Building on the successes of the 2012 FPC we are writing to you to seek your input into preparing the next iteration of the Foundation Programme Curriculum (FPC) in readiness for the 2016 intake into Foundation Years 1 and 2.
This revision will be addressing any issues related to the content and operational delivery of the 2012 FPC. We also intend to review information provided by the Shape of Training review and will consider recommendations made by ‘Better training: Better care’ including the Broadening the Foundation Programme report. We will take into account the progress made in response to recent Foundation Programme reviews in England and Scotland.
We expect changes from the 2012 FPC to be evolutionary and therefore do not anticipate major changes from the 2012 format, syllabus, assessment, methodology or the principles and purpose of formative learning tools which were introduced in 2012.
We will be sharing responses and working closely with the UK Foundation Programme Office. This will allow the parallel review of the FP Reference Guide and enhancements to supportive e-portfolio material and updating of the FP Curriculum Resource. Therefore, in addition to seeking feedback on the curriculum, we are also consulting on any operational issues presented by the 2012 FPC.
We are particularly keen to learn of any:
1. Errors or omissions you perceive to exist within the 2012 FPC?
2. Issues with the assessment process introduced in the 2012 FPC?
(Please be specific and provide recommendations as to how you would you like to see the process improved)
3. Issues with the formative learning processes in particular supervised learning events?
(Please be specific and provide recommendations as to how you would you like to see the process improved)
4. Areas / topics which require clarification in 2012 FPC?
(Please give specific examples of the outcomes / competences and provide suggestions for improvement.)
5. New topics which you think merit consideration for inclusion within the 2016 FPC?
6. Areas that are particularly good/working well within the FPC and should not be changed?
7. Areas of the 2012 curriculum which are out of date / have been superseded by newer guidelines, terminology, techniques etc.?
(Please provide specific examples and suggestions for revision and relevant supporting documentation)
8. Areas of the 2012 curriculum which could be deleted?
9. Operational issues relating to the supervision and monitoring of 2012 FPC coverage?
10. Operational issues relating to the recording and evidencing of FPC outcomes and competences within the e-portfolio*.
11. Examples of good practice implemented locally to support FPC coverage/delivery.
12. Any other issues / changes you believe would improve the FPC and would like to raise for consideration?
* Please only provide feedback relevant to specific FPC outcomes and competences. Issues related to NES/Horus e-portfolio are being addressed by a separate customer satisfaction survey.
There have been changes in the GMC process for curricular approval which mean that the curriculum will need to be submitted to the GMC in summer 2015 if it is to be ready for launch in August 2016.
Royal College of Physicians of Edinburgh’s response to Academy of Medical Royal Colleges’ consultation on the Foundation Programme Curriculum (FPC)
The Royal College of Physicians of Edinburgh (“the College”) is pleased to respond to the AMRC consultation on the next iteration of the Foundation Programme Curriculum (FPC).
1. Errors or omissions you perceive to exist within the 2012 FPC?
The Liverpool Care Pathway should not be included in future iterations as this has been dropped nationally.
The existing curriculum is very generic and could be more specific about areas of clinical knowledge – for example, having learning directed towards the top ten medical and surgical presentations.
2. Issues with the assessment process introduced in the 2012 FPC?
The assessment process is generally satisfactory although it could be made easier to access – for example, an app would be sensible to allow real time Supervised Learning Event (SLE) recording and completion of feedback.
3. Issues with the formative learning processes in particular supervised learning events?
Supervised learning events introduced a new concept but seem workable and if changes are required these can be measured and evolutionary. The process is time consuming, so the forms could be simplified to allow as much as possible to be completed by the trainee before requesting completion by the trainer.
Reflective learning could be added to a trainee’s routine clinical work in order to consolidate the educational value of service work ie when not in formal educational activity.
4. Areas / topics which require clarification in 2012 FPC?
The areas linked to the e-portfolio may require clarification. All except one Deanery currently subscribe to the NHS Education Scotland portfolio. It may be useful to have some e-portfolio advice.
