NHS Education for Scotland
The Scotland GP Enhanced Induction Programme
2015 Context
The Scotland GP Enhanced Induction Programme is for GPs who have never worked in NHS General Practice but are registered with the GMC, included on the GP specialty register with a licence to practise as a GP, and are committed to living and working in Scotland.
Provided the Health Board Medical Director is willing to include the doctor on the Performers’ List when the programme is satisfactorily completed, the NES GP Advisor agrees that the programme is appropriate, and the doctor has successfully completed the entry requirements, a suitable funded placement in an approved GP training practice for up to six months will be found. A series of proscribed work place based assessments will inform a recommendation to the Health Board Medical Director in relation to suitability for independent practice on completion of the programme.
The programme involves supervised clinical sessions in General Practice, workplace based assessments & educational guidance.
During the practice attachment the doctor will be included on the Performers’ List as “in training for a fixed period”.
Satisfactory completion means that the named educational supervisor, informed by workplace assessments, is in a position to recommend to the Health Board Medical Director that the doctor has reached the standard required for independent practice. Where this standard is not met, the educational supervisor will identify the areas that need further development and the decision to place the doctor unconditionally on the Performers’ List will be at the discretion of the Health Board Medical Director.
The programme is funded by Scottish Government.
Details and frequently asked questions in relation to the Scotland GP Enhanced Induction Programme can be found at: http://www.nes.scot.nhs.uk/gp-return-induction
Aims
The aims of the Enhanced Induction Programme are to:
1. Provide a supportive and clinically relevant educational environment in which GPs who have never worked in NHS GP before can acquire a working knowledge of the NHS, are both clinically safe and able to practice in accordance with the values of the NHS, and are comfortable managing patients’ expectations across the broad curriculum of general practice.
2. Provide a formative assessment for the GP during the practice attachment.
3. Provide a clinical recommendation through an Educational Review Report, supported by evidence, to those managing the Performer List.
4. Enable GPs, who are committed to live and work in Scotland, to join the GP work force.
Eligibility Criteria
To be eligible for the programme, the following criteria must be met:
Hold a Certificate Confirming Eligibility for GP Registration (CEGPR) to UK General Practice
Be registered with the GMC (in good standing); on the GMC GP Specialty Register with a licence to practise in General Practice.
Committed to be domiciled in and work in Scottish NHS General Practice
Have the right to work in the UK If you are a member of an EEA state, evidence that you have knowledge of English which, in the interests of you and patients who you may provide medical services to, is necessary for performing primary medical services
If you come from out with the EEA, evidence of proficiency in English to the level of IELTS 7.5
Application Process
If you wish to practice as a GP in Scotland and have no previous experience of General Practice in Scotland, you should register your interest on the website http://www.nes.scot.nhs.uk/gp-return-induction
If you wish to proceed, you first need to apply to be considered for inclusion on the Performers List of the Scottish Health Board area in which you are or will be domiciled. A list of Health Board Performers’ List administrators is attached here (accurate at May 2015)
AREA CONTACTS FOR PERFORMERS LIST Lothian & Borders Susan Summers [email protected] Ayrshire & Arran Karien Foote [email protected] Dumfries & Galloway Shiona Burns [email protected] Fife Linda Neave [email protected] Forth Valley Jackie Lennox [email protected] Grampian Debbie Gordon [email protected] Greater Glasgow & Clyde Kate McGloan [email protected] Highland Melanie Meechan [email protected] Lanarkshire Lee Tannock [email protected] Orkney Arlene Tait [email protected] Shetland Liz Sutherland [email protected] Tayside Allison Rooney [email protected] Western Isles Chrisann Mackenzie [email protected]
The administrator will send you an application pack by post which you should complete and return including all the documents requested.
Your application to join the Performers List will be considered by the Health Board Medical Director who will decide whether you can have immediate and unconditional entry to the Performers’ List.
If the decision is to include you unconditionally on the Performers’ List then you may start work as an independent general practitioner. You should apply for GP posts which are normally advertised in the BMJ or on the SCOTS website. You will be offered an early appraisal.
If the Medical Director believes you are eligible to do the GP Enhanced Induction Programme, then he/she will request advice from a NES GP Advisor.
The Performers’ List administrator will contact the relevant NES GP Advisor and request that they contact you.
The NES GP Advisor will arrange an appointment to review your previous training and experience and advise on next steps. At that interview the Advisor will provide a recommendation to the Health Board Medical Director.
This recommendation will be discussed with the Health Board Medical Director. If the recommendation is that the Scotland GP Enhanced Induction Programme will be required before inclusion on the Performers’ List then you will be advised to apply to sit the national assessment. This can be arranged through the National Recruitment Office. Provided your score is band three or above (see below) you will then be required to sit a Simulated Surgery. There is a fee to sit these assessments, for which you will be responsible.
