Care Assessment Tool (CAT which includes CbD) - from August 2020

CbDs in General Practice / primary care placements are being replaced by Care Assessment Tools (CATs), which allows a greater range of information and performance to be recorded and assessed against the Capabilities. CbDs will remain in the non-primary care setting and become one type of CAT in in the primary care setting.

Below are suggested events that may be assessed as CATs, with details of the preparation required in advance, the content of the assessment, the Capabilities that may be assessed and the recording required.

A minimum of 4 CbDs will be required for both ST1 and 2, and a minimum of 5 CATs (which can include CbDs) by the end of ST3.

Suggested CAT formats

Case based discussion

The following is a brief summary of this type of CAT:

Preparation in advance:

Trainee:

  • Select a case for discussion.
  • State which Capabilities you feel you can demonstrate with the case.
  • Prepare a short summary of the case.
  • Prepare to discuss how you handled the case and how you met the Capability descriptors.

Supervisor /Trainer:

  • Review the case the trainee has suggested along with the medical notes. 
  • Check it is suitable for the Capabilities suggested and of a sufficient complexity.
  • Prepare questions to test the Capability areas and explore what the trainee actually did in that case. See Appendix E for suggested questions.
  • Review the Capability descriptors and suggested questions to become familiar with what the trainee needs to demonstrate for the various grades.

Content:

Supervisor guidance:

  • The trainee briefly describes the case.
  • The supervisor asks which Capabilities the trainee wishes to discuss first.
  • The supervisor questions the trainee in a way that allows them to demonstrate the highest level they can, based on the Capability descriptors.
  • Questioning continues with the supervisor postponing any questions from the trainee until the feedback section.
  • Each Capability of the 3-4 to be addressed is discussed with time for the trainee to add anything else they wish.
  • Both refer to the Capability descriptors. It is good practice for both the supervisor and trainee to consider these during the discussion.
  • Once the case and Capabilities have been fully discussed the supervisor moves to the feedback section.
  • It can be helpful to get the trainee to say which grade they feel they have demonstrated and to give their own feedback first.
  • The supervisor gives feedback on what was done well and demonstrated with grade decision followed by feedback for improvement, future different cases, and Capabilities that still need to be covered.

Capability areas suggested:

All

Random case review

Preparation in advance:

None required

Content:

Supervisor guidance:

  • Select a date and surgery at random from the trainee’s appointment list and access the patient records.
  • There are many different ways to review random cases. Reviewing consecutive patients can be helpful and reviewing a whole surgery will give a picture of overall performance.
  • It can also be useful to review a random surgery looking through one particular ‘lens’ e.g. the appropriateness of the diagnosis or decision making; or understanding of the home circumstances of each patient / their support systems etc. i.e. how well the trainee assessed them holistically; or considering examinations carried out in detail; or recording (use of coding); or completion of all possible pop up tasks. 
  • Alternatively, it can be appropriate to look at only 1-2 cases chosen by the supervisor and review multiple Capabilities in more detail in these cases. 
  • Review how long the consultation took, as well as their recording of the consultation itself. These can be used to assess organisation, management and leadership
  • Review the trainee’s recording, using READ/ SNOMED codes as appropriate, observations recorded, history and other data gathering as well as clinical management, diagnosis and decisions and follow up.
  • Involvement of other doctors or team members may also be reviewed which can give information for the Capability of working with colleagues and teams.
  • How much health promotion was undertaken? Holistic care and managing medical complexity.
  • Did the trainee see a range of patient types, conditions and mix of urgent and unscheduled care and routine appointments? Are there actions that need to be planned in response to the balance of their work across clinical experience groups and medical specialities? 

Capability areas suggested:

All areas may be possible depending on the detail of recording.

Recording in the Portfolio:

Supervisor guidance:

  • Pick the Capabilities demonstrated and give specific case detail to justify the grading given, relating this to the Capability descriptors.
  • Give specific feedback for each Capability with agreed plans for each.

Leadership activity

The description of how to do a leadership activity is shared in this document. 

Prescribing assessment follow up

This is a follow up to the full prescribing assessment and should focus on the areas for development detailed in the prescribing assessment and how you (the trainee) have progressed with these. This may involve finding and analysing prescriptions done for specific Clinical Experience Groups, for example, children, end of life, controlled drugs use, advice re over the counter (OTC) medications, particular specialty drugs e.g. for COPD, or contraception. The Prescribing Assessment is covered later in this document. 

Preparation in advance:

Trainee:

  • You review your prescribing assessment and agreed actions. In particular you need to ensure that any of the prescribing proficiencies which you did not cover in your assessment have now been met
  • You will need to upload any further results in the Portfolio learning log.
  • You will need to reflect on your performance against the prescribing competences. 
  • Your supervisor will review your evidence and discuss this with you.

Supervisor guidance:

  • Review and discuss the trainee’s further evidence in the Portfolio and evidence from random case reviews and debriefs.
  • Review the prescribing assessment action plan and PDP entry progress.
  • Discuss areas done well and areas for improvement.
  • Together agree plans for further improving the trainee’s prescribing or increasing their exposure to patient groups to meet the prescribing competences.
  • Discuss how this has provided evidence for the prescribing competences as described in the feedback and recommendations.
  • Discuss hypothetical situations where issues have not been not covered such as prescribing unlicensed drugs, drug interactions, over the counter (OTC) medication, allergies and monitoring requirements.

