UKFPO Bulletin: 23 November 2021

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Tony Choules, Faculty and Operational Advisor to the UKFPO 

With the majority of our Foundation doctors coming into the second half of their first placement I wanted to remind supervisors to think about the Placement Supervision Group (PSG) report and foundation doctors about the summary narrative.

Although the formal PSG report has been in the Foundation eportfolio for some time, it has not been used in all schools and some clinical supervisors might not be familiar with it.

Like the other multisource feedback process used in Foundation – the TAB, the PSG report makes use of a number of different viewpoints to ensure a fair report is given on the performance of the Foundation doctor.  The PSG should comprise a nominated group of senior healthcare professionals who work alongside the FD and are in a position to provide feedback on a day-to-day basis.  

The importance of feedback in Foundation is reviewed by Lorraine Parks, FSD for Northern Ireland here in the Giving feedback factsheet and more can be found in the curriculum 2021.

The makeup of the PSG will vary depending on the placement but is likely to include:

  • Doctors more senior than F2, including at least one consultant or GP principal
  • Senior nurses including practice nurses or nurse practitioners (band 5 or above) 
  • Ward pharmacists 
  • Allied health professionals 

For the PSG report which informs the clinical supervisor report (CSR), feedback is collected via a structured form which must be sent out to respondents by the clinical supervisor (CS) who is responsible for reviewing the responses.  Where possible, a PSG report should be collected in each of the FD’s CSRs but, at a minimum, formal PSG feedback must be involved in one report for each level of the foundation training.   This is best done in the first placement.  (Details on how to manage this process this can be found on the curriculum page of the UKFPO website: New UK Foundation Programme Curriculum 2021 – UK Foundation Programme Topic 5).

There have been some queries around exactly what constitutes a PSG report that a clinical supervisor can sign off as ‘no concerns’/’satisfactory’ and some more detailed guidance is being developed.  When considering PSG feedback, supervisors should remember that it is largely formative and, when raters raise ‘concerns’,  these should be taken in the context of the FD’s overall progress through the programme.  It is up to the CS to decide whether these amount to genuine concern for the FD’s progress necessitating a repeat of the PSG in a subsequent placement or as areas for development in a FD who is otherwise making satisfactory progress and who should not be required to undergo another round of formal ‘summative’ PSG feedback.

Moving on to the ‘Summary Narrative’ for the benefit of foundation doctors (and supervisors)…

The narrative is new to Foundation but is used in some specialty training programmes.  It is designed to help you assess your own progress against the three main areas (HLOs – Higher Level Outcomes) of the Foundation curriculum 2021.
To complete the narrative, you will need to look at the evidence you have in your eportfolio that can be used against each of the 13 Foundation Professional Capabilities (FPCs) – SLEs, feedback, teaching sessions, personal learning, reflection etc.   It is up to you to decide which of these to link to each FPC and then think what other things you still need to do to demonstrate to your supervisor that you are capable in each of the FPCs.  Remember, some of the evidence you choose must relate to directly supervised clinical activity.

More information on this can be found on the curriculum page of the UKFPO website: New UK Foundation Programme Curriculum 2021 – UK Foundation Programme (Topic 8) where you can read the factsheet or watch Fiona Cameron, FSD for Scotland and Vice Chair of the AoMRC Foundation Programme Committee talk you through the process. 

You might also like to view Topic 11 which covers building a portfolio both to help you complete FP and as a resource for the future when you apply for posts after the Foundation Programme.

Below are a few examples, and an example summary narrative for HLO 1– the doctor as an accountable, caring and compassionate clinician, can be found here

HLO1 – the accountable, capable and compassionate clinician

  • I have linked three mini-CEX which show I can take a history and examine a patient (FPC 1).  The patient with pancreatitis was quite unwell and I managed him with support from my registrar (FPC 2).  The elderly lady with the bowel obstruction was found to have stage 4 cancer and I sat in with my registrar as he communicated treatment options.  I have read around this and done a reflection on my learning (FPC 3&4).  I then made the referral to palliative care and liaised with social services (FPC 5 and social care).
  • I am confident in common procedures and have done a DOPs for inserting an arterial line.  (FPC 4)
  • I attended a teaching session on eating disorders and have done some eLfH modules on mental health assessment (FPC 1 and mental health)
  • In the next rotation I will attend an ALS course to consolidate my acute skills (HLO2) and will ensure I obtain a mini-CEX for assessing a mental health conditions

Adding in the second placement…

  • I passed my ALS course (FPC2) and have assessed and managed a patient with suicidal intent (see CBD) (FPC2 – mental health).  I also clerked a girl with anorexia (CBD) and discussed her with the crisis team (see reflection).  She did not have capacity and was admitted for NG feeding.  (FPC1-5 mental health)
  • I have attended a number of departmental teaching sessions and core teaching which has helped me to manage the conditions I see in MAU.  See learning log  (FPC1-5)
  • I have liaised with care homes over a number of elderly patients to gather information and arrange discharge.  (Social care, FPC1,5).
  • I put in a chest drain (see DOPs) and feel confident in initiating and undertaking the GMC sore procedures (FPC4)

HLO2 – a valuable member of the healthcare team (probably in the second placement to have got this far…)

  • My TAB was good (FPC 6-8).
  • I attended a leadership course and reflected on this (FPC 6 and 8)
  • I was becoming tired with shift work and read the article on good sleep hygiene.  I have been trying to follow the advice. (FPC 7)
  • I have been attending QI meetings and am undertaking an audit or mental health presentations on MAU (FPC 9)
  • I have delivered a teaching session on acute coronary syndrome.  I did not get very good feedback but have reflected on this and I know how to improve my teaching.  (FPC 10)