Education Quality Improvement Framework

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1 Education Quaity Improvement Framework for Undergraduate and Postgraduate Medica Education and Training in the UK

2 The duties of a doctor registered with the Genera Medica Counci Patients must be abe to trust doctors with their ives and heath. To justify that trust you must show respect for human ife and you must: Make the care of your patient your first concern Protect and promote the heath of patients and the pubic Provide a good standard of practice and care n Keep your professiona knowedge and skis up to date n Recognise and work within the imits of your competence n Work with coeagues in the ways that best serve patients interests Treat patients as individuas and respect their dignity n Treat patients poitey and consideratey n Respect patients right to confidentiaity Work in partnership with patients n Listen to patients and respond to their concerns and preferences n Give patients the information they want or need in a way they can understand n Respect patients rights to reach decisions with you about their treatment and care n Support patients in caring for themseves to improve and maintain their heath Be honest and open and act with integrity n Act without deay if you have good reason to beieve that you or a coeague may be putting patients at risk n Never discriminate unfairy against patients or coeagues n Never abuse your patients trust in you or the pubic s trust in the profession. You are personay accountabe for your professiona practice and must aways be prepared to justify your decisions and actions. Genera Medica Counci 2

3 Contents The GMC Quaity Improvement Framework for Undergraduate and 4 Postgraduate Medica Education and Training in the UK Introduction 4 Background 5 Principes of better reguation 6 The Quaity Improvement Framework introduced 8 Quaity assurance 9 Quaity management 9 The roe of the dean in reation to serious concerns 11 Quaity contro 11 Risk-based reguation 12 Quaity Improvement Framework the four eements 13 Approva against standards 13 Post and programme approva 15 Trainer approva 16 Curricuum and assessment systems approva 16 Shared evidence 17 Sources of evidence 18 Reports from medica schoos and deaneries to the GMC 18 Annua speciaty report from medica Roya Coeges and 19 Facuties to the GMC Surveys 19 Nationa survey of trainee doctors 20 Nationa survey of trainers 20 Deveopment of the surveys 20 Visits incuding checks 20 Regiona visits 22 Thematic quaity assurance 22 Checks 22 Composition of GMC visit teams 23 Responses to concerns 23 Triggered visits 25 Responses to concerns process 26 Good practice 27 Governance 28 Gossary of Terms 29 Acronyms 30 Genera Medica Counci 3

4 The GMC Quaity Improvement Framework for Undergraduate and Postgraduate Medica Education and Training in the UK Introduction 1 The Genera Medica Counci (GMC) protects the pubic by ensuring proper standards in the practice of medicine. We do this by setting and reguating professiona standards not ony for quaified doctors practice, but aso for both undergraduate and postgraduate medica education and training. 2 A number of organisations pay different roes in ensuring the quaity of medica education and training, and this quaity improvement framework (QIF) wi aign this activity. In doing so, it wi: deiver a robust, rigorous set of processes that wi assure the pubic and the medica profession about the standards of medica education and training in the UK demonstrate vaue for money, be fit for purpose and refect fuy the principes of better reguation drive standards in the quaity of medica education and training empower oca soutions and mean the GMC ony intervenes when necessary engage students, trainees, patients and the pubic ensure that high quaity education and training of the medica workforce is maintained within the heath services by engaging empoyers through oca education providers (LEPs). 3 This document sets out how the GMC wi quaity assure (QA) medica education and training in the UK from The institutions and structures referred to in this document refect the system at the time of pubication. 5 The outcomes of the Department of Heath (Engand) consutation Liberating the NHS:Deveoping the Heathcare Workforce and the command paper Enabing Exceence Autonomy and Accountabiity for Heathcare Workers, Socia Workers and Socia Care Workers wi need to be considered in terms of the QIF. The proposas in Deveoping the Heathcare Workforce wi, if impemented, bring about radica structura changes to the organisation and deivery of medica education and training in Engand. However, our statutory powers are sufficienty broad and fexibe to accommodate such changes, and the principes and approach set out in the QIF woud remain vaid whatever structures may emerge. The QIF is a iving document which wi and must be responsive to change. 6 In this pubication we have used the term deaneries in the absence of certainty about what body or network may take on the quaity management (QM) of postgraduate medica education and training in Engand. Genera Medica Counci 4

