Health Education Kent, Surrey and Sussex ARCP

Health Education Kent, Surrey and Sussex
ARCP 2014 Guidance for Broad Based Training Pilot
Programme
June 2014
BBT ARCP Guidance - June 2014 v1
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Contents
OVERVIEW ................................................................................................................................... 3
ROLES AND RESPONSIBILITIES ...................................................................................................... 4
THE ARCP PROCESS ...................................................................................................................... 6
1. Convening the Panel ....................................................................................................................... 6
2. Identifying Trainees......................................................................................................................... 6
3. Preparation for ARCP Review Meeting ........................................................................................... 6
4. At the ARCP Meeting....................................................................................................................... 8
5. Review of Outcomes ....................................................................................................................... 9
6. After the ARCP ................................................................................................................................ 9
7. Appeals.......................................................................................................................................... 11
BBT AND REVALIDATION ............................................................................................................ 13
Outcomes .......................................................................................................................................... 13
Additional Time or Remedial Training .............................................................................................. 14
Broad Based Training ARCP Decision Aid – Standards for Recognising Satisfactory progress ......... 15
Issuing Department
HEKSS Schools of General Practice, with reference
to HEKSS ARCP Quality Management Guidelines
2014 FINAL
Issue Date
June 2014
Version
V1-2014
Equality Impact Assessment Date
TBA
Review Date
May 2015
BBT ARCP Guidance - June 2014 v1
Approved
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OVERVIEW
Trainees enrolled in the BBT programme will in line with other specialty trainees have an
ARCP in accordance with ‘A Guide to Specialty Training In the UK, 2014’ (the Gold Guide)
and the GMC approved BBT curriculum (Nov 2012).
The guidance for undertaking ARCP for BBT trainees encompasses guidance drawn from
the Gold Guide and HE KSS ARCP 2014 Quality Management Guide which is designed to
provide information for trainees, the BBT LFG, participating BBT Schools and Medical
Workforce teams.
The Gold Guide stipulates that Quality Management (QM) in the context of assessment and
review of outcomes is essential because ‘decisions from the panel have implications for both
the public and individual trainees’. This activity requires that there should be external
scrutiny of the process from a non-clinical Lay Representative / Assessor and the outcomes
from a clinical External Assessor from one of the specialties represented by BBT
The Gold Guide stipulates that QM should meet the requirement that at least 10% of
outcomes, plus all trainees whose performance gives cause for concern, are scrutinised by
these external sources.
Revalidation started on 3rd December 2012. Revalidation applies to all doctors, including
those in training, from Foundation Year 2 upwards including BBT trainees. The Revalidation
of Trainee Doctors will occur during the ARCP process.
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ROLES AND RESPONSIBILITIES
Administrative Support – will be provided by the HEKSS GP School
The Panel Chair – will usually be the BBT Training Programme Director.
The Heads of School – are not mandatory participants in the BBT ARCP process. The
Head of the GP School will be responsible for signing the Outcome forms on behalf of the
Dean.
The Lay Representative - will be specifically appointed by HEKSS GP Department. They
are responsible for scrutinising the process as a whole, and for ascertaining the view of
panel members, and trainees where they are attending in person, on the procedures that are
in place to support them. The Lay Representative should participate in at least 10% of
reviews and comment upon the observed process.
The Lay Assessor should fulfil the same role as described in detail in the HEKSS ARCP
2014 Quality Management Guide. This involves ascertaining the view of panel members,
and trainees where they are attending in person and participate in 10% of reviews.
The External Representative - will be a suitably informed individual from within one of the
four specialties but from outside the training programme or school. The External
Representative may not need to attend an ARCP Review in person. Particularly if the
number of trainees under review is very small, it may be more practical for them to conduct
their review remotely.
The External Assessor should fulfil the same role as described in detail in the HEKSS ARCP
2014 Quality Management Guide
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INTERIM REVIEW
Trainees in the BBT programme would be expected to have an Interim Review in line with
best guidance from the Gold Guide. The process allows for each Trainee to be reviewed
against expected progress and have any problems identified in writing (the ePortfolio).
