Finals - the Liverpool system

Transcription

1 Finals - the Liverpool system The clinical apprenticeship Towards clinical governance and the independent practitioner

2 Fourth year exams Last formal written examination (3 papers) Last formal clinical examination OSCE Communication Skills LOCAS

3 Fourth year examinations Written papers (integrated) 1 - knowledge 2 - application of knowledge 3 - critical evaluation

4 Fourth year examinations Clinical examinations OSCE, Communication skills - have the skills LOCAS - can use the skills Fifth Year - use the skills

5 Final year - Aims To be trained as a house officer for either hospital or community To experience in practice emergency and long-term care in the hospital and community To experience in depth possible career choices of clinical specialities To establish a framework for quality of clinical care To establish the foundation for post-graduate learning and assessment

6 General Objectives Critically evaluate patient problems Show logical reasoning and decision-making on management Undertake practical tasks in a safe and responsible manner. Prescribe safely aware of risk and benefit Evaluate the outcome (reflect on practice) Recognise when things do not go as planned (adverse events) Recognise the uncommon and know when to seek help. Help patients and relatives to deal with emotional distress Work as an effective member of a team, understand leadership and sharing in decision making Communicate effectively with both patients and colleagues

7 Structure of Final year Five attachments each assessed by RITA process (not necessarily in this order) Acute CARE (A/E) Ward CARE (PRHO shadowing) Community Oriented Medical Practice Selective In Advanced Medical Practice Selective In Advanced Medical Practice Hospital Based 8 weeks Hospital Based 8 weeks In the Community 8 weeks In a speciality 8 weeks In a speciality 8 weeks Seven weeks of each attachment are to be spent gaining intensive clinical experience. The eighth week of each attachment for reflection and to prepare portfolio for assessment

8 Principles of attachments One student One named consultant supervisor for each RITA Shadowing supervision depends on environment to allow practice of skills, application or reasoning contribution to decision making, practical prescribing (benefit -v- risk) Case based learning Reflective analysis of practice

9 Elements of the assessment Record of in training assessment - RITA Consultant/supervisor expert report (1:1) Five sequential assessments Portfolio evidence of clinical practice cases, reports, logs etc. Electronic case log Responsibility resides with the student Externally validated

10 The portfolio Case reports (min 3 per week each attachment) Electronic log printout Clinical skills record card Personal prescribing formulary RITA forms from each attachment Mid-point R.I.T.A. Final R.I.T.A. SAMP critical reviews x 2 (2500 words) CV and Other evidence of learning Evidence of approved absence

11 Clinical case records Evaluate Collect Analyse Collect information Key features of history and examination Analyse Problem list/differential diagnoses Investigations to discriminate or guide Rationalise treatment plan, prescribing etc. Evaluate review, monitor progress/complications etc Rationalise

12 Clinical case records Clinical case records Evaluate Review the working diagnosis Monitoring the disease, progress and treatment? Match care to good practice and best evidence guideline? Briefly mention the key features of any current guideline that apply to this case. Describe any problems, adverse events explain why these might have occurred how they could have been prevented? List any family or social implications? Evaluate Collect Rationalise Analyse

13 Reflection Evaluate Collect Analyse Has this case related to your RITA learning objectives? How has this case improved your knowledge and understanding of medicine? How has this case improved your skills? Have your professional attitudes been affected by this case? How will this influence your behaviour in the future? What have been your strengths in dealing with this case? How could you improve on your performance in this case? What have you learned from this experience? Rationalise

14 Record of In Training Assessment Meeting 1 -Week 1 Orientation + Introductions Review learning objectives Set timetable and attendance requirements Meeting 2 -Mid-point RITA Week 4 or 5 Review of portfolio Reflect and discuss personal progress Advice or warning given Mid-point RITA signed and returned to Faculty Meeting 3 - Final RITA Week 7 or 8 Final review of portfolio Discussion of progress and achievements Final RITA signed and returned to Faculty

15 Requirements to graduate Five satisfactory RITA forms Satisfactory completion of critical reviews from SAMPs Completed skills log Evidence of clinical activities (case summaries and computer case log) Evidence of any approved absence/notification of sickness.

16 Student responsibility Ensure assessment complete within each attachment SAMPs reviews completed in time To ensure RITA forms completed and returned to faculty Any leave is approved Provisionally register in April (end 4th) Register completed portfolio in faculty 2 weeks before graduation date.

17 Criteria for Failing Agreed attendance unsatisfactory. Leave or sickness incorrectly recorded a minimum attendance of 90% overall and no more than 2 weeks in any one attachment. An unprofessional attitude or behaviour The student fails to achieve an overall satisfactory clinical standard for the objectives agreed within each RITA. Fail mark in a critical review

18 What happens if a RITA is failed? Each of the five RITA attachments is complete in itself RITA decision is final unless incorrect process Any failure of attachment means Interview with Director Year 5 Appeal only on basis of contrary evidence Attachment is repeated (once) Graduation deferred until five satisfactory RITAs.

19 External evaluation Two external examiners (+ 6 internal) Review process in March Randomly select 16 students detailed interview examine portfolios examine electronic log Review decisions to defer graduation all failed RITAs reviewed with portfolios in June