Supervised Learning Events (SLE)

RCPCH has updated its guidance on the use of workplace based assessments for the coming year. This has started to filter down to trainees and trainers and we wanted to make sure that ALL trainees and trainers had seen the two page guidance and understood what it is saying about workplace based assessments. I have attached the document to this message along with a link to last year's more comprehensive (but quite readable) guidance on assessments.

 

The headline in this year's guidance is that there is no longer a minimum requirement on the numbers of SLEs to be completed during the year. At first glance this might appear to say trainees don't need to complete any SLEs. I wanted to make sure that this is not the message being received. 

 

I have highlighted the key points from the RCPCH document in this message and added a few thoughts drawn out of our experience of the latest round of ARCPs. I hope they are helpful. At worst you could log them away in your portfolio or appraisal folder, with a reflective note on having read them before the new training year begins (ie as evidence of learning relevant to your role as trainee or trainer)

 

All the best

 

Andy Mellon

Head of Northern School of Paediatrics

 

 

"The purpose of SLEs is as a means of engaging in formative learning; therefore, a trainee who presents evidence of SLEs that cover only a restricted area of the curriculum runs the risk of being judged as having poor strategic learning skills."

Northern School guidance: ensure you have provided a range of evidence to demonstrate your progress in achieving the requirements of the curriculum. You need to be able to show that you have gained knowledge, experience, skills and demonstrated performance across the range of the generic and specific curriculae. While not expecting every single outcome to have evidence, you should be able to provide evidence covering the range of the curriculum generally and in some areas to show depth of your knowledge, experience, skills and performance. Please don't link in bulk with evidence that doesn't support the outcome eg a single patient with an arrhythmia cannot provide evidence of having gained wide experience of the cardiology curriculum. SLEs should support other forms of evidence including your personal logs, notes on patients seen, clinical questions posed and answered, change management projects involved in, etc. 

 

"Trainees should use SLEs to demonstrate that they have engaged in formative feedback; they should record any learning objectives that arise in their PDP and show evidence that these objectives have subsequently been achieved."

Northern School guidance: The first bit is generally done ok. The second bit isn't. Many assessors take the time to suggest areas for trainees to focus on. In general most portfolios don't provide the extra evidence of trainees bringing back further evidence of their subsequent reading, research, questioning or experience in working on those learning points. We would like supervisors to encourage trainees to create new PDP points that address important areas of feedback, but always to encourage trainees to address the learning points in a professional manner whether by formally putting into PDP or simply reflecting, reading, uploading resources that demonstrate an appropriate response to the feedback. A reflective note that summates a response to feedback is very helpful as a way of showing the response and adds to the portfolio requirements in a meaningful way.

 

"There are no minimum numbers of SLEs (other than the mandatory assessments described in the curriculum). Trainees and supervisors should aim for quality not quantity; a useful SLE will stretch the trainee, act as a stimulus and mechanism for reflection, uncover learning needs and provide an opportunity for the trainee to receive developmental feedback. "

Northern School guidance: Don't stop doing SLEs. If anything this advice may lead to trainees providing more SLEs, rather than fewer, because we feel it points to a need to do more of the activities suggested. If portfolios were completed as they are often now but without the use of SLEs we would definitely end up with significantly more adverse outcomes at ARCP. Some of these may be ARCP 5 but some would be ARCP 2 or 3. The point about SLEs is to make them reflect the work you are doing and your progress in training. The bold points should be stimulating trainees to be challenged and trainers and assessors to be challenging. This does not mean "difficult" or "harsh".  I recently heard a phrase used by a local psychiatrist doing an introductory session to final year students in a large lecture theatre when asking challenging questions and dealing with imperfect responses, which may be useful to consider trying out when asking questions of trainees. "Let's play with that idea" I'd like to encourage the ethos behind that response to come across in our senior - junior discussions and I would include SLEs in that.

 

"Ratio of mini CEX to CbD assessments; it is anticipated that more junior trainees might undertake relatively more mini-CEX and more senior trainees undertake more CbD, reflecting the increasing complexity of decision-making, etc."

 

"Trainees are also encouraged to undertake the assessments indicated as optional."

 

"The numbers of SLEs given for ACAT, HAT, LEADER and Safeguarding CbD are minimum requirements; senior trainees in particular should bear in mind that each of the SLEs is designed for formative assessment of different aspects of the curriculum and more than this minimum number of some types of SLE might be required, depending upon the specific requirements and clinical context of a subspecialty. Trainees are therefore advised to consult their relevant subspecialty CSAC curriculum, in case there are additional specified assessment requirements"

Northern School guidance: Think ahead and try and set up opportunities to undertake  these in the most relevant settings. These are often quite useful at ARCP for picking up on some of the subtle developments needed during training. Feedback comments can again be a really helpful focus for trainee PDPs.