practice do they suggest?

How can a change in practice be implemented?

What have you learned from this audit/research?

Further training/educational needs identified by this audit/research:

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6.4 Log-book of procedures

Name of trainee: Training period From: Trust: GMC number: To: Department:

A log-book of procedures gives you the opportunity to show how many specific procedures you have completed in your Foundation Programme. This is especially useful for specific skills that may be required in your chosen career pathway. Date(s) Procedure With or without assistance

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Appendix 1
(Seek advice from your educational supervisor as to whether this form is required at your foundation school)

Clinical supervisors feedback report

(To be completed at the end of the placement by clinical supervisor and forwarded to foundation doctor's named educational supervisor.)

Name of foundation doctor: Educational supervisor: Consultant clinical supervisor: Speciality firm: NHS trust: Attendance: Satisfactory Unsatisfactory Clinical assessment grades: 6= 2= 1= Excellent 5= Very Good

F1 / F2 (delete as appropriate)

Dates: Comment:

4=

Good

3=

Satisfactory (bare pass)

Poor performance (further experience in this subject is desirable) Unsatisfactory performance (further experience in this subject is strongly recommended)

The grades should be allocated based on a combination of performance throughout the four-month placement.

Please insert grades for each of the following: Area Grade Comments
Clinical work Theoretical knowledge Time management Attitude/behaviour/ organisational skills Interest Overall grade Any helpful suggestions:

Do you have any specific concerns?

Clinical supervisor: Signed: Educational supervisor: Signed: Foundation doctor: Signed:

Print name: Print name: Print name:

Date: Date: Date:

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Appendix 2: Trainee-written training for assessment tools

mini-PAT (Peer Assessment Tool) TRAINEE GUIDANCE What is the mini-PAT? mini-PAT provides feedback from a range of co-workers across the domains of Good Medical Practice. These can be mapped to the core objectives of the Foundation curriculum. PMETB and GMC have identified peer ratings as suitable for postgraduate assessment and revalidation evidence. A number of groups have been involved in developing and evaluating multi-source feedback tools (MSF). The tool being evaluated for this project for use in Foundation training assessment, mini-PAT (Peer Assessment Tool) builds on this work. It is derived from the Sheffield Peer Review Assessment Tool (SPRAT) and has been shortened on the basis of content validity in relation to the MMC curriculum. Who should you ask to assess you? You need to provide the names and contact details of 12 healthcare professionals (any doctor, nurse or allied healthcare professional) to assess you using mini-PAT. Your current supervising consultant must be one of the assessors. You should choose a range of raters from the different healthcare professionals and across the grades in Medicine. mini-PAT has not been designed for completion by patients or administrative staff. Please use the Rater Nomination Form provided. Discuss with your raters the fact that you have nominated them and let them know that you would really appreciate them taking the time to complete the form and provide you with honest feedback. e.g. Name Miss Jackie Rogers Dr Richard Kilrack-Silk Position (title) Staff Nurse Consultant Dermatologist Contact Address Ward C3, Royal Holby City Hospital, Loathsome, Berkshire Dermatology Department, Royal Holby City Hospital, Loathsome, Berkshire

Self mini-PAT Please complete the self-assessment form. The questions are identical to those in the mini-PAT form that will be sent to your nominated raters. Try to reflect on the areas that you feel are going well as well as those that you hope to get better at. Try to think of ways in which you think you could perform better. Basic Data Form Please complete the basic data form. This is to collect demographic data about you that can be used to explore potential sources of bias within the assessment system as part of the quality assurance process. What next? Please return all three forms (rater nomination form, self mini-PAT and basic data form) to your Foundation Programme Co-ordinator. You need do nothing more. Your raters will be contacted directly.