5 Background 7 The GMC s responsibiities for medica education and training incude: setting standards, requirements and outcomes identifying where these are not being met through quaity assurance and ensuring that those responsibe take appropriate action driving improved standards in medica education and training across the UK. 8 Our powers in this area are determined by the Medica Act 1983 and subsequent amendments to the act. 9 The QIF buids on the GMC s existing work to drive up standards in the quaity of every stage of medica education and training in the UK. This work incudes our Quaity Assurance of Basic Medica Education (QABME) programme, our Quaity Assurance of the Foundation Programme (QAFP) and the Quaity Framework for Speciaty Incuding GP Training (QF). 10 The QIF gives an overview of how we wi QA undergraduate and postgraduate medica education and training in the UK unti Having such a framework wi ensure consistency and transparency in QA. The institutions and structures referred to in this document refect the system as it operates today. However, this does not precude changes in the future. 11 A number of organisations are invoved ensuring the quaity of medica education and training in the UK in different ways and these can be spit into three types of activity: QA, QM and quaity contro (QC). 12 The GMC is responsibe for QA of both undergraduate and postgraduate education and training. Medica schoos, meanwhie, are responsibe for QM of the education and training they are deivering to undergraduate medica students and deaneries for postgraduate trainees. Medica students and trainees aso receive education and training within the heath service and the heath services are responsibe for the QC of this. (The differences between these three types of activity are expained in the section entited The Quaity Improvement Framework introduced ater in this document.) 13 The UK Foundation Programme Office (UKFPO) and Roya Coeges/Facuties are invoved in a three types of activity. For exampe, they advise the GMC s undergraduate and postgraduate boards, design curricua and assessments and enabe their impementation. The Roya Coeges/ Facuties aso compete Annua Speciaty Reports (ASRs) for the GMC and have a regiona presence within LEPs. 14 The ast cyces of QABME, QAFP and the QF show that QM in deaneries and medica schoos has matured. QC within LEPs, however, is ess deveoped and the monitoring and evauation of their progress by deaneries and medica schoos foowing QM activity such as oca visiting is not being carried out to a consistent standard. 15 The QIF wi be suppemented by an Operationa Guide, to be pubished in Summer The Operationa Guide wi give a detaied how to and expains the processes and eements of the QIF for those with an active roe in medica education and training. The Operationa Guide is a ive document that changes as the QIF is impemented. This means that processes and protocos wi be deveoped and refined through experience and feedback. Genera Medica Counci 5

6 Principes of better reguation 16 Deveopment of this QIF was guided by the five principes for assessing and improving the quaity of reguation originay estabished by the Better Reguation Task Force and updated in the Better Reguation Task Force Annua Report for 2004/5: Proportionaity Accountabiity Consistency Transparency Targeting Reguators shoud ony intervene when necessary. Remedies shoud be appropriate to the risk posed, and costs identified and minimised. Reguators must be abe to justify decisions and be subject to pubic scrutiny. Government rues and standards must be joined up and impemented fairy. Reguators shoud be open, and keep reguations simpe and user-friendy. Reguation shoud be focused on the probem and minimise side effects. 17 The foowing tabe sets out the principes and how these are addressed in this QIF. 18 Compementary to the principes of better reguation, there is a need to ensure that the QIF is agie and adaptabe. The principes of QA, QM and QC set out in the QIF can be appied fexiby and be responsive to: diverse medica schoos; the changes to medicine and the NHS brought about by a change in government and varying arrangements for commissioning and providing education and training within and between the four UK countries. Principe Proportionaity Accountabiity Consistency How the QIF addresses it QA activities are proportionate in time and focus. The QIF is based around medica schoo and deanery QM and the ways in which they work with LEPs and Coeges/Facuties at a oca eve. The GMC is moving towards a risk based QIF, saving money and reducing burden whie targeting the areas that need it most. The GMC is committed to working with other reguators to share information and coordinate activities and wi, where possibe, receive and use data that are gathered once and used for a partners. Activities such as visiting wi be coordinated across a stages to reduce the burden on LEPs being visited and, where possibe, to coincide with schedued events. The GMC wi base its decisions on an evidence base made up of information generated both internay and externay. Degrees of accountabiity at a eves have been identified. The GMC wi introduce a Quaity Scrutiny Group to ensure consistent consideration by experts of a outcomes of the QIF. The QIF inks a the eements of the GMC s QA activities for undergraduate and postgraduate medica education and training. Through our QA activity we are creating a picture of undergraduate and postgraduate medica education and training which wi contribute to more consistent and informed QA by buiding on the outcomes of QABME, QAFP and the QF. The GMC is moving away from the cycica and repetitive review of the units we aready know to be functioning reasonaby we. The GMC wi pubish a caendar of activity to support the QIF from 2011 to 2012 in its operationa guidance.. Genera Medica Counci 6

7 Principe Transparency Targeting How the QIF addresses it The QIF and suppementary documentation make it cear what is required from partners. Within the QIF, partner organisations are asked both to take action and to provide evidence of those actions. Medica schoo and deanery sef assessment wi be undertaken against the GMC s pubished standards, requirements and outcomes. The pubic, patients, students, trainees and empoyers can access pubished QIF guidance, QA reports and action pans on the GMC website. QA activities wi focus on the probems, aiming for improvement and on the dissemination of good practice. Visits wi be focussed on issues identified from the evidence base and responses to concerns wi be targeted and appropriate. Genera Medica Counci 7