Trainees in BBT will have a placement review with their supervisor (as detailed in the BBT
handbook) at the end of their first six month rotation. There will also be an interim review of
progress mid-way through the second placement to identify any Trainee who is not on track
to receive an Outcome 1.
At the Interim Review, the Trainee should be advised of their possible Unsatisfactory
Outcome and be given specific, written guidance as to how they may prevent this from
happening, together with an action plan. There should be adequate advice and support
available to the trainee who may be expecting an unsatisfactory outcome. The trainee may
invite a friend or colleague to the Interim Review meeting.
The Interim Review should be with the supervisor as detailed in the schedule in the BBT
handbook.
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THE ARCP PROCESS
1. Convening the Panel
The GP Training Manager will make arrangements for the ARCP panel to meet, schedule
the dates, and make appropriate venue arrangements and keep appropriate records in
discussion with the BBT TPD and Heads of the four Schools.
The ARCP Review Panel is to be convened by the HEKSS who will ensure that each Panel
has the minimum required membership and
• Ensure that all members of the Panel have received Equality & Diversity Training
within the last three years.
• Check that logins are available for ePortfolios, where required.
• Brief both the Lay Chair and the External Representative on their roles and
responsibilities.
• Supply the Lay Chair and the External Representative with copies of their report
templates and timeframes for expected return.
For BBT trainees attending ARCP the Minimum Panel consists of five members:
•
•
•
•
•
Minimum of four panel members, with one representative from each of the four
schools contributing to the BBT programme
The panel members may be drawn from the following groups:
o Head of a School participating in BBT
o BBT TPD (Chair)
o Educational supervisor
o Clinical Supervisors
o Associate Deans / Directors
PLUS one Lay Representative / Chair (minimum attendance at 10% of reviews)
PLUS one External Representative (who may not be actually present)
Administrative Support should attend the ARCP meeting so as to help ensure that
appropriate paperwork is completed and the proper process is followed. It is not the
role of Administrative Support to contribute to the assessment itself.
2. Identifying Trainees
Only those trainees that are expected to achieve an Outcome 2, 3 or 4 should be invited to
attend the ARCP Review Panel meeting in person.
The end of placement review and Interim review plus LFG minutes will be used to identify
those trainees likely to receive an unsatisfactory outcome.
When inviting trainees to attend the ARCP Review meeting in person it should be made
clear, in writing, on what basis this is required i.e. what required competences are yet to be
achieved. This gives the trainee opportunity to achieve these competences in the time
remaining prior to the review. This should take the form of an Action Plan or similar
document which outlines the targets and is signed with the Educational Supervisor.
3. Preparation for ARCP Review Meeting
The GP Training Manager should produce an agenda for the ARCP Review Panel meeting
which includes, by name, any Trainees that have been invited to attend.
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Trainees for External and Lay Review
Trainees expected to receive an unsatisfactory outcome should be identified to the lay and
external representative – these will need to be reviewed, plus a random cross section of at
least 10% of all other trainees.
Educational Supervisors
The GP Training Manager and BBT TPD will be responsible for notifying Educational
Supervisors of the deadline for completion of ES reviews.
Enhanced Form Rs and collating and checking assessments
The GP Training Manager will be responsible for ensuring enhanced Form Rs have been
received ahead of the ARCP and Exit Returns have been received for employers of BBT
trainees.
For the BBT pilot The BBT TPD and GP Training Management Team and will be responsible
for collating and checking the number of assessments and collating the data on a BBT
Assessment Summary Sheet.
Contacting Trainees
The GP Training Manager will be responsible for contacting trainees needing to attend the
ARCP. Information to be included:
• Confirmation of the ARCP date, time and location
• Reasons for invitation to attend (if required)
• The deadline for receipt of the Educational Supervisor’s Report
• HEKSS address for correspondence
• A process outline
• A copy of the possible Outcomes, as per the Gold Guide
• Reference to the relevant section of the Gold Guide
Booking the ARCP Review Panel Meeting
The GP Training Management Team are responsible for ensuring that facilities suitable for
the ARCP Review Panel Meeting are booked and made available. This includes but is not
exclusive to:
• Refreshments (lunch should only be ordered when the ARCP panel is for the entire
day.)