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mini-CEX (Clinical Evaluation Exercise) TRAINEE GUIDANCE What is the mini-CEX? mini-CEX is designed to provide feedback on skills essential to the provision of good clinical care by observing an actual clinical encounter. In keeping with the Foundation Programme quality improvement assessment model, strengths, areas for development and agreed action points should be identified following each mini-CEX encounter. This form samples a range of areas within the Foundation curriculum and can be mapped to Good Medical Practice but was designed originally by the American Board of Internal Medicine. Who should you ask to assess you? You need to get at least six different doctors (experienced SpRS, Specialist Associate/Staff Grades, consultants or GPs) to assess you by the end of your rotation, i.e. spread them out over the different posts. You should try to include the supervising consultant in each post. Please complete the forms in order so that your progress can be evaluated. What should you be assessed doing? mini-CEX is suitable for use in a community-based, out-patient, in-patient or acute care setting. It is designed to provide feedback that should be of help to you. Therefore, you should be assessed undertaking the actual clinical encounters normally expected of you, such as clerking in a new patient. It is important that you choose different cases that cover the main areas of the curriculum in order to assess its contents. The main areas are: airway, breathing, circulation, neurological, psychological/behavioural and pain. For more information, refer to the Curriculum document on the MMC website at www.mmc.nhs.uk. When should you use mini-CEX? mini-CEX can be used at any time of the day or night, whenever you have a clinical interaction with a patient and a potential assessor is available. You could ask your consultant to let you review the last patient on a ward round or your trainer to let you see the next patient to come in to the GP surgery. While on-call you could ask a senior doctor to accompany you to see a new patient. How should it work? The observed process should take no longer than 15 minutes. Do what you would normally do in the situation. This is not meant to be a long case examination taking hours. Your assessor should then provide some immediate feedback which should take no longer than 5 minutes. What next? Retain the form in your portfolio and give a copy to your administrator.

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Directly Observed Procedural Skills (DOPS) TRAINEE GUIDANCE What is DOPS? It is essential that all trainees should be adequately assessed for competence in the practical procedures they undertake. Directly Observed Procedural Skills (DOPS) is a method, similar to the mini-CEX, which has been designed specifically for the assessment of practical skills, and was originally developed by the RCP. In keeping with the Foundation Programme quality improvement assessment model, strengths and areas for development should be identified following each DOPS encounter. Who should you ask to assess you? You need to get at least four different healthcare professionals (consultants, SpRs, specialists associate/staff grades, nurses, GPs and any allied health professional who has experience in this procedure) to assess you in your F1 year, or six in your F2 year, i.e. spread out over the different posts. Please complete the forms in order so that your progress can be evaluated. You should try to get your supervising consultant in each post to observe you. What should you be assessed doing? DOPS is designed to provide feedback that should be of help to you. Therefore you should be assessed undertaking procedures normally expected of you and undertake them in the usual work environment that you would normally do the procedure, i.e. not in the clinical skills laboratory. It is important that you choose different procedures that cover the Curriculum. You should aim to be observed undertaking the following procedures, with a different assessor each time. You must undertake a minimum of four in your F1 year, or six in your F2 year. Procedures Venepuncture Cannulation Blood Culture (peripheral) Blood Cultural (Central) IV Infusions ECG Arterial Blood Sampling (Radial/Femoral stab)

SC Injection ID Injection IM Injection IV Injection Urethral Catheterisation Airway Care NG Tube Insertion Other

When should you use DOPS? DOPS can be used at any time of the day or night. You could, for example, ask your SpR to come with you to put in a cannula or the practice nurse could observe you taking blood. How should it work? The observed process should take no longer than 15 minutes. Do what you would normally do in the situation. Your assessor should then provide some immediate feedback, which should take no longer than five minutes. What next? Retain the form in your portfolio and give a copy to your administrator.

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Case-based Discussion TRAINEE GUIDANCE What is CbD? Case-based Discussion is used to enable the documenting of conversations about, and presentations of, cases by trainees. This activity happens throughout training, but is rarely conducted in a way that provides systematic assessment and structured feedback. The approach is called chart simulated recall in the United States and Canada, and is widely used for the assessment of residents and of established doctors who are in difficulty. In the UK it is used, and is being evaluated by, both the National Clinical Assessment Authority (NCAA) and the GMC in the assessment of established practitioners. CbD is designed to assess clinical decision-making and the application or use of medical knowledge in relation to patient care for which the trainee has been directly responsible. It also enables the discussion of the ethical and legal framework of practice, and in all instances, it allows trainees to discuss why they acted as they did. Although the primary purpose is not to assess medical record keeping, as the actual record is the focus for the discussion, the assessor can also evaluate the record keeping in that instance. An example might be a discussion around an admission clerking and choosing to discuss the reasoning behind your choice of investigations. It should not be taken as an opportunity to discuss the whole case in a viva style approach. Further guidance is available online at www.mmc.nhs.uk. Who should you get to assess you? You need to get at least six different doctors (experienced SpRs, Specialist Associates/Staff Grades, consultants or GPs) to assess you by the end of your rotation, i.e. spread them out over different posts. You should try to include the supervising consultant in each post. Please complete the forms in order that your progress be evaluated. What should be assessed? CbD is suitable for use in a community-based, out-patient, in-patient or acute care setting. It is designed to provide feedback that should be of help to you. Choosing the cases is up to you. Each time you arrange to meet with an assessor, please pick two cases in which you have written in the notes. Each CbD should represent a different clinical problem and you should try to sample from each of the core problem groups identified in the Foundation Curriculum by the end of the year. These are summarised on the form, e.g. clinical assessment of airway/breathing on one occasion and then management of pain on another. For more information, please refer to the Curriculum on the MMC website at www.mmc.nhs.uk. The assessor on each of the six occasions will choose one of the two cases that you have provided. You should provide the notes prior to the meeting in order to give the assessor time to familiarise themselves with the case. How should it work? The discussion process should take no longer than 15 minutes. Your assessor should then provide some immediate feedback, which should take no longer than 5 minutes. What next? Retain the form in your portfolio and give a copy to your administrator.