8 The Quaity Improvement Framework introduced Key messages The QIF buids on the good work that has previousy been carried out in this area. We have improved our approach to QA by making more use of our evidence base and targeting our activity where it is most needed to maintain standards and improve quaity. By coordinating QA of a stages of medica education and training we wi be better positioned to generate a comprehensive picture of medica education and training across the UK. The GMC is committed to deivering a more risk based and proportionate approach to QA. We are moving away from a one size fits a mode of QA to be responsive to the needs and chaenges of individua medica schoos and deaneries. 19 The diagram beow shows how the different eves of QA, QM and QC reate to each other. 20 Currenty, medica schoos and deaneries are the units which manage the quaity of medica education and training, maintaining and improving standards over time. But the mode is fexibe enough to adapt to future structures shoud this change. It emphasises the importance of the distinct roe that quaity managers have in ensuring that training programmes and students/trainees meet the required standards and outcomes. Quaity Assurance GMC Quaity Management Medica Schoos Deaneries Commissioners and ead providers Roya Coeges/ Facuties Quaity Contro Loca education providers Genera Medica Counci 8

9 Quaity assurance 21 QA incudes a the poicies, standards, systems and processes in pace to maintain and enhance the quaity of medica education and training in the UK. The GMC carries out systematic activities to assure the pubic and patients that medica education and training meets the required standards. This activity is carried out within the principes of better reguation (see page 7-8). 22 QA is based on the statutory remit of the GMC which is to set standards, requirements and outcomes for a stages of medica education and training. Decisions regarding approva wi be informed by assessment against these standards. For the purposes of this document, the term approva, which is used throughout, incudes: (a) the recognition of programmes under Part 2 of the Medica Act 1983 (b) the recognition of speciaties (c) confirming which organisations can deiver the Foundation Programme (d) the ist of those universities which are recognised as meeting the standard in respect of quaifying exams at undergraduate eve (e) curricua and assessment systems and speciaty programmes. 23 The GMC quaity assures: (a) bodies responsibe for medica educationa and training ocay (universities and deaneries) (b) training posts and programmes (foundation and a speciaties incuding GP) (c) curricua and assessment systems underpinning training programmes (the Foundation Programme and a speciaties incuding GP). 24 Medica schoos and deaneries are asked to provide the GMC with reports that show how they are meeting the pubished standards and outcomes supported by evidence and accompanied by an action pan. 25 The GMC s approach to QA combines the principes of peer review and consistent scrutiny. Eements such as visits and, sometimes, responses to concerns wi be by peer review. The reports of these visits and other eements of the QIF such as medica schoo, deanery and speciaty reports, sef assessment, curricuum and assessment system approvas wi be subject to consistent scrutiny by a fixed membership Quaity Scrutiny Group. The fina decision on approva remains with the GMC. Quaity management 26 QM refers to the arrangements through which a medica schoo or deanery satisfies itsef that LEPs are meeting the GMC s standards. These arrangements normay invove reporting and monitoring mechanisms. 27 Medica schoos are responsibe for the educationa governance of university and LEP based undergraduate medica education. The schoo s curricua and assessment system/s are reviewed against the standards and outcomes of Tomorrow s Doctors. 28 Deaneries are responsibe for the educationa governance of a approved foundation programme and speciaty incuding GP training programmes. A foundation and speciaty incuding GP training takes pace within training programmes approved by the GMC against the Genera Medica Counci 9