Once you have completed these assessments and the results are available, you should make a further appointment to see the NES GP Advisor who will find a suitable GP attachment. The programme that you will be offered is up to a maximum of six months. Process for GPs with no previous NHS GP experience who are committed to live and work in NHS GP in Scotland
Health Board Responsibility
Deanery Responsibility
revalidation as scheduled Entry Assessments
If it is established that you are suitable and eligible to be considered for the GP Enhanced Induction Programme then you will be required to undertake more formalised assessments through
Validated Multiple Choice Question (MCQ) papers which assess knowledge and values
A simulated surgery
Your assessments enable NES and the Health Board Medical Director to identify whether you are suitable for acceptance onto the programme and have the potential to successfully contribute to General Practice in Scotland.
Your assessments also help to determine the length of workplace experience and clinical supervision required up to a maximum of six months (whole time equivalent)
If offered a placement then you will be included on the Performers’ List as “in training for a fixed period”.
The MCQ Learning Needs Assessment
The MCQ is a computer based test delivered across the UK by computer using Pearson Vue testing centres and also some venues outside the UK. The assessments are held four times a year. You will be able to schedule a place at your nearest test centre once your application has been accepted. There is a fee of £150. You are allowed a maximum of four attempts. The Clinical Knowledge Test and Professional Dilemmas Test form the two parts of this exam. The schedule of sittings in the UK is published on the National Recruitment Office (NRO) website.
The Deanery Educational Advisor will inform the GP NRO that you wish to sit the assessment and a form will be forwarded to you by the GP NRO to complete.
MCQ Assessment Dates http://gprecruitment.hee.nhs.uk/Induction-Refresher
Wednesday 2nd September 2015 Registration forms must be received from the supporting deanery by 5th August 2015
Wednesday 2nd December 2015 Registration forms must be received from the supporting deanery by 4th November 2015
Wednesday 2nd March 2016 Registration forms must be received from the supporting deanery by 3rd February 2016.
For information around how the MCQ Learning Needs Assessment is structured refer to Appendix 3.
What does the Simulated Patient Surgery Involve?
Simulated surgeries are held quarterly at the RCGP examination centre in London. The schedule of assessments is published on the NRO website. http://gprecruitment.hee.nhs.uk/Induction-Refresher Saturday 25th July 2015 Registration and payment must be received by 24th June 2014 Saturday 24th October 2015 Registration and payment must be received by 23th September 2015 Saturday 23th January 2016 Registration and payment must be received by 23th December 2015 Saturday 23th April 2016 Registration and payment must be received by 23th March 2016
The purpose of the assessments is to determine your suitability for and the appropriate length of programme up to 6 months whole time equivalent. All candidates taking the simulated surgery are provided with feedback about their performance to inform their learning needs and professional development planning. These are held 4 times a year in London usually 4 – 6 weeks after the MCQ. There is a fee of £850. You are allowed a maximum of 2 attempts.
The GP NRO will provide further information about both assessments, including example assessments and answers to frequently asked questions once your application has been received.
The Royal Medical Benevolent Fund – www.rmbf.org – or the Cameron Fund http://www.cameronfund.org.uk/ may be able to provide financial assistance for the GP Enhanced Induction assessments
Costs of the MCQ and Simulated Surgery will be borne by the applicant.
Following Successful Completion of the Entry Assessments
Once you have successfully completed these assessments and have your results, you must make an appointment to meet your NES GP Associate Advisor whom you met earlier in the process. Your start date on the programme will be subject to the availability of a suitable placement.
In order to undertake the programme, you will need to be registered on the Performers’ List as being “in training for a fixed period”. This will be organised by NHS Education for Scotland HR. NES will be your employer for the duration of your programme.
The practice to which you will be attached will be a GMC approved training practice with experience of teaching and assessments. The GP Unit will offer you a practice that as closely as possible suits your situation however the actual location is dependent upon availability.
Teaching and learning
The GP Enhanced Inductee will be supervised by a named Educational Supervisor (ES) who will have overarching clinical and educational responsibility for the doctor. The supervisor will be an experienced GP Educator who will establish educational needs and construct an educational contract to address these. This will describe the number of clinical sessions that will be expected to be worked every week, the programme and timetable for completing assessments, and clinical and educational supervision arrangements. The ES will:
Arrange a thorough induction to the practice and highlight any recent changes to the NHS in Scotland before the GP Enhanced Inductee embarks on the formal agreed timetable.
Facilitate a learning needs assessment using self-rating scale such as Lanarkshire checklist: LanarkChecklist Discuss learning needs during the first mentoring session, and a plan designed to meet these needs will be agreed.
Tailor the weekly timetable to the learning needs of the EI Doctor.
Provide an educational contract in the first week for mutual signature (modeled on the timetable suggested below).
