What is the range of evidence I need for CEPS?
Apart from the five mandatory examinations as required by the GMC it will be up to you to discuss your learning needs with your Educational Supervisor. The CEPS to be considered and the range of evidence required will depend on various factors such as your prior experience and the nature of your current placement. Remember that you are training to be a GP and so procedures that are unlikely to be performed in a GP setting, whilst interesting to reflect on, are not so relevant. Nevertheless all examinations and procedures have some common features such as the need to gain consent and the need to consider the comfort of the patient.
What are intimate examinations is there a definition?
There is no agreed definition of what constitutes an intimate examination. The five examinations for which evidence of competence is required by the GMC are generally accepted examples of intimate examinations but there are many others. For instance, the competent examination of the eye with an ophthalmoscope is considered by many, if not most, patients to be an intimate examination, especially as it requires the examination room to be darkened. Ultimately it is the individual patient who determines what is intimate or invasive for them and this will be determined by a number of possible factors including their prior experiences, their religion and their cultural background.
Is it sufficient to just do each mandatory CEPS once in training?
Yes, if the observer states you are competent to perform that specific CEPS unsupervised, if not it will need repeating.
How many CEPS do I need?
here is no set number. There needs to be enough to demonstrate, to your Educational Supervisor’s satisfaction, your competence in CEPS.
What is the standard of the clinical examination expected?
The standard is that of an independent fully qualified General Practitioner. As well as the technical aspects of examination and the ability to recognise abnormal physical signs, it includes the choice of examination best suited to the clinical context. For instance, a competent GP very rarely performs an extensive neurological examination but will perform a limited neurological examination as determined by the history taken from the patient.
Can CEPS be assessed in a skills laboratory?
Training in a skills lab and the use of manikins can be a very helpful adjunct to training in the work place. In general, and certainly in the case of the five intimate examinations as required by the GMC, this will not be sufficient evidence of competence without the demonstration that your skills can be applied in a clinical context.
Would an observed full insurance medical examination be enough evidence?
Although being observed performing such an examination might be helpful it would be unlikely to provide sufficient evidence of clinical competence. For instance, the extent of the examination in such a situation is determined by the insurance company and not by the clinician.
If I have demonstrated competence in an examination does this need repeating?
No, if your Educational Supervisor is satisfied that the evidence you have provided for one of the five intimate examinations as required by the GMC is sufficient this does not need to be repeated. However, it is important that this evidence is recorded in such a way that you can remember where it is. The easiest ways to do this is to use the CEPS forms. At the final review before a Certificate of Completion of Training (CCT) is recommended your Educational Supervisor will need to answer a specific question in relation to these examinations.
What if I am unable to complete a CEPS due to a disability?
All GP trainees, including those with a disability, are to meet the required competences to ensure patient safety. This includes having the insight to:
- recognise when a disability prevents completion of an examination
- understand the examination required, and that it is a necessary part of the consultation
- facilitate a patient examination in a timely fashion
- demonstrate that the trainee knows what to do with the findings.
- If a trainee feels this guidance may apply to one of their examinations (regardless of whether it is a mandatory examination or not) they should discuss this with their educational supervisor/programme director in the first instance.
For example, one possible approach might be that a trainee who cannot physically carry out an examination refers the patient to a colleague to carry it out.
In a training context, to satisfy the CEPS requirement, the observer (who could be the person who performs the examination) should document on the assessment form the part of the CEPS they did observe, and document why it was necessary for the examination to be done in this way.
This should be added into the observation and feedback performance box on the assessment form.