10 standards and outcomes of The Trainee Doctor. 29 The GMC expects medica schoos and deaneries to demonstrate compiance with the standards and requirements that it sets. To do this, they wi need to work in cose partnership with the medica Roya Coeges and Facuties, NHS trusts and heath boards and other LEPs. This means that QM shoud be seen as a partnership between those organisations because it is ony through working together that medica schoos, deaneries, Roya Coeges and Facuties, with LEPs, can deiver medica education and training to the standards required. 30 Medica schoos, deaneries and Roya Coeges/Facuties may benefit from carrying out their own surveys, but shoud avoid doing so at the time of the annua nationa training surveys. Such surveys may be suppemented by asking students and trainees to evauate student assistantships, cinica pacements, posts and programmes. Medica schoos and deaneries may aso wish to use muti-source feedback and/or peer review to monitor the quaity of teaching. 31 As part of their QM activity, medica schoos and deaneries, in conjunction with medica Roya Coeges and Facuties, may need to carry out a form of oca visiting with the goa of improving education and training opportunities. This may be hepfu to the LEPs and enabe oca probem soving and dissemination of good practice. 32 If medica schoos and deaneries do carry out oca QM visits, they shoud bear the foowing in mind. (a) Ony the GMC can award or withdraw approva of training, so such visits wi be advisory and focus on improving the quaity of training. (b) Visits to a medica schoo or deanery cannot be undertaken without the agreement of its dean. (c) Visits shoud incude expertise externa to the programme being reviewed. (d) Visits shoud have a very cear and articuated purpose, ensuring that the GMC s standards and requirements are met and promoting quaity improvement. 33 Wherever possibe, trusts, heath boards and other LEPs shoud be aowed to monitor their own performance against GMC standards and requirements. 34 Any Roya Coege or Facuty, or indeed any other interested party such as students, trainees or patients, can raise concerns with the GMC. As set out in Good Medica Practice, it is a professiona requirement of a registered medica practitioners to protect patients from risk of harm and to report when there is good reason to think that patient safety is or may be seriousy compromised by inadequate premises, equipment, or other resources, poicies or systems. If there are concerns about a medica schoo or deanery, the GMC expects these to be raised with the medica schoo or deanery first so that they can provide reassurance. If probems persist, the individua or organisation shoud then contact the GMC and we wi investigate prompty. If medica schoos or deaneries remove students or trainees from an LEP due to concerns about the quaity of training or patient safety they must inform the GMC. 35 Day-to-day reassurance that medica education and training is being deivered to the standards required wi be at QM eve. 36 Coeges/facuties wi continue to need information about individua trainees in order to prepare the evidence for submission to the GMC for an award of CCT. 37 It is expected that medica schoos and deaneries wi not have to provide different information from each partner body but to draw upon the same information for QA as QM and QC. Genera Medica Counci 10

11 38 Externa scrutiny is important in maintaining standards at both undergraduate and postgraduate eve and can be achieved in a number of ways. One of the most important ways of doing so in medica schoos is the use of externa examiners. Tomorrow s Doctors (2009) requires that medica schoos have in pace a mechanism to ensure comparabiity of standards with other institutions and share good practice. The mechanisms must cover the appointment of externa examiners. The duty and powers of externa examiners must be ceary set out. Suppementary advice regarding externa examiners wi be pubished in eary Universities UK has aso ed a review and the QAA is deveoping minimum expectations of the roe. 39 Deaneries must ensure active externa scrutiny in the QM processes. This can be addressed in two ways. Firsty, at speciaty eve, externa advice shoud be obtained on a the processes of deivery, assessment and evauation of speciaty incuding GP training. The GMC expects that such speciaist advice wi normay come from the medica Roya Coeges and Facuties. Secondy, deaneries shoud consider externa advice about the management of speciaty incuding GP training, for exampe through the engagement of empoyers; NHS Education for Scotand (NES), Strategic Heath Authorities (SHAs), their successor or equivaent organisations; or other heath professions or other deaneries. 40 Externa advisers must have appropriate expertise and be independent of the deanery. They shoud incude educationaists, trainees, patients and the pubic as we as members of the medica profession. 41 Medica externa advisers shoud have expertise appropriate for the programme, course or foundation/speciaty schoo being considered and wi normay be drawn from other deaneries, Roya Coeges, Facuties or speciaty associations. 42 Medica schoos and deaneries must be abe to demonstrate that a externa examiners and advisers are independent of the programme, course, foundation/speciaty schoo or deanery, have the reevant expertise and have no conficts of interest. The roe of the dean in reation to serious concerns 43 If there are training concerns, deans can remove one or more groups of students or trainees from a setting or organisation. Such a change shoud invove the appropriate medica Roya Coege or Facuty at postgraduate eve. It must be reported to the GMC immediatey and recorded as part of the schoo or deanery report to the GMC, setting out the actions taken to remedy the situation where appropriate in the accompanying action pan. Quaity contro 44 QC is the arrangements through which LEPs (heath boards, NHS trusts, the independent sector and any other service providers that host and support medica students and trainees) ensure that medica students and postgraduate medica trainees receive education and training that meets oca, nationa and professiona standards. 45 LEPs shoud normay have a board eve officer accountabe for this function. Genera Medica Counci 11