• Laptops and internet access
• Trainees informed of deadlines
• Standard correspondence sent to Panel members with relevant enclosures.
• All documents required from trainees secured.
• Upon receipt of documentation, packs will be created for each trainee to include:
o Educational Supervisor’s report (where not ePortfoilo)
o Form R (both Parts)
o A blank ARCP Outcome form
• Checklist and comments for Panel members/trainees printed
• Prepare Outcome report
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4. At the ARCP Meeting
Consideration of the Evidence
Without the Trainee being present, the Panel should consider the documented evidence in a
systematic manner and reach an agreement as to an outcome. The panel will review the
BBT Assessments together with the evidence in the BBT portfolio before recording a
decision using the specified BBT paperwork (written / electronic)
The Panel should also review the Trainees expected date for successful completion of BBT
training, taking into account any factors that may delay or change the anticipated date (such
as OOP, LTFT training, or absence for any reason).
Trainee Attendance
Trainees attending ARCP will need to sign the ARCP register on arrival as confirmation of
their attendance. Proof of identity will be confirmed by checking against the Form R.
The following steps will then be followed:
•
The panel will meet to review the evidence and will meet the Trainee only after
the Panel has met, considered the presented evidence and made an outcome
decision
•
The panel will invite the trainee to a discussion
This means that the situation may arise where a Trainee is invited to the ARCP Panel as
they were identified as being at risk of receiving an Outcome 2, 3 or 4, but after
consideration of the evidence the Panel actually decides upon an Outcome 1. It is not
necessary to meet with the Trainee in this circumstance, but the Panel may wish to do so to
advise the Trainee as to the reasons for the decision as the Trainee is already in attendance.
Revalidation
Trainees will be required to complete an enhanced Form R.
Should the Panel discover any evidence during the Panel meeting that raises concerns over
the Trainee’s Fitness to Practice, the Panel Chair should undertake to write to the
Postgraduate Dean on that same day to advise of the details and seek further advice and
guidance if this is not supplied as part of the evidence to the panel.
Trainees That Received an Unsatisfactory Outcome at Their Last ARCP
When trainees are given an Outcome 2 at ARCP, this may be changed to an Outcome 1 if
objectives are achieved prior to the trainee’s move to the scheduled next year of the
programme. However, if the trainee does not achieve their objectives in time, the Outcome
2 will stand and the trainee may progress to their next year of training.
Where a Trainee was given an Outcome 2 and has progressed to their next year of training,
there should be regular review throughout the course of the year to ensure that objectives
are being achieved. At the next ARCP, the documentation specifying the required further
development should be reviewed and progress against those objectives taken into
consideration. In effect, this means that to gain a Satisfactory Outcome in their current
ARCP, a trainee must achieve the competence requirements for their current year of training
as well as the objectives outlined in their action plan from the previous year [GG 7.70].
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Trainees that have resigned from the Programme
Where a Trainee has resigned from the Programme part-way through the training year, they
should be issued with an Outcome 3. It should be documented on the ARCP form that the
trainee has resigned from the programme and comments made on progression highlighting
any concerns.
Concerns raised by the Lay or External Representative
The Lay or External Representative should raise any concerns with the process during the
meeting, not after. This will allow for consultation with the Panel Chair who may either seek
further advice or/and amend the process if necessary. If such concerns are raised, they
should still feature in the Lay or External Representative’s report but be acknowledged as
resolved.
Unforeseen Unsatisfactory Outcomes
A circumstance may occur where a Trainee is expected to achieve a Satisfactory Outcome,
but upon review are found to be eligible for an Unsatisfactory Outcome. On these occasions,
the trainee must be present when the Unsatisfactory Outcome is confirmed. Therefore, if the
trainee has not been invited to the initial ARCP Review Panel meeting, the panel should plan
to reconvene at its earliest convenience and invite the trainee to attend.
