Episode 53: Transition gap analysis

Welcome to this Medicine Podcast. I'm Zoe Fleet, I'm the Royal Cardia Physicians Curriculum and Credentials Manager. I'm here today with Anastasia Madanidou, who is the Rheumatology SAC trainee representative. Could you just tell us a little bit more about yourself please Anastasia? Yeah, thank you Zoe for the invitation and having me today. I'm Anastasia, I'm a Rheumatology and General Medicine Registrar. As you said, I'm also the SAC trainee representative. This means that I got involved in the SAC webinar about the new Rheumatology and General Medicine curriculum. And as part of this, I made a presentation about the gap analysis. And therefore I'm here today to discuss about the transition period and the gap analysis. In terms of the gap analysis, the reason you needed to do this was because you had to move to the new curriculum that have just been launched by the Joint Royal Cardia Physicians Training Board. Can you tell us a little bit about why you had to transfer to the new curriculum? Yes, that's right. So last year I was ST5 Rheumatology and General Medicine. So this means I had to transfer from the old to the new curriculum. This is a ZMC requirement. All the trainees should be trained according to the new requirements, according to the new curriculum. And only doctors in the final year of the training are not required to transfer to the new curriculum. Okay, and what actually is involved then in transferring to the new curriculum? What does it mean? Yeah, initially, what we should do is to find the gaps between the new, the old and the new curriculum, because there are differences. There are some different requirements. And this may sound daunting. And that's why we need to do this gap analysis. This is what actually gap analysis means, finding the gaps. And we need to capture all these things in a form, the gap analysis form. And we complete this gap analysis form along with our educational supervisor. And we're advised from the training board to arrange a meeting, a gap analysis meeting, where we write down the differences. And this will help organise our training through the year. And how did you feel about doing the gap analysis? Yeah, good question. So, you know, transitioning, just to start transitioning from the old to the new curriculum was a bit daunting, you know, because even capturing all the evidence for one curriculum is a lot of work. Now trying to find the differences and trying to meet the new expectations. It's more hard work. So I wasn't really happy about the transfer or about completing the form, to be honest with you. But I think it's a very crucial form to be completed. Because this, actually, this is the way to feel comfortable with the new curriculum, because you actually, you need to go through the requirements of the new curriculum and understand what you need to do. And plan your remaining training years with the help with your educational supervisor. So just to summarise, you know, completing this form, in a way, it's a daunting experience. But it's very helpful, because at the end of the day, we all want to become consultants. So we need to meet the expectations. And this is the only way to do so. And how did you prepare for that meeting, then? Presumably, you needed to find out what's in the new curricula to be able to do this, and your supervisor as well. Yes, exactly. So what I did, so I use the CAP analysis form. So the CAP analysis form is a very well structured form. I don't know if you were involved in this form, Zoe. So it actually tells you the differences and what you need, really need to do. So for example, there was one question about the outpatient clinic. So now, all the trainees, all the group one specialty trainees, not only the rheumatology ones, we have to do 20 outpatient clinics outside our main specialty. So I have never done any clinics outside rheumatology. So I found this CAP. And then, I spoke to my education supervisor what we need to do, because it's something new. So we didn't have to do this before. So it's all about planning. It's all about working together. I think that's really good advice, because I do understand that from the development of the curricula and looking at the gap analysis. That is something that does make trainees quite anxious, this 20 clinics and how much time they've got left in their training programme. I think it's probably worth pointing out that it can be pro rata. So if someone is getting towards the end of their training, perhaps only has a couple of years left, that with discussion with the educational supervisor, it could be less than 20 clinics. It's about getting that experience. And I think there's good guidance in the curriculum and in the form, as you say, about what are the educational objectives of those clinics. It's not just number counting. As I said before, it's important to plan. So the gap analysis meeting should take place at the beginning of the training. So today, for example, it's 12th of September. So I would expect all the trainees to have arranged the gap analysis meeting. Because if you need to plan some extra clinics, some respiratory or gastroenterology or any other clinics outside your main specialty, this needs some time, all these clinics to set up, because it has to do also with how NHS works. It's about the six week notice, cancelling clinics, finding room. And also just to point out, these clinics are important for our training. It's not about service provision. So I would expect a consultant to be present in order for us to get trained. So all these things need planning. So no, we need time for this. I think that's really, really good advice. And the two points really, isn't it, is like setting up that meeting, because it might take a little while to get time with your educational supervisor. They may not be in the same trust as you. And then to plan ahead to put in these educational, these sort of learning opportunities throughout the rest of the programme. And I think that's the really strong point about the gap analysis, isn't it, that it helps to tailor your programme, tailor what you do over the next year, two years, three years, to make sure those opportunities are picked up. Other than outpatients, then what are the other sort of internal medicine capabilities that you would focus on? About general, yeah, I think this was the main difference between the old and the new curriculum in terms of general medicine. There are some other differences in the rheumatology curriculum, but I don't think we should focus on this today. So would you say that what you'd already been doing in general internal medicine was helpful? It still counted, didn't it, that experience? Of course, of course, yeah, of course it counts. And the other thing I'd like to point out is that we don't need to relink the evidence, because this was one of my initial concerns. So, because I had collected a lot of evidence in my portfolio, so I thought, why do I need to transfer to the new curriculum, relinking all the evidence? Because it's very time consuming. So we don't need to relink the evidence, just to show to our educational supervisor during the meeting, the evidence is here, I'm competent to do this. But just about the other, I think I was saying about the other capabilities in internal medicine, that, as you say, I think it's important that the outpatients is a