Handbook for Broad Based Trainees
Welcome to Broad Based Training.
This is an exciting training scheme that aims to develop a generation of young doctors who will develop significant experience as a doctor in a number of specialties in different health-care settings. The programme also aims to train the doctors for the future, as changes to health care provision will be delivered increasingly in community settings.
This is a new and evolving pilot and as adult learners you will have significant input into the training program.
There are currently 7 LETBs running this national pilot from August 2015 it will be rolled out to the remaining LETBs.
The programme involves four specialties, general practice, medicine, paediatrics and psychiatry. During the first year of the training programme you will have experience in each of these specialties and there is career advice available for you to make a decision of your chosen specialty.
Whilst Broad Based Training (BBT) in the South West is part of a national pilot project it is important to remember that it is subject to the criteria, requirements and guidance of the GMC, and those described in ‘A Reference Guide for Postgraduate Medical Training in the UK’ (commonly known as the Gold Guide) http://www.mmc.nhs.uk/specialty_training/specialty_training_2012/gold_guide.aspx
The BBT programme has also been developed in agreement between the four Royal Colleges and supported in its development by the Academy of Medical Educators and the Academy of Medical Royal Colleges.
This document has been created to guide you through the requirements of your BBT programme and should be read in conjunction with the BBT curriculum.
- The Postgraduate Dean is Martin Beaman
- Head of School of General Practice is Simon Newton
- Head of School of Medicine is Stirling Pugh
- Head of School of Paediatrics is Tom Villiard
- Head of School of Psychiatry is Rob MacPherson
Broad Based Training Programme
- Training Programme Director is Louise Davis
- Administrator is Nicola Snowden-Higgs
- Careers advisor Heather Samuel
- Gloucester Supervisors
- GP supervisor is Mike Andrew
- General Medicine/Oncology supervisor is Nick Reed
- Paediatric supervisor is Russell Peek
- Psychiatry supervisor is Amjad Uppal
- Swindon Supervisors
- GP supervisors James Millar and Martyn Hewett
- General medicine supervisor is Sarah White
- Paediatric supervisor is Nick West
- Psychiatry supervisor is Kalai Ramasamy
- Somerset Supervisors will be confirmed later this year
- GP Supervisor is Carola Steidl
- General Medicine/Oncology supervisor is Simon Cooper
- Paediatric Supervisor is Alexandra Powell
- Psychiatry Supervisor is Rosemary Brook
- Head of School of General Practice is Paul Thomas
- Head of School of Medicine is Nick Withers
- Head of School of Paediatrics is Yadlapalli Kumar
- Head of School of Psychiatry is Kate Lovett
Broad Based Training Programme
- Training Programme Director is Sarah Robbins
- Administrator is Sarah Anderson
- Peninsula Supervisors
- GP supervisors are Sarah Robbins and David Hopes
- General Medicine supervisor is Paul Hancock
- Paediatric supervisor is Catherine Derry
- Psychiatry supervisor is William Lee
The pilot is managed by North West Deanery.
- Website for information https://www.nwpgmd.nhs.uk/bbt
- IT manager for PRISM eportfolio is Dan Powley
This is a 2 year programme following on from F2 with four placements each lasting 6 months in Psychiatry, Paediatrics, Medicine and General Practice. During each 6 month placement (major) 10% of the time is spent in one of the other specialties (minor), thus enabling trainees to have experience of all 4 specialties each year.
On successful completion of BBT trainees will enter automatically into the ST2 or CT2 year of their chosen specialty.
You need to choose a specialty by the end of the first BBT year, and to complete the allocation form on Prism by September of your second year available on PRISM site.
You will be asked to preference your chosen specialty by geography. Specialty heads of school will allocate trainees to post based on their specialty choice. Your preferred geography will be taken into account where possible.
Allocation to GP
Where possible and where rotations allow, your previous experience in Paediatrics, CMT and Psychiatry will be taken into account by the relevant Deanery’s GP TPD when allocating to GP ST2, so that you will have the opportunity to experience specialties other than Paediatrics, Psychiatry and medical specialties previously covered in BBT.
You are expected to stay in the same Training Programme, however, if circumstances mean you need to move, then you can apply for an inter deanery transfer during any of the training period, these are subject to posts available in the new deanery.
There is no opportunity for out of placement experience during the Broad Based Training Program.
If you wish to take time out at the end of the programme then you may no longer be guaranteed a place in specialty training in Health Education South West. If you wish to explore this option please discuss this with your Training Programme Director.
Case Based Discussion
Assessment of clinical expertise
Mini Assessment of clinical expertise
Patient Satisfaction Questionnaire
Acute care assessment tool
Case based discussion group assessment (CBDGA)
Journal Club Presentation
8 mandatory GP skills
During each specialty you must show evidence that you are engaging with the training process. This is done by ensuring you complete all the relevant workplace based assessments successful and by adding log entries that show that adequate reflective learning has taken place and that you can demonstrate learning of the healthcare process across traditional boundaries. You are required to record at least one anonymised case of a patient who has required care between specialties during each six month period. You should also aim to enter at least 2 reflective log entries per week.
