The Milton Keynes Traffic Light
System
A structured mechanism for identifying
trainees in difficulty
From: Greg Simons
Overview of Presentation
•
•
•
•
•
•
Introduction
RDMp Model
Reflection/ Insight
Traffic Light system
Implications of the traffic light
Expectations
Introduction
• GP
• GP Trainer
• National Clinical Lead GP access and
responsiveness
• Associate GP Dean
– PD support
– Trainer Support
– Trainee Support
– Executive rep at Deanery Board level
– Faculty Development
The RDM-p Model
• Tim Norfolk – Quality in Primary Care 2009 17
(1), pp37-49
• Unifying theory of clinical practice
• Links Relationship, Diagnostics, Management
and Professionalism
• Overarching model, provides a framework
that can incorporates criteria and
competencies across the range of assessments
of a GP's work
RDMp Relationships
descriptor
descriptor
R=relationships
Negative
positive
•Holistic
•Consulting skills
•Communicating
•Working with
colleagues
•Lacks warmth in
voice/manner
•uses too many
closed questions
•Unable to adapt
language
•Unclear when
communicating
•Gives little
support
•confrontational
(+p)
•Authoritarian
(+p)
•Good non verbal
behaviour
•Uses open
questions
•Adjusts
questioning
•Expresses ideas
clearly
•Encourages
contribution
•Delegates
appropriately
•Non-judgemental
Adapted from Tim Norfolk; Quality in
Primary Care 2009
RDMp Diagnostics
descriptor
descriptor
D=Diagnostics
negative
positive
•Data gathering
•Data interpretation
•Making diagnoses
•Making decisions
•Clinical Management
•Managing complexity
•Can’t find a way of
resolving the problem
(D+M)
•Makes immediate
assumptions
•Dogmatic
•Overlooks important
information
•Options too limited
•Positive when dealing
with problems
•Thinks around issues
•Open to new ideas
•Shows interest and
understanding
•Identifies key points
•Aware of options
Adapted from Tim Norfolk, Quality in
Primary Care 2009
RDMp Management
descriptor
descriptor
M= management
negative
positive
•Community orientation
•Practice Management
•IMT
•Maintaining performance
•Learning and teaching
•Unsystematic
•Fails to apply lessons
•Disorganised
•Doesn't keep up to date
•Poor prioritisation
•Misses reasonable
deadlines
•Doesn't think ahead
•Doesn't cope well with
unexpected
•Becomes agitated
•Sound systematic
judgement
•Admits to and learns from
mistakes
•Organised
•Regularly updates job
related skills
•Prioritises effectively
•Coordinates activity
•Thinks ahead
•Delivers on time
•Stays calm under pressure
adapted from Tim Norfolk, Quality in
primary care 2009
RDMp professionalism
descriptor
descriptor
P= professionalism
negative
positive
•Ethics
•Fitness to practice
•Defensive (M+P)
•Critical
•Shows favouritism
•Narrow perspective
•Fails to take responsibility
for poor actions
•Treat issues as problems
•Disrespectful to
colleagues, staff or patients
•Finds it difficult to seek
help when appropriate
•Receptive
•Gives constructive
feedback and support
•Collaborates
•Sees bigger picture
•Takes responsibility
appropriately
•Recognises limitations
•Shows respect
•Seeks help when
necessary
Adapted from Tim Norfolk, Quality in
primary care 2009
RELATIONSHIP
DIAGNOSTICS
Practising Holistically
Data Gathering &
Interpretation
Communication &
Consulting Skills
Making a Diagnosis /
Making decisions
professionalism
Working with Colleagues
& in Teams
Maintaining an Ethical
Approach to Practice
Fitness to
Practise
Clinical Management
Managing Medical
Complexity
Community
Orientation
Primary Care
Administration
& IMT
Maintaining Performance,
Learning & Teaching
MANAGEMENT
© Tim Norfolk
Tim Norfolk
Quality in Primary Care 2009, 17 (1), pp37–49
RDMp and Good Medical Practice
Tim Norfolk 2009
Insight/ Reflection
Amar Rughani’s Insight Table
Performa Insight
nce
Reflect
What do you think??
Good
Good
•Ideal
Good
Poor
•Unconsciously competent doctors may not adapt to changing
situations as they don't understand why they are (currently)
competent. They may also engage in risky practices through lack
of insight regarding the connection between action and effects.
Poor
Good
•Consciously incompetent doctors might be difficult because they
have low motivation to improve. The causes of low motivation,
such as stress need to be looked for.
Poor
Poor
•Unconsciously incompetent doctors may be the most difficult to
remediate because despite regular exposure to deficiencies in
performance, they may lack the capacity to change
Using the Traffic Light System
• Look at descriptors for RDMp domains
• Apply the grading in each domain using your
knowledge of the trainee, experience and
evidence e.g. eportfolio, feedback
Grading (Milton Keynes)
•
•
•
•
•
1 = clearly failing
2 = concerns
3 = expected stage
4 = above expectation for stage
5 = ready for independent practice
• Add in insight/lack insight (-/+)
Using the Traffic Light System
• Look at descriptors for RDMp domains
• Apply the grading in each domain using your
knowledge of the trainee, experience and
evidence e.g. eportfolio, feedback
• Decide whether the trainee demonstrates
insight with reflective ability with + or • Categorise Green/ Amber/ Red
Traffic Light System for MKVTSTables
colour
concern
eportfolio
ES
PD/AD
Green
none
•Sufficient
number and
quality of
entries.
•Progression in
PDP and skills
log
•Satisfactory
coverage
curriculum
•Satisfactory
completion
Assessments
•Continue
regular review
eportfolio
•Continue
6/12ly reviews
•RDMp3+ in all
areas
•Monitor
eportfolio
Traffic light system for MKVTS
colour
concern
ePortfolio
ES
PD/AD
Amber
Some
•Consistently
poor quality/
number of
entries
•Poor PDP
•Poor coverage
of curriculum
•Inadequate
number of
mandatory
assessments
•RDMp2 in any
one area
•One area may
be (-) for
insight
PD interviews
trainee + ES
Traffic light system for MKVTS
colour
concern
ePortfolio
ES
PD/AD
Red
Significant
•Failure to
engage
ePortfolio
•Unsatisfactory
progress
signalled by ES
or CS
•RDMp1/2 in
more than one
area
•poor insight (-)
in multiple
domains
Interview with
PD/AD with ES
with a view to
referral to
ARCP
Implications of Traffic Light
• Feedback monthly for those in GP, Quarterly
for those in Hospital (more freq if problems)
• Early referral to ARCP
• Reflective Skills very important
• Early, Frequent and open discussion with Ed
Supervisor
Expectations
• Full engagement
• Professionalism
• Self Directed