new requirement, that is something that's going to be new to people, but that for trainees who've been working in general internal medicine, doing the acute take, managing inpatients, that experience is all valid and you will have evidence in your portfolio that you've already achieved a level of capability. So in terms of sort of looking at the gap, there might not be that much of a gap or the trajectory of training that you already had in place would be, would mean that you can meet the capabilities in the new curriculum. Yes, I think so. If you're someone like me that did two years of internal medicine, so this means that you should have done a lot of ACAT, CBD, so there should be a lot of evidence, because otherwise you can't really pass the RCP panels. Absolutely. So when you did your gap analysis, did you need to have any additional time added onto your programme to meet the new curriculum requirements? Not really, but this is different for each trainee, because I know that some trainees got involved a lot in COVID-19 and they were redeployed. So every trainee is different. And as you said before, we need to tailor the training years according to its training. So I expect also additional time may be required for a few trainees. And that's why we need this meeting, because it's a meeting between one specific inter-care supervisor and one trainee. It's not the deanery that decides about the training years and about the requirements for its training. Yeah, that's a really good point. And I guess another thing that's worth noting then is if between the trainee and the supervisor, they decide that, yes, additional training time is going to be needed either to meet the internal medicine capabilities or the specialty capabilities for that curricula, that then it would be an ongoing, you know, sort of flagging that to the training programme director and to the deanery. And it would be at the ARCP process that any change to the CCT would be agreed, just to make that point. So what did you find, what would be your sort of top tips for how to make the whole thing run as smoothly as possible? Yeah, so, yeah, so my top tip would be to work with your educational supervisor, because we can bring different knowledge on the table. So our educational supervisors are experienced, they have supervised trainees before. They also know the training opportunities that their hospital can offer. So from the training point of view, as trainees, we know what we have done the previous training years. We know which evidence is in our portfolio. So together, we can plan the training year ahead and make sure we get the training. But in a way, we also tick the boxes. And well, what about sort of resources or help if somebody's struggling with this or their supervisor isn't being supportive, as I'd like them to be? I think this is very rare, to be completely honest with you. Educational supervisors are usually consultants. They like supervising trainees and they like helping junior colleagues. But sometimes circumstances are not ideal. In this case, I would suggest a trainee to speak to their training programme director. In rheumatology, I think in all specialties, there are also regional trainees representatives. I would also reach out the regional trainee representatives. And I don't know, Zoe, if there is anything here you would like to add? Yeah, I think it'd be good to point out in the Joint Malaculture Physicians Training Board website, there are quite a lot of resources on there. So each specialty has its own page where you could find the curriculum, the new curriculum, the ARCP decision aids. There's things called the rough guides, which is a sort of operational guide to the new curriculum. And it does include a bit of guidance on transition, which might be specific to that specialty. And then in the transition, there is a transition page. It's a link from the front page of the JRCPTB website to more detailed guidance on transition, because there are some complexities for some specialties where there might be slightly more complex arrangements for who does transfer and who doesn't. And there is some information there on the gap analysis and a word, a downloadable document version of the gap analysis form if people want to have a look at it before they prepare for the meeting. And then, as you say, the gap analysis form itself is on the ePortfolio. It will be available in the all forms section or in the educational supervisor, the supervision section to go through with the educational supervisor. And as you say, it was nice to hear, because, yes, I was involved in putting the form together, that it is relatively intuitive, I think, isn't it? And there's good guidance in the document itself. So hopefully it isn't daunting once you get started. I think you're absolutely right that the key thing is to get it in the diary if it isn't already. Yeah. And I just want to say something. For example, when we were preparing this webinar about the new curriculum, we had all these meetings discussing about the capabilities in practice, how the new curriculum is not a competence-based and it's more trainee-friendly. And then I was asked to make a presentation and give a trainee perspective. And I thought that we discuss all these things. Sometimes all these discussions are very theoretical. And the more theory you put in something, the more daunting it can sound. So I decided to do something practical. Okay, we discuss this gap analysis, the difference between the old and the new curriculum. I thought, I need to sit down and really find these differences. And when you actually do something, when you go through the structured gap analysis form, this is the way to find out that this is not something very tricky. I can actually survive through this and go ahead with a new curriculum and stop crying about the transfer. And it's difficult. The transition period is difficult. And to be completely honest, initially, I asked to stay on the old curriculum because I, as I told before, I had collected a lot of evidence. So I thought there is no real point for me moving to the new one and meet the new requirements. And now, honestly, I feel comfortable with this transition. And having this SSC role, some trainees in my region have asked my advice, just because I went through this process. And it's not so daunting, but we need all trainees and education supervisors, you know, to go through this transition period. And I think, and it's my opinion, not just to clarify what I'm saying today. It's just my opinion. I'm not representing today the SSC committee or training board, but I think we need to support each other. You know, we need to support our educational supervisors and the trainees to support us because it's all brand new for everyone. And we make, we may make mistakes, but we can learn, make things better the next training year. It's really well put. Thank you. And it's, I think it's going to be really reassuring to trainees to hear from somebody who's experienced it themselves, and especially you going into it, feeling like, oh, this is going to be tricky and actually finding a completely different experience. So thank you so much. That's been really, really helpful. Thank you, Anastasia. Thank you. So thanks for listening to this podcast. You'll find some resources linked in the description below and look forward to speaking to you next time.