Clinical experience groups - frequently asked questions

The RCGP curriculum has been updated and the new approach to linking with clinical experience groups has been approved by the GMC. You are now expected to link learning log entries to nine clinical experience groups rather than the previous 25 curriculum statements. Historically trainees felt compelled to complete clinical encounter entries in order to demonstrate adequate curriculum coverage. However such entries often had minimal content and so little educational benefit. The focus has shifted away from specific topics and now looks at the GP population setting.

The GP training curriculum is constantly evolving to meet the changes in general practice – and the changing needs of the trainees. The move to using clinical experience groups within the WPBA ensures that you gain adequate breadth of exposure to the general practice population.

The full curriculum continues to be sampled in the AKT and CSA and is also blueprinted to the WPBA component of the MRCGP. You are still reminded to regularly review the clinical modules of the curriculum, and recommended to make reference to these within their log entries.

You can link up to two different clinical experience groups. It is not expected that every case review will be linked to one of these groups, and some case reviews may be linked appropriately to two. There is no benefit to linking to more than one group as we are not counting up numbers of linked groups.

No. It is expected that by the end of training there should be sufficient coverage of the clinical experience groups to demonstrate your capabilities to work as a GP in the UK in a range of settings. You should therefore be aware at each stage of training whether you are accumulating sufficient evidence. Minimum expected numbers have deliberately not been set and should not be set locally as the demonstration depends on the educational needs of the trainee, the quality of evidence and the reflections on learning rather than on numbers alone.

No. Please see above answer.

Where there is no linkage between one clinical experience group and a capability for example no Fitness to Practise evidence relating to young people, consideration should be made of the quality of evidence relating to the Fitness to Practise capability in other clinical experience groups, and in other WPBA tools.

Evidence of professional learning such as attending conferences, external courses for leadership etc. should only be linked to the relevant GP capabilities of ‘Being a General Practitioner’, the basis for all reflective log entries. For log entries that don't have a clinical component, it is appropriate, and acceptable to not tick any clinical experience group headings. These log entries are equally valuable. 

Depending on the focus of the log entry, you can choose whichever clinical experience group(s) you feel is most appropriate to what you have written about. The linking relates to the context of the reflections and the capability linking. Should a clinical case not sit appropriately in the main clinical experience groups, there is an option to link to the group ‘Clinical problems not linked to a specific clinical experience group’, however this should only need to be used infrequently.

The RCGP Curriculum group have created ‘The RCGP Curriculum; The Curriculum Topic Guides’ – a detailed document which breaks down examples of questions and what could be covered for each capability for the professional topics, life stage topic and clinical topics, giving a case example of each. The clinical experience groups are covered amongst these guides. See further information on the Curriculum Topic Guides. 

A group specific to the adult population (between young people and older adults) is not included as it is implied that this group is seen when all other groups relating to population groups are covered. Should it be felt the case does not fit into any other category then the category ‘Clinical problems not linked to a specific clinical experience group’ should be used, although as much as possible linking to this group should be discouraged unless absolutely necessary.

The RCGP Curriculum team have written an extensive document detailing information about the clinical topics and life stages. The clinical experience groups weave into this. Further information can be found via the guide.

Patient with vertigo

Examples of how could link depending on which aspect of the patient contact is reflected on: 

1. Infants, children and young people [under the age of 19yrs]: uncommon but could be present in young people
2. Gender, reproductive and sexual health (including women’s, men’s, LGBTQ, gynae and breast)
3. People with long term conditions including cancer, multi-morbidity and disability: patient might have a background history breast cancer raising suspicion of brain metastasis causing the vertigo 
4. Older adults including frailty and/or people at end of life: patient could be in the older adult category 
5. Mental health (including addiction, alcohol and substance misuse)
6. Urgent and unscheduled care: If seen in the urgent/unscheduled care setting or acute onset and unwell with symptoms
7. People with health disadvantage and vulnerabilities (including veterans, mental capacity difficulties, safeguarding and those with communication difficulties/disability): might have difficulty explaining the condition to patient due to mental capacity difficulties if elderly/frail
8. Population Health and health promotion (including people with non-acute and/or non-chronic health problems): could be picked if the focus was more on health promotion – empowering the patient to self manage their symptoms, depending on the cause of the vertigo or discussing not driving etc. 
9. Clinical problems not linked to a specific clinical experience group: this might be appropriate if no other relevant groups are covered as part of the history/presentation. 

