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External Clinical Teaching (ECT) visits and Mini Clinical Evaluation Exercises (MiniCEX) / Case Based Discussions (CBD) are an excellent learning opportunity for both you and your registrar. Dr Rebecca Lock is one of the educators involved in training ECT visitors and overseeing registrar ECT / MiniCEX visits. Here she shares her insights into why they are so valuable and how you can help your registrar prepare for them.

ECT / MiniCEX visits offer real value to you and your registrar

To achieve Fellowship, RACGP registrars must participate in at least five ECT visits and for ACRRM registrars, their MiniCEX formative assessments are undertaken during an ECT visit. They involve an external GP supervisor or medical educator directly observing your registrar’s patient consultations for a morning or an afternoon. Over the years, Rebecca has come to realise they offer some unique benefits.

“In general practice, there are many ways to do the same thing or arrive at the same outcome. ECT visits allow your registrar to expand their circle of knowledge by getting a second take on their patient consultations for that day,” she says. “It’s very rare that we actually get somebody to sit in with us during our consults. Mostly it’s just our patient and us. It’s a real luxury to have someone observing and looking at the structural component of the consultation and offering advice. That’s really the main aim of the visit.”

To reinforce the benefits of shared knowledge and experience, Rebecca says GPTQ try to ensure five different ECT visitors observe a registrar over the course of their training.

Some groundwork you can do before your registrar’s ECT / MiniCEX visit 

Rebecca says: “Reflect on your registrar and identify any areas where there’s room for growth. Perhaps it’s addressing the structure of their consultation, the fluidity of their physical exam, or their approach in breaking bad news,” she says. “Talk to your registrar about these areas before the visit and encourage them to work on these things while they’ve got somebody sitting in with them.”

As a supervisor, you’ll also have the chance to sit down with the ECT visitor either before or after their observation. Both ways offer advantages so it’s really about what suits you best.

“Doing it before can be useful because you can say ‘I want you to look out for this as I think this registrar is struggling with a particular type of presentation’ and you can guide the visit,” Rebecca says. “Or you might be better off seeing them afterwards and getting their impressions based on the visit they have had to see how the registrar is going. Either way can be valuable.”

Helping your registrar prepare for their upcoming ECT / MiniCEX visit

If this is your registrar’s first ECT visit, Rebecca has a few tips to share.

“The key is to reduce any anxiety they may feel about a stranger coming and watching them. Of course, there is an assessment component to the ECT visit because you can’t give feedback without first assessing what’s going on. But assure them it’s feedback for learning – not assessment that stops them progressing their training,” she says. “The visit is meant to be ‘low stakes’ so sharing this will hopefully allay their worries about being judged.”

De-mystifying the process is also beneficial

“Let them know the visitor will spend around three hours with them. Most of that time is spent observing but a small portion sets up the ‘ground rules’ such as how the registrar will introduce the visitor to the patient. Also, mention some time is spent with you and the practice manager,” Rebecca says.

“The ECT process can vary from visitor to visitor. Some prefer to be the true ‘fly on the wall’ and tell registrars ‘If you normally call your supervisor during a consultation, do that as I want to observe your interaction’, whereas others say ‘If you’d like some clinical advice while I’m here, I’m happy to do some teaching about the people you see.’”

Rebecca feels it’s good to advise your registrar that the ECT visit is not about what they do and don’t know content-wise. It’s more about the structure of the consultation and refining it.

Debriefing and following up after the ECT / MiniCEX visit

Rebecca suggests incorporating a few ideas from the ECT visitor’s report into your registrar’s regular learning plan to allow them to work on these areas in time for their next visit.

“A few weeks down the track, you could sit in with them during a couple of consultations. This would be an ideal way of following up on the report and checking in with how they’re going with that particular aspect.”