Send a copy of the timetable to the Regional NES GP Advisor (who will be happy to advise re content and suitability), for approval.
Provide weekly educational supervision meetings.
Give regular formative feedback to the EI Doctor with explicit documented comments about progress.
Advise about a Personal Development Plan (PDP) and evidence required for appraisal and revalidation
Suggested weekly timetable
Day Morning Afternoon Monday Surgery Surgery
Tuesday Surgery Surgery
Wednesday Surgery A face to face session with the Educational Supervisor
Thursday Surgery Surgery
Friday Surgery Self directed learning to address areas identified as weak through educational needs assessment OR Planned Educational Session as suggested by ES for example: combined surgery recorded surgery for discussion with ES appraisal preparation reflective log entries (see appendix 1) CDM Clinic with nurse
A session is defined as four hours.
A ‘surgery’ is to include direct patient contact, telephone advice, on-call responsibilities, home visits, and administration as timetabled by the practice.
Initially each surgery will require close supervision appropriate to the experience, competence and confidence of the EI Doctor
The consultation rate should be graduated so that by end of the attachment, the doctor has achieved the standard of an independent general practitioner with an average of 10 minute appointments to include documentation, in line with other clinicians working in the practice.
Combined surgeries should be offered on a regular basis to allow observation of an experienced practitioner’s management of patients, time management and other strategies.
We recommend a maximum of eight general surgeries per week but this should be negotiated in line with the educational needs of each EI Doctor. The ES will be encouraged to contact the Regional NES GP Advisor for any advice needed or with any concerns at an early stage.
The EI Doctor should work in Out of Hours (OOH) with the anticipation that he/she will contribute to the OOH service in future. Provided the local OOH service can accommodate clinical supervision and once the ES is satisfied that he or she is ready to do this then the EI Doctor should do two sessions in OOH per month and a pay supplement will be applied.
The Educational Supervisor will be paid a normal trainers’ grant (pro rata) by the Deanery.
Assessment
Minimum requirements:
The EI Doctor will be required to do a specified number of formative assessments during their practice attachment.
Work place based assessments should be recorded in the logbook which is attached at the end of this document (appendix 2). These assessments include assessments of clinical skills, communication skills and teamwork and are based around observed consultations, case based discussions, 360 degree feedback from patients (Patient Satisfaction Questionnaire (PSQ)) and colleagues (Multisource Feedback (MSF)) and observations of clinical procedures. PSQ and MSF can both be used towards appraisal and revalidation; it is thus in the EI Doctor’s interests to complete these during a stable funded post. Details of all of these requirements can be found on the RCGP website RCGPAppraisal and through the Scottish Online Appraisal Resource SOAR
Normally this will be at least one Case Based Discussion (CBD) and one Clinical Exam & Procedural Skills (CEPS) assessment per month (pro-rata if less than full time).
Reflective educational diary to be shared with the ES (see appendix 1)
A PDP in preparation for early appraisal
The educational supervisor will write a structured report based on work place based assessments and performance whilst under their supervision. They will provide a recommendation in relation to readiness for independent general practice. This will either recommend inclusion on the Performers’ List unconditionally or recommend that further development is necessary. The areas that need further development will be described.
This recommendation will be provided to the Health Board Medical Director who will make a decision about inclusion on the Performers’ List. This decision lies with the Medical Director. All GPs who have undergone the Scottish GP Enhanced Induction programme will be recommended to have their first appraisal within six months of entry to the Performers’ List
The EI Doctor’s employment contract will be determined on the basis of the entry assessments. Any extension to this is dependent upon satisfactory progress which will be considered after 10 weeks on the programme. The maximum length of time that the doctor can be on the programme is six months.
Outcomes of Attachment
The intention is that the Educational Supervisor will be in a position to provide an evidence-based clinical reference to support the decision whether to recommend unconditional inclusion on the local Performer List.
The possible recommendations will be as follows i) no concerns ii) needs further development Review of progress
There will be a review of progress by the Educational Supervisor at the beginning, midpoint and end of attachment with a summative conclusion being reached at the end of the programme, using the Educational Review Document (see Appendix 2). This will be shared with the learner and should demonstrate satisfactory and incremental progress throughout the programme, and continuing ability to reflect and learn from the doctor’s own and colleagues’ practice.
The NES GP Associate Advisor will make contact at the midpoint of the attachment to help with any problems
1. The overall time allotted to the programme will not normally be extended and will be a maximum of six months.
2. A failure to progress in achieving the agreed objectives (reaching the standard of an independent General Practitioner) may result in non inclusion on the Performers’ List.
3. If a failure to progress raises concerns in relation to patient safety or professional probity, the Deanery’s Responsible Officer may, in consultation with the Health Board’s Medical Director, make a referral to the GMC.
