SUPERVISION WORKSHOP CBFP PART 1 RANZCP Fellowship Regulations

SUPERVISION WORKSHOP CBFP – PART 1 RANZCP Fellowship Regulations 2012 V 0. 3 1

CONTRIBUTORS Dr Felicity Plunkett Director of Training, NZ Auckland Dr Wayne de Beer Deputy Chair Board of Education, NZ Hamilton Dr Martin Cohen Director of Training, NSW Newcastle Dr Neil Port Supervisor, NSW Newcastle V 0. 3 2

WORKSHOP PROGRAM AM SESSION 9. 00 – 10. 30 am Information about CBFP Discussion and questions 10. 30 – 10. 45 am Break 10. 45 – 12. 15 pm Information and practical exercises: Workplace-based Assessments (WBAs) – Mini-CEX and Casebased Discussion 12. 15 – 12. 30 pm Final discussion and questions V 0. 3 3

WORKSHOP PROGRAM PM SESSION V 0. 3 1. 30 – 3. 00 pm Information about CBFP Discussion and questions 3. 00 – 3. 15 pm Break 3. 15 – 4. 45 pm Information and practical exercises: Workplace-based Assessments (WBAs) – the Mini. CEX and Case-based Discussion 4. 45 – 5. 00 pm Final discussion and questions 4

WORKSHOP OBJECTIVES Following this session, you should be able to: • Understand the key elements of the new CBFP training • Understand the main ways in which CBFP training will affect you as a supervisor • Understand the main ways in which CBFP training will affect your trainees • Understand the new Mini-CEX and Case-based Discussion (Workplace-based Assessments) • Undertake the new Mini-CEX and Case-based Discussion with your trainees V 0. 3 5

WHY CHANGE THE CURRICULUM? • Reflects current learning and teaching trends • Regular timely (immediate) feedback during training • Clear expectations for Trainees and Supervisors • Enable Trainees to focus on competency as a goal • Assessments in practice prepare Trainees for job readiness V 0. 3 6

MODERN EDUCATIONAL TRENDS Miller’s triangle - hierarchies of competence DOES Performance Workplace-based Assessments SHOW Demonstrates competence OCI, OSCE, Entrustable Professional Assessments KNOWS HOW Applied knowledge KNOWS Factual knowledge V 0. 3 Written Exam 7

MODERN EDUCATIONAL TRENDS Multi-dimensional competency framework The seven Can. MEDS roles V 0. 3 8

EDUCATIONAL PRESSURES • External regulation of medical education – AMC/NZMC accreditation, Government funding • Standard of psychiatrists graduating • Efficiency and effectiveness of training • Changed social contract and expectations of psychiatrists and mental health services • Modern technology and ways of accessing and using information Generational changes in our Trainees • V 0. 3 9

CHANGES TO THE ASSESSMENTS Different drivers for these changes V 0. 3 • Expert educationalist advice to improve exam fairness and reliability (by Dr Gareth Holsgrove and Professor Brian Hodges) • Too costly in time and resources to continue with separate trainee and exemptions exams • Coalescing them back into one sitting means the clinical exams are exit exams 10

WHEN DOES CBFP START? • The 1 st year Trainees will start under the new 2012 Training Regulations - from December 2012 in NZ, and from January 2013 in Australia • Current Trainees stay under the existing 2003 training regulations • Transition time line and conversion matrix now available on College website • Trainees from overseas part-way through training start under the existing 2003 training regulations V 0. 3 11

TRANSITION - TWO PARALLEL PROGRAMS New Zealand Stage 1 December 2012 Stage 2 December 2013 Stage 3 December 2015 Australia Stage 1 January 2013 Stage 2 January 2014 Stage 3 January 2016 • • Allows training & adjustment time for all involved • Will have case-by-case decisions, especially for 3 rd year plus Trainees V 0. 3 Those under the current regulations will all be transitioned to CBFP by the end of 2015 12

WHICH PARTS ARE DIFFERENT? • 3 training stages – Stage 1, Stage 2, Stage 3 • No longer 2 - Basic and Advanced Training • Basic training is across 2 stages – Stage 1 is 1 st year – Stage 2 is 2 nd and 3 rd years • V 0. 3 Stage 3 is Advanced training – 4 th and 5 th years 13

STAGES OF TRAINING STAGE 1 STAGE 2 Basic STAGE 3 Proficient Advanced DEVELOPMENTAL TRAJECTORY V 0. 3 14

