Introduction
Workplace-based assessment and feedback are central to the philosophy of foundation training. Regular assessment ensures trainees are progressing, provides documentary evidence of achievements and can be used to identify any problems.
The goal is to help trainees provide better care to patients; and to help them strengthen any areas of weakness that are identified.
Foundation trainees will be assessed against the standard of competence that is expected of a doctor completing the F1 or F2 year. This means that, in their first days as a foundation doctor, they may not reach the standard required. This is to be expected and is NOT a failure. The assessments are designed to measure progress through the year. At the end of F1 and F2, trainees will be expected to have progressed to a satisfactory level.
There are three types of assessment:
1. Multi-Source Feedback (MSF) provides an opportunity for a number of your colleagues to rate your abilities and offer comments. The MSF tool currently used in Severn is the Mini Peer Assessment Tool (mini-PAT)
Trainees will be asked to nominate colleagues (including non-clinical members of the healthcare team) as possible raters/assessors. Compiled reports are sent (via e-portfolio) to educational supervisors, who will discuss the results and comments with trainees.
2. Direct observation of doctor/patient encounters are observed clinical interactions which provide the opportunity for immediate feedback to the junior doctor. The two most commonly used tools are:
- Direct Observation of Procedural Skills (DOPS)
- Mini Clinical Evaluation Exercise (Mini-CEX)
During your placements, trainees should ask experienced colleagues (including SpRs, consultants, GP principals, plus experienced nurses and allied health professionals in the case of DOPS) to observe them performing particular procedure (DOPS) or clinical consultation (mini-CEX), rate their level of competence and provide feedback. It is the trainee’s responsibility to arrange the assessments and submit copies of the reports.
3. Case-based Discussion (CbD). This is a structured review of cases in which trainees have been involved. It allows trainees to discuss their decision-making and clinical reasoning in a safe, non-judgemental environment with a senior clinician.
In the Severn Foundation School, trainees are required to complete the following during each year (F1 and F2):
| Multi-source Feedback (mini-PAT) |
2 rounds minimum |
| Mini-Clinical Evaluation Exercise (mini-CEX) |
6 minimum |
| Direct Observation of Procedural Skills (DOPS) |
6 minimum |
| Case-based Discussion (CbD) |
6 minimum |
A Trainee Timeline, detailing all requirements for Sign-Off, can be downloaded here 
Trainee Timeline
Mini-PAT Dates for 2009/10:
| FIRST ROUND |
|
| Opens: |
Monday 21 September 2009 |
| Assessor nomination deadline: |
Friday 9 October 2009 |
| Assessor response and self deadline: |
Friday 30 October 2009 |
| SECOND ROUND |
|
| Opens: |
Monday 25 January 2010 |
| Assessor nomination deadline: |
Friday 12 February 2010 |
| Assessor response and self deadline: |
Friday 5 March 2010 |
Brief Description of the Assessment Tools
What is mini-PAT?
The mini-PAT (Mini Peer Assessment Tool) provides feedback from a range of co-workers across the domains of Good Medical Practice. These can be mapped to the core objectives of the Foundation curriculum. PMETB and GMC have identified peer ratings as suitable for postgraduate assessment and revalidation evidence. A number of groups have been involved in developing and evaluating multi-source feedback (MSF) for trainees. The tool being evaluated for this project for use in Foundation training assessment, mini-PAT builds on this work. It is derived from the Sheffield Peer Review Assessment Tool (SPRAT) and has been shortened on the basis of content validity in relation to the MMC curriculum.
What is mini-CEX?
The mini-clinical evaluation exercise, or mini-CEX, is designed to provide feedback on skills essential to the provision of good clinical care by observing an actual clinical encounter. The mini-CEX is a “snapshot” of a doctor/patient interaction. Not all elements need be assessed on each occasion. In keeping with the Foundation programme quality improvement assessment model, strengths, areas for development and agreed action points should be identified following each mini-CEX encounter. This form samples a range of areas within the Foundation curriculum and can be mapped to Good Medical Practice but was designed originally by the American Board of Internal Medicine.
What is DOPS?
It is essential that all trainees should be adequately assessed for competence in the practical procedures that they undertake. Directly Observed Procedural Skills (DOPS) is a method, similar to the mini-CEX that has been designed specifically for the assessment of practical skills, and was originally developed and evaluated by the RCP. In keeping with the Foundation programme quality improvement assessment model, strengths and areas for development should be identified following each DOPS encounter
What is CbD?
Case-based discussion (CbD) is used to enable the documenting of conversations about, and presentations of, cases by trainees. CbD is designed to assess clinical decision-making and the application or use of medical knowledge in relation to patient care for which the trainee has been directly responsible. It also enables the discussion of the ethical and legal framework of practice, and in all instances, it allows trainees to discuss why they acted as they did. Although the primary purpose is not to assess medical record keeping, as the actual record is the focus for the discussion, the assessor can also evaluate the record keeping in that instance.