Managing trainee performance - assessment tools

Generic skills

History & Examination

• Takes a proper clinical history
• Carries out a proper clinical examination
• Is proficient in the use of basic diagnostic tools, for example: stethoscopic examination of the heart, chest and abdomen, use of the sphygmomanometer, otoscope, ophthalmoscope. peak flow meter and electronic thermometer
• Understands basic communication theory and consultation models
• Understands body language and cues
• Understands physical, social and psychological influences on illness behaviour
• Can assess accurately what the patient does and doesn't know
• Can communicate bad news sensitively and effectively
• Can communicate effectively with patients and relatives.

Investigations

• Can initiate and arrange appropriate investigations
• Has a thorough understanding of the appropriate use of investigative techniques such as:-
• Indications for and interpretation of ECG's
• The use of chest and abdominal X-rays
• The range and scope of laboratory investigations
• The scope and use of ultrasound and various imaging techniques.

Problem solving/making a diagnosis/management plans

• Has good problem-solving skills
• Has an understanding of how doctors think and work
• Can cope with uncertainty
• Reflects formatively on accuracy and inaccuracy in diagnosis
• Can assess existing provision, future need and initiate provision of: physiotherapy, occupational therapy, homecare, social and financial support, day care/respite, use of voluntary agencies & housing assessment
• Can assess the implications of the patient's social context including effects of: retirement, bereavement, isolation, polypharmacy, need for palliative care and support for carers.

Prescribing

• Has a thorough understanding of the principles of prescribing and therapeutics including drug side effects, interactions and contra-indications
• Is committed to generic prescribing
• Understands prescribing in children the elderly and pregnancy
• Is aware of prescribing costs in the hospital and community
• Understands the purpose and use of drug formularies
• Understands the role of the pharmacist.

Record Keeping

• Understands the structure of the clinical record
• Keeps regular, appropriately detailed, accurate records
• Understands medico-legal and risk management aspects of record keeping.

Emergency Care

• Understands how emergency medical care is organised in hospital and in primary care.
• Understands how unplanned care is organised and integrated including the role of the GP, NHS Direct/24 and other systems and structures
• Can understand the presentation of, accurately assess and initiate a management plan for medical emergencies
• Can fully assess a patient in collapse/arrest, initiate and manage basic CPR, life support and use of the defibrillator
• Proficient in the assessment of the unconscious and/or very ill patient, stabilising them and initiating an action plan
• Proficient in establishing venous access and venous blood sampling.

Works within limits of confidence

• Is aware of available and relevant guidelines, evidence and protocols
• Engages appropriately in critical self-appraisal
• Can engage team support appropriately
• Understands the nature of departmental senior staff support and engages this appropriately.

Maintaining Good Medical Practice

• Enthusiastically participates in and effectively contributes to learning opportunities
• Has a good ability to access and appraise medical literature
• Accepts and values constructive criticism
• Effectively participates in and contributes to the departmental training programme
• Commits whenever possible to parallel training programmes eg GP modular programmes
• Understands audit opportunities in primary care and the hospital
• Understands and is able to set quality standards
• Understands how audit feeds into quality assurance
• Ensures completion of agreed audit work.

Working relationship with colleagues

• Understands the roles of the wider health care team both in the hospital and the community
• Respects and engages all team members knowledge and skills
• Communicates accurately and effectively with team members
• Effectively engages with the whole medical team to ensure best outcomes for patient care
• Appropriately delegates and participates in care management
• Is committed to maximising team work between GPs and hospital doctors
• Has a competent telephone manner
• Constructs good quality letters - both for admission, referrals and discharge
• Communicates accurately and effectively with primary care colleagues, especially keeping them informed about their patients.

Relationship with patients

• Has a good basic understanding of human rights
• Understands basic personal needs of patients and relatives, respects their dignity and minimises discomfort
• Can illustrate patience and tolerance
• Copes with and defuses confrontation
• Uses language appropriate to patient and relatives' understanding
• Takes appropriate responsibility for initiating communication with patients and relatives
• Has a basic understanding of ethnic influences on patient care.

Teaching and Training

• Willing to participate in departmental teaching and training responsibilities
• Willing to develop basic training skills and attributes
• Appropriately supervises/mentors more junior staff and can motivate others
• Provides honest feedback on colleagues when requested.

Probity

• Understands what constitutes acceptable and unacceptable ethical practice
• Understands and maintains professionalism at all times
• Seeks help early if concerned about their own performance or that of others
• Understands how to handle complaints
• Understands the legal requirements and how to handle: death certification, The Mental Health Act, fitness to drive, child protection and notifiable conditions
• Understands and is committed to medical confidence
• Understands rights regarding access to information
• Ensures punctuality and availability when on duty
• Understands principles of time management
• Understands the need for high levels of honesty and trustworthiness in medicine including when financial transactions are involved
• Ensures that information relating to medical services is given clearly and objectively
• Never exploits patient vulnerability especially in terms of financial issues
• Always declares and withdraws from issues with conflict of interest.

Health

• Is aware of health issues that may affect ability to work safely as a doctor
• Is aware of work issues that might affect personal health
• Understands stress effects on doctors, patients and carers
• Manages personal causes and effects of stress
• Has an awareness of strategies for coping with stress
• Understands and tolerates other personality types
• Maintains as high a level of personal health and fitness as possible
• Has an awareness of the scope of Occupational Health services.