Abstract
Each month we review a different RCGP curriculum statement, giving ideas to help with achieving wide ranging coverage across the ePortfolio and Workplace-based Assessment. This month we cover men’s health.
Clinical example 3.07: Men’s health
This statement focuses on the skills and qualities needed to manage issues and problems relating to the care of men in primary care. Men access primary care services 20% less than women. This is despite them having a higher prevalence of many diseases and being more likely to die prematurely than women. Clinical example 3.07 therefore includes topics not only related to male-specific conditions (e.g. prostate and testicular cancer, lower urinary tract symptoms and erectile dysfunction), but also the challenges of promoting health and targeting services to men, and consulting and managing problems in a male specific way.
Learning log
The learning log is the contemporaneous record of a trainee’s activities and achievements across a wide range of areas. Each entry should be reflective as well as demonstrating how learning has occurred. They are linked to curriculum statements and can then be validated (providing relevant) by the educational supervisor who links the entries to competencies. The learning log is a good demonstration of a trainee’s progress and helps supply evidence as part of the Workplace-based Assessment (WPBA) – it should therefore be viewed as being just as important as exams and other MRCGP assessments.
Suggestions of relevant entries include:
A consultation with a patient wanting screening for prostate cancer A consultation with an anxious 18-year-old male who has noticed a testicular lump, yet is not keen to be examined A professional conversation with the partnership about a patient who has made advances to a female GP and how this should be dealt with A consultation with a 15-year-old male presenting with dysuria in the presence of his mother A consultation with a man presenting with erectile dysfunction who feels that he should be prescribed something ‘on the NHS’ A difficult consultation with a man who is presenting with physical complaints, yet it is clear his main problem is related to mental health An audit of male versus female attendance at NHS health checks and a review of changes that can be made to make attendance more uniform A consultation with a man requesting circumcision and a discussion of the reasons behind this The review of a patient wanting treatment for the ‘male menopause’ A consultation with a man who very rarely attends the surgery and yet now attends with an apparently trivial problem A consultation with a man presenting with several months of lower urinary tract symptoms who now cannot pass urine
Direct observation of procedural skills
The direct observation of procedural skills (DOPS) tool is a WPBA that assesses skills relevant to providing high-quality clinical care. There are eight compulsory DOPS that must be assessed as satisfactory before the completion of training. There are also 11 optional DOPS that may be carried out to demonstrate a wider range of clinical skills. Trainees can complete DOPS as opportunities arise during training and it is recommended that the mandatory skills are completed early and in good time. While DOPS may be carried out at any point during training, trainees should check with their deanery whether they also require them to be demonstrated during a GP placement.
DOPS relevant to men’s health include:
Male genital examination Prostate examination Rectal examination (this can be combined with prostate examination)
Personal development plan
The personal development plan (PDP) should be viewed not only as essential but also as a valuable part of the e-portfolio helping to focus and guide learning aims. Aims should be SMART (specific, measurable, attainable, relevant, time-bound) and regularly updated throughout the year with guidance from the educational supervisor if required.
Suggestions of relevant learning aims:
The development of a practice newsletter specifically targeting the promotion of health in men A quality improvement project trying to improve engagement with men in the practice and encouraging a reduction in delayed presentation Attendance at a sexual health clinic particularly focusing on male sexual health Attendance at a urology clinic targeting an improvement in prostate examination Promotion of the National Men’s Health week in the surgery; this could include running special male health clinics, running talks and giving other targeted interventions (the National Men’s Health week is promoted by the Men’s Health Forum and tends to focus on a different topic area each year, for example the focus in 2014 was work and health) Attendance at the local job centre to discuss unemployment, particularly in men, and the problems this can bring A review of obesity rates in male patients in the practice and specific ways that this could be targeted
Consultation observation tool
Consultations with male patients present the perfect opportunity to demonstrate many of skills assessed through consultation observation tools (COTs). The curriculum statement recognises that men often fail to articulate the true extent of their problems and may also present in different ways to women (such as when presenting with depression). Such patients would, therefore, allow higher level demonstration of the performance criteria involving encouraging patient’s contribution and responding to cues.
Case-based discussion
A case-based discussion (CbD) is a WPBA involving the assessment of competencies through a discussion about a case that a trainee has seen. It is important that this is an assessment of what actually happened rather than a hypothetical discussion about future events. Establishing the competencies to be assessed at the beginning of the CbD can help focus the discussion and each case should take approximately 30 minutes. Cases involving men’s health might lead to the assessment of the competencies data gathering and interpretation, making diagnoses/decisions and clinical management (although realistically cases could cover any of the competencies depending on the focus of the case).
Educational supervisors review
Evidence that trainees collect in the ePortfolio, either naturally through the learning log or more formally through WPBA, is reviewed at 6-monthly intervals (irrespective of whether a trainee is full or part-time) by the educational supervisor during the educational supervisors review (ESR). This face-to-face meeting allows a review of, not only progress to date, but also helps plan areas needing focus going forward, as well as informing the Annual Review of Competence Panel (ARCP) regarding progress and competence. A final review occurs towards the end of training to help inform a judgement on suitability for licensing. Competence progression is assessed through self-assessment by the trainee and then a review of evidence provided. Curriculum coverage is also reviewed to help build up a picture of performance. For these reasons it is important the ePortfolio is kept regularly up-to date with a breadth of quality entries (this is more relevant than the quantity) demonstrating reflection, learning and progress. The outcome of an ESR is a recommendation by the educational supervisor that progress is either satisfactory, unsatisfactory or needs referral to the ARCP panel.
It should be noted that the above are only suggestions and not an exhaustive list of what to include in the ePortfolio. If you have any comments/ideas on how to improve Crammer’s Corner please email us at editorialoffice@innovaitjournal.co.uk.