12 46 The GMC quaity assures medica education and training through the medica schoos and deaneries but day-to-day deivery is at LEP eve. This deivery invoves medica staff, medica education managers, undergraduate and postgraduate medica centre staff, other heath professions and empoyers. Cinica pacements, student assistantships, individua foundation programme and speciaty incuding GP training are deivered through carefu supervision and assessment by speciaists in the reevant discipine advised and overseen by regiona and oca staff from the UKFPO, the Academy of Medica Roya Coeges and the reevant medica Roya Coege or Facuty. 47 Each LEP must demonstrate how the GMC s standards and requirements are being achieved. Medica schoos and the deaneries shoud support LEPs in doing this and ensure that systems of deivery and QC are consistent across speciaties and LEPs. Risk-based reguation 48 The GMC accepts and endorses the principe of risk-based reguation. QABME and QAFP both incuded robust processes to QA a medica schoos and a deaneries against a of the standards and outcomes in Tomorrow s Doctors (2003) and The New Doctor. This has provided a weath of data and a usefu, recent picture of the state of undergraduate medica education and foundation training. The GMC is using the outcomes of these programmes to set a baseine for risk assessment. Risk assessment against such a baseine aows us to direct reguatory resources where they can have the most impact. 49 This targeted and focused risk based approach is in ine with the principes of better reguation and the GMC wi engage and work with a partners to deveop the necessary structures and processes. 50 The QIF must aso continue to ceebrate and disseminate good practice and it is important to recognise that innovation and deveopment for the better can occur more frequenty where risks are taken. Genera Medica Counci 12

13 Quaity Improvement Framework the four eements 51 There are four eements to the QIF: (a) approva against standards (b) shared evidence (c) visits incuding checks (d) responses to concerns. The standards are the framework against which a QA activity is undertaken and the evidence base supports and focuses QA activity. Approva against standards Visits incuding checks Responses to concerns Shared evidence Approva against standards Key messages: The GMC approves bodies or combinations of bodies to award UK primary medica quaifications; deaneries responsibe for foundation training; LEPS deivering foundation and speciaty incuding GP training; foundation and speciaty incuding GP curricua and assessment systems and foundation and speciaty incuding GP programmes. The GMC requires medica schoos to compy with the standards and outcomes of Tomorrow s Doctors (2009) by August Standards, requirements and outcomes for the foundation programme and speciaty incuding GP training are being aigned and wi be pubished in a singe document. They wi be substantiay reviewed from Trainers approva status wi be pubished enabing deaneries to maintain a current ist. 52 Standards for education and training are an essentia eement of the QIF. They form the backbone of the framework against which the other eements are deveoped and measured. 53 The standards and outcomes for undergraduate medica education and training, incuding curricua and assessment systems, are set out in Tomorrow s Doctors. The GMC consuted widey when drawing up the revised standards and outcomes. Medica schoos must meet the standards and outcomes of Tomorrow s Doctors (2003) whie working towards compiance with Tomorrow s Doctors (2009) by the beginning of the academic year The GMC wi pubish suppementary advice in eary Genera Medica Counci 13

14 54 The standards and outcomes for postgraduate medica education and training have been aigned foowing the merger of PMETB with the GMC. The Trainee Doctor combines the standards and outcomes previousy set out in The New Doctor, the Generic Standards for Speciaty Incuding GP Training and the Standards for Trainers and Standards for Deaneries. The combined standards wi be reviewed substantivey from The standards and outcomes for the foundation and speciaty incuding GP curricua are set out in the Standards for Curricua and Assessment Systems. 56 The GMC approves the foowing against the above standards: (a) new institutions to deiver undergraduate medica education or the decouping of institutions which previousy jointy deivered it (b) programmes of education or training (c) trainers (d) foundation, speciaty incuding GP and subspeciaty curricua and assessment systems. 57 Medica schoos and deaneries are reviewed against the reevant set of standards for each of the above and are then either granted approva or approva is withdrawn. Where necessary, the GMC wi set requirements that medica schoos and deaneries must meet to ensure conditions are not paced on their approva. If such conditions are not met, we wi then take steps to withdraw approva. Approvas against standards GMC QA using evidence, approvas against standards, visits and responses to concerns Are there requirements? YES NO Have the requirements been met? YES Approved without conditions NO Approved with conditions YES Have the conditions been met? NO Withdrawa of approva Genera Medica Counci 14