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Appendix 3: Rater/assessor-written training for assessment tools

mini-PAT RATER WRITTEN TRAINING The doctor named on the attached form has proposed you as an assessor for their multi-source feedback (360) assessment, using mini-PAT. Thank you in advance for helping them by completing this form. What is mini-PAT? mini-PAT provides feedback from a range of co-workers across the domains of Good Medical Practice. These can be mapped to the core objectives of the Foundation Curriculum. PMETB and the GMC have identified peer ratings as suitable for postgraduate assessment and revalidation evidence. A number of groups have been involved in developing and evaluating multi-source feedback (MSF) for trainees. The tool being evaluated for this project for use in Foundation training assessment, mini-PAT (Peer Assessment Tool) builds on this work. It is derived from the Sheffield Peer Review Assessment Tool (SPRAT) and has been shortened on the basis of content validity in relation to the Foundation Programme Curriculum. Should I have been asked to complete this form? You should be a doctor, nurse or allied health professional to complete this form. mini-PAT has not been designed for completion by patients or administrative staff. About the form This questionnaire is confidential and your individual ratings and comments are anonymised to the trainee for the process of providing feedback. However, should the trainee specifically request to see the individual forms, they will be entitled to do so under the Freedom of Information Act 2005. It will take less than ten minutes to complete. Please fill in the questionnaire as accurately as possible. Use the whole scale. Comparison should be made with a doctor who is ready to complete the Foundation Programme (the end of the first SHO year). It is expected that some ratings below meets expectation for the completion of Foundation are in keeping with the trainees level of experience. This will particularly be the case for F1s/PRHOs. Try to think about the individual question you are being asked. Good doctors are not always good at everything. Nice doctors may not be good at much. It is also an educational tool. It will make a difference for this individual. Please return the questionnaire in the addressed envelope provided in the hospital post within two weeks. Please do write comments to illustrate your rating, as we know that trainees find these helpful and help them to build on the strengths and address areas for development. Please note, however, that these comments are fed back to the trainee anonymised, but as written. Think carefully about how you word comments in relations to problems so that the trainee can learn as much as possible about them. Specifically, try to be constructive rather than destructive when making comments in relation to any problem areas.

Thank you very much for completing and returning the form in the envelope provided.

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mini-CEX (Clinical Evaluation Exercise) RATER WRITTEN TRAINING Thank you for agreeing to complete this assessment for the trainee. What is the mini-CEX? Mini-CEX is designed to provide feedback on skills essential to the provision of good clinical care by observing an actual clinical encounter. The mini-CEXS is a snapshot of a doctor/patient interaction. Not all elements need be assessed on each occasion. In keeping with the Foundation Programme quality improvement assessment model, strengths, areas for development and agreed action points should be identified following each mini-CEX encounter. This form samples a range of areas within the Foundation Curriculum and can be mapped to Good Medical Practice but was designed originally by the American Board of Internal Medicine. Should I have been asked to be an assessor? You need not have prior knowledge of this trainee. You should be an experienced SpR, SASG, consultant or GP. mini-CEX is suitable for use in a community-based, out-patient or acute care setting. How should it work? Please ensure that the patient is aware that the mini-CEX is being carried out. The process is trainee led. They have chosen you to assess them and they have chosen the clinical encounter. The encounter should, however, be representative of their workload. The observed process should take no longer than 15-20 minutes. Immediate feedback should take no longer than five minutes. mini-CEX: Competencies Assessed and Descriptors Question area History taking Descriptor for a satisfactory trainee Facilitates patients telling of story, effectively uses appropriate questions to obtain adequate information, responds appropriately to verbal and non-verbal cues Follows efficient, logical sequence, examination appropriate to clinical problem, explains to patient, sensitive to patients comfort and modesty Shows respect, compassion, empathy, establishes trust Attends to patients needs of comfort, respect, confidentiality. Behaves in an ethical manner, awareness of relevant legal frameworks. Aware of limitations. Makes appropriate diagnosis and formulates a suitable management plan. Selectively orders/performs appropriate diagnostic studies, considers risks, benefits Explores patients perspective, jargon free, open and honest, empathetic, agrees management plan/therapy with patient Prioritises; is timely; succinct; summarises Demonstrates satisfactory clinical judgement, synthesis, caring, effectiveness. Efficiency, appropriate use of resources, balances risks and benefits, awareness of own limitations

