The Milton Keynes Traffic Light System

A structured mechanism for identifying trainees in difficulty

From: Greg Simons

Overview of Presentation
Introduction RDMp Model Reflection/ Insight Traffic Light system Implications of the traffic light Expectations

Introduction
GP GP Trainer National Clinical Lead GP access and responsiveness Associate GP Dean
PD support Trainer Support Trainee Support Executive rep at Deanery Board level Faculty Development

The RDM-p Model

Tim Norfolk Quality in Primary Care 2009 17 (1), pp37-49 Unifying theory of clinical practice Links Relationship, Diagnostics, Management and Professionalism Overarching model, provides a framework that can incorporates criteria and competencies across the range of assessments of a GP's work

RDMp Relationships
descriptor R=relationships Holistic Consulting skills Communicating Working with colleagues Negative Lacks warmth in voice/manner uses too many closed questions Unable to adapt language Unclear when communicating Gives little support confrontational (+p) Authoritarian (+p) descriptor positive Good non verbal behaviour Uses open questions Adjusts questioning Expresses ideas clearly Encourages contribution Delegates appropriately Non-judgemental

Adapted from Tim Norfolk; Quality in Primary Care 2009

RDMp Diagnostics
descriptor D=Diagnostics negative descriptor positive

Data gathering Data interpretation Making diagnoses Making decisions Clinical Management Managing complexity

Cant find a way of resolving the problem (D+M) Makes immediate assumptions Dogmatic Overlooks important information Options too limited

Positive when dealing with problems Thinks around issues Open to new ideas Shows interest and understanding Identifies key points Aware of options

Adapted from Tim Norfolk, Quality in Primary Care 2009

RDMp Management
descriptor M= management Community orientation Practice Management IMT Maintaining performance Learning and teaching negative Unsystematic Fails to apply lessons Disorganised Doesn't keep up to date Poor prioritisation Misses reasonable deadlines Doesn't think ahead Doesn't cope well with unexpected Becomes agitated descriptor positive Sound systematic judgement Admits to and learns from mistakes Organised Regularly updates job related skills Prioritises effectively Coordinates activity Thinks ahead Delivers on time Stays calm under pressure

adapted from Tim Norfolk, Quality in primary care 2009

RDMp professionalism
descriptor P= professionalism negative descriptor positive

Ethics Fitness to practice

Defensive (M+P) Critical Shows favouritism Narrow perspective Fails to take responsibility for poor actions Treat issues as problems Disrespectful to colleagues, staff or patients Finds it difficult to seek help when appropriate

Receptive Gives constructive feedback and support Collaborates Sees bigger picture Takes responsibility appropriately Recognises limitations Shows respect Seeks help when necessary

Adapted from Tim Norfolk, Quality in primary care 2009

RELATIONSHIP

DIAGNOSTICS

Practising Holistically Communication & Consulting Skills

Data Gathering & Interpretation Making a Diagnosis / Making decisions

professionalism
Working with Colleagues & in Teams Maintaining an Ethical Approach to Practice

Clinical Management Managing Medical Complexity

Fitness to Practise

Community Orientation Primary Care Administration & IMT Maintaining Performance, Learning & Teaching

MANAGEMENT

Tim Norfolk
Tim Norfolk Quality in Primary Care 2009, 17 (1), pp3749

RDMp and Good Medical Practice

Tim Norfolk 2009

Insight/ Reflection
Amar Rughanis Insight Table
Performa Insight nce Reflect What do you think??

Good
Good

Good
Poor

Ideal
Unconsciously competent doctors may not adapt to changing situations as they don't understand why they are (currently) competent. They may also engage in risky practices through lack of insight regarding the connection between action and effects. Consciously incompetent doctors might be difficult because they have low motivation to improve. The causes of low motivation, such as stress need to be looked for. Unconsciously incompetent doctors may be the most difficult to remediate because despite regular exposure to deficiencies in performance, they may lack the capacity to change

Poor

Good

Poor

Poor

Using the Traffic Light System

Look at descriptors for RDMp domains Apply the grading in each domain using your knowledge of the trainee, experience and evidence e.g. eportfolio, feedback

Grading (Milton Keynes)

1 = clearly failing 2 = concerns 3 = expected stage 4 = above expectation for stage 5 = ready for independent practice

Add in insight/lack insight (-/+)

Using the Traffic Light System

Look at descriptors for RDMp domains Apply the grading in each domain using your knowledge of the trainee, experience and evidence e.g. eportfolio, feedback Decide whether the trainee demonstrates insight with reflective ability with + or Categorise Green/ Amber/ Red

Traffic Light System for MKVTSTables

colour Green concern none eportfolio Sufficient number and quality of entries. Progression in PDP and skills log Satisfactory coverage curriculum Satisfactory completion Assessments ES Continue regular review eportfolio Continue 6/12ly reviews RDMp3+ in all areas PD/AD Monitor eportfolio

Traffic light system for MKVTS

colour Amber concern Some ePortfolio Consistently poor quality/ number of entries Poor PDP Poor coverage of curriculum Inadequate number of mandatory assessments ES RDMp2 in any one area One area may be (-) for insight PD/AD PD interviews trainee + ES

Traffic light system for MKVTS

colour Red concern Significant ePortfolio Failure to engage ePortfolio Unsatisfactory progress signalled by ES or CS ES RDMp1/2 in more than one area poor insight (-) in multiple domains PD/AD Interview with PD/AD with ES with a view to referral to ARCP

Implications of Traffic Light

Feedback monthly for those in GP, Quarterly for those in Hospital (more freq if problems) Early referral to ARCP Reflective Skills very important Early, Frequent and open discussion with Ed Supervisor

Expectations
Full engagement Professionalism Self Directed