Preparing for your educational supervisor's review (ESR)

Advice to help GP registrars to prepare for their ESR, including how to collect evidence for self-rating and how to demonstrate you meet each competence area.

Most of the preparation for a trainee's educational supervisor’s review (ESR) involves completing the components of workplace-based assessment and tidying up the personal development plan (PDP).

If trainees have not written any PDP entries within the review period, they will need to propose at least one 'SMART' PDP before starting their self-rating. Self-rating is an important part of the ESR and this article guides you through producing a good, evidence-based self-rating.

What is an ESR?

The ESR is a six-monthly discussion, written up in a pre-formatted report, on the trainee's e-portfolio. The trainee undertakes a self-rating and the educational supervisor provides additional evidence and feedback.

The report summarises the trainee's progress in an evidence-based manner for the deanery's Annual Review of Competence Panel (ARCP).

The trainee and educational supervisor meet to review the progress made towards completing previously agreed action plans; reflect on the trainee's personal and professional development; identify educational needs and agree an educational plan.

During their preparation, the trainee will need to write three action plans which will be linked to the RCGP's workplace-based assessment competences. At the ESR these can later be edited by the educational supervisor, who can add a further two action plans. This will be particularly relevant if the educational supervisor is rating the trainee at a level of ‘below expectation’.

On completion of the review, the educational supervisor will submit the ESR and at this point it will be released and viewable by all who have access to the ePortfolio.

How should trainees prepare?

In short, start early, use a wide range of evidence and be specific.

To prepare well, trainees should start collecting evidence for their self-ratings early. In fact, some trainees link evidence from learning logs, consultation observation tools (COTs), case-based discussions (CbDs), clinical supervisor reports (CSRs), patient satisfaction questionnaires (PSQ), clinical evaluation exercises (CEX) and multi-source feedback (MSF) as they come in rather than compiling it all just before the review.

The more timely the write-up, the clearer the reasons are for making the links.

For example, under the practising holistically competence a trainee may write:

‘My clinical supervisor in a CbD (16 Aug) marked me as competent in this area. In learning log (24 Aug) I picked up a non-verbal cue (patient's discomfort in colposcopy clinic) and my questioning uncovered her concerns about HPV and her husband's potential infidelity, ie the impact on her marital relationship.

'In learning log (11 Oct) I advised a patient on a graduated return to work and physical activities post-op, and I supported the patient and husband. My clinical supervisor’s report (14 Oct) marked me as "very considerate" being able to recognise the impact of the problem on the patient’s life. To quote a comment from my October multisource feedback: "She has a caring and holistic approach to the patients".’

An educational supervisor can see, from the chronological order of the evidence provided, that this trainee has been linking the evidence for the competence as it emerged in her e-portfolio. The wide range of the evidence produced in this example is also good. The trainee quoted from CbDs, learning logs, a clinical supervisor report and multisource feedback – she triangulated her evidence.

The RCGP website provides a useful table of where you’re most likely to find good evidence for each competence area. This is reproduced below:

Be specific for the competency

The evidence quoted in the example above is also very specific for the competency. In order to be specific it is important to cross reference the RCGP’s descriptors, which can be accessed here.

The table below sets out the desciptors for the practising holisitcally competence.

Practising holistically: This competency is about the ability of the doctor to operate in physical, psychological, socio-economic and cultural dimensions, taking into account feelings as well as thoughts.

Not a level - below NFDNeeds further developmentCompetentExcellent

Treats the disease, not the patient

Enquires into both physical and psychological aspects of the patient’s problem

Demonstrates understanding of the patient in relation to their socio-economic and cultural background

Uses this understanding to inform discussion and to generate practical suggestions for patient management

Recognises the impact of the problem on the patient

Additionally, recognises the impact of the problem on the patient’s family/carers

Recognises and shows understanding of the limits of the doctor’s ability to intervene in the holistic care of the patient

Uses him/herself as the sole means of supporting the patient

Utilises appropriate support agencies (including primary health care team members) targeted to the needs of the patient

Organises appropriate support for the patient’s family and carers

If we use this to assess the example above we can see that the trainee gave evidence in her August learning log of enquiring into the physical and psychological aspects of a patient's problem. She also provided evidence of recognising the impact of illness on the patient and her husband and she supported them.

Her advice about a graduated return to work was evidence of 'practical suggestions for patient management'.

Be prepared for feedback

Trainees are 'competent' if they practise at the standard expected of a doctor who is certified to practise independently as a general practitioner.

In the first two years of training, trainees are judged against the standard they should have reached at the end of training. Inevitably, in the first two years of training developmental needs will be identified. The ESR highlights these learning needs and clarifies an educational plan.

Trainees who are open about their difficulties should expect tailored feedback and bespoke help; the process is meant to be facilitative and supportive.

However, trainees should remember that the standards must be met so, however supportive, they are expected to act on feedback and be willing to change to progress towards meeting the standards by the next review.

  • 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.

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