'Putting it into words': developing the RCGP competency descriptors to include 'at-risk behaviours'.

As part of the Royal College of General Practitioners' (RCGP) arrangements to satisfy the GMC's requirement for Work Place Based Assessment (WPBAs) a range of 12 WPBA competencies was drawn up. Further to this the RCGP produced descriptors of the behaviours that would demonstrate a trainee had gained competence in that area. Recently the RCGP have expanded the rating scale available to educational supervisors at the time of a review to allow for a finding of 'Needs Further Development (NFD) - below expectations'. In the North of Scotland Deanery it has been recognised that a number of trainees are struggling to demonstrate competency in WPBA and to complete training. Reviewing how we could help these trainees and their educational supervisors there was recognition that early identification of these trainees would assist remedial action. Additionally, having reliable indicators of behaviours associated with a trainee in difficulty would aid the assessment of a trainee as 'NFD - below expectations'. Although many reliable descriptors of 'at-risk' behaviour exist, within frameworks and systems for doctors felt to be in difficulty these systems lie outwith the WPBA competency framework. This paper describes the work undertaken in the North of Scotland Deanery to modify the original table of descriptors for the 12 WPBA competencies to include an 'NFD - below expectations'/'at-risk' behaviours column. The descriptors of behaviours associated with trainees in difficulty have been aligned to the 12 WPBA competencies and used to populate the additional column in the descriptor table. The expectation is that the expanded table of descriptors will assist both in early identification of trainees' at-risk behaviours so that formative work can be engaged in at an early stage in an attachment, and also in the objective assessment of a trainee at an educational supervisor's review if they're in difficulties.