What does writing an evidence based report mean?
The criteria used by the RCGP have already been outlined - Sheet 12. In summary, all judgements need to be supported by specific examples of behaviours, performance or portfolio entries.
If I observe my trainee regularly, and say they are competent, then surely that should be good enough without further “evidence”?
If you are clinical supervising as well as being an ES, then your observations should indeed be used as part of your evidence. In this case, you should cite specific examples. Many trainers in this case write a separate CSR - Sheet 3 and Sheet 17. However, the strength of WPBA is using multiple sources of evidence to strengthen judgements and make the judgements less subjective.
Why does it matter to have objective judgements?
This is because, the ultimate decision on progression is made by the ARCP Panel. The panel relies on the ES to synthesise the portfolio evidence in discussion with the GPStR and present it in a way that allows the panel to make fair and rationale decisions.
Can’t I just say “refer to COTs and CBDs” to justify the assessments?
Unfortunately, that is not helpful to the Panel. These assessments are primarily formative and are likely to vary significantly in challenge. It would, for example, be possible for a trainee to have 6 “satisfactory” but low challenge COTs, yet not have reached competence in consultation skills in more challenging scenarios. That is why specific, dated examples of behaviours are expected.
But what if my GPStR has just passed the CSA or AKT, surely that is good enough evidence?
Passing a written exam, or demonstrating competencies in an artificial environment does not necessarily mean that the trainee performs competently in the workplace over an extended period of time. A CSA or AKT pass should not be used as evidence for any of the competency areas in WPBA.
This sounds like it requires an enormous amount of writing?
This is not necessarily so. See Practical examples of an evidence based ESR. An average of 3 pieces of evidence (which might include observed behaviours) should usually be cited to cover the breadth of that competency as described in the associated competency word pictures.
But it still sounds extremely time consuming?
The ES review and report should not take more than 3 hours to do. We recommend that the ES links in advance of the meeting those log entries to competency areas that might be useful as evidence - Sheet 6. In addition, the GPStR should spend some time sifting all the portfolio evidence to compile their self-rating. The ES may then be able to use this same evidence in their own assessments. See Sheet 2 for a Step by Step guide and Sheet 17 for top tips to make the process more efficient.
But how do I do all this if the GPStR is in a hospital post?
The document Evidence requirements for Competencies indicates where to find the evidence, with an example of an ST1 report shown in the Practical examples document as noted in 6 above. The evidence recommendations for learning logs - Sheet 15, should also make this easier.
It seems that the ePortfolio software makes this all too difficult?
Deaneries around the country are putting more pressure on the RCGP to improve the functionality of the portfolio, and things have been improving with further plans for future development - Sheet 17.
Well, I still think this all sounds like unnecessary bureaucracy, particularly if the GPST is clearly doing well?
Not infrequently, a GPStR seems to be doing well in practice, then might fail the CSA or AKT. Evidence-based reports of their progress are essential should they require evidence to gain extensions or to support appeal hearings. Using evidence to support judgements is also a core skill for GPStRs to develop to support NHS appraisal and revalidation.
What if the panel thinks my ES report is not evidence based?
Supportive feedback is being given to ESs on the quality of their report. Should an ESR not have evidence-based judgements, then it may be judged as “insufficient evidence” leading to an unsatisfactory ARCP outcome.