External Clinical Teaching Visits (ECTVs) - FAQs

What is an ECTV?

• An External Clinical Teaching Visit is a visit by an experienced GP to watch a GP Registrar ‘in action’ and provide teaching and feedback based around what is happening in the consulting room.
• Visits are usually for half a day and occur in the registrar’s own consulting room.
• The purpose is to provide individualised feedback and teaching directly relevant to the Registrar’s actual clinical performance.

Are they required training?
The RACGP’s Vocational Training Standards expect that 5 direct observation sessions will be  conducted by Medical Educators for each GP Registrar during training.

How many do I have?
Most GP Registrars will have 5 visits during training. Where there are problems for the GP Registrar and additional help is needed more visits may be arranged.

When do I have them?
Generally GP Registrars will have two visits per 6 months in their first year of general practice then one further visit during their second year of general practice.

How are ECTVs organised?
Usually a visitor is appointed to each GP Registrar by CSQTC. The visitor normally contacts the GP Registrar to make arrangements for a mutually suitable date and time for the visit. At this time it will be discussed as to who will inform the GP Trainer and the Practice staff about the visit.

Who are the ECT Visitors?
CSQTC’s ECT Visitors are all experienced GPs. They receive training for this role to continually improve their feedback and teaching ability.

What are the visits like?

• Every visit is different, depending on the patients you have that day and the particular ECT Visitor.
• Each visitor brings their own style, strengths and personality to the visit.
• Each visitor will discuss with the GP Registrar the format and approach of the particular visit.
• Most GP Registrars are quite nervous for the first visit but become increasingly relaxed over time.
• ECT Visits are traditionally one of the most highly valued educational experiences by GP Registrars during GP Training.
• Remember it is primarily a teaching session so be sure to use this experienced resource to your best advantage.

What about patient consent?

• As the ECT Visit deals with real patients and problems patients consent is very important.
• ECT Visitors will leave the room for any consultation at the request of the patient.
• You can discuss with the ECT Visitor or your practice (they have been through this many times before) ways of informing patients and gaining consent.

Are ECTVs an assessment?

• Within CSQTC ECT Visits are a teaching sessions, not an assessment. In some other parts of Australia they are used as an assessment tool.
• There is a distinction between ‘formative’ and ‘summative’ assessment. Thinking this way an ECT visit can be described as ‘formative’ assessment – making judgements to help ‘form’ the learner (ie. feedback and its application) but not affecting the GP Registrars overall status in the Training Program. Formative assessment remains internal to its own process. ‘Summative’ assessment is what is more commonly thought of as assessment and makes a contribution to the overall assessment of progress of the Registrar.
• CSQTC’s ECT Visits are not summative assessment.
• CSQTC wants GP Registrars to behave ‘as normally as possible’ during ECT Visits in order to maximise learning opportunities. It is not desired for GP Registrars to be focussed on ‘passing’ the visit. Hence CSQTC’s approach. We realise this creates a certain vulnerability for the GP Registrar but the reward is more meaningful feedback and learning.
• Having said this it is important to note that significant problems during an ECT Visit will be flagged and may lead to further discussions with the GP Registrar.
• The ECT Visit alone will not be used as a mechanism to affect the GP Registrar’s training.

How do I get feedback?
Most feedback is given during the session. ECT Visitors usually write a letter following the visit summarising the feedback and perhaps adding further insights.

How is a GP Trainer/Supervisor involved?
Ideally the GP Trainer is involved in the planning of the visit and has some time to share with both GP Registrar and ECT Visitor during the visit. At the very least the GP Trainer receives a copy of the ECT Visitor’s letter.

What about direct observation by a Supervisor – how is this different?
An external Visitor has a different capacity from what can be provided by one’s own GP Trainer directly observing consultations. Both teaching methods are very important. The external visitor will not be known to the patients and does not have other relationships (employer, colleague, principal teacher) with the GP Registrar. The external visitor has also seen many other GP Registrars in action and can provide insights from that perspective. Equally, the GP Trainer has some advantages – local knowledge of resources and patients as well as close knowledge of the GP Registrar and the ability to build on learning that is already happening in the Practice.