The Milton Keynes Traffic Light System A structured mechanism for identifying trainees in difficulty...
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Transcript of The Milton Keynes Traffic Light System A structured mechanism for identifying trainees in difficulty...
The Milton Keynes Traffic Light System
A structured mechanism for identifying trainees in difficulty
From: Greg Simons
Overview of Presentation
• Introduction• RDMp Model• Reflection/ Insight• Traffic Light system• Implications of the traffic light• Expectations
Introduction• GP• GP Trainer• National Clinical Lead GP access and responsiveness• Associate GP Dean
– PD support– Trainer Support– Trainee Support– Executive rep at Deanery Board level– Faculty Development
The RDM-p Model
• Tim Norfolk – Quality in Primary Care 2009 17 (1), pp37-49
• Unifying theory of clinical practice• Links Relationship, Diagnostics, Management
and Professionalism• Overarching model, provides a framework
that can incorporates criteria and competencies across the range of assessments of a GP's work
RDMp Relationshipsdescriptor descriptor
R=relationships Negative positive
•Holistic•Consulting skills•Communicating•Working with colleagues
•Lacks warmth in voice/manner•uses too many closed questions•Unable to adapt language•Unclear when communicating•Gives little support•confrontational (+p)•Authoritarian (+p)
•Good non verbal behaviour•Uses open questions•Adjusts questioning•Expresses ideas clearly•Encourages contribution•Delegates appropriately•Non-judgemental
Adapted from Tim Norfolk; Quality in Primary Care 2009
RDMp Diagnosticsdescriptor descriptor
D=Diagnostics negative positive
•Data gathering•Data interpretation•Making diagnoses•Making decisions•Clinical Management•Managing complexity
•Can’t find a way of resolving the problem (D+M)•Makes immediate assumptions•Dogmatic•Overlooks important information•Options too limited
•Positive when dealing with problems•Thinks around issues•Open to new ideas•Shows interest and understanding•Identifies key points•Aware of options
Adapted from Tim Norfolk, Quality in Primary Care 2009
RDMp Managementdescriptor descriptor
M= management negative positive
•Community orientation•Practice Management•IMT•Maintaining performance•Learning and teaching
•Unsystematic•Fails to apply lessons•Disorganised•Doesn't keep up to date•Poor prioritisation•Misses reasonable deadlines•Doesn't think ahead•Doesn't cope well with unexpected•Becomes agitated
•Sound systematic judgement•Admits to and learns from mistakes•Organised•Regularly updates job related skills•Prioritises effectively•Coordinates activity•Thinks ahead•Delivers on time•Stays calm under pressure
adapted from Tim Norfolk, Quality in primary care 2009
RDMp professionalismdescriptor descriptor
P= professionalism negative positive
•Ethics•Fitness to practice
•Defensive (M+P)•Critical•Shows favouritism•Narrow perspective•Fails to take responsibility for poor actions•Treat issues as problems•Disrespectful to colleagues, staff or patients•Finds it difficult to seek help when appropriate
•Receptive•Gives constructive feedback and support•Collaborates•Sees bigger picture•Takes responsibility appropriately•Recognises limitations•Shows respect•Seeks help when necessary
Adapted from Tim Norfolk, Quality in primary care 2009
RELATIONSHIP DIAGNOSTICS
MANAGEMENT
Communication & Consulting Skills
Working with Colleagues & in Teams
Maintaining an Ethical Approach to Practice
Data Gathering & Interpretation
Clinical Management
Maintaining Performance, Learning & Teaching
Primary Care Administration
& IMT
professionalism
Community Orientation
Fitness to Practise
Managing Medical Complexity
Making a Diagnosis / Making decisions
Practising Holistically
Tim Norfolk Quality in Primary Care 2009, 17 (1), pp37–49
© Tim Norfolk
RDMp and Good Medical Practice
Tim Norfolk 2009
Amar Rughani’s Insight TablePerformance
InsightReflect
What do you think??
Good Good •Ideal
Good Poor •Unconsciously competent doctors may not adapt to changing situations as they don't understand why they are (currently) competent. They may also engage in risky practices through lack of insight regarding the connection between action and effects.
Poor Good •Consciously incompetent doctors might be difficult because they have low motivation to improve. The causes of low motivation, such as stress need to be looked for.
Poor Poor •Unconsciously incompetent doctors may be the most difficult to remediate because despite regular exposure to deficiencies in performance, they may lack the capacity to change
Insight/ Reflection
Using the Traffic Light System
• Look at descriptors for RDMp domains
• Apply the grading in each domain using your knowledge of the trainee, experience and evidence e.g. eportfolio, feedback
Grading (Milton Keynes)
• 1 = clearly failing• 2 = concerns• 3 = expected stage• 4 = above expectation for stage• 5 = ready for independent practice
• Add in insight/lack insight (-/+)
Using the Traffic Light System• Look at descriptors for RDMp domains• Apply the grading in each domain using your
knowledge of the trainee, experience and evidence e.g. eportfolio, feedback
• Decide whether the trainee demonstrates insight with reflective ability with + or -
• Categorise Green/ Amber/ Red
Traffic Light System for MKVTS- Tables
colour concern eportfolio ES PD/AD
Green none •Sufficient number and quality of entries. •Progression in PDP and skills log•Satisfactory coverage curriculum•Satisfactory completion Assessments
•Continue regular review eportfolio•Continue 6/12ly reviews•RDMp3+ in all areas
•Monitor eportfolio
Traffic light system for MKVTScolour concern ePortfolio ES PD/AD
Amber Some •Consistently poor quality/ number of entries•Poor PDP•Poor coverage of curriculum•Inadequate number of mandatory assessments
•RDMp2 in any one area•One area may be (-) for insight
PD interviews trainee + ES
Traffic light system for MKVTScolour concern ePortfolio ES PD/AD
Red Significant •Failure to engage ePortfolio•Unsatisfactory progress signalled by ES or CS
•RDMp1/2 in more than one area•poor insight (-) in multiple domains
Interview with PD/AD with ES with a view to referral to ARCP
Implications of Traffic Light
• Feedback monthly for those in GP, Quarterly for those in Hospital (more freq if problems)
• Early referral to ARCP• Reflective Skills very important• Early, Frequent and open discussion with Ed
Supervisor
Expectations
• Full engagement• Professionalism• Self Directed