Issuing Unsatisfactory Outcomes without the Trainee Present
It may happen that unforeseen circumstances such as illness or transport issues mean that
a trainee who planned to attend their ARCP meeting is suddenly unable to do so. In these
circumstances the panel should continue to issue an Outcome based on the available
evidence, although the chair of the panel may wish to make themselves available to the
trainee for discussion afterward.
5. Review of Outcomes
ARCP Outcome forms should not be issued to trainees on the date of the ARCP, even if the
trainee is present. All ARCP Outcomes are considered Indicative until an ARCP Quality
Review has been completed.
Outcome 1, or 8 Quality Review
Where trainees have been issued with an Outcome 1 or 8 at ARCP and the panel agrees
that all relevant competences have been achieved, a Quality Review will take place within
ten working days of the final ARCP meeting.
Outcome 2, 3, 4, Quality Review
Where trainees have been issued with an Outcome 2, 3 or 4 at ARCP, a Quality Review will
take place. This date will fall after the last opportunity for appeals against unsatisfactory
outcomes has passed.
Outcome 5 Quality Review
Where trainees have been issued with an Outcome 5, this should not be considered a final
Outcome as it is indicative of further evidence being required. The Quality Review should
take place for the outcome that the panel agrees is final after all evidence has been received
and considered.
6. After the ARCP
Distributing the Outcome Form
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This will normally be done when the BBT ARCP episode is complete for that period and the
quality review has taken place. Recipients include:
•
•
•
•
•
•
•
The HoS of four specialty colleges involved in BBT
The Medical Director of the Trainee’s current employing organisation
The BBT TPD
The Trainee’s Educational Supervisor, who will use it as the basis for further
educational and workplace based appraisal.
The Trainee, who must sign and return it to HEKSS within ten working days while
retaining a copy for themselves. Where e-Portfolios are in use, electronic signatures
are acceptable.
The GP Workforce Teamshould take the signed copy returned by the Trainee and
add it to the Trainee’s file.
The GP Team will update the Responsible Officer on ARCP outcomes for the
purpose of Revalidation.
Updating the Database
The GP Training management Team should ensure that the database (Intrepid) is updated
with the Outcome.
Planning for Exit into Chosen Speciality
It is envisaged trainees will make the choice of their Exit Speciality in preparation for the
ARCP between BBT1 and BBT 2. Where this is known the ES will record this and
information will be shared with the participating Schools.
Trainees with a satisfactory Outcome will not be required to attend the ARCP. However for
BBT trainees immediately following the ARCP, there will be a review of career intentions
which all trainees will be expected to attend.
A trainee must make a decision on Exit Speciality with sufficient time for the Schools to plan
for their annual recruitment rounds
Unsatisfactory Outcome Meetings
All Trainees that receive an Outcome 2, 3 or 4 are required to meet as soon as possible with
their TPD and/or Educational Supervisor to draw up an Action Plan and objectives. This
meeting should occur within the remaining current academic year.
These Trainees should also be added to the Trainee in Difficulty / Trainee Support Group
register.
If the Trainee fails to attend a meeting or sign a copy of the Action Plan, the BBT TPD
should write to the trainee advising them that failure to respond to communications by a fixed
date will result in assumed acceptance of the Action Plan. A copy of this letter should be
added to the Trainee’s file and attached to a copy of the Action Plan.
The GP Training Management Team should receive a copy of the Action Plan and ensure it
is added to the Trainee’s file.
Lay Representative Report
The Lay Representative Report should be completed on the supplied template and received
within ten working days of the ARCP Review Panel meeting.
Where areas for concern are identified, the Panel Chair should carefully review the report
and assess whether the Panel should be re-convened. However, any concerns that the Lay
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Representative has should have been expressed at the time of the ARCP Review Panel
meeting and therefore not require a re-review of Trainees.
External Representative Report
The External Representative Report should be completed on the supplied template and
received within ten working days of the ARCP Review Panel meeting.
ARCP Data
The GP Department will be responsible for recording ARCP data with the GMC.
