SLEs represent an important opportunity for learning and improvement in practice, and are a crucial component of the curriculum. It is the duty of the foundation doctor to demonstrate engagement with this process. This means undertaking an appropriate range and number of SLEs and documenting them in the e-portfolio (table 7). SLEs are not formal examinations of knowledge or summative assessments, and should not be treated as such by either the assessor, supervisor or the foundation doctor; but rather, as an opportunity for the foundation doctor to be observed in the clinical setting, to see how they work with others (especially the patient) and to be given feedback with the aim of improving their practice. The clinical supervisor's end of placement report will draw on the evidence of the foundation doctor's engagement in the SLE process. Participation in this process, coupled with reflective practice, is a way for the foundation doctor to evaluate how their performance is progressing as they gain experience during the foundation programme.

Table 7. Recommended minimum number of SLEs

Supervised learning event (Recommended minimum number per four month placement)

Direct observation of doctor/patient interaction (3)

• Mini clinical evaluation exercise (at least 2)

• Direct observation of procedural skills (optional to supplement mini clinical evaluation exercise)

Case-based discussion (2 or more)

Developing the clinical teacher (1 or more per year)

 

Purpose of the SLE

The purpose of the SLE is to:

  •  provide immediate feedback, highlight achievement and suggest areas for further development.
  •  demonstrate engagement in the educational process.
 

SLE methodology

Foundation doctors are expected to demonstrate improvement and progression in their performance during each placement and throughout foundation training. Undertaking and reflecting on SLEs will help foundation doctors develop their clinical and professional practice.

 

Timing of SLEs

It is recommended that SLEs are undertaken from early in each placement when the trainee has the most to learn. SLEs should continue to be performed throughout the placement. SLEs do not need to be planned or scheduled in advance and should occur whenever a teaching opportunity presents itself.

 

Subject matter for an SLE

SLEs can be used to cover a spread of different acute and long-term clinical problems and discussion should include the management of long-term aspects of patients' conditions.

 

Targeted SLEs

Improvement in clinical practice will only happen if regular SLEs lead to constructive feedback and subsequent review of and reflection on progression. For this to occur some targeted SLEs should specifically be related to previous feedback and developmental targets. This may be facilitated if the foundation doctors agree to the timing and the clinical case/problem with the trainers in advance. However, unscheduled SLEs can also be focused on specific needs. In addition to immediate feedback, SLEs should be used to stimulate discussion with the clinical and/or educational supervisor.

 

Who to approach for an SLE?

A different teacher/trainer should be used for each SLE wherever possible, including at least one at consultant or GP principal level per placement. The educational or clinical supervisor should also be used for an SLE.

Teachers/trainers must be sufficiently experienced to teach and assess the topic covered by the SLE and be able to provide meaningful feedback. Typically this will be a doctor with higher specialty training (with variations between specialties), a specialist nurse (band 5 or above) a ward pharmacist or senior allied healthcare professional; this is particularly important with case based discussion.

 

Responsibility

Foundation Doctor

The foundation doctor, with the support of the supervisor(s), is responsible for arranging SLEs and ensuring a contemporaneous record in the e-portfolio. The clinical and educational supervisors will have access to SLEs within the foundation doctor's e-portfolio.

Trainer

The trainer must:

  •  Be trained in giving feedback
  •  Understand the role of the tool being used
  •  Be able to teach, assess and provide feedback on the chosen subject.
 

Educational and development tools

There are four different tools used for SLEs.

Two tools are used to give feedback after observation of doctor/patient encounters:

  •  Mini-clinical evaluation exercise (mini-CEX)
  •  Direct observation of procedural skills (DOPS).

Two tools are used to give feedback on events, which take place remote from the patient:

  •  Case-based discussion (CBD)
  •  Developing the clinical teacher.
 

Direct observation of doctor/patient encounter

Foundation doctors are expected to undertake directly observed encounters in every placement.

They are required to undertake a minimum of NINE directly observed encounters per annum in both foundation year 1 (F1) and in foundation year 2 (F2). At least six of these encounters each year should use mini-CEX.

 

Mini-clinical evaluation exercise mini-CEX

This is an SLE of an observed clinical encounter, mini-CEX must not be completed after a ward round presentation or when the doctor/patient interaction was not observed.

  •  Foundation doctors should complete a minimum of six mini-CEX in F1 and another six in F2. These should be spaced out during the year with at least two mini-CEX completed in each four month period
  •  There is no maximum number of mini-CEX and foundation doctors will often achieve very high numbers of SLEs recognising the benefit they derive from them.
 

Direct observation of procedural skills (DOPS)

The primary purpose of DOPS in foundation training is to give feedback on the trainee doctor's interaction with the patient when performing a practical procedure.

  •  Foundation doctors may submit up to three DOPS in one year as part of the minimum requirements for evidence of observed doctor-patient encounters.
  •  Different assessors should be used for each encounter wherever possible.
  •  Each DOPS could represent a different procedure and may be specific to the specialty (NB: DOPS may not be relevant in all placements).
  •  Additional DOPS may be undertaken to demonstrate progression of procedural skills but this is a secondary purpose of DOPS in Foundation.
  •  There is no maximum number of DOPS and foundation doctors will often achieve very high numbers of SLEs recognising the benefit they derive from them.

Supervised learning events which take place remote from the patient

 

Case-based discussion (CBD)

This is a structured discussion of a clinical case managed by the foundation doctor. Its strength is an investigation of, and feedback on, clinical reasoning.

  •  A minimum of six CBDs should be completed each year with at least two CBDs undertaken in any four month period.
  •  In contrast to mini-CEX, a CBD can follow presentation at a ward round.
  •  Different teachers/trainers should be used for each CBD wherever possible.
  •  There is no maximum number of CBDs and foundation doctors will often achieve very high numbers of SLEs recognising the benefit they derive from them.
 

Developing the clinical teacher

This is a tool to aid the development of a foundation doctor's skill in teaching and/or making a presentation and should be performed at least once a year. The foundation doctor will be encouraged to develop skills in preparation and scene-setting, delivery of material, subject knowledge and ability to answer questions, learner-centeredness and overall interaction with the group.