The Educational Prescription in Postgraduate Assessment

1
The Educational Prescription in Postgraduate
Assessment

• An assessment for GPs wishing to return to
  clinical practice in London

Anwar Khan, Penny Trafford, Peter Burrows, Neil
Jackson
2
Background

• A shortage of GPs in London due to
•   Retirement, flexible careers,
•   Shortfall in recruitment and training,
•   Expansion of services (NHS plan 2000).
• Department of Health stopped GP Returner funding
  in 2005

3
Issues

• Doctors entitled to work but
• Most Primary Care Organisations (PCO) will not
  admit to performers list when ..
• UK Returners - time out gt3 years
• EU GPs relocation and hence no UK Primary Care
  experience.
• Performance Unit clients (PU) PCT/GMC
  involvement
• Learning need recognised by
• Individual doctors decreasing clinical skills
  and knowledge over time
• Deanery educational need due to changes in NHS
• PCOs require quality assurance of competence for
  safe and independent practice in NHS

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Induction Course

• 3-6 month full-time equivalent (FTE) programme
• Duration dependent on the educational
  prescription
• Attachment to practice with mentor
• Supervised consultations and tutorials
• Half-day release course with tutor, peer group
  support and self-directed learning

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Entry Assessment

• Prior to induction course
• Multiple choice paper Clinical knowledge
• need to pass to progress to next stage
• Simulated surgery (OSCE) Consultation skills and
  clinical problem solving
• Summative minimum scores for entry
• Formative identifying learning needs for
  educational prescription

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Exit Assessment

• On completion of induction course
• NHS logbook evidence of formative workplace
  based learning
• Simulated surgery (OSCE) Consultation skills
  and clinical problem solving
• Summative successful completion can be used by
  PCT for decision re inclusion on the
  performers list
• Formative confirms candidates progress and
  instils confidence

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Simulated Surgery (OSCE)

• Circuit of ten stations
• Common primary care presentations
• 10-minute consultations
• Simulated patients
• Assessed by observer
• Language observer as appropriate

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Marking

• Case specific marking schedules
• Each case marked in five domains
• Gathering medical information
• Eliciting the patients concerns
• Explaining the diagnosis
• Managing the problem
• Closing the consultation
• Passing scores are set for
• Entry to the induction course
• Exit and information to the PCT

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Marking case specific
Case  Topic
1 Gynaecology A
2 Diabetes B
3 URTI C
4 Neurology D
5 Dermatology E
6 Breaking bad news F
7 Obesity G
8 Ill child H
9 Musculoskeletal I
10 Metabolic J
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Marking domain specific
SKILL Description  
Gathering medical information history taking, physical examination and using information from records a
Eliciting the patient's concerns use of listening skills, verbal and non-verbal cues, patient centredness b
Explaining the diagnosis using appropriate language and checking the patient's understanding c
Managing the problem negotiating a safe and effective management plan, rational prescribing d
Closing the consultation arranging follow-up, anticipating future problems, safety-netting e
TOTAL SCORE   f
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Formative feedback

• After each consultation, brief comments about the
  doctors performance are recorded by the observer
  and the role-player
• These are compiled so that each candidate
  receives a sheet with feedback from 10
  role-players and 10 observers
• Feedback to be positive and/or constructive with
  suggestions for improvement.

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Educational prescription

• On completion of OSCE, each candidate has
  individual feedback from an observer
• Presented with personal score sheet
• Significance of results explained
• Discuss strengths and weaknesses
• Discuss feedback from observers/ role-players
• Learning needs agreed
• During practice placement mentor uses educational
  prescription to plan the mentees learning/PDP

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Applications 2003-2008
  UK Assessments only since 2005 EU PU Assessments only since 2006
Number of enquiries 144 271 22
enquiries proceeding to interviews 68 52 82
Mean age 49 37 58
Females () 56 48 18
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MCQ results ()
UK Candidate no. 80 EU Candidate no. 131 PU Candidate no. 16
MCQ mean score 77 60 71
Score range 57-95 8-81 19-87
MCQ pass rate (gt59) 92 59 68
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OSCE results ()
UK Candidate no. 51 EU Candidate no. 76 PU Candidate no. 11
OSCE mean score 61 48 53
Score range 31-76 18-67 30-66
OSCE pass rate 90 54 73
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Outcomes of the programme
UK EU PU
No. assessed (MCQ) 80 131 16
No. assessed (OSCE) 51 76 11
passed both entry assessments 90 31 56
needing 6 months full-time placement 54 97 100
No. failed exit assessments 1 1 0
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Conclusions

• Educational prescription given to those doctors
  who pass the summative entry assessments
• Minimum entry requirements to ensure safe
  clinical care during the placement
• Individualised educational prescription provides
  formative guidance during the placement promoting
  adult learning
• The NHS logbook provides the evidence of the
  practitioners development in compliance with the
  educational prescription