It is essential you learn how to examine patients within the general practice setting.
To be awarded your CCT, evidence for both of the following must be included:
- The five mandatory intimate examinations. A suitably trained professional will need to observe and document your performance on a CEPS evidence form.
- A range of additional Examinations and Procedural Skills relevant to General Practice which demonstrate new learning.
- Your supervisor must also be satisfied through observed evidence or documented evidence from others that you are competent in general and systemic examinations for the clinical curriculum areas. These may well have been completed in your previous training but can be easily covered in joint surgeries for example.
Proficient Clinical Examination and Procedural Skills are fundamental to effective general practice. Relevant evidence for this Capability needs to be gathered regularly throughout each review period and recorded in your Portfolio. As with the other Capabilities, there are sets of word descriptors to help you reflect on your progression as you acquire these skills.
Which skills need to be assessed?
By the end of training your Educational Supervisor must have observed or have documented evidence from others that you are competent in general and systemic examinations in the clinical curriculum areas.
There are 5 intimate examinations which need to be specifically included, as these are mandated by the GMC. These include breast, rectal, prostate, male genital examination and female genital examination (which includes a speculum and bimanual pelvic examination).
You need to be observed performing the intimate examinations by a suitably trained professional. The assessor records their observation on the CEPS evidence form. If this is another doctor they must be at ST4 level or above, or an SAS equivalent. If the colleague is another health professional, such as a specialist nurse, they must confirm their role and training so that your Educational Supervisor can be satisfied that they have been appropriately trained. You may also decide to write a separate log entry on any of these specific skills.
It is also important to note that this is not an exhaustive list of intimate examinations and indeed any examination can be considered intimate by some patients (for example, a competent examination of the eye with an ophthalmoscope), but the examinations listed are those that, due to their particularly intrusive nature, need to be specifically observed, and commented on, during your training.
The 5 mandatory examinations are not a 'minimum requirement' and cannot by themselves demonstrate overall competence in CEPS. A range of CEPS which are relevant to general practice are also required. This again is not an exhaustive list, nor is there a set minimum number as everyone has different needs. You are expected to document your performance in CEPS in your learning log and/or discuss your learning needs during placement planning meetings with your supervisors. The range of examinations, procedures and the number of observations will depend on your particular requirements and the professional judgement of your Clinical and Educational Supervisors.
For example, you may recognise that your learning needs include more experience of joint examinations, the examination of the eye, or doing a newborn baby check. You may wish to discuss with your supervisor how these can be addressed. Your supervisor may also recognise areas that need to be addressed such as completing a neurology examination within a GP-length consultation, or examining a diabetic patient’s feet correctly.
You may already be aware of specific CEPS you want to address but these can equally become apparent during your consultations with patients.
In addition, it is important to recognise the procedures you may need during emergency presentations in General Practice. For example, can you explain to a patient who is having an asthma attack what you are going to do in setting up a nebuliser?
Completion of CEPS
These can be completed in a variety of ways:
- CEPS evidence form (in the assessments section of the Portfolio)
- Learning logs (there is a filter for CEPS entries)
You will not be able to be signed off as competent in CEPS by your Educational Supervisor during your final review unless they are satisfied you are competent in general and systemic examination of the clinical curriculum areas, the 5 mandatory intimate skills and a range of CEPS relevant to General Practice. This will also be reviewed at your ARCP panel and an unsatisfactory outcome given if these are not present.