4. If a failure to progress is related to sickness absence, it may be appropriate to defer the plan’s completion date. The normal quota of annual leave may be taken during the period of the action plan, but this must be pro-rata. Any period of sickness absence greater than that covered by self-certification must be supported by a doctor’s certificate. A cumulative absence due to illness of more than four weeks in six months will trigger a referral to the Occupational Health Service unless seen as unnecessary in the opinion of the NES GP Associate Advisor in consultation with the doctor and his/her educational supervisor. Reasons for not making an OH referral will be given.
5. On completion of the programme, the ES will make an evidence-based summative recommendation to the Health Board Medical Director
6. NES is responsible through the Deanery for the delivery of the educational assessment and the provision of the Scotland GP Enhanced Induction Programme. Applicants who wish to complain or appeal against the outcome of any assessment or recommendation would do so through an appeal process with NES. If you feel that your Enhanced Induction Programme has not been compliant with the terms of your educational contract, you will be expected to have registered your concerns contemporaneously with documented evidence during the course of your post rather than after receiving your educational supervisor’s assessment. In the absence of valid grounds for appeal, the educational supervisor’s assessment is final.
7. Admission to the Performers’ List is the decision of the individual Health Board’s Medical Director. A decision to refuse an application or to apply conditions on a registration is taken by the Medical Director. Any appeal regarding the outcome of this decision should be made to the Health Board.
Further details around terms & conditions can be found at: http://www.nes.scot.nhs.uk/gp-return-induction
20th May 2015 Appendix 1
Example of a Reflective Educational Diary
For completion by GP Returner
Specimen
Date and activity Learning points Impact/change in What further do I practice need to know? 01/01/2000 -HF commonest cause of hospital -Understand need for - Clarification on Directed reading following admission >65yrs referral for urgent lipid testing and consultation with patient -Average age diagnosis 76yrs and assessment when to fast suffering from Heart 2/3rds have IHD -Would now consider - Confirm target of failure -NYHA system based on symptoms and classification as guide to BP treatment guides treatment not echo or Ix treatment 140/90 in HF /IHD findings. ( NYHA1-4 see page 8 re -High risk condition with treatments) very poor prognosis
Date and activity Learning points Impact/change in What further do I practice need to know?
Add further rows as required Appendix 2 NHS EDUCATION SCOTLAND
EDUCATIONAL REVIEW
LOGBOOK
Name of Doctor:
Supervisor:
Acknowledgement: to North Western Deanery Department of Postgraduate General Practice and Dr Julian Page for developing the outline of this logbook.
Developed from the 9 Point Rating Scale, it incorporates the GMC’s 14 “Duties of a Doctor”
1 History taking and examination
1 2 3 4 5 6 7 8 9 Incomplete, inaccurate, Clear history taking, appreciates the importance of Accomplished and concise confusing history taking, clinical, psychological and social factors, performs history taker; including cannot get patient co- adequate and appropriate examinations clinical, psychological and operation for examination, social factors. Skilled technique poor examination technique, effective listener
Date Score Comment 2 Investigations
1 2 3 4 5 6 7 8 9 Inappropriate, random, Investigates appropriately, ensures all investigations Arranges, completes and unnecessary requested by the team are completed, knows what to acts on investigations investigations no thought do with abnormal results intelligently, economically given. Often and diligently fails to perform investigations requested
Date Score Comment
3 Record Keeping
1 2 3 4 5 6 7 8 9 Poor, confusing records. Clear records made in notes, medico-legally sound, Records his/her information Inadequate, illegible others are able to understand accurately and efficiently. Easy for others to follow
Date Score Comment
4 Problem solving / Making a diagnosis 1 2 3 4 5 6 7 8 9 Unable to make decisions, Can make a sound diagnosis, and produce safe, Plus – shows intelligent or even make a working appropriate management plans. Involves patients in interpretation of available diagnosis. Fails to involve decision making. Good recognition of own limits data to form an effective patients in decision hypothesis, understands the making. Unaware of own importance of probability in limits diagnosis
Date Score Comment
5 Multimorbidity and medical complexity
1 2 3 4 5 6 7 8 9 Accepts a key role in co- ordination and management Manages health problems Simultaneously manages both acute and chronic of acute and chronic separately, without health problems. Can tolerate uncertainty, including problems. Anticipates and considering implications of that of the patient where appropriate. Communicates uses strategies to manage multimorbidity. Maintains risk effectively to patients. Encourages patient uncertainty. Co-ordinates positive approach to involvement in health promotion and disease team-based approach to patient’s health. prevention. health promotion, prevention, cure, care and palliation and rehabilitation.
Date Score Comment 6 Emergency care 1 2 3 4 5 6 7 8 9 Does not respond to Responds quickly to emergency calls, works well Shows ability in evaluating emergency calls, chaos within team, appropriate management of situation the emergency situation and panic in emergency calmly and intelligently, situations establishes priorities correctly, organises assistance and treatment promptly.