15 58 The GMC assesses whether medica schoos and deaneries are meeting the required standards through the foowing QA activities. (a) Medica schoos and deaneries submit reports to the GMC setting out their activity against the reevant standards, outcomes and requirements. (The structure of the report and when it must be submitted are set by the GMC.) The reports must draw on evidence gained through the QM and QC processes and incude action pans that address how any probems are being tacked. This shoud incude updates on any conditions, requirements and recommendations made in visit reports, how good practice is being disseminated and the goas for the year ahead. (b) The GMC carries out routine visits to medica schoos and deaneries. (c) The GMC carries out triggered visits or other responses to concerns where necessary. (Triggered visits, as opposed to routine visits, are undertaken to investigate possibe serious educationa faiure or risk to patient or trainee safety.) (d) The medica Roya Coeges and Facuties submit annua summary reports to the GMC confirming that the curricuum and associated assessment systems continue to meet GMC standards and requirements. (e) The GMC carries out nationa training surveys every year and examines other evidence sources where avaiabe, for exampe through coaborative activities, to confirm that standards are being met. (f) The GMC re-approves curricua and associated assessment systems. 59 The process for the withdrawa of approva is avaiabe on the GMC s website at org/education Post and programme approva 60 The GMC is the soe authority responsibe for the approva of bodies awarding UK medica degrees; foundation programmes and speciaty incuding GP training posts; courses and programmes, incuding appications for re-approva of expired posts and programmes. 61 Approva at undergraduate eve reates to: (a) the process through which new, couping or decouping institutions are quaity assured and recognised by the GMC and added to the ist of bodies abe to issue UK PMQs (b) the continued approva of bodies abe to issue UK PMQs through annua reporting and the visit process, and by the approva by the GMC of any major changes. 62 Deaneries wi now be approved to deiver foundation programme and speciaty incuding GP training through the QIF as a singe process. (Previousy, deaneries have been approved separatey to deiver foundation training through the QAFP process and speciaty incuding GP training posts and programmes through the QF). They wi be approved against The Trainee Doctor using shared evidence, nationa training surveys, a singe visiting process and responses to concerns. The GMC wi receive programme approva data for foundation programmes from deaneries as it does for speciaty incuding GP programmes. Genera Medica Counci 15

16 63 A speciaty incuding GP posts, courses and programmes (fu time and ess than fu time) intending to ead to the award of a CCT must be approved in advance by the GMC. This incudes academic integrated pathways and periods spent out of programme for research (OOPR) or other training (OOPT) or earning opportunities. Activity reating to the approva of programmes and posts within those programmes is set out within this QIF. 64 Where the GMC has granted conditiona approva to posts and programmes, we wi monitor these through the annua reports submitted to us by medica schoos, deaneries and medica Roya Coeges/Facuties; the nationa training surveys and visits. Medica schoos and deaneries, aong with medica Roya Coeges and Facuties and LEPs, wi be expected to monitor training at a oca eve. This monitoring wi form an important part of the QM and QC activity. Trainer approva 65 Criteria for the approva of GP trainers were deveoped by the Roya Coege of Genera Practitioners and agreed by PMETB. Deaneries identify which trainers meet these criteria and are currenty deivering training through ocay deivered processes and provide this data to the GMC. We then grant approva of trainers based on this data. 66 We are committed to deivering a framework for a trainers, so we wi be ooking again at the process through which this is currenty done and seek to QA the data through the other eements of the QIF. This coud incude an audit of approva processes during a visit, information from the nationa trainer survey and/or response to concerns. 67 In the short term, we wi move from historica to rea time information sharing and approvas with deaneries and pubish information which refects those trainers approved to deiver training. Curricuum and assessment systems approva 68 The GMC ensures that curricua and assessment systems for the foundation programme and speciaty incuding GP training meet GMC standards and that there is consistency in standards across medica speciaties in the UK. 69 Consistent standards in curricua hep ensure that a doctors are equipped with the necessary skis, knowedge and behaviours to perform effectivey in a constanty changing heath service provided in a wide range of settings. 70 Approva of undergraduate medica curricua and their associated assessment systems is against the standards and outcomes of Tomorrow s Doctors (2009) and through the other eements of the QIF. These incude the evidence base, visits and responses to concerns. 71 The GMC approves the foundation programme curricuum and a speciaty incuding GP training curricua which ead to CCTs and subspeciaty curricua that ead to the award of a certificate against the Standards for Curricua and Assessment Systems. Medica Roya Coeges, Facuties or other interested parties are responsibe for submitting proposas for new speciaties to the department of heath and for new subspeciaties to the GMC for approva. The GMC wi then approve the curricuum and associated assessment system of new speciaties and subspeciaties as appropriate. Genera Medica Counci 16