Patient with diabetes

Examples of how could link depending on which aspect of the patient contact is reflected on:

1. Infants, children and young people [under the age of 19yrs]: could be picked if seeing a new diagnosis diabetic
2. Gender, reproductive and sexual health (including women’s, men’s, LGBTQ, gynae and breast): could be picked if a patient presents with recurrent thrush/erectile dysfunction/complications when pregnant
3. People with long term conditions including cancer, multi-morbidity and disability: could be an option if seen in diabetic clinic
4. Older adults including frailty and/or people at end of life: could be picked if for example a medication review is being undertaken and rationalizing medication /realization overmedicated
5. Mental health (including addiction, alcohol and substance misuse): could be picked if the mental health problem means they don't understand they need to take diabetic medication, or the medication to manage the mental health problem has caused diabetes
6. Acute, urgent and unscheduled care: could be an option if seen in the urgent/unscheduled care setting or acute onset and unwell with diabetic symptoms
7. People with health disadvantage and vulnerabilities (including veterans, mental capacity difficulties, safeguarding and those with communication difficulties/disability): could have a learning disability which limits their understanding of diabetes and their compliance with medication
8. Population Health and health promotion (including people with non-acute and/or non-chronic health problems): could be picked if the focus was more on health promotion
9. Clinical problems not linked to a specific clinical experience group: this might be appropriate if no other relevant groups are covered as part of the history/presentation.

Heroin addict

Examples of how could link depending on which aspect of the patient contact is reflected on: 

1. Infants, children and young people [under the age of 19yrs]: Could be the parent of a drug addict, could be a young person who has become addicted
2. Gender, reproductive and sexual health (including women’s, men’s, LGBTQ, gynae and breast): could have contracted blood bourne illnesses through drug seeking behaviour which have an implication wit a sexual relationship
3. People with long term conditions including cancer, multi-morbidity and disability: might have other long term medical conditions
4. Older adults including frailty and/or people at end of life: could misuse heroin which would affect medication used in end of life
5. Mental health (including addiction, alcohol and substance misuse): drug misuse
6. Acute, urgent and unscheduled care: could be admitted septic and seen in same day access GP appointment
7. People with health disadvantage and vulnerabilities (including veterans, mental capacity difficulties, safeguarding and those with communication difficulties/disability): patients children need safeguarding due to the presentation on this occasion
8. Population Health and health promotion (including people with non-acute and/or non-chronic health problems): encourage patient to engage with drug misuse services locally
9. Clinical problems not linked to a specific clinical experience group:  this might be appropriate if no other relevant groups are covered as part of the history/presentation.

Suspected skin cancer

Examples of how could link depending on which aspect of the patient contact is reflected on: 

1. Infants, children and young people [under the age of 19yrs]: could have strong genetic link in family and either patient is atypical young patient or they want to discuss risk of getting melanoma 
2. Gender, reproductive and sexual health (including women’s, men’s, LGBTQ, gynae and breast): Could have a melanoma on penis, which could affect reproductive/mens health
3. People with long term conditions including cancer, multi-morbidity and disability: initial or representation of skin cancer
4. Older adults including frailty and/or people at end of life: could have lived abroad and had lots of sun exposure and have lots of previous skin cancers removed, or could have suspected skin cancer on a bedbound patient who has previously had a stroke
5. Mental health (including addiction, alcohol and substance misuse): suffers with significant health anxiety
6. Acute, urgent and unscheduled care: presented on GP triage list and seen due to 4 week wait to see routine patients and this could not wait for the routine appointment
7. People with health disadvantage and vulnerabilities (including veterans, mental capacity difficulties, safeguarding and those with communication difficulties/disability): previously naval officer who lived abroad for years or alternately has communication difficulties.
8. Population Health and health promotion (including people with non-acute and/or non-chronic health problems): opportunistic health promotion of sun awareness
9. Clinical problems not linked to a specific clinical experience group: this might be appropriate if no other relevant groups are covered as part of the history/presentation.

Rash on arm that patient thinks might be due to a tick bite and is worried about Lyme disease

Examples of how could link depending on which aspect of the patient contact is reflected on:

1. Infants, children and young people [under the age of 19yrs] : could be a young person and need to consider treatment if high level of suspicion
2. Gender, reproductive and sexual health (including women’s, men’s, LGBTQ, gynae and breast): not likely linked
3. People with long term conditions including cancer, multi-morbidity and disability: a relative might have had a disability from chronic lymes disease
4. Older adults including frailty and/or people at end of life: could be an older adult with the rash
5. Mental health (including addiction, alcohol and substance misuse): suffers with significant health anxiety
6. Acute, urgent and unscheduled care: presented on GP triage list /phones 111 and is given an appointment at a hub
7. People with health disadvantage and vulnerabilities (including veterans, mental capacity difficulties, safeguarding and those with communication difficulties/disability): patient could have a learning disability and attend with their carer and may not have capacity to make decisions or alternately has communication difficulties.
8. Population Health and health promotion (including people with non-acute and/or non-chronic health problems): discussion around what lyme disease is and the typical rash and how to protect self against getting lyme disease and manage a tick bite. If the patient was of an adult age, this is likely to be the category picked.
9. Clinical problems not linked to a specific clinical experience group: this might be appropriate if no other relevant groups are covered as part of the history/presentation.