These methods are described briefly below. More information about these methods including guidance for trainees and assessors is available in the ePortfolio and on the JRCPTB website www.jrcptb.org.uk.
Workplace-based assessments should be recorded in your ePortfolio. The workplace-based assessment methods include feedback opportunities as an integral part of the assessment.
This is the GMC curriculum guide to these assessments:
Multi-source feedback (MSF)
This tool is a method of assessing generic skills such as communication, leadership, team working, reliability etc., across the domains of Good Medical Practice. This provides objective systematic collection and feedback of performance data on a trainee, derived from a number of colleagues. ‘Raters’ are individuals with whom the trainee works, and includes doctors, administration staff, and other allied professionals. The trainee will not see the individual responses by raters, feedback given to the trainee by the Educational Supervisor.
mini-Clinical Evaluation Exercise (mini-CEX)
This tool evaluates a clinical encounter with a patient to provide an indication of competence in skills essential for good clinical care such as history taking, examination and clinical reasoning. The trainee receives immediate feedback to aid learning. The can be used at any time and in any setting when there is a trainee and patient interaction and an assessor is available.
Direct Observation of Procedural Skills (DOPS)
A DOPS is an assessment tool designed to evaluate the performance of a trainee in undertaking a practical procedure, against a structured checklist. The trainee receives immediate feedback to identify strengths and areas for development.
Case-based Discussion (CbD)
The CbD assesses the performance of a trainee in their management of a patient to provide an indication of competence in areas such as clinical reasoning, decision-making and application of medical knowledge in relation to patient care. It also serves as a method to document conversations about, and presentations of, cases by trainees. The CbD should focus on a written record (such as written case notes, out-patient letter, discharge summary). A typical encounter might be when presenting newly referred patients in the out-patient department.
Acute Care Assessment Tool (ACAT)
The ACAT is designed to assess and facilitate feedback on a doctor’s performance during their practice on the Acute Medical Take. Any doctor who has been responsible for the supervision of the Acute Medical Take can be the assessor for an ACAT.
Patient Survey (PS)
Patient Survey address issues, including behaviour of the doctor and effectiveness of the consultation, which are important to patients. It is intended to assess the trainee’s performance in areas such as interpersonal skills, communication skills and professionalism by concentrating solely on their performance during one consultation.
Audit Assessment (AA)
The Audit Assessment tool is designed to assess a trainee’s competence in completing an audit. The Audit Assessment can be based on review of audit documentation OR on a presentation of the audit at a meeting. If possible the trainee should be assessed on the same audit by more than one assessor.
Teaching Observation (TO)
The Teaching Observation form is designed to provide structured, formative feedback to trainees on their competence at teaching. The Teaching Observation can be based on any instance of formalised teaching by the trainee which has been observed by the assessor. The process should be trainee-led (identifying appropriate teaching sessions and assessors).
Paediatrics also has 2 additional assessments that are not compulsory in BBT training but you may be interested if you wish to pursue a career in paediatrics:
SAIL Sheffield Assessment Instrument for Letters (SAIL)
has been developed and validated for use in paediatrics. The instrument assesses the trainee’s competences in written communication, over time.
Paed CCF (Originally SHEFFPAT)
has been developed and validated for paediatrics and seeks the views of parents and guardians about the care of their child.
The assessments are necessarily slightly modified for psychiatry:
Assessment of Clinical Expertise (ACE)
modified from the Clinical Evaluation Exercise (CEX), in which an entire clinical encounter is observed and rated thus providing an assessment of a doctor’s ability to assess a complete case
Mini-Assessed Clinical Encounter (mini-ACE)
modified from the mini-Clinical Evaluation Exercise (mini-CEX) used in the Foundation Programme, part of a clinical encounter, such as history-taking, is observed and rated.
Case Based Discussion Group Assessment (CBDGA)
has been developed by the College to provide structured feedback on a trainee’s attendance and
contribution to case discussion groups (also known as Balint-type groups) in Core Psychiatry Training.
Structured Assessment of Psychotherapy Expertise (SAPE)
has been developed by the RCPsych to provide evidence of satisfactory completion of a psychotherapy case.
Case Presentation (CP)
developed at the RCPsych; this is an assessment of a major case presentation, such as a Grand Round, by the Trainee.
Journal Club Presentation (JCP)
similar to CP, and also developed at the RCPsych, this enables an assessment to be made of a Journal Club presented by the Trainee.
Assessment of Teaching (AoT)
has been developed at the RCPsych to enable an assessment to be made of planned teaching carried out by the Trainee.
You each have an Educational Supervisor (ES) who will be responsible for your reviews, at the beginning and end of each attachment; we also recommend at least one mid-post review. Your ES is also responsible for reviewing your log entries in the eportfolio and advising you further on your learning. Your ES can advise you on learning needs, suitable courses and careers.