17 72 The GMC wants to be responsive and enabe the deveopment of curricua and assessment systems in innovative ways. This is important to ensure that any significant change is fuy considered and approved prior to impementation. Organisations deveoping curricua and assessment systems are responsibe for ensuring that changes - minor or major - are ceary communicated to the GMC and, once approved, to the deaneries in a timey fashion. Major changes to curricua must ony be made where there is a cear service need or deveopment within the speciaty that must be refected in the curricuum to avoid deaneries having to deiver different curricua for the same speciaty or subspeciaty at the same time. 73 In 2009/10 a forma review of a speciaty and subspeciaty curricua was undertaken against the 17 Standards for Curricua and Assessment Systems. The outcomes of the review were pubished in the GMC Quaity Framework: Learning Points (Juy 2010). Shared evidence Key messages The evidence base incudes evidence from different stages of medica education and training from the GMC s other functions such as registration and fitness to practise and from externa sources such as heath systems reguators. The evidence base is being strengthened and wi inform a aspects of reguatory QA. To undertake proportionate QA the evidence wi be used to identify risks for exporation. Over time, the GMC wi focus on coecting the most reevant information and spend more time anaysing information and ess time processing it. Greater emphasis wi be paced on benchmarking and sharing information with partners to support effective quaity management and quaity contro. Information within the evidence base that is reevant to other eements of the QIF wi be shared with those undertaking QA activity on behaf of the GMC. 74 The evidence base is maturing. As this becomes more comprehensive and robust it provides a firmer basis for targeting QA activity where reguatory intervention is most effective. 75 The purpose of the shared evidence is to: (a) identify areas of risk that need further investigation by the GMC (b) trianguate (verify) the evidence provided by different partners and check whether it is consistent and comparabe (c) identify trends or patterns which ead to thematic QA activity by the reguator where the GMC considers an aspect of medica education and training across undergraduate and postgraduate education and throughout the UK and makes wide-ranging judgements on the quaity of deivery of that aspect (d) identify trends eading to new items incuded in the nationa training surveys (e) identify trends or patterns which ead to targeted checks (f) enabe the GMC to fufi its statutory function of approving and monitoring training in the UK through a range of evidence. Genera Medica Counci 17

18 Sources of evidence 76 Medica schoos, deaneries and medica Roya Coeges/Facuties are key sources of evidence. Data required from these key sources are defined and transparent, with the minimum dataset requirements identified. This is suppemented by data from other heathcare reguators and organisations. 77 Evidence is aso drawn from the four UK heath departments, heathcare systems and organisations and from other eements of the QIF and GMC functions. 78 The shared evidence for the QIF wi incude: (a) reports and action pans from medica schoos and deaneries (b) annua speciaty reports from medica Roya Coeges and Facuties (c) the approva of posts, programmes, trainers, curricua and assessment systems (d) previous visit reports (e) both GMC and externa surveys data (f) reports from bodies to which deaneries are accountabe (namey SHAs, NES, Wesh Assemby Government (WAG), Department of Heath, Socia Services and Pubic Safety of Northern Ireand (DHSSPS)) (g) other audit and quaity assurance bodies (for exampe the NHS Litigation Agency (NHSLA), the Care Quaity Commission (CQC), Quaity Improvement Scotand (QIS), Heath Inspectorate Waes (HIW) and Reguation and Quaity Improvement Authority (RQIA)). Reports from medica schoos and deaneries to the GMC 79 A medica schoos are required to submit a report to the GMC in the required time and structure, which wi be detaied in the operationa guidance. Medica schoos are required to compete an enhanced annua report (EAR) which aows the GMC to monitor progress towards impementation of Tomorrow s Doctors (2009). 80 Due to the nature of postgraduate medica education and training within the cinica environment, the GMC is moving from coection of historica data to rea time shared data based on current training. Deaneries wi therefore be required to update their reports and associated action pans at six monthy intervas and report any patient or trainee safety and immediate risks through the responses to concerns eement of the QIF. 81 Reports from both medica schoos and deaneries shoud set out how the issues identified through externa scrutiny, for exampe GMC visits, are being addressed. They shoud aso set out the outcomes of oca QM they have carried out and QC undertaken by LEPs and other partners deivering medica education as part of the medica schoo s programme/s. Deans must be abe to provide evidence to support their action pans if requested by the GMC. 82 An action pan in response to GMC visits and oca QM and QC activity shoud be submitted as part of the schoo/deanery report. Medica schoos and deaneries shoud take prompt and effective action (where appropriate) in response to a QA, QM and QC activity. Through their QM, medica schoos and deaneries shoud be aware of the issues affecting medica education and training for their students and trainees and ensure that the responses are proportionate, measured and evauated. Action pans are a usefu too to show improvement and dissemination of good practice as we as how probems have been addressed. Genera Medica Counci 18

