- HEE recognised Roadmap Supervisors are being trained by HEE Roadmap National Trainers or are existing GP educational supervisors.
- As detailed in the roadmap each practitioners will require 2 workplace based assessments (WPBA) per month which will take on average a total of 45-60 minutes to complete both. In addition to the WPBA there will be at least a daily debrief of approximately 20-30 minutes in length.
- Some debrief can be done remotely if the ‘debriefer’ has access to the patient record – eg. phone/teams
- Each full-time equivalent Roadmap supervisor can supervise up to four practitioners at a time.
Portfolio of evidence
- As a practitioner who is working in primary care seeing undifferentiated and undiagnosed presentations it is key to ensure patient and practitioner safety.
- Having a portfolio of triangulated evidence against agreed capabilities is a robust method of evidencing capability. The development of a portfolio of evidence is the responsibility of the practitioner but they should have the support of a supervisor.
- Editable PDF versions of the portfolio tools will be added to the Landing Page for stage two.
- The evidence for stage one should demonstrate capability against the knowledge, skills and attributes (KSA) in the profession specific Roadmap. Stage one needs to demonstrate level 7 knowledge, complex clinical reasoning, and critical thinking.
- Any level 7 modules/credits can be mapped across and any learning outcomes from the modules will help this process. It is likely a practitioner will require 5 pieces of reflection to show currency of their KSA in daily practice.
- On the landing page there is a video explain how to evidence level 7 KSA. Examples of reflective writing will be added soon.
- The portfolio of evidence for stage 2 must use the portfolio tools in the framework otherwise the evidence will not be valid. Each Roadmap has a table of requirements for stage 2.
- One learning log reflection a week would build up evidence of application of knowledge and skills in everyday practice. Work-place based assessments (WPBA) provide an assessment of capability by a trained Roadmap supervisor.
- One COT & one CBD per month is stated in the roadmap and this should take an average of 45-60 minutes a month.
- Feedback from patients/the public and the primary care team also provide evidence for your portfolio. The portfolio tools with guidance how to use them is included in the Roadmap appendices.
Debriefing is essential not only to ensure patient safety but also to provide specific and constructive feedback to the trainee. The debrief is an ideal opportunity to encourage complex clinical reasoning and reflection. The learning opportunities provided by debriefing should not be underestimated. Trainees are more likely to remember information when linked to a patient they have seen.
Whatever the style of feedback/debriefing, the aim is to have a conversation that is genuine, mutual, clear, and trusting. The conversation must also set out to understand personal and situational factors. Human factors can influence practice enormously and should be recognised and acknowledged. For example, you may behave differently if you're running late; if you are feeling stressed; if the computer is running slowly; if patients behaviour is challenging.
Here are some ideas to help you debrief. This is NOT a script just ideas to get you going.
Ask the trainee to talk through the consultation, including the history, data gathering, examination and clinical management plans. Ask questions:
- How did you gather the history, what questions did you ask?
- How did you assess for any red flags?
- What examination did you undertake and why ('show me how' for junior trainees)?
- How did you make your decisions?
- What were you thinking?
- Why do you think you made that decision?
- What different decisions might you have made, and on what basis?
- Let us discuss similar and variant cases.
- How do you think the patient/care/relative felt?
Ask the trainees about their strengths and points for improvement
- What were you happy with?
- What went well and why?
- What were you not happy with?
- What would/could you do differently next time?
- How did that make you feel?
- So, in summary
Provide the trainees with some feedback regarding their strengths and points for improvement:
- … was good/excellent
- I liked.....
- Maybe you need to improve or to consider, or to do differently…
- What about trying/thinking...
- Has this identified any learning needs?
- So, to sum up…
Please check documentation and read coding has been done appropriately.
Further useful question suggestions
- I see that you… What was your intention then?
- How was that compared to last time?
- What was different?
- I am concerned that… How does that sound to you?
- How did it go with the team?
- I am interested to know how you are getting on with…
- I am getting worried that you may be… Is that a possibility do you think?
- I think… How do you see it?
- So, how will you proceed now to increase your flexibility/speed of response/team communication?
- What other questions does this raise for you/the team?
- So, what have we discussed?
Obviously when debriefing we have a finite amount of time so you will need to select the things you wish to discuss in more detail. Any learning needs should be identified and then the trainee can address these through self-directed study, a tutorial, shadowing etc.