Physical examination

Professionalism

Clinical judgment Communication skills Organisation/efficiency Overall clinical care

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Completing the form Specific points: Assessor training is helpful in any assessment process so please read the entire form, trainee guidance and this written training. You can indicate that you have done this on the form by crossing Yes, written training, Number of previous mini-CEX observed? This question is to explore the impact of familiarity/experience on rater performance using mini-CEX as part of the quality assurance process. Please score how many mini-CEXs you have ever observed with any trainee. Focus of clinical encounter: Diagnosis should include an assessment of the trainees examination skills ad their abilities to reach a provision diagnosis. Complexity of case: Please score the difficulty of the clinical case for the level of a trainee completing the Foundation Programme. Using the scale: Please use the full range of the rating scale. Comparison should be made with a doctor who is ready to complete the Foundation Programme (end of first SHO year). It is expected that some ratings below meets expectation for completion of Foundation will be in keeping with the trainees level of experience. Feedback In order to maximise the educational impact of using mini-CEX, you and the trainee need to identify agreed strengths, areas for development and an action plan. This should be done sensitively and in a suitable environment. Thank you very much for completing this form and feeding back to the trainee.

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DOPS (Directly Observed Procedural Skills) RATER WRITTEN TRAINING What is DOPS? It is essential that all trainees should be adequately assessed for competence in the practical procedures they undertake. Directly Observed Procedural Skills (DOPS) is a method, similar to the mini-CEX, that has been designed specifically for the assessment of practical skills by the RCP. In keeping with the Foundation Programme quality improvement assessment model, strengths and areas for development should be identified following each DOPS encounter. Should I have been asked to be an assessor? You need not have prior knowledge of this trainee. You should be a consultant, SASG, SpR, Nurse, GP or allied health professional with expertise in this procedure. How should it work? Please ensure the patient is aware that DOPS is being carried out. The process is trainee led. They have chosen you to assess them and they have chosen the procedure. The encounter should, however, be representative of their workload. The observed process should take no longer than 15-20 minutes. Immediate feedback should take no longer than five minutes. Procedures Trainees should only be observed undertaking one of the following procedures. Please write the corresponding number for the procedure in the box provided on the form. Code 1 2 3 4 5 6 7 Procedure Venepuncture Cannulation Blood Culture (Peripheral) Blood Culture (Central) IV Infusions ECG Arterial Blood Sampling (Radial/Femoral stab) Code 8 9 10 11 12 13 14 15 How to complete the form: Specific points: Assessor training is helpful in any assessment process, so please read the entire form, trainee guidance and this written training. You can indicate you have done this on the form by crossing Yes: Written Training. Number of previous DOPS Observed? This question is to explore the impact of familiarity/experience on rater performance using DOPS as part of the quality assurance process. Please score how many DOPS you have ever observed with any trainee. Number of times procedure performed by trainee: Please ask the trainee for their estimation/log book. Difficulty of procedure: Please score the difficulty of the procedure for the level of a trainee completing the Foundation Programme. Procedure SC Injection ID Injection IM Injection IV Injection Urethral Catheterisation Airway Care NG Tube Insertion Other

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Question 3: This question includes the trainees discussion of possible complications and their management where appropriate. Question 8: Post-procedural management (for example, disposal of sharps, CXR check, instructions to nurses, documentation of procedure)

Using the scale Please use the full range of the rating scale. Comparison should be made with a doctor who is ready to complete the Foundation Programme (end of first SHO year). It is expected that some ratings below meets expectation for completion of Foundation will be in keeping with some trainees level of experience. This will particularly be the case for F1/PRHOs. Feedback In order to maximise the educational impact of using DOPS, you and the trainee need to identify agreed strengths and areas for development. This should be done sensitively and in a suitable environment.