COMPETENCY DRIVEN TRAINING • Explicitly defined competencies and role of psychiatrist • Competencies are a combination of knowledge, skills and attitudes • Required competencies have to be achieved to become eligible to sit the written and clinical exams and to progress through the 3 Stages V 0. 3 15

COMPETENCY DRIVEN TRAINING What are the Roles of a Psychiatrist? Can. MEDS roles What Competencies are needed for these? Fellowship Competencies and Developmental Descriptors What are the Learning Outcomes for these Competencies? Detailed Learning Outcomes for each Stage V 0. 3 16

COMPETENCY DRIVEN TRAINING • Defined syllabus for each stage of training • Assessments mapped to syllabus and learning outcomes • Formative assessment o formal and informal assessment procedures o involves qualitative feedback (rather than scores) • Summative assessment o Tests the knowledge and understanding of information, skills, concepts or processes o Final evaluation V 0. 3 17

WHICH PARTS ARE THE SAME? • Still a 5 year program • Stage 1 – General Adult Psychiatry, 6 months Acute • Commence a College accredited Formal Education Course • Stage 2 - mandatory rotations: • V 0. 3 • • Consultation-Liaison (6 months) Child & Adolescent (6 months) 2 optional rotations 18

WHICH PARTS ARE THE SAME? • Stage 2 competencies: o o Addiction Old Age ECT Several psychotherapy modalities • Stage 3 can still be Generalist or in a Certificate program – advanced level competencies • Certificate programs – the same 7 as before (Addiction, Adult, Child, C-L, Forensic, Old Age, Psychotherapy) V 0. 3 19

WHICH PARTS ARE THE SAME? • The structure of the Written, OCI and OSCE exams remains the same (the timing and standard has changed) • Written exam - still 2 x 3 hour exam papers (in late Stage 2, set at junior consultant standard) • OCIs - still must pass 2 of 3 OCIs (in Stage 3, at advanced standard) • OSCE – 12 stations, 8 short cases, 2 long cases, 2 byes (at advanced standard) V 0. 3 20

WHAT ABOUT SUPERVISION? Business as usual in many ways Same time requirements for supervision One 1: 1 hour and 3 clinical supervision hours per week Across min. 40 weeks of the year Similar training and accreditation requirements for supervisors V 0. 3 21

WHAT ABOUT SUPERVISION? Aspects of supervision that are different WORKPLACE-BASED ASSESSMENTS • Structured workplacebased assessments • Written feedback FEEDBACK AND GRADING ARE MORE FORMALISED CLEARER STANDARDS V 0. 3 • More training resources for supervisors • More guidance about the standards expected in each Stage of training 22

WHICH PARTS ARE DIFFERENT? • The 1 st Episode Case History has been removed • Professional writing tasks are required in some WBAs • The Psychotherapy long case will be restructured • The Scholarly Project is a new mandatory requirement and can be commenced at any stage V 0. 3 23

WHICH PARTS ARE DIFFERENT? • The OCI and OSCE exams will be set at exit level and will be sat closer to the end of training (Stage 3) • OCI and OSCE exams will be sat in 4 th and 5 th year (some time during certificate training) • Entrustable Professional Assessments (EPAs) are new • EPAs are summative assessments V 0. 3 24

NEW - WORKPLACE-BASED ASSESSMENTS (WBAS) • V 0. 3 Cb. D Case-based Discussion PP Professional Presentation Mini-CEX Mini Clinical Evaluation Exercise OCA Observed Clinical Activity Highly recommended that trainees experience all of these tools early in their training 25

RANGE OF WBAS You can choose: Mini-CEX Briefly observed clinical tasks Cb. D Detailed case discussions with supervisor PP Case Presentations OCA A full 50 minutes assessment with structured feedback and clear standards At least 3 of these will determine whether an EPA has been achieved. V 0. 3 26

WHY WORKPLACE-BASED ASSESSMENTS (WBAS)? • On the job assessment (efficient use of supervision time) • Relevant tools to assess key clinical activities • Feedback is ensured and structured • Clearer standards and guidelines for the supervisor • A clearer paper trail to document trainee’s performance V 0. 3 27

WBA IN THE FIRST MONTH • The initial formative WBA is to be scheduled in the first month of the rotation • Aim to do it within the first 4 weeks that the trainee and supervisor have worked together • To help the supervisor assess the trainee’s strengths and weaknesses, and alert them to any significant problems V 0. 3 28

ENTRUSTABLE PROFESSIONAL ACTIVITIES (EPAS) • Relate to activities identified as core to the profession • Complex, whole tasks (requires knowledge, skills, professional behaviours and attitudes) • Involve more than one learning outcome • Relate to more than one of the seven Can. MEDs roles V 0. 3 29

