The Milton Keynes Traffic Light System

How to get round Milton Keynes avoiding the roundabouts

A structured mechanism for identifying trainees in difficulty

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

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

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 (+/-)

Amar Rughani’s Insight TablePerformance

InsightReflect

What do you think??

Good Good •Ideal 5+

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 1-

Insight/ Reflection

ROMp - Defines the Performance Concern, records the behavioural evidence and looks for themes

Relationship Diagnostics Management Professionalism

With patients Assessing patients and their needs

Managing patients Respect for people

With staff Assessing oneself Managing oneself: Performance, health, well being

Respect for protocol

With other colleagues inside/outside practice

Assessing staff and colleagues

Managing staff and colleagues

Being aware of and carrying out contractual responsibilities

Decision making in practice related activities

Managing practice related activities

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

Looking for the Cause of Performance Problems - often several contributing factors

Past Factors Current Factors - External Current Factors -Internal interacting with the individual acting within the individual

Personal history Work environment Attitudes

Upbringing/culture Relationships Personality : Traits/AttributesPrimary relationships Resources Health& Capacity- Physical/mentalOther significant Workloadexperiences/influences Systems etc

Professional history Non-work environment These all have an effect on:

Style of med education Home & Social life Skills and KnowledgeMedical experience Relationships

ResourcesResponsibilities

Non Medical ProfessionalHistory