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CbD (Case-based Discussion)

RATER WRITTEN TRAINING What is CbD? Case-based Discussion (CbD) is used to enable the documenting of conversations about, and presentations of, cases by trainees. This activity happens throughout training, but is rarely conducted in a way that provides systematic assessment and structured feedback. The approach is called chart stimulated recall in the United States and Canada, and is widely used for the assessment of residents and established doctors who are in difficulty. In the UK it is used, and is being evaluated by, both the NCAA and the GMC in the assessment of established practitioners. CbD is designed to assess clinical decision-making and the application or use of medical knowledge in relation to patient care for which the trainee has been directly responsible. It also enables the discussion of the ethical and legal framework of practice, and in all instances, it allows trainees to discuss why they acted as they did. Although the primary purpose is not to assess medical record keeping, as the actual record is the focus for the discussion, the assessor can also evaluate the record keeping in that instance. Should I have been asked to be an assessor? You need not have prior knowledge of this trainee of the case. You should be an experienced SpR, SASG, consultant of GP. How should it work? Trainees are asked to undertake six sessions of CbD during the year with a different assessor for each session. The trainee will have selected two case records from patients they have seen recently, and in whose notes they have made an entry. Please select one of these for this CbD session. An example might be a discussion around an admission clerking and choosing to discuss the reasoning behind the trainees choice of investigations. It should not be taken as an opportunity to discuss the whole case in a viva style approach. Further guidance is available online at www.foundationprogramme.nhs.uk. An assessment record should then be filled out and the whole session should take no longer than 20 minutes including feedback and completion of the assessment form. The discussion must start from and be centred on the trainees own record in the notes. CbD: Competencies Assessed and Descriptors Question area Medical record keeping Descriptor against which you should consider your rating of the trainee A satisfactory trainee: The record is legible, signed, dates and appropriate to the problem, understandable in relation to, and in sequence with, other entries. It helps the next clinician who used the record to give effective and appropriate care. Can discuss how they understood the patients story and how, through the use of further questions and an examination appropriate to the clinical problem, a clinical assessment was made from which further action was derived.

Clinical assessment

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Question area Investigation and referrals

Treatment Follow-up and future planning Professionalism

Overall clinical care

Descriptor against which you should consider your rating of the trainee A satisfactory trainee: Can discuss the rationale for the investigations and necessary referrals. Shows understanding of why diagnostic studies were ordered/performed, including the risks and benefits and relationship to the differential diagnosis. Can discuss the rationale for the treatment, including the risks and benefits Can discuss the rationale for the formation of the management plan including follow-up Can discuss how the care of this patient, as recorded, demonstrated respect, compassion, empathy and established trust Can discuss how the patients needs for comfort, respect, confidentiality were attended to. Can show how the record demonstrated an ethical approach, and awareness of any relevant legal frameworks. Has insight into own limitations Can discuss own judgement, synthesis, caring, effectiveness for this patient at the time that this record was made.

Completing the form: Specific points: Assessor training is helpful in any assessment process so please read the entire form, trainee guidance and this written training. You can indicate that you have done this on the form by crossing:Yes: Written training. Complexity of case: Please score the complexity of the case for the level of a trainee completing the Foundation Programme.

Using the scale Please use the full range of the rating scale. Comparison should be made with a doctor who is ready to complete the Foundation Programme (end of first SHO year). It is expected that some ratings below meets expectation for completion of Foundation will be in keeping with the trainees level of experience. This will particularly be the case with F1/PRHOs. Feedback In order to maximise the educational impact of CbD, you and the trainee need to identify agreed strengths, areas for development and an action plan. This should be done sensitively and in a suitable environment.

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Appendix 4: GMC guidance on probity and health

The extract below is taken from the GMCs guidance Good Medical Practice. Being honest and trustworthy paragraphs 56 to 59 56. Probity means being honest and trustworthy, and acting with integrity: this is at the heart of medical professionalism. You must make sure that your conduct at all times justifies your patients trust in you and the publics trust in the profession. You must inform the GMC without delay if, anywhere in the world, you have accepted a caution, been charged with or found guilty of a criminal offence, or if another professional body has made a finding against your registration as a result of fitness to practise procedures. If you are suspended by an organisation from a medical post, or have restrictions placed on your practice you must, without delay, inform any other organisations for which you undertake medical work and any patients you see independently.

57.

58.

59.