Date Score Comment
7 Attitude to and relationship with patients 1 2 3 4 5 6 7 8 9 Discourteous, Courteous & polite, communicates well with patients, Excellent bedside manner, inconsiderate of patients shows appropriate level of emotional involvement in able to anticipate patients’ views, dignity & privacy. the patient and family. Respects privacy & dignity emotional and physical needs Unable to reassure, and plans to meet them. subject of repeated Explains clearly and complaints Checks understanding.
Date Score Comment
8 Team working / relationship with colleagues 1 2 3 4 5 6 7 8 9 Unable / refuses to Listens to colleagues – accepts the views of Able to bring together communicate with others. Flexible – ability to change in the face of views for a common goal. colleagues. Can’t work to valid argument Team goal is put before common goal, selfish, personal agenda inflexible
Date Score Comment
9 Lifelong learning / Involvement in Teaching 1 2 3 4 5 6 7 8 9 Does not see the need Positive approach to learning, participated in Enthusiastic approach to for learning, does not teaching, learns from mistakes, > 50% attendance at learning, reports own errors learn from mistakes. teaching sessions unhesitatingly and shows Fixed blinkered approach, ability to learn from poor attendance at the experience, good teaching sessions attendance (> 75%)
Date Score Comment Has a responsible and professional attitude and approach to their work, in the 10 following areas:-
• Manners • Ethics • Dress code • Honesty • Time management • Trustworthiness • Punctuality • Confidentiality • Safeguarding (Children and Vulnerable Adults)
1 2 3 4 5 6 7 8 9 Reasonable attitude/ approach in above areas, a Poor attitude/ approach in Excellent attitude / approach good doctor above areas, possible in above areas, a credit to the concerns. Fails to make profession. Patient care is the care of patient first priority concern, own beliefs prejudice care, abuses position as a doctor
Date Score Comment
11 Verbal Communication - Understanding
1 2 3 4 5 6 7 8 9 Poor comprehension of Good comprehension of English, can follow a Can understand all that is even simple sentences, conversation, few misunderstandings, understands said, can cope with unable to follow a most medical terminology and abbreviations “difficult” accents. conversation, no understanding of medical terminology and abbreviations
Date Score Comment 12 Verbal Communication – Being Understood
1 2 3 4 5 6 7 8 9 Such a difficult accent Has a good command of spoken English, may Clear speech, little or no that patients are unable have some accent, can use appropriate medical accent, n misunderstandings to understand. Unable terminology to construct sentences. Liable to be misunderstood
Date Score Comment
13 Written Communication - Comprehension
1 2 3 4 5 6 7 8 9 Cannot understand a Can read typed letters, can mostly understand Can easily comprehend both simple typed medical written notes of others, and may have some type hand written text letter. Frequent difficulty with doctors’ handwriting. misunderstandings
Date Score Comment
14 Written Communication – Being Understood
1 2 3 4 5 6 7 8 9 Cannot dictate or write a Can dictate or write clear letters, notes in records Good clear letters, able to simple letter, cannot understandable. Legible. Uses appropriate medical deliver complex messages make suitable records terminology. that are understandable. Misuses medical terminology. Illegible
Date Score Comment
Social Integration and/or Adjustment 15 For this section a score was felt to be inappropriate, a simple discussion on how the doctor and family are settling in to; a. their new life (e.g. making friends, accommodation, children’s schooling etc.) or b. coping with their return to clinical work
Date Comment
16 Integration/Re-Integration with the National Health Service
1 2 3 4 5 6 7 8 9 No awareness of the Coping well with the NHS systems, can Working well within the NHS systems, overcome teething problems and is learning confines of the NHS, aware unable to adapt to the new ways of working and correct use of its new ways of working systems. Good awareness on professional etiquette
Date Score Comment
17 Case-based discussion (CBD)
1 2 3 4 5 6 7 8 9 Significant concerns/learning Good reflection, no concerns Some concerns/learning needs noted needs identified no
Date Comment
18 Clinical Examination & Procedural Skills Assessment (CEP)
1 2 3 4 5 6 7 8 9 Significant Some concerns/learning needs noted No concerns noted concerns/learning needs identified
Date Comment
19 Multi-source feedback (MSF) Please use a recommended tool for detailed feedback as no specific tool is mandatory. Expectation is one per six month placement (i.e. if part-time over 12 months then two MSFs expected)
1 2 3 4 5 6 7 8 9 Some concerns/learning needs noted No concerns noted Significant concerns/learning needs identified
Date Score Comment 20 Patient satisfaction questionnaire (PSQ) Please use a recommended tool for detailed feedback as no specific tool is mandatory. Expectation is one per six month placement (i.e. if part-time over 12 months then two PSQs expected)
1 2 3 4 5 6 7 8 9 Significant No concerns noted concerns/learning needs Some concerns/learning needs noted identified
Date Comment
21 Out-of-hours Experience (OOH) - This is an optional field only if OOH sessions have been included within the programme
Date Comment
COMMENTS/ LEARNING OBJECTIVES AFTER FIRST REVIEW
Signed: Date: COMMENTS/ LEARNING OBJECTIVES AFTER SECOND REVIEW
Signed: Date:
COMMENTS/ LEARNING OBJECTIVES AFTER THIRD REVIEW
Signed: Date:
Practice Address Educational Supervisor
Name:
GMC Number:
Signed:
Date : Final Conclusion (please tick as appropriate) No concerns Needs further development in areas identified above
Signed Director of Postgraduate GP Training or Nominated Deputy
Name:
Date: Appendix 3
How is the MCQ Learning Needs Assessment structured? 1.
