Naturally Occuring Evidence.
Naturally Occurring Evidence (NOE) in ePortfolio
NOE refers to evidence that you provide on your learning log that is in addition to the evidence required by the RCGP (CBDs, COTs etc.). This evidence should help you to demonstrate the various competencies, as well as well as providing evidence that you have satisfactorily covered the curriculum.
The RCGP and Committee of GP Educational Directors (COGPED) have confirmed that from 2014 it will be expected that there is involvement in several of these areas and defined guidance on this . Therefore reflection is nationally expected on:
- at least one SEA (in the GP rather than the major incident meaning) per 6 months is now expected. (the School advice would still be to aim for 3 per 6m)
- each post undertaken looking at how they completed their learning and how the post went (see the guidance below on how to make this as useful to yourself in relation to demonstrating competencies)
- an audit (or Quality improvement Activity) at least once during the course of training.
Some of the competencies are harder to demonstrate than others if we simply rely upon the WPBA and clinical encounters. For this reason the School has developed a suggested a scheme of evidence that we feel covers these harder to demonstrate competencies, particularly: the teaching element of Maintaining Performance; Learning and Teaching; Fitness to Practice; Community Orientation and Working with Colleagues and in Teams.
In addition to this, you need to provide evidence of sufficient and satisfactory out of hours (OOH) training, detail any leave taken, and record complaints or Significant Events (as defined by the GMC) or their absence. This is to enable the RCGP to award you a certificate of completion of training. For more details about how this evidence fits in, please see the Naturally Occurring Evidence and displaying competencies and Naturally Occuring Evidence documents.
In order to help you show where you have placed this recommended evidence, as well as assist your educational supervisors in making their assessments, a spreadsheet has been developed and you are strongly encouraged to complete this as you go through your training year and share it with your ES at your reviews and prior to ARCP. In addition to providing an elegant way of highlighting and presenting your evidence, you can map your COTs/CBDs/miniCEXs, which will enable your ES to more easily make their assessment, as well as help you to plan your CBDs so that you demonstrate progression and cover all the competencies.
You should have been provided with a copy of the spreadsheet by your local Training Programme: NOE Evidence Workbook
You can choose to provide the evidence in other ways, e.g. don’t do a presentation but instead reflect on a teaching session you delivered to medical students. But be aware that we feel the suggested evidence is enough to help you to demonstrate these competencies. Below is our suggestion of the evidence you'd be advised to collect and some guidance relating to them. All our required in accordance with RCGP/COGPED national certification guidance in the information below.
Your Leave and Complaints to date
The RCGP certification unit will not be able to process an application for a CCT unless they have confirmation of any leave taken in addition to the annual leave that is allowed. For this reason we need to have clear and available recording of this so that trainees avoid delays in receiving their CCT.
All trainees should be keeping a log of their leave to date and any complaints that have arisen during their training period. These need to be submitted to ARCP panels when your review is due (i.e. when moving from ST1 to ST2, ST2 to ST3 and ST3 to CCT)
All trainees need to keep a log of the following continuously throughout their training period and submit these to the ARCP panel review meeting when it is due.
- Statement / summary of GP release attendance (time taken to attend the release course is paid time, there is therefore a potential probity issue if a trainee does not attend the expected percentage of release course meetings for their posts)
- Complaints and Compliments - to be logged on eportfolio and recorded on Form R document
File under Professional Conversations
- File under Significant Event Analysis in your ePortfolio
- One is required but to make sure you have a good enough coverage we suggest 3 SEAs in every six month post (or 2 in every four month post)
- Please complete these as soon as possible after the event as it is best to allow the educational supervisor to look at big events like these promptlty.
1. A significant event should have significant personal involvement; it is suggested that there is balance between SEAs which focus on individual learning and those which deal with team issues and improving systems of care. The format we expect is being used to support appraisal for GPs and is part of the QOF framework, so you will be learning important skills for the future.
2. A significant event (also known as an untoward or critical incident) is any unintended or unexpected event, which could or did lead to harm of one or more patients. This includes incidents which did not cause harm but could have done, or where the event should have been prevented.
3. ALL patient safety related SEA’s (formerly known as SUIs) need to be recorded as part of your NOE to comply with the narrower GMC definition of SEA used for Revalidation. You are currently required (see below under Other Essentials) to declare any SUIs or Critical Incidents – and the description of the incident should be recorded in the ePF under SEAs and given a title of SUI.
- File under Courses/Certificates
- 1 in every post
Concise summary of learning points, including reflections on learning achieved (in terms of knowledge, skills and attitudes), and how this relates to a career in GP. This reflection will result in new learning objectives for next posts. (Recommended length up to one page A4).
- File under audit/project
- either an audit or evidence of managing change to improve quality e.g. through reflection on a QOF area should be completed
Normally this should be done in the first GP attachment as there is an enormous workload for GPSTRs in ST3 year and be available for the ARCP panel within four months of completion of the first GP post. There is no requirement from an ARCP perspective for multiple audits or Quality Improvement Projects. (Though these would be excellent practice).There is an expectation that the quality improvement work should be done in a Primary Care setting and not just be part of a hospital audit programme.
The purpose of the audit or Quality Improvement Project (QIP) is for the trainee to develop and demonstrate skills in leading change management in the practice in order to improve the quality of patient care. Audit and leadership are referred to by the GMC as part of Good Medical Practice, on which re-validation is based.
The GP curriculum 2015 has several bullet points particularly relevant to the expectations here. Trainees should:
* Analyse relevant patient feedback and health outcome data to identify unmet health needs, identify inappropriate variation and highlight opportunities to reduce inequalities and improve health outcomes
* Contribute your experience to the evaluation, re-design and (where relevant) commissioning of care pathways, to achieve a more integrated, effective and sustainable health system
* Make effective use of the tools and systems that enable evaluation and improvement of your personal performance (e.g. through use of reflective portfolios, patient satisfaction surveys, multi-source feedback, significant event audits and other quality improvement tools)
If an Audit is chosen it should demonstrate a complete cycle. The trainee may need to take one day study leave from a hospital post to return to the practice to do a second data collection and this can appropriately be applied for ( often linked to returning for an ESR meeting.)
A copy of the audit should be uploaded as an attachment to the learning log entry and a good quality learning log entry will demonstrate appropriate reflection on the audit
QIP or QOF reflection. Choose one quality indicator – e.g. a QOF indicator, LES or an indicator where performance is sub optimal. Examine and clarify the issues with reference to literature including suggestions to improve performance.
The reflection should show how the recommendations are shared with the team and how progress is reviewed against the action plan. A significant part of leadership involves managing people, ranging from getting shared commitment, enabling colleagues to contribute to changes and managing disagreements or concerns. A good quality learning log entry will explore these facets explicitly.
If you attend an audit or QOF meeting and you record these in your learning log, you should file them under lecture/seminar, because you should reserve the audit/project heading for audits etc. that you personally carried out.
- Guidance for Audit
- Features of a good learning log entryfor audit / project
- File under Lecture/Seminar
- 1 in every 6 month post
This can be a presentation of a clinical case study, literature review, a research project, a discussion paper or notes review; such a presentation may have been given in a departmental setting or VTS group
Key points considered in the assessment of this work are:
- discussion of how practice relates to the evidence base
- demonstration of relevance to career in GP
- Consideration of the teaching approach used
Remember, if you do a departmental or VTS presentation, this can be mapped to curriculum statement 3.7; teaching, mentoring and clinical supervision.
(A set of power point slides with no discussion or reflection will be judged inadequate)