#GPFUQ 194 How do we overcome wasteful and unnecessary bureaucracy associated
with poorly designed accreditation and reaccreditation courses. The challenge is to provide appropriate
learning for each learner. Not too little and not too much.
GPs are often expected by third
parties to have initial accreditation in a task that the GPs want or need to
do, and once accredited they may be expected to reaccredit their knowledge and
competence at regular intervals. Many of the standards for accreditation may not
be truly fit for purpose because
1.
There is poor linkage
between the GPs learning needs or gaps and the learning objectives; poor linkage
between the learning objectives and the content of courses: poor linkage
between the content and the outcome questions about performance or patient outcomes;
and poor linkage between the outcome questions and the learning objectives. As a result a danger is that the content of
the course is either poor quality or over engineered and wasteful of the time
of the learner, and/or the outcome of the course in that the learners
performance is not determined so there is no feedback to the learner or the
course designer on the success or failures of the course.
2.
The proliferation of
poor quality accreditations and re accreditations is an expensive misuse of
scarce NHS resources (eg GP time).
3.
Poorly designed
accreditation and re accreditation courses contribute to the unnecessary
bureaucracy that make GPs feels overwhelmed.
All GPs need to give robust
feedback to accreditors that the quality of accreditation and reaccreditation
processes must be improved following the best quality improvement and learning
principles and processes.
Principles of Quality Improvement
and Learning suggest
1. What are you trying to
achieve? All learning starts with a problem. You always need to describe the
problem that needs to be solved. For example with cx sampling in the National
Screening programmes: Is it the quantity of samplers (ie not enough to run the
programme), or the quality of samples that is a problem (ie too many poor
quality samples).
2.What do you know about this
problem?
When you know the problem conduct
a learning needs analysis, describe the gap analysis, write learning
objectives, develop the content for the course and then write the assessment of
outcome questions.
The needs assessment and gap analysis
may need a literature review, quality performance data review, and expert
interviews. This might be either interrogating the data to see if it's a
general problem (affects all areas and samplers) or a specific problem (areas
and samplers who have the problem can be identified). Has anyone else has the
problem and solved it already?
You should identify the
needs/gaps by outcomes like knowledge, confidence, competence, performance and
patient outcomes
3. What are you able to do with
the available resources? You should include the costs you are passing onto
others (eg the learners time, and opportunity costs associated with that). You
should aim for the ‘good enough’ solution. You don’t want to over engineer the
solution. For example if there is a cheap, fast, reliable way to fix the
problem (eg gets Cx samplers to watch a You tube video) you should use that
solution in preference to anything that is more expensive or slower.
4. How are you going to measure
success? What are the success criteria? You will need to have success criteria
based on outcomes that are linked through the learning objectives and process
to the initial needs assessments. There must be a clear connection for the
structure and process of learning between the needs assessment and the
outcomes. If there are any broken or weak links they must be identified and
removed or repaired
and finally
5.How and when will you review
what you are doing?
Examples of questions to ask are
given in Appendix A- Linkage of Learning Objectives to Outcomes levels and
questions
I have used Cx sampling
accreditation and re accreditation as an example to test these principles and
practices – see appendix B.
Appendix A
Linking (ref Derek Dietze-
Linkage of Learning Objectives to Outcomes levels and questions: A practical
solution for Optimal results)
1.Linking Identified Needs/gaps
to Learning Objective. Do the objectives
- Address the identified
needs/gaps?
- Reflect and deliver on the level
of desired/promised outcomes?
- Seem achievable given the nature
of the intervention?
2.Linking Learning objectives to
Content. Does the content
- Specifically address each
learning objective?
- Prepare the learner to achieve
the desired outcome?
3.Linking Content to Outcomes
Questions. Are the outcome questions
- answered in the content and is
sufficient time spent on the areas being measured?
- Asked at the right time/place (ie in follow up for
performance and patient questions)?
4.Linking Outcome Questions to
Learning Objectives. Is each outcomes question
- specifically designed to assess
achievement of a specific learning objective?
- Designed to assess the level of
outcome indicated in the learning objective it is linked to?
Appendix B
Good practice guidance for
cervical sample takers
A reference guide for primary
care and community settings in the NHS Cervical Screening Programme
https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/469962/CSP_GPG2_uploaded_211015.pdf
SECTION FOUR
Sample taker training
The resource pack for trainers of
sample takers
represents best practice and is
available at
www.cancerscreening.nhs.uk
A competency framework has been
developed by Skills for Heath relating to Cervical Cytology Sampling CH37 and
can be found at
www.skillsforhealth.org.uk
Organisation of training
Training for sample takers should
be in two parts; a theoretical course followed by a period of practical
training. Practical training should take place in the practice or clinic where
the trainee is based. It should be supervised bythe mentor (see Criteria for
Sample Taker Mentoring below).
Trainees should keep a record of
their training.
Theoretical course
A theoretical training course
should cover the following the NHSCSP, its background and context equality of access
to cervical screening understanding test resultsanatomy and physiology of the
pelvic organs practical aspects of taking cervical samples.
Update training
Sample takers should undertake a
minimum of one half day's update training every three years. E-learning update
modules may be used if they fulfil both the national and local requirements.
Whatever form it takes, update training must cover all of the following areas
current developments in the
NHSCSP, nationally and locally
recent literature relevant to
sample taking, sampling devices and women's needs
changes to local screening
policies and procedures
personal learning needs
qualitative assessment of 20
recent consecutive samples produced by the sample taker.
Criteria for sample taker
mentoring
Trainers
Trainers should have good
teaching and communication skills, and ideally hold a relevant teaching
qualification. They should undertake regular update training and maintain
awareness of developments in the NHSCSP. They must be practising sample takers
who are able to demonstrate continuing competence in taking samples for
cervical screening with particular reference to
transformation zone sampling
sampling technique
equipment and sample preparation
audit of results, including
adequacy rates
effective communication awareness
of developments in the NHSCSP
Practical training
For the first practical session/s
the trainee should be accompanied by the training mentor and should
identify training needs in
discussion with the mentor
observe at least two samples
being taken
take a minimum of five samples
under supervision.
The mentor and trainee should
then decide whether the student may proceed without further direct supervision.
Once this is confirmed, the trainee should arrange to take and document a
minimum of 20 unsupervised samples. Easy access to a trained colleague is
essential throughout this period.The trainee should visit both the cytology
laboratory and the colposcopy clinic, documenting the visits
in the training record book
Final assessment
Both mentor and trainee are
expected to maintain regular contact and to discuss progress towards meeting
identified training needs and any problems. They should meet for a final
evaluation session, which should include a final clinical assessment. The trainee
must have completed a minimum of 20 cytologically adequate samples before the
final evaluation session. All training should be completed within a nine month
period.
Maintaining competence
To help to ensure continued
competence in accordance with their professional codes of conduct, sample
takers should conduct continuous self evaluation. They should audit and reflect
on their individual rates of inadequate tests and abnormal test results
compared with the rates reported by the local laboratory.