There are two parts to the MCQ Learning Needs Assessment; both are designed to assess some of the essential competences outlined in the National Person Specification f o r G P and are based around clinical scenarios. You will first be asked to complete a Professional Dilemmas (PD) paper, followed by a Clinical Problem Solving (CPS) paper.
Professional Dilemmas (50 items, 100 min) The PD paper is a Situational Judgment Test (SJT). This part of the assessment focuses on a candidate’s approach to practicing medicine. Specifically, the paper measures one’s understanding of situations that arise for doctors in the NHS, particularly in General Practice; judgment in differentiating between appropriate and inappropriate responses; and the ability to recognize the most important concerns in any situation. It focuses on appropriate behavior with respect to interacting with patients and colleagues and in managing one’s own workload. It does not require specific knowledge of general practice but does assume general familiarity with typical primary and secondary care procedures.
The test covers three core domains:
. Professional integrity . Coping with pressure . Empathy and sensitivity
The PD paper consists of 50 items and there are 100 minutes in which to complete the test.
Clinical Problem solving (86 items, 65 min) In this part of the assessment, candidates are presented with clinical scenarios that require them to exercise judgment and problem solving skills to determine appropriate diagnosis and management of patients. This is not a test of knowledge per se, but rather one’s ability to apply it appropriately. The topics will be taken from areas with which a General Practitioner is expected to be familiar.
The CPS paper consists of 86 questions and there are 65 minutes in which to complete the test.
2. How is the raw score calculated for the PD paper?
There are 50 items in the PD paper. Around half of the items are ranking items and the other half of the items are multiple choice. As with the CPS paper, there is no negative marking.
SJT items are scored against pre-determined keys that have been derived from consultations with multiple GP Subject Matter Experts (SMEs), so that the scoring of the test is standardised and fair to all candidates.
Ranking items The items in Part One of the paper require candidates to rank a series of options in response to a given situation. Answers are marked by comparing a candidate’s response to the model response determined by an expert panel (i.e. GP SMEs). The closer the response is to the model response, the more marks that are awarded. A perfect match generally receives 20 marks, and a candidate does not need to get every option exactly in the correct order to obtain a good score on an SJT item. It is important to note that this marking convention means that even if a candidate were to answer a ranking item completely out of order, they would score a minimum of 8 marks for that question. Skipping or missing an item, however, results in a score of 0 marks for that question.
The table and example below illustrate the scoring system in more detail.
Key Candidate Rank
Rank 1 (C) 2 (D) 3 (A) 4 (E) 5 (B) 1 (B) 4 3 2 1 0 2 (C) 3 4 3 2 1 3 (A) 2 3 4 3 2 4 (D) 1 2 3 4 3
5 (E) 0 1 2 3 4
Example: Imagine you are answering a ranking SJT question in the MCQ Learning Needs Assessment. You are given a list of five actions/options and are then asked to rank in order the following actions in response to this situation (1 = most appropriate; 5 = least appropriate). The predetermined key for this question is BCADE. Option B has thus been predetermined by multiple SMEs to be the ‘most appropriate’ option (and in other words, ranked as 1 out of 5). If you then select Option B as the most appropriate action you would be awarded 4 full marks for this part of the question. Instead, if you select the option that has been predetermined as the second most appropriate action, Option C, you would still be awarded 3 points. If you were to select Option A, you would be awarded 2 points, and if you were to selection Option D you would only be awarded 1 point. You therefore get allocated marks based on the proximity of how you rank each of the possible options in accordance to the pre-determined key. So for example, if you were to answer this question using the key CDAEB instead, you would get 12 marks (3 + 2 + 4 + 3 + 0 = 12).
Multiple choice items The items in Part Two of the paper require candidates to select three from a maximum of eight possible responses to a given situation. As with ranking items, answers are marked by comparing the response to the model response determined by an expert panel. Multiple choice items are worth a maximum of 12 marks. Each of the three individual responses is worth 4 marks.
