Policy responses and statements

Name of organisation:

Name of organisation: General Medical Council/Postgraduate Medical Education and Training Board (PMETB)

Name of policy document:

Quality Assurance of the Foundation programme - a consultation

Deadline for response:

15 October 2006

Background: The College is invited to take part in this consultation on the Quality Assurance of the Foundation Programme (QAFP). The enclosed document has been drafted following a year of piloting the QAFP mechanism, and has taken into account all the feedback which has been gained from the pilots and also from individual organisations.

Both the GMC Education Committee and the PMETB Training Committee would value views on this subject. There are 8 main areas on which views would be appreciated. These are:

1. Standards and outcomes for Foundation Programme training.
2. The philosophy underpinning the quality assurance methods.
3. The nature of the quality assurance process.
4. Phase 1 - Information gathering.
5. Phase 2 - The nature of the visit.
6. Phase 3 - Reporting and Approvals.
7. Composition of visiting teams.

COMMENTS ON
GENERAL MEDICAL COUNCIL / POSTGRADUATE MEDICAL EDUCATION AND TRAINING BOARD (PMETB)
QUALITY ASSURANCE OF THE FOUNDATION PROGRAMME - A CONSULTATION

The Royal College of Physicians of Edinburgh is pleased to respond to the General Medical Council/Postgraduate Medical Education and Training Board (PMETB) on Quality Assurance of the Foundation programme - a consultation. We have used the specific questions to frame the responses:

Principles

1a) Are our principles and objectives appropriate?
Generally agreed with the following comments

13.c Reliable: some judgements will inevitably be subjective if they are based on the experience and views of individuals.

13.j Accountable: perhaps transparent describes this principle more effectively with accountability included under 13.l

1b) What principles have we not included?

None

Key Issues

2a) Are the outcomes and standards right for this stage of development for the Foundation Programme?

The standards are very ambitious for this stage of development although appropriate in the longer term. Given the present shortfall in resources at Deanery level, these would be difficult to achieve in a short timeframe. Consideration should be given to prioritising the standards and introducing them incrementally in terms of expectations.

Yes

2b) Comments on drafts of both include:

Outcomes

Para 9 – regarding whistle blowing – should this be strengthened to ensure it is understood that this responsibility extends to senior colleagues in addition to peers?

Para 12 – it would be useful to emphasis actual learning from audit in addition to understanding the process

Paras 16-21 – relationships with patients - are a little  subjective and may be difficult to assess in a meaningful way.

Standards

Domain 1 – during early implementation it may be helpful to remind clinical supervisors of the level of supervision required for F1 doctors, particularly in departments previously less familiar with working with PRHOs.

Domain 6 -  Para 82 – all trainees and trainers must have access to up to date careers advice to support young doctors in their (earlier) career choices. This is likely to be an area requiring resources in many Deaneries and much of the supporting material could be developed jointly or even nationally.

Domain 6 - Para 84 – the resource required to ensure that all trainers also have appropriate training in their education and assessment roles should not be underestimated. This should be reflected in education contracts between Deaneries and Foundation Programmes and the Trusts or Boards.

Domain 8 – Para 104 – it would be helpful to include guidance on ranges of appropriate ratios of trainers to trainees.

3a) Do you support the philosophy underpinning the QAFP process

Yes – the College is particularly supportive of the constructive approach to data collation, analysis and visiting with the main aim being to improve Foundation training through benchmarking and external QA.

3. Do you agree that there should be three phases to the joint GMC/PMETB Quality Assurance process?

Yes. Incorporating a risk based approach to action planning for the visiting team provides a better focus for the team whilst retaining the opportunity to triangulate other information on a sample basis.

It is important, particularly in the early years of the Foundation programme to stimulate comments from trainees and trainers about implementation success.

The independent judgement through GMC or PMETB allows for independent scrutiny of the evidence (particularly if details are challenged by the Deanery)  and for some cross comparison between reports.

5. Does the template strike the right balance requiring the right quality and quantity of information?

It would be tempting to assume that such a large amount of data would only be gathered once but with a 5 year planned interval this is unlikely to be the case. Consequently it is an onerous data collation task for the Deaneries and a major sifting task for the visitors. Comments in question 2 a) about prioritising apply.

However once the Foundation Programmes are fully embedded, most of the required information will be routinely available for internal QC purposes.  Deaneries should be encouraged to provide only information that evidences their questionnaire responses.

As the system beds down it would be helpful to keep information requirements under review.

6a) Are visits an essential part of the verification process at this stage of the development of the Foundation Programme?

Visits appear to be an essential part of the verification process at this stage and the resulting information should be helpful to Deaneries as they establish and consolidate their Foundation Programmes. However the College acknowledges the cost and disruption of such visits and it is vital than an objective evaluation of face-to-face and questionnaire based surveys is undertaken.  As the programme becomes better embedded it may be possible to reduce the extent of visiting.

6b) What alternative models should we be considering?

The suggested model is sound but should be kept under review. Providing email access to the assessment team for local trainees and trainers during the visit might encourage information flow from other hospital sites and allow those not selected for visits the opportunity to participate.

6c) Do you support the initial completion  of the Deanery questionnaire by all Deaneries?

Please see responses to (2) (5) and (6a). Deaneries  will need time to put all the standards in place and a phased approach to completion might support implementation. It would be helpful to know more about the costs and benefits  of such an approach as the GMC and PMETB may also struggle to process  this amount of information in a timely way and in the detail that the questionnaire demands.

6d)  Is five years the right time for a quality assurance cycle?

Five years is the longest period that would be acceptable  and only for those organisations making acceptable progress. More regular scrutiny would be required following a qualified report or triggered by adverse information from local trainees, trainers and others (as is planned for the QA of  specialist training).

7a) What would be the appropriate body to be approved in each of the four countries of the UK?

From previous college visiting experience, there can be great variability in the quality of training between different units within the same deanery and it may be that individual programmes will need to be approved (as is currently the case for hospital medical specialties).

The unit of approval should reflect the unit ultimately responsibility for all aspects of Foundation Training including the local QC and delivery. In so doing both local delivery and regional support and planning will be captured by the QA activity. For a Deanery to maintain their approval, all Foundation Programmes must be deemed acceptable. This will provide a significant  incentive to rectify problem areas and be fair to those trainees who are allocated to units in difficulty.

8. Is the proposed reporting process fair and sufficient to enable the GMC and the PMETB to make a judgement about Foundation Programmes?

It is cumbersome to require that a working group checks the Visitors’ findings as well as the Approvals Board. If the visitors are appropriately selected and trained, this should not be necessary.

9a) Are the person and team competences right?

The competences are reasonable but should also include the ability to analyse apparently conflicting information from different sources on the same issue and write succinct reports

9b)  How could they be improved?

See above

9c)  Are we right to require certain experience in the team in addition to the competences? If so, what should it be?

Yes. It would be useful to ensure that the team includes an  educational supervisor, and also an individual who has previous experience of visiting or being visited

10a) Do the proposals described in this paper meet our commitment to equality and diversity?

Yes.  No other steps required.

10b) If not, what other steps might we take to achieve this?

See above

10c) Are there groups for whom these proposals would have an adverse effect?

No

Copies of this response are available from:

Lesley Lockhart,
Royal College of Physicians of Edinburgh,
9 Queen Street,
Edinburgh,
EH2 1JQ.

Tel: 0131 225 7324    ext 608
Fax: 0131 220 3939

[13 October 2006]