The aim of this article is to help you to capture the key educational issues arising from the discussion you hold with your clinical supervisor (CS) within two weeks of starting your placement. This discussion should cover your learning needs and wants, as well as your responsibilities and the learning opportunities available to you. It is also important to timetable the dates and times for completion of workplace-based assessments.
Some CSs ask you to read the relevant aspects of the GP curriculum and do a confidence rating prior to the meeting. Scotland Deanery South East Region has produced a useful resource for GP trainees and CSs to help focus the planning discussion.
It details, clearly and succinctly, the possible learning opportunities GP trainees could access within 11 different hospital specialities, from Obstetrics and Gynaecology to Orthopaedics and Trauma. It helps inform the discussion about learning needs, and helps you to create an action plan. You then use this action plan to create a SMART PDP.
Your educational supervisor (ES) reads your placement meeting learning log in conjunction with the PDP you agree with your CS. He or she will be able to comment on whether your learning activities have an appropriate GP slant, to ensure that you acquire from this placement the knowledge and skills a GP needs.
To help you to write a good placement meeting log entry, there is an example entry below, which you should critically appraise so that you become familiar with the way in which these entries are assessed.
Example learning log
After reading the learning log provided, please answer the following questions, which I, as an ES, would ask:
- Does this learning log give sufficient information about the educational discussion? Did the trainee describe the areas, in broad brushstrokes, that he or she wishes to cover? Does this learning seem reasonable to their development as a GP?
- Was the trainee explicit about what new knowledge and skills they wished to gain?
- Has the trainee identified appropriate resources for this learning?
Subject title: Initial Meeting with CS, Dr B, at community mental health clinic
What were the main areas discussed?
- Introduction to the CMH team, the area it covers and its role
- My role in the department, my timetable and clinical supervisor’s timetable
- Orientation: safety (alarms) and staff (who they are and what they do)
- Teaching: timetabling of debriefs and tutorials
- Assessment: plans for CBDs and mini-CEX; mid and final reviews
- Possible audit topics
What learning opportunities were highlighted in this post?
- Assessing and treating common presentations (depression, PND, and anxiety; alcohol and addiction; eating disorders; OCD and borderline personality disorders)
- Assessing suicide risk
- Learning specific skills – mental health act assessment; motivational interviewing
- Visiting the community addiction clinic and learning about detox services
- Visiting PCAMs and mother/baby unit – how to refer; what they do
Which competence areas do you expect to cover in this post?
Dr B emphasised data-gathering; making a diagnosis; clinical management and team-working. After a brief period of observing Dr B's new patient and follow-up clinics, he would like me to interview my own new patients and debrief with him. I am expected to clerk the patient, make the diagnosis and propose an evidence-based management plan.
Which curriculum areas do you expect to cover in this post?
- 2.01 The GP Consultation in Practice
- 2.02 Patient Safety and Quality of Care
- 3.10 Care of People with Mental Health Problems
- 3.14 Care of People who Misuse Drugs and Alcohol
What objectives did you agree on?
- To be able to take a good psychiatric history – including assess competence; consult with patients with learning disability
- Conduct a mental state examination, including assessment of risk to self and others
- Learn about the evidence based management of common (eg depression and anxiety) and serious psychiatric problems (eg psychosis, high suicide risk) that may be seen in primary care
- Know how to plan for discharge and liaise with social care
- Safe prescribing: initiation, titration, switching, weaning
- Learn about the legal aspects of mental health, especially capacity, consent, fitness to drive, Mental Health Act
What plans have you agreed to achieve these objectives?
- I have a clear timetable with slots for new patients, clinical reviews, tutorials, GPVT teaching and MDT meetings. I will be able to arrange time with the CPNs and for inpatient visits.
- I will use NICE guidance, books and protocols to aid me.
- I will write SMART PDPs to help me structure how to achieve these objectives.
- I will get feedback from my Consultant on my interactions with patients and my management plans in order to develop effective skills.
- We will use CBD and mini-CEX for formal feedback on this eportfolio.
Feedback on the learning log
This learning log would be cited as evidence for the domain ‘Maintaining performance, learning and teaching’.
The trainee has clearly understood their learning needs (knowledge and skills); these needs are relevant to their development as a GP and can realistically be completed during their four-month placement. They have also identified appropriate learning methods (having debriefs, tutorials, reading guidance, obtaining feedback).
Some trainees undertake practice AKT questions (for example about assessment of suicide risk, competence, capacity, DVLA) and upload their baseline scores as evidence of objective assessment of learning needs. Others discuss how they would access (and appraise) the guidelines and protocols. Some include plans to present at a Journal Club or contribute to the department's clinical governance activity.
The placement meeting learning log is not meant to be exhaustive. However, on reading it, the CS and ES are better placed to understand the associated PDPs and give tailored feedback to help the trainee gain relevant, useful and appropriate experience.
- This article was written by Dr Prashini Naidoo, with thanks Dr Sophie Foxen (ST2 GP trainee) for her contribution to writing the learning log. Dr Naidoo is a GP trainer in Oxford. She has written three books on how to pass the CSA. The latest book, CSA Practice Cases for the MRCGP, was published in January 2016.
- RCGP Workplace-based assessment PDP guidance
- Super Condensed GP Curriculum Guide by Scotland Deanery South East Region
- Getting the most out of your GP trainer (GPonline article)
- Plan effective learning strategies