Summary
It is essential you learn how to examine patients within the general practice setting.
To be awarded your CCT, evidence for both of the following must be included:
- Five mandatory intimate examinations. A suitably trained professional will need to observe and document your performance on a CEPS evidence form.
- A range of Clinical Examination and Procedural Skills relevant to General Practice.
Introduction
Competent Clinical Examination and Procedural Skills are fundamental to effective general practice. Relevant evidence for this capability needs to be gathered regularly throughout each review period and recorded in your ePortfolio. As with the other capabilities there are a set of word descriptors to help you reflect on your progression as you acquire these skills.
Which skills need to be assessed
There are five intimate examinations, which need to be specifically included, as these are mandated by the GMC. These include breast, rectal, prostate, male genital examinations and female genital examination, to include speculum examination and bimanual pelvic examination. You need to be observed performing these examinations by a suitably trained professional. The assessor records their observation on the CEPS evidence form. If this is another doctor they must be at ST4 level or above. If the colleague is another health professional - such as a specialist nurse - they must confirm their role and training so that your Educational Supervisor can be satisfied that they have been appropriately trained. You may also decide to write a log entry on any of these specific skills but this would be in addition to the CEPS evidence form.
It is also important to note that this is not an exhaustive list of intimate examinations and indeed any examination can be considered intimate by some patients (for instance, a competent examination of the eye with an ophthalmoscope), but the examinations listed are those that, due to their particularly intrusive nature, need to be specifically observed, and commented on during your training.
The five mandatory examinations are not a 'minimum requirement' and cannot by themselves demonstrate overall competence in CEPS. A range of CEPS which are relevant to general practice are also required. This again is not an exhaustive list, nor is there a set minimum number as everyone has different needs. You are expected to document your performance in CEPS in your learning log and /or discuss your learning needs during placement planning meetings with your supervisor. The range of examinations, procedures and the number of observations will depend on your particular requirements and the professional judgement of your clinical and educational supervisors.
For example, you may recognise that your learning needs are joint examinations, the examination of the eye or doing a newborn baby check and if needed, you can discuss with your supervisor how these can be addressed. Your supervisor may also recognise areas that need addressing such as how to do a neurology examination within a GP-length consultation or examine a diabetic patients feet correctly.
You may already be aware of specific CEPS you want to address but these can equally become apparent during your consultations with patients.
In addition, it is important to recognise the procedures you may need during emergency presentations in General Practice; for example can you explain to a patient who is having an asthma attack what you are going to do, set up and start them on a nebuliser?
Completion of CEPS
These can occur in a variety of ways and these include;
- CEPS evidence form (in the evidence section of the ePortfolio)
- Learning logs (there is a filter for CEPS entries)
- Mini-CEX
- COT (criterion 6 refers to examination skills)
- MSF
- CSR
You will not be able to be signed up as competent in CEPS by your Educational Supervisor during your final review, unless there is observed evidence of the 5 mandatory intimate skills and a range of CEPS relevant to General Practice. This will also be reviewed at your ARCP and an unsatisfactory outcome given if these are not present.
Educational Supervisor Reviews
The evidence will be reflected on and summarised in the ESR every 6 months along with the evidence for other competences. At each review the ES will be expected to respond to the following questions:
- Are there any concerns about the trainees’ clinical examination or procedural skills? If the answer is ‘yes’, please expand on the concerns and give an outline of the plan the trainee needs to follow for these to be rectified.
- For all trainees: Has the trainee demonstrated progression in their Clinical Examination and Procedural Skills, commensurate with their stage of training, during the period under assessment? Please comment specifically on breast, rectal, prostate, male genital and female pelvic examinations.
- For final review only: Is the trainee competent in breast, rectal, prostate, male genital and female pelvic examinations? Please refer to specific evidence including Learning Log entries, CEPS, COTs and CbDs etc.
Useful links
Frequently asked questions