You also have a Clinical Supervisor (CS) in each post and in your first attachment will also be your Educational supervisor. Your clinical supervisor is responsible for writing up your WBPAs and reviewing progress in that specialty, they will also be responsible for your learning and teaching during your placement. Your CS is responsible for writing your CSR (even when they are also your ES as this is required for ARCP.)
The eportfolio entries, reports and reviews form part of the ARCP.
BBT training can bring to light different kinds of personal and professional stresses which can be difficult to cope with. Should this happen then there are a number of routes of support. Maybe your first port of call could be your colleagues in your peer group, many of whom may have had similar experiences.
Remember, you are not on your own; there will always be someone to turn to for advice.
Your educational and clinical supervisors are an important source of support throughout your BBT programme. If you have specific concerns about the placement you are in this should be addressed in the first instance with your clinical supervisor for that post and if you wish extra support from your educational supervisor.
If you would like to discuss your choices for the exit into a specialty, please see the careers page on your eportfolio where you can find the relevant contact details.
Teaching and learning BBT has a Training Programme Director (TPD) who is employed by the HESW to support and facilitate the running and delivery of the training for the whole BBT Programme in Severn. The TPD will co-ordinate your training programme throughout your two year Programme.
You should attend teaching in each specialty with other ST1/2s or CT1/2s. Your clinical supervisor will advise you on this.
There will be regular Specific BBT Learning Sessions.
More details are available from your Training Programme Director. During these sessions you will cover the common competencies:
Some of the session will also be devoted to case discussion; these should be cases that cross the interface of hospital and community settings or between specialties. The trainees and supervisors will take turns to present these for discussion.
You must apply for study leave for these sessions. Regular teaching sessions within your specialty do not require study leave.
You can access the Professional and Generic Skills programme available through the Severn Postgraduate Medical Education. The modules are particularly relevant to Broad Based Training.
There is study leave and study budget available for individual courses and you may wish to do some on line learning also in your own time. To apply for study leave you should submit a form to your Educational Supervisor or Clinical Supervisor and forward this to Nicola Snowden-Higgs for Severn and Sarah Anderson for Peninsula, you may copy it to the Training Programme Director. Please see Study leave page on the website for Study leave application and expenses claims forms. Forms are also available from the Program Administrator. Forms should be submitted 6 weeks in advance.
Please note examination fees will not be reimbursed.
There are 30 days study leave per year, the Peer Learning Sessions must be taken from this leaving approximately 25 days.
Any questions about this should be directed to your Training Programme Director.
BBT trainees will need to complete:
The Enhanced Form R –All Doctors in Training are required to complete the Enhanced Form R and Severn is required to have this available in advance of each ARCP. The Form R is the document that all Specialty trainees sign annually, and again prior to CCT, this enhanced version requires you to answer questions about whether you have been involved in any complaints or investigated incidents over the last year.
Trainees must demonstrate satisfactory progress within each year. You will not have been deemed as successfully completing Broad Based Training unless you have satisfied the ARCP panel at the end of the second year of the programme. Without this you will not be able to progress into the specialty of your choice without a further extension of 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.
In preparation for ARCP you will have had an interim review and should have a clear understanding of what is expected to give a likely satisfactory outcome.
The panel consists of the BBT Programme Director and include representation from each of the four specialties involved in the BBT programme. There is also lay and external representation on the panel. The purpose of the panel is to make a decision on whether the evidence you have presented in your e-Portfolio along with the ES appraisals is adequate for you to pass to the next level of training. You will be invited to discuss your outcome and the programme in general with the panel after the panel have decided on the outcome.
Trainees successfully completing BBT will be issued an Outcome 6 at the ARCP panel
- GMC http://www.gmc-uk.org/education/14310.asp
- Severn Postgraduate Medical Education http://www.severndeanery.nhs.uk/
- Education Resource Locator (ERL) https://gpappraisal.severndeanery.nhs.uk/default/erlmaterial/index
- Gloucestershire GP Education Trust http://www.ggpet.org.uk/
- Swindon Education Trust http://www.swindongpeducation.co.uk/
- Peninsula Postgraduate Medical Education http://www.peninsuladeanery.nhs.uk
- Royal College of Physicians http://www.rcplondon.ac.uk/
- Royal College of General Practitioners http://www.rcgp.org.uk/
- Royal College of Paediatrics and Child Health http://www.rcpch.ac.uk/
- Royal College of Psychiatrists http://www.rcpsych.ac.uk/
- Health Education North West BBT Programme https://www.nwpgmd.nhs.uk/bbt
- Academy of Medical Royal Colleges http://www.aomrc.org.uk
- Leadership Academy http://www.leadershipacademy.nhs.uk/
- NHS http://www.england.nhs.uk/
- Community Health Partnerships http://www.communityhealthpartnerships.co.uk
- Public Health England https://www.gov.uk/government/organisations/public-health-england
- Centre for Sustainable Healthcare http://sustainablehealthcare.org.uk
We hope you will enjoy the four specialties in Broad Based Training and take advantage of the extra skills this programme will give you in the career you choose for your future