7. Appeals
Appeals follow the process as described in the Gold Guide
The Quality Review process includes a Review Panel to plan the further action which is
required to address the issues of progress identified in the ARCP meeting. Where a trainee
has been issued with an outcome 4, the Review Panel should make it clear to the trainee
with which competences they will leave the programme.
If a trainee is issued with an Outcome 2,3,or 4, they should receive notification in writing
together with a copy of this Appeals Process and flow chart The trainee should also be
referred to the Gold Guide section 7.113 – 7.134.
Appeals against an Outcome 2 (Gold Guide 7.128-7.130)
•
•
•
•
•
•
The Trainee should write to the Chair of the ARCP panel they attended within ten
working days of being notified of the panel’s decision. In their letter to the Chair, they
should include:
o Their reasons for wishing to have the outcome decision reviewed
o Details of any further evidence that they wish to present to the panel
The Chair should arrange a further meeting for the trainee within fifteen working days
of the request being received.
Where possible, the original panel should reconvene to reconsider the outcome. The
trainee should be invited to attend this meeting.
The trainee may provide additional evidence at this stage.
Proceedings should be documented and a copy of this account should be given to
the trainee as well as being kept by HEKSS.
The decision of the panel following such a review is final and there is normally no
further appeal process.
Appeals against an Outcome 3 or 4 (Gold Guide 7.131-7.150)
•
•
The Trainee should write to the / Postgraduate Dean and GP Dean within ten
working days of being notified of their Outcome 3 or 4.
The appeal process follows the Gold Guide with a Stage 1 discussion and Stage 2
Formal Appeal.
Stage 1: Post ARCP Discussion & Review
•
The trainee should meet with two of the Heads of the four Schools participating in
BBT. The purpose of this meeting is to discuss the perceived issues with the
Trainee’s progress and try to reach an agreement regarding next steps.
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•
•
•
If, after discussion, the Trainee accepts the ARCP Panel’s decision of an Outcome 3,
an action plan should be developed with specific objectives and timelines.
If an Outcome 4 is accepted by the Trainee, then they will leave the training
programme.
If, after discussion, the Trainee still does not accept the Panel’s decision, they may
wish to progress to Step 2.
Step 2: Formal Appeal
• The Trainee should write to the Postgraduate Dean within ten working days of the
discussion outcome detailed above. In their letter to the Postgraduate Dean, they
should include:
o Their reasons for appeal
o Whether they wish to have external representation
o Whether they wish to submit further written evidence to the panel before it
convenes.
• The Postgraduate Dean should arrange a further interview for the trainee within
fifteen working days of the request being received.
• Members of the original ARCP Review Panel must not take part in the appeal
process.
• Where lack of progress may result in the extension or termination of a contract of
employment, the employer must be kept informed of each step of the appeal
process.
• The Appeal Panel’s decision is final and there is no further avenue for appeal.
Address to which Trainee should write:
For BBT Trainees:
GP Dean
Health Education Kent, Surrey and Sussex
7 Bermondsey Street
London
SE1 2DD
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BBT AND REVALIDATION
In order to incorporate Revalidation, the Annual Review of Competence Progression (ARCP)
has been enhanced by developing the existing documents. The Form R, Educational
Supervisors report and ARCP Outcome form now include sections relevant to revalidation,
and in addition, an Employer’s report has been created.
Added to the Form R, are questions about significant events, complaints, compliments,
probity and health. In addition, there is a scope of practice section where trainees are
required to list their past and present employers, time out of programme, advisory or
voluntary roles or any other activity undertaken since their last ARCP in their capacity as a
registered medical practitioner (including all locum and non NHS work, even that done with
their current employer).
The Educational Supervisor’s report will include additional questions regarding concerns and
investigations relating to conduct, capability, serious incidents (SI), significant event
investigations or complaints.
The Employer’s report from each place of employment will be collected by HEKSS, and has
two elements:
1. A Collective Exit Report showing whether or not a trainee has been involved in
conduct, capability, formal serious incidents, significant event investigations or
complaints.
2.
An Exception Exit Report for individuals for whom the answer to any the above
questions was “Yes”, detailing the issue and stating whether or not the issue is
resolved.