Capability areas suggested:

  • Clinical management. Has the trainee prescribed safely? Are they aware of and are they applying local and national guidelines including drug and non-drug therapies? Are they aware of legal frameworks for appropriate prescribing?
  • Managing medical complexity. Has the trainee simultaneously managed patients’ health problems, both acute and chronic (e.g. by taking into account comorbidities, existing medication and allergies), communicated risk effectively to patients (from documentation in the clinical records), recognised the inevitable conflicts that arise when managing patients with multiple problems and taken steps to address these.
  • Organisation, management and leadership. Has the trainee produced records that are succinct, comprehensive, appropriately coded and understandable?
  • Community orientation. Has the trainee demonstrated how they have adapted their own clinical practice to take into account their local resources, for example colleagues with GPSPI experience; or in cost-effective prescribing by following local protocols?
  • Maintaining performance Learning and teaching. Has the trainee shown a commitment to professional development through reflection on performance and the identification of personal learning needs? 
  • Fitness to practice. Has the trainee reflected on and learnt from performance issues (e.g. drug errors) in order to improve patient care?

Recording in the Portfolio:

Supervisor guidance:

  • the supervisor completes a prescribing assessment CAT detailing the Capabilities covered and record for each:
    • Specific feedback on performance
    • Recommendations for further development

Referrals review

Preparation in advance:

Trainee:

  • Gather together either a list of all your referrals or copies of the referral letters to review.
  • Ensure sufficient time has elapsed to get letters back from the clinic visit following the patient appointment.

Supervisor guidance:

  • Look through the letters the trainee has written encouraging the trainee to critique their work.
  • Discuss the content commenting on what is good and what could be improved.
  • Is there evidence in the referral letters of appropriate data gathering, clinical examinations and procedural skills, clinical management and diagnosis and decisions?
  • Look at the correspondence received following the referral and subsequent GP consultations. 
  • Comment on the quality of the trainee’s records.
  • Discuss the appropriateness and effectiveness of the referral. What other options were available?
  • What does the trainee feel, in retrospect, about each referral?
  • What feedback would you give the trainee in general about their referrals?
  • Were any 2 week wait referrals in line with current guidance?
  • What percentage of 2 week wait referrals resulted in a diagnosis of cancer?
  • Review the appropriateness in particular of these referrals checking for any delays but also commenting on examples of good patient care. 
  • Has the referral review demonstrated that the trainee is being exposed to the full range of patients groups in general practice and a broad range of curriculum types?
  • How might the trainee develop experience in populations or specialties in which there does not appear to have been sufficient exposure?

Capability areas suggested:

  • Select the Capability areas the trainee has demonstrated during this discussion.
  • Give feedback on what they did well and what they should work on to improve or demonstrate in future learning events

Recording in the Portfolio:

Supervisor guidance:
  • Describe for each Capability how the trainee performed using the Capability descriptors and specific aspects of the cases discussed.
  • Describe the agreed actions discussed.

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Documents

Care Assessment Tools (CATs) - FAQs

What is a CAT?

A CAT is a Care Assessment Tool. It is a workplace-based assessment that is used to record a trainee’s ability in any of the capabilities, and can be any one of a variety of different types of assessment tools including the Case Based Discussion (CbD).

How many CATS do I have to do?

In ST1/2 you will only need to do CbDs.  You are expected to complete four CbDs in each training year (a minimum of two for each 6 monthly Educational Supervisor Report (ESR))

How is a CAT different from a CbD?

A CAT is an overarching workplace assessment term which includes CbDs.  Other types of assessment can also be used to assess and record your performance in all the capabilities and are also considered to be CATs.  These include problem patient discussions, random case reviews, debriefs, referral analysis and other consultation assessment tools.

Are a range of CATS needed or are single assessments sufficient e.g. all random case reviews?

In ST1 and ST2 you will only do CbDs as this is a tool that is already familiar in both primary and secondary care settings and it will ensure consistency.  In ST3, however, you can complete a range of different types of CAT depending on the clinical / educational setting. There are no set numbers for each different type of CAT.

Do all the capabilities have to be graded in at least one CAT?

Ideally the CATS will cover the full range of the capabilities. This will provide a triangulation of grades for each capability across of range of different assessment methods.

It is expected that you will have been assessed in all of the capabilities using a formal assessment tool at least once in your training.

Do I have to do a CAT for each of the Clinical Experience Groups?

While it is not mandatory for you to have a CAT for each Clinical Experience Group, a range of types of assessment and information will need to be provided in the Portfolio to show exposure to, learning from, and competence in caring, for the range of Clinical Experience Groups across each training year.

Do I have to do a CAT for each of the Clinical Experience Groups?

While it is not mandatory for you to have a CAT for each Clinical Experience Group, a range of types of assessment and information will need to be provided in the Portfolio to show exposure to, learning from, and competence in caring, for the range of Clinical Experience Groups across each training year.

When I am in Primary care as an ST1 or 2, in addition to the required number of CbDs can I also complete other types of CAT?

You will need to complete the minimum number of CbDs for that post but you can also complete additional CATs.  However, it should be noted that these will not replace other mandatory assessments.

How many capabilities and Clinical Experience Groups can be linked to each CAT?

It is expected that a maximum of 3 capabilities and 2 Clinical Experience Groups be linked to each CAT so that in-depth reflection and meaningful feedback is given for each.

Separate assessments can be used if the assessment covers a larger number of either.

Can I do a leadership activity out with the specific examples given?

No.  It is expected that the assessments will be spread out over time to demonstrate that you are progressing. The number stated are a minimum and if you are not demonstrating the grade expected for your level of training, additional assessments should be completed.

How long will it take me to complete a CAT?

This will depend on the type of assessment being completed. A referrals review may take a couple or hours. A debrief may take 15 minutes and a CbD usually takes between 20- 30 minutes. A random case review may take an hour but will depend on the number of consultations reviewed.  The time for each assessment will depend on the content and the discussion that takes place.

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