3. How is the raw score calculated for the CPS paper? There are 86 items in the CPS paper. Around half of the items are Extended Matching Questions (EMQ) and the other half are Single Best Answers (SBA), including a few Multiple Best Answers (MBA). EMQs can cover more than one clinical topic and refer to multiple clinical scenarios that are linked to the same set of response options.
For each item in the CPS test, 1 mark is awarded for choosing the correct response. For each MBA item, multiple marks are awarded for each correct response you select (up to a maximum of 3 marks). There is no negative marking.
4. How are the raw scores converted to final ‘T scores’?
Both the CPS test and SJT raw scores are converted to a standardised ‘T score’, which is the final mark allocated for each test.
T scores will generally have a mean of 50 and a standard deviation of 10. The advantage of using a T score, as opposed to the raw score, is that T scores eliminate the natural variations between test questions and provide a way to determine whether scores are high or low. In addition, scores for both papers can be easily compared.
PD paper example: Your raw SJT score was 598 marks. When converted to a T score, the resulting final score is 28. The conversion process is illustrated below:
598 – 661.7 (this is the ST3 population mean) = -63.7 -63.7 / 28.7 (this is the standard deviation of scores in the ST3 population) = -2.2 (-2.2 x 10) + 50 = 27.8 (rounded up this would be 28)
CPS paper example: Your raw CPS score was 67 marks. When converted to a T score, the resulting final score is 44. The conversion process is illustrated below:
67 – 72.7 (this is the ST3 population mean) = -5.7 -5.7 / 8.9 (this is the standard deviation of scores in the ST3 population) = -0.6 (-0.6 x 10) + 50 = 43.6 (rounded up this would be 44) 5. How are T scores used? T scores will generally have a mean of 50 and a standard deviation of 10. In the case of candidates who apply to the Enhanced Induction Programme, however, the distribution of scores is not normal – it is negatively skewed. What this means is a large proportion of candidates tend to achieves scores that are at the lower end of the distribution/range of scores. As a result, normal interpretation of a T score (where the average score is usually 50) is not applicable.
The following guidance, based on the overall performance of Induction &Returner candidates in England that sat the assessments during 2013 to 2015, can be followed when interpreting final scores in relation to other candidates that are applying for the Enhanced Induction Programme:
Final score interpretations based on previous I&R candidate performance
Bottom 25% Average Top 25 % Final Final Score Range Final Score Score Range
CPS paper 39 or less 46 56 or more
PD paper 30 or less 38 49 or more
Final scores in either test are grouped into one of five bands to help interpretation of these T scores with regards to recommendations for the Enhanced Induction Programme are as follows:
Allocation of final scores to bands based on expected ST3 performance Band T score range Interpretation
Band 1 22 and below Well below the minimum standard required
Band 2 23-28 Below the minimum standard required
Adequate level of performance, will need up to max Band 3 29-44 6 months WTE
Good level of performance, will need standard Band 4 45-59 induction of about 3 months WTE
Excellent level of performance, will need standard Band 5 60 and above induction of about 3 months WTE
The scores indicate a candidate’s general level of performance. Please note, that the interpretation of performance is determined by comparing the performance of induction scheme candidates to the estimated performance of ST3 GP specialty trainees in either test. This group is the most similar group for which performance data is available. The use of this comparison group in this way allows performance to be benchmarked. Score below minimum standard required
Band 1 Where a score is in Band 1, it is likely that the candidate will require significant support and pre-application advice prior to reapplying for a place on the Enhanced Induction Programme. Band 1 scores on either paper suggest substantial deficiencies in performance.
Band 2 Where a score is in Band 2, it is likely that the candidate will require some support prior to reapplying for a place on the Enhanced Induction Programme. Band 2 scores on either paper suggest deficiencies in performance that need to be addressed.
Band 1 and Band 2 scores on the C PS p a p er suggest a need to improve clinical knowledge. Some candidates will find their knowledge has deteriorated through lack of use or that their knowledge is now out dated due to changes in practice. Low scores on the CPS paper can also be due to poor problem solving skills, that is difficulty applying knowledge in clinical situations. This can include difficulties in identifying the key issues in a situation, poor integration of knowledge or failure to determine the most likely or critical possibilities in a situation.
Band 1 and Band 2 scores on the P D p a p er suggest a difficulty in identifying the best response to situations. This may be the result of inappropriate assumptions about the role of a doctor working in an NHS General Practitioner post, both in the provision of care and as part of an organisation providing clinical care. This can include a poor understanding of professional ethics or use of less patient- centered approaches to the provision of care. Candidates with scores in this band can sometimes fail to take account of how others are feeling, have difficulty making decisions under pressure or cope less well with the stresses and strains of being a medical practitioner.