5. New topics which you think merit consideration for inclusion within the 2016 FPC?
Top ten acute medical and surgical presentations could be added.
6. Areas that are particularly good/working well within the FPC and should not be changed?
Team Assessment of Behaviour (TAB) works well. Patient safety, prescribing and mapping to GMC domains also work well and should not be changed.
7. Areas of the 2012 curriculum which are out of date / have been superseded by newer guidelines, terminology, techniques etc.?
Liverpool Care Pathway and DNR policies.
8. Areas of the 2012 curriculum which could be deleted?
The changes since 2010 (pages 63-66) could be deleted or amended/updated.
Subcutaneous and intramuscular injections are virtually exclusively undertaken by nursing staff, so the College questions whether it is necessary for these to be listed as core procedures for F1.
9. Operational issues relating to the supervision and monitoring of 2012 FPC coverage?
At an operational level the curriculum appears to be succeeding in the aim of providing broad based training experiences that equip trainee doctors for successful transition into specialty training.
From a trainer’s perspective, it would be useful to have a tariff enforced for all job plans across the UK (for example, 1 hour per week per 4 trainees) so that those taking responsibility for supervising Foundation Doctors know how much time their organisation expects them to be spending on this.
A decision will have to be taken on the inclusion of the Prescribing Safety Assessment and its place in the prescribing section.
10. Operational issues relating to the recording and evidencing of FPC outcomes and competences within the e-portfolio.
The e-portfolio is improving and getting easier to use, but there is a need to be careful not to introduce changes too frequently.
There is currently no Academic e-portfolio and this should be added alongside the current e- portfolio.
11. Examples of good practice implemented locally to support FPC coverage/delivery.
FY2 small group teaching and case discussions facilitated by STs.
Virtual ward simulation exercises and clinical skills centre for teaching practical skills and time management skills.
Curriculum mapping of educational programmes to the curriculum in Mersey.
Efforts to deliver with critical analysis of progress and revised training schedules, all with a view to improving the experience of Foundation Doctors.
12. Any other issues / changes you believe would improve the FPC and would like to raise for consideration?
Overall the Foundation Curriculum has worked well and should be a suitable platform for training young doctors in the future, particularly in the context of Shape of Training. Major changes are not required, and the new curriculum should incorporate improvements and change in an evolutionary fashion.
The covering letter refers to Shape of Training and Broadening the Foundation Programme. Traditionally the UK Foundation Programme Office has been a very successful organisation, but recently has been involved in mandatory reconfiguration of posts to enhance recruitment in shortage specialties such as Psychiatry and General Practice. These initiatives should be rolled back, as Broadening the Foundation Programme insists on 100% of F2s rotating through general practice. Without new funding this means that, in those Deaneries with historically low numbers of GP placements, large numbers of hospital based placements will be moved to General Practice. The figures show that for each GP placement fully funded, 2.75 hospital posts will be lost.
Giving the majority a 4-month block in GP or other relevant community placement by 2015 and all such a placement by 2017 will need planning to provide cover for traditional roles undertaken by F1 and F2 (might include extended Hospital at Night (H@N) teams, other specialist nursing input, and use of physician assistants). The service, especially in Scotland, is not close to being able to accommodate this change.
There will be issues of education, role development, changing working practices and resourcing if this is to succeed, and it is suggested that Broadening the Foundation Programme should perhaps be made aspirational and not mandatory as there is the risk of serious service effects if large numbers of F2s are removed from hospitals.
Work should be undertaken with medical schools to ensure that undergraduates become familiar with SLEs by incorporating them into their senior medical undergraduate years. Thus, for UK graduates at least, there will be a continuum from undergraduate to postgraduate.
Foundation Doctors have a lot to cope with when they start, so they are often slow to engage with e-portfolio which they perceive to be a low priority. Undergraduates should get into the habit of regularly uploading information/evidence onto an equivalent site to the e-portfolio and it could offset some of these problems.