All the above information will then feed into the ARCP panel and the panel will make a
recommendation to the Responsible Officer of “there are no known current unresolved
causes of concern” OR “there are current known unresolved causes of concern”. The ARCP
Panel will determine whether or not there are any causes for concern, and the chair of the
panel will relay this to the Responsible Officer via the ARCP Outcome form.
Outcomes
Outcome 1
Outcome 2
Outcome 3
Outcome 4
Outcome 5
Satisfactory Progress – Achieving progress and the development
of competences at the expected rate. This is subject to
successful completion of the training period.
Issued at the end of BBT where a trainee has made satisfactory
progress
Development of specific competences required - additional
training time not required
Inadequate progress – additional training time required
Issued when a trainee resigns prematurely from the BBT
programme
Released from training programme – with or without specified
competences
Incomplete evidence presented – additional training time may be
required
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Additional Time or Remedial Training
A certificate of satisfactory completion of the Broad Based Programme will not be issued
unless a trainee has satisfied the ARCP panel at the end of the second year of the
programme. Without this trainees will not be able to progress into the specialty of their
choice without a further training period. This further training cannot be guaranteed within the
Broad Based Training Programme but each trainee will be governed by the regulations that
were in force when their training began.
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Broad Based Training ARCP Decision Aid – Standards for Recognising Satisfactory progress
Curriculum domain BBF first 6/12
Educational
Supervisor report(s)
ALS
Workplace Based
Assessments
(WPBAs)
Quality Improvement
Project or Audit
Common
Competencies
Satisfactory with no
concerns
BBF second 6/12
BBF third 6/12
BBF last 6/12
Satisfactory with no concerns
Satisfactory with no concerns
Valid
Valid
Satisfactory with no
concerns
Valid
WPBAs should be performed proportionately throughout each training year and performed by a number of different
assessors
It is expected that a range of assessments will be used and structured feedback given to aid the trainee’s personal
development. For the MSF assessment replies should be received within a 3 month time window from a minimum of 12
raters including 3 senior doctors and a mixture of other staff (medical and non medical) for a valid MSF. If significant
concerns are raised then arrangements should be made for a repeat MSF(s)
Number of WPBAs as
Number of WPBAs as per
Number of WPBAs as per
Number of WPBAs as per
per relevant specialty
relevant specialty
relevant specialty
relevant specialty
MSF
MSF
MSF
MSF
1
1
1
1
Specialty specific
competences
Confirmation by
Confirmation by educational
Confirmation by educational
Confirmation by
educational supervisor
supervisor that satisfactory
supervisor that satisfactory
educational supervisor that
that satisfactory progress
progress is being made in
progress is being made in
level of performance in this
is being made in this
this area of the curriculum
this area of the curriculum
area of the curriculum is
area of the curriculum
satisfactory
Confirmation by
Confirmation by educational
Confirmation by
Confirmation by
educational supervisor
supervisor that satisfactory
educational supervisor that
educational supervisor
that satisfactory progress
progress is being made in
satisfactory progress is being that satisfactory progress is
is being made in this
this area of the curriculum
made in this area of the
being made in this area of
area of the curriculum
curriculum
the curriculum
It is expected that the appropriate specialty specific WPBAs will be used to assess workplace performance of these
competencies
Procedures
Foundation procedural skills must be maintained
Procedures should be evidenced by DOPS (initially training / formative and then assessment / summative to confirm
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competence where required).
DOPS to be repeated until clinical independence (where required) is confirmed by assessor
Clinics (or
equivalents)
Overall teaching
attendance
For potentially life-threatening procedures, at least 2 DOPS confirming competence are required from different
assessors
Satisfactory performance in appropriate specialty clinics by the end of the Broad Based Program
Satisfactory record of teaching attendance to include 75% attendance at the required teaching programme within the
Deanery, or evidence of attendance at equivalent teaching events
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It is expected
that performance
in outpatients
will be assessed
using Mini CEX
and COT, CbD.
Reflective
practice and
patient survey
are also
recommended
The
requirements to
attend teaching
attendance
should be
specified on
commencement
of training
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