Writing reports and CVs, giving evidence and signing documents paragraphs 63 to 69 63. You must be honest and trustworthy when writing reports, and when completing or signing forms, reports and other documents. You must always be honest about your experience, qualifications and position, particularly when applying for posts. You must do your best to make sure that any documents you write or sign are not false or misleading. This means that you must take reasonable steps to verify the information in the documents, and that you must not deliberately leave out relevant information. If you have agreed to prepare a report, complete or sign a document or provide evidence, you must do so without unreasonable delay. If you are asked to give evidence or act as a witness in litigation or formal inquiries, you must be honest in all your spoken and written statements. You must make clear the limits of your knowledge or competence. You must co-operate fully with any formal inquiry into the treatment of a patient and with any complaints procedure that applies to your work. You must disclose to anyone entitled to ask for it any information relevant to an investigation into your own or a colleagues conduct, performance or health. In doing so, you must follow the guidance in Confidentiality: Protecting and providing information. You must assist the coroner or procurator fiscal in an inquest or inquiry into a patients death by responding to their enquiries and by offering all relevant information. You are entitled to remain silent only when your evidence may lead to criminal proceedings being taken against you.

64.

65.

66.

67.

68.

69.

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Research paragraphs 70 to 71 70. Research involving people directly or indirectly is vital in improving care and reducing uncertainty for patients now and in the future, and improving the health of the population as a whole. If you are involved in designing, organising or carrying out research, you must: a. put the protection of the participants interests first b. act with honesty and integrity c. follow the appropriate national research governance guidelines and the guidance in Research: The role and responsibilities of doctors.

71.

Conflicts of interest paragraphs 74 to 76 74. You must act in your patients best interests when making referrals and when providing or arranging treatment or care. You must not ask for or accept any inducement, gift or hospitality which may affect or be seen to affect the way you prescribe for, treat or refer patients. You must not offer such inducements to colleagues. If you have financial or commercial interests in organisations providing healthcare or in pharmaceutical or other biomedical companies, these interests must not affect the way you prescribe for, treat or refer patients. If you have a financial or commercial interest in an organisation to which you plan to refer a patient for treatment or investigation, you must tell the patient about your interest. When treating NHS patients you must also tell the healthcare purchaser.

75.

76.

The extract below is taken from the GMCs guidance Good Medical Practice. 77. If you are involved in designing, organising or carrying out research, you must: a put the protection of the participants interests first b act with honesty and integrity c follow the appropriate national research governance guidelines and the guidance in Research: The role and responsibilities of doctors. You should protect your patients, your colleagues and yourself by being immunised against common serious communicable diseases where vaccines are available. If you know that you have, or think that you might have, a serious condition that you could pass on to patients, or if your judgement or performance could be affected by a condition or its treatment, you must consult a suitably qualified colleague. You must ask for and follow their advice about investigations, treatment and changes to your practice that they consider necessary. You must not rely on your own assessment of the risk you pose to patients.

78.

79.

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Appendix 5: Important links

COPMeD Conference of Postgraduate Medical Deans www.copmed.org.uk DH Department of Health www.dh.gov.uk GMC General Medical Council www.gmc-uk.org MMC Modernising Medical Careers www.mmc.nhs.uk PMETB Postgraduate Medical Education and Training Board www.pmetb.org.uk Royal Colleges The Royal College of Anaesthetists: www.rcoa.ac.uk The Royal College of General Practitioners: www.rcgp.org.uk The Royal College of Nursing: www.rcn.org.uk The Royal College of Obstetricians and Gynaecologists: www.rcog.org.uk The Royal College of Ophthalmologists: www.rcophth.ac.uk The Royal College of Paediatrics and Child Health: www.rcpch.ac.uk The Royal College of Pathologists: www.rcpath.org The Royal College of Physicians of Edinburgh: www.rcpe.ac.uk The Royal College of Physicians of London: www.rcplondon.ac.uk The Royal College of Physicians and Surgeons of Glasgow: www.rcpsg.ac.uk The Royal College of Psychiatrists: www.rcpsych.ac.uk The Royal College of Radiologists: www.rcr.ac.uk The Royal College of Surgeons of Edinburgh: www.rcsed.ac.uk The Royal College of Surgeons in Ireland: www.rcsi.ie The Royal College of Surgeons of England: www.rcseng.ac.uk The Royal Society of Medicine: www.rsm.ac.uk Academy of Medical Royal Colleges: www.aomrc.org.uk Faculty of Public Health: www.fph.org.uk

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