Patient with a 2-month history of altered bowel habit which has worsened in the last 3 weeks.  The patient has been on the internet and thinks they have irritable bowel syndrome

Examples of how could link depending on which aspect of the patient contact is reflected on: 

1. Infants, children and young people [under the age of 19yrs] : could be a young person (18 years old), with a family history of inflammatory bowel disease/irritable bowel syndrome
2. Gender, reproductive and sexual health (including women’s, men’s, LGBTQ, gynae and breast): it might be a consideration to check a CA125 with symptoms that might mimic irritable bowel syndrome in an older woman
3. People with long term conditions including cancer, multi-morbidity and disability: the patient might be presenting with symptoms as a side effect of multiple medications or have a background history of cancer
4. Older adults including frailty and/or people at end of life: could be an older adult with symptoms, although this would be rare to present with new symptoms of IBS
5. Mental health (including addiction, alcohol and substance misuse): suffers with anxiety and/or depression which makes the symptoms worse
6. Acute, urgent and unscheduled care: could have presented in the acute/urgent/unscheduled care setting which is likely to be inappropriate
7. People with health disadvantage and vulnerabilities (including veterans, mental capacity difficulties, safeguarding and those with communication difficulties/disability): patient could be deaf and use sign language/relying on an interpreter and/or write on paper to have a conversation.
8. Population Health and health promotion (including people with non-acute and/or non-chronic health problems): likely to fit most appropriately here. History/examination and exploring ideas/concerns/expectations and discussion around what IBS is and how to best manage, empowering the patient
9. Clinical problems not linked to a specific clinical experience group: this might be appropriate if no other relevant groups are covered as part of the history/presentation.

Patient presents with second episode of tonsillitis this year and wants referral for tonsillectomy

Examples of how could link depending on which aspect of the patient contact is reflected on: 

1. Infants, children and young people [under the age of 19yrs] : could be a young person in their first year of university or at school and parents are requesting the referral to avoid missing school
2. Gender, reproductive and sexual health (including women’s, men’s, LGBTQ, gynae and breast): not likely linked
3. People with long term conditions including cancer, multi-morbidity and disability: patient may have chronic fatigue syndrome/ME which is worsened by the tonsillitis
4. Older adults including frailty and/or people at end of life: not likely linked
5. Mental health (including addiction, alcohol and substance misuse): suffers with anxiety/depression and has had lots of episodes of time out of work which is affecting employment, therefore wants to prevent further tonsillitis
6. Acute, urgent and unscheduled care: presented on GP triage list /phones 111 and is given an appointment at a hub to treat tonsillitis and during consultation requests referral
7. People with health disadvantage and vulnerabilities (including veterans, mental capacity difficulties, safeguarding and those with communication difficulties/disability): patient could have presented to A&E with tonsillitis inappropriately and then to GP and could be on a child protection plan
8. Population Health and health promotion (including people with non-acute and/or non-chronic health problems): if presented in a routine appointment to discuss onward referral, the patient could be educated on the process for individual finding requests and the need to have further episodes before onward referral.
9. Clinical problems not linked to a specific clinical experience group: this might be appropriate if no other relevant groups are covered as part of the history/presentation.

Patient has had a persistent cough for 6 weeks. They are otherwise well and are a non-smoker. They have seen advice about consulting a GP if a cough lasts for more than 2 weeks

Examples of how could link depending on which aspect of the patient contact is reflected on: 

1. Infants, children and young people [under the age of 19yrs] : could be a toddler who has gone to nursery and picking up lots of viral illnesses back to back, but parents perceive it is the same illness rather than different illnesses
2. Gender, reproductive and sexual health (including women’s, men’s, LGBTQ, gynae and breast): not likely linked
3. People with long term conditions including cancer, multi-morbidity and disability: slightly different background could include background of asthma/COPD/heart failure etc.
4. Older adults including frailty and/or people at end of life: could be an older adult picking up high on frailty index with the symptoms. The patients relative could have died from lung cancer
5. Mental health (including addiction, alcohol and substance misuse): could have history of substance misuse and/or suffers with health anxiety, leading to the appointment
6. Acute, urgent and unscheduled care: presented on GP triage list /phones 111 and is given an appointment at a hub
7. People with health disadvantage and vulnerabilities (including veterans, mental capacity difficulties, safeguarding and those with communication difficulties/disability): patient previously served in the navy and could have had exposure to asbestos
8. Population Health and health promotion (including people with non-acute and/or non-chronic health problems): patient presented in a routine GP appointment. Having examined them and no concerns raised/red flags for lung cancer, the consultation unfolds educating re red flags and provides opportunistic health promotion.
9. Clinical problems not linked to a specific clinical experience group: this might be appropriate if no other relevant groups are covered as part of the history/presentation