Professional development - Membership of the RCGP

Dr Sathya Naidoo explains the criteria that are required for completing iMAP.

Interim membership by assessment of performance (iMAP) is a portfolio-based assessment to allow established GPs to become members of the RCGP; iMAP is about providing evidence from daily work and being able to reflect on it as well as justify it.

Available until the end of July 2009, iMAP comprises 19 criteria on which the candidate must provide evidence.

The iMAP pilot showed that most GPs could complete the iMAP portfolio in three to six months. The iMAP handbook and portfolio are free to download from the RCGP website so prospective candidates can start on iMAP without registering with the RCGP. This allows candidates to see how they get on with iMAP before actually registering or incurring any costs.

iMAP requires that candidates are competent in CPR


The criteria set out for iMAP are discussed below.

Prescribing is at the heart of general practice and these two criteria give candidates the opportunity to simply reflect on their prescribing habits and justify what they do.

Criterion 1 Prescribing rationally - the candidate provides evidence that he can prescribe rationally and the prescribing is evidence based.

Candidates need to demonstrate how to use a guideline or protocol to prescribe rationally. They should pick a guideline or protocol they know well and show how it was used in managing a particular patient.

Criterion 2 Prescribing effectively - the candidate prescribes appropriately and cost-effectively.

Candidates are asked to look at the drugs they prescribe and record 100 drugs that they have been responsible for initiating and prescribing. They then need to reflect on the four most frequently prescribed drugs.

Audits give GPs a chance to reflect on their own performance. It allows all clinicians a chance to stand back and objectively look at their own work.

Criterion 3 Review of clinical practice (audit) - the candidate uses audits to improve his/her clinical care of patients.

This can be a clinical audit or non-clinical, such as how long patients are kept waiting in the waiting room. The audit should be meaningful to the candidate's professional performance.

There are plenty of audits that look at the performance of the practice team and the practice as a whole. These should not be included unless they really reflect the candidate's own performance. The important aspect of this criterion is understanding the process of the audit rather than the results themselves.

Criterion 4 Significant event analysis (SEA) - the candidate undertakes significant event reviews in the course of his/her professional work. Nearly all practices carry out SEA as part of the quality framework.

Drugs and equipment
Criterion 5 Drugs and equipment - the candidate has access to a justifiable selection of essential in-date drugs and functional equipment.

The drugs and equipment each GP has access to vary greatly from practice to practice. However, the drugs the candidate does have access to must be justifiable.

All GPs must be able to deal with an unexpected emergency as well as providing a service to patients with more routine problems. Candidates should be aware of the regulation covering controlled drugs.

Medical care of patients
The next four criteria look at acute illness, long-term patient care, emergency admissions and CPR.

Criterion 6 The candidate makes rational and competent decisions regarding the diagnosis and management of patients with a range of acute illnesses.

This is a log of 20 consecutive acute presentations. It should be simple and straightforward. Candidates need to check that management plans and prescribing are up to date. It is worth checking the latest guidelines to ensure that they have been used. If they have not been used there should be some reflection on this.

Criterion 7 The candidate demonstrates that he/she can effectively care for patients with long-term conditions or requiring palliative care.

This is to demonstrate how candidates work effectively with their primary healthcare team in providing care for patients with long-term illness. The evidence essentially takes the form of a diary which shows how particular aspects of long-term care are achieved.

Criterion 8 The candidate's management of emergency admissions is competent.

This requires documentation of five emergency admissions. This can be in any context including out of hours.

Criterion 9 The candidate will be competent in emergency resuscitation. This requires the submission of a CPR certificate.

Continuing professional development

Criterion 10 The candidate can demonstrate how he/she identified a substantial educational need within the past year, how he/she met the need and the change that occurred in clinical care or practice management. This is familiar because it is part of the NHS appraisal system.

Criterion 11 The candidate participates in continuing educational activities. This is a simple diary of educational activities with some reflection on the topics covered and the learning methods used.

Relationship with patients
Criterion 12 The candidate provides evidence of competent communication skills; iMAP gives a choice between two questionnaires used to look at an individual doctor's communication skills. The individual should reflect on the results.

Criterion 13 The candidate is aware of a complaints procedure which complies with current guidance. Candidates need to know what is good practice when handling complaints.

Working with colleagues
Criterion 14
The candidate works effectively with different members of the primary healthcare team.

Candidates need to submit multisource feedback. Not all GPs will be familiar with this but it may well be used with revalidation.

Criterion 15 The candidate surveys the information he/she provides when making a referral.

Criterion 16 The candidate critically evaluates his/her referrals to health professionals. This is a reflection of the effectiveness of candidate's referrals.

Criterion 17 The candidate makes legible and appropriate records. This is 10 single entries into the medical records. This is about ensuring safe continuity of care for patients.

Criterion 18 The candidate is prepared to discuss personal experience of ethical dilemmas.

All GPs face difficult dilemmas in day-to-day practice. This criterion is about how to seek advice or access information to deal with these issues.

Child protection
Criterion 19 The candidate can produce evidence of child protection training.

Thankfully, child protection issues are rare in practice. This criterion allows candidates to reflect on how they might use their training in practice.

Dr Naidoo is a GP principal in Nottingham and chairman of iMAP at the RCGP

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