ENTRUSTABLE PROFESSIONAL ACTIVITIES (EPAS) • 2 summative EPAs per 6 month rotation • Mandatory EPAs in each of the 3 Stages • Despite signing off an activity as “entrustable”, the supervisor remains responsible to oversee the trainee’s clinical performance V 0. 3 30

EPAS IN STAGE 1 Stage 1: 4 mandatory EPAs • Active participation in multidisciplinary team meeting / ward round • Produce succinct, organised and informative discharge summaries in a timely manner • Initiating an antipsychotic in a patient known to have schizophrenia • Provide an explanation to a family about a young adult’s major mental illness V 0. 3 31

EPAS IN STAGE 2 Stage 2: 5 mandatory EPAs • Demonstrate proficiency in all the expected tasks associated with prescription, administration and monitoring of ECT • The application and use of the Mental Health Act • Assessment and management of risk of harm to self and others • The safe and effective use of clozapine in psychiatry • Cultural Competence V 0. 3 32

HOW IT ALL FITS TOGETHER? V 0. 3 AN EXAMPLE 33

TASKS IN STAGE 1 TRAINING ROTATION 1 WBA Formative ROTATION 2 WBA Formative First 4 weeks V 0. 3 WBA Formative First 4 weeks Supervisor assessment Summative Formative mid rotation Supervisor assessment WBA Formative Formative mid rotation Supervisor assessment WBA Formative Supervisor assessment Summative WBA Formative EPA 1 EPA 2 EPA 3 EPA 4 Summative Minimum of 3 WBAs for 1 EPA 34

SUMMATIVE ASSESSMENTS BASIC STAGE 1 ADVANCED PROFICIENT STAGE 2 STAGE 3 WRITTEN OCI OSCE EPAs and SUPERVISOR ASSESSMENTS PSYCHOTHERAPY LONG CASE SCHOLARLY PROJECT V 0. 3 35

BREAK Reconvene in 15 minutes V 0. 3 36

PLAN - SECOND HALF OF WORKSHOP • Mini-CEX – information and practical exercises • Case-based Discussion (Cb. D) – information and practical exercises • Final discussion and wrap-up V 0. 3 37

MINI CLINICAL EVALUATION EXERCISE (MINI-CEX) • Yes, the name’s hilarious, but get over it • A brief, defined clinical task • Takes about 20 min • Done in the usual hour of 1: 1 supervision time • Task is negotiated between Trainee and Supervisor beforehand • Both trainee and supervisor fill in the mark-sheet • Structured written feedback immediately after • Formative assessment to shape their practice V 0. 3 38

WBAS: MINI-CEX Mini-CEX can be used for: • • V 0. 3 Mental state examination Detailed cognitive testing A specific aspect of history-taking (like addictions & gambling history or family history) Risk assessment EPSE or other physical assessment Medication/side-effects review Talking to a family Getting consent to treatment 39

MINI-CEX DVD EXAMPLES 30 minutes • Watch DVD – 2 examples • Samples of mark-sheets • Practice marking • Discuss and questions V 0. 3 Choose areas to mark : • History taking process • History taking content • Mental state exam • Physical exam skills • Communication skills • Data synthesis • Organisation/efficiency 40

CASE-BASED DISCUSSION (CBD) • Done in the usual hour of 1: 1 supervision time • • Trainee selects 4 cases they are managing • Choose cases from usual clinical work, or an on-call assessment • Cases can be focused on a specific diagnosis or issue if that’s best for trainee’s learning • Structured written feedback immediately after • Formative assessment to shape their practice V 0. 3 Supervisor chooses 1 of the cases 41

CASE-BASED DISCUSSION (CBD) • Trainee briefly presents the case • Supervisor then asks questions to explore the trainee’s knowledge and how they approached the case • Presentation and discussion - 30 minutes • Trainee and supervisor complete the mark-sheet • Feedback - marking is discussed and explained at the end • Can be some teaching or suggestions for further reading V 0. 3 42

DVD FOR CASE-BASED DISCUSSION (CBD) 30 minutes • Watch DVD – 4 brief clips Choose areas to mark: • Clinical record keeping • Clinical assessment • Samples of mark-sheets • Risk assessment & management • Practice marking • Medical treatment • Discuss and compare the examples • Referral • Investigation • Follow-up, care planning & transfer of care • Professionalism • Clinical reasoning V 0. 3 43

FINAL WRAP-UP • Questions? • Final Discussion • Part 2 of this Workshop • Certificates of Attendance V 0. 3 44