Score just above minimum standard required
Band 3 Where a score is in Band 3, there are likely to be development needs which might be addressed during participation in the Enhanced Induction Programme. Based on performance at the next stage of assessment (i.e. simulated surgery), candidates may be asked to complete up to 6 months (whole time equivalent) of supervised clinical sessions in General Practice, as well as workplace based assessment and educational guidance.
Band 3 scores on the C P S p a p e r suggest that the candidate will need to improve their clinical knowledge. This may always have been an issue for the candidate, or their knowledge may have deteriorated since their initial training or last period of practice. Low scores on the CPS paper can also be due to poor problem solving skills, where candidates have difficulty applying their knowledge in clinical situations. This can be due to difficulties in identifying the key issues in a situation, poor integration of knowledge or inability to determine the most likely or critical possibilities in an ambiguous situation.
Band 3 scores on the PD p a p er suggest that the candidate does not always identify the best response to situations. This can be the result of poor insight or inappropriate assumptions about the role of a doctor working in an NHS General Practitioner post, both in the provision of care and as part of an organisation providing clinical care. Factors such as a poor understanding of professional ethics or use of less patient-centered approaches to the provision of care can contribute to low scores. Candidates with scores in Band 3 are likely to have less understanding of, or take less account of, how others are feeling. They can have difficulty making decisions under pressure and/or cope less well with the stresses and strains of being a medical practitioner. Score well above minimum standard required
Band 4
Where a score is in Band 4, there are likely to be some development needs which might be addressed during participation in the enhanced induction programme. Based on performance at the next stage of assessment (i.e. simulated surgery), candidates may be asked to complete the standard induction covering 3 months (whole time equivalent) of supervised clinical sessions in General Practice, as well as workplace based assessment and educational guidance. Scores in Band 4 show a good level of performance.
Band 5
Where a score is in Band 5, there are likely to be very few development needs that need to be addressed during participation in the Enhanced Induction Programme. Based on performance at the next stage of assessment (i.e. simulated surgery), candidates may not require much support in terms of induction into General Practice. Scores in Band 5 show an excellent level of performance.
6. How has the minimum standard required been calculated?
The minimum passing score for each paper has been determined to be a T score of 29, based on a standard setting exercise that was carried out in 2015 with an expert panel of GPs. It is estimated that approximately a quarter of candidates will score below this level.
7. What is the general advice for candidates preparing to sit the MCQ Learning Needs Assessment?
You can take a generic tutorial to familiarise yourself with the controls and screen layouts in advance – see Pearson VUE for details:
h t t p : / / w w w . p e a rs o n v u e. c o m/ a then a/ athe n a. a sp
Papers are NOT negatively marked so make sure you answer all the questions. It is important to note that the marking convention for the PD ranking items means that even if a candidate were to answer a ranking item completely out of order, they would score a minimum of 8 marks for that question. Skipping or missing an item, however, results in a score of 0 marks for that question.
Read the instructions and questions carefully. There may be times when you would like more information to answer questions. Just give your best answer given the information provided.
Read the example questions carefully. If you feel you would benefit from revisiting some areas of knowledge or practice in order to be better able to show your capability then you should do this before the assessment.
For more information about the format of the questions that are contained in the CPS paper, you can use access the following links: EMQs: h t t p : / / en . w i ki p ed i a.or g / w i ki / E x t e nd ed _ m a t ch ing _it e m s h t t p : / / w w w . m ed s ch o o ls . a c . u k /M SC A A / e x a m p le q u es t i o n s / P a g e s / E M Qs.a s p x h t t p : / / g l o b al . o up .c om / u k / o r c / m ed i ci n e / c o x / 01 s tu d e n t / e m q s/
SBAs: h t t p : / / w w w . m ed s ch o o l s .a c . u k /M SC A A / E X A M PL E QUE S TIO N S/ P a g e s / S B As . as p x
The test specification for the MCQ Enhanced Induction Learning Needs Assessment is built from the current GP Recruitment Stage 2 Assessments. You can familiarise yourself with the format of the CPS and PD papers by visiting the following link: h t t p : / / gp recru i t m ent. h e e . nh s. u k / P o rtal s / 8 / Do c u m e n ts / E xa m p l e % 20 Q u es t i o n s / Exa m p le s % 2 0 - % 20 Sta g e % 2 0 2 . pd f
We will provide a glossary where questions use terms or abbreviations which are not in universal use or may be misunderstood by some candidates.
For abbreviations that are used in general medicine, please ensure that you familiarise yourself with these prior to sitting the CPS paper. A list of possible abbreviations that are covered in the assessment is available on the NRO website and can be accessed by visiting the following link: h t t p : / / gp recru i t m ent. h e e . nh s. u k / P o rtal s / 8 / Do c u m e n ts / E xa m p l e % 20 Q u es t i o n s / G P % 20 C P S % 20 A bb r e v iat i o n s %2 0 2 0 1 5 - 1 6 . pd f