19 83 Medica schoo and deanery action pans wi be pubished on the GMC s website at 84 Specific additiona information may be requested to support anaysis of risk, concerns and good practice. These requests wi be kept to a minimum. 85 Wherever possibe, the GMC wants to receive and use data that are gathered once and used for a partners. Information wi be shared once a data protection issues have been fuy addressed. Annua speciaty report from medica Roya Coeges and Facuties to the GMC 86 The GMC receives information from Roya Coeges and Facuties in the form of annua speciaty ASRs. The reports provide an essentia speciaty perspective, a nationa overview by speciaty and subspeciaty, and wi be particuary usefu for sma speciaties. 87 A pro forma is provided to assist medica Roya Coeges and Facuties to structure their reports. The reports shoud focus on anaysis of information from activity such as nationa exams, training courses, externaity the coege or facuty has provided to deanery QM activities such as attendance on a deanery visit to an LEP. 88 The report shoud identify good practice, concerns and trends by deanery, LEP, speciaty programme and country from the perspective of the Roya Coege/Facuty. The speciaty expertise of the Coeges and Facuties is crucia and the GMC wi seek their advice on areas of risk to curricuum deivery and assessment systems. This coud take the form of, but is not constrained to, comments in the ASR which contribute to the evidence base for identifying risks to be investigated, contribution of questions for the nationa surveys and/or questions to be addressed during visits and raising concerns. 89 Roya Coeges and Facuties need to work with deaneries to share appropriate information to inform QM and QC and to ensure the annua reporting to the GMC is accurate and informed. Surveys 90 The GMC s nationa training surveys are an important part of the evidence base because they revea perceptions of training from both trainer and trainee perspectives by country, deanery, speciaty incuding GP training, foundation programme, graduating medica schoo and at a oca eve. The findings of the surveys may require action by deaneries, which wi be monitored by the GMC through reporting, resuts of future surveys, trends and visits. Findings wi aso inform the GMC s visits and responses to concerns. 91 Whie the surveys are an important source of evidence, their outcomes must be viewed in the context of a four eements of the QIF. Deaneries have access to a range of evidence and QM shoud not focus entirey on the surveys. 92 The trainee survey asks trainee doctors to refect on their undergraduate education, for exampe their preparedness for medica practice. Data from survey items which reate to undergraduate medica education wi be shared with medica schoos. 93 The GMC has identified the points of transition (from medica schoo to the foundation programme, from the foundation programme to speciaty incuding GP training and from speciaty incuding GP training to CCT) as points of potentia risk. As a resut, we aso survey these groups. Genera Medica Counci 19

20 94 The surveys of trainees and trainers enabe the GMC to identify, at a nationa eve, aspects of medica education and training which require further investigation as potentiay good practice and which may need to be improved. Survey reports are sent to deaneries, Roya Coeges and Facuties and LEPs; outcomes of the surveys are pubished and avaiabe onine. Nationa survey of trainee doctors 95 The survey provides a snapshot of trainee doctors perceptions of their training posts and programmes providing the GMC with invauabe information to hep monitor changes to the training environment. Feedback from the survey heps shape the future of postgraduate medica education in the UK. The trainee survey has speciaty-specific questions, as we as questions reevant to the GMC standards for postgraduate medica education and training. Nationa survey of trainers 96 The GMC aso conducts a survey of a trainers in the UK, incuding those who train medica students, foundation doctors and speciaty trainees. The nationa survey of trainers aims to coect evidence on whether trainers are abe to undertake their duties as trainers effectivey, how these duties are formay recognised in job pans and training, and how supported trainers fee in their roe. Trainers are considered to be experienced practitioners who are invoved in training and supervision in the workpace. Trainers therefore incude educationa supervisors, cinica supervisors and other doctors and quaified professionas providing cinica supervision of medica students and doctors in training. Deveopment of the surveys 97 The GMC wi deveop the surveys function further. For exampe we wi piot refective evauation by newy quaified GPs and consutants of how their training programmes prepared them for their roes. 98 By deveoping existing or introducing suppementary surveys we wi be abe to produce better information about graduates preparation for practice. This wi be used to inform the GMC s work and wi aso be provided to partners. 99 The GMC wi aso investigate how best to coect data regarding sma speciaties where the sma number of trainees precudes us from reporting survey resuts. Visits incuding checks Key messages Visits wi be designed on an individua basis to refect the differences between deaneries and medica schoos and wi be targeted towards areas of risk. Visits wi be coordinated across a stages of medica education and training within a region. Thematic QA wi be expored both within visits and by undertaking supporting activities. Genera Medica Counci 20

21 100 A medica schoos have been visited once since 2004 and most deaneries have been visited three times (and at east twice) in the five years before the introduction of this QIF. The evidence submitted to the GMC shows that QM within these institutions is maturing and quaity systems are becoming embedded. But the outcomes of previous visit cyces suggest that the deveopment of QC within LEPs is ess deveoped at both undergraduate and postgraduate eve. The GMC wi therefore agree a yeary programme of visits across the UK where the order in which institutions wi be visited and the areas for exporation during visits are identified using the evidence base. These visits wi share good practice, review medica schoo and deanery management of concerns and investigate other areas as indicated by the evidence base. 101 The GMC has gathered feedback about visits and suggestions for improvement from medica schoos, deaneries, GMC visitors and other partner organisations during 2009 and As a resut, we wi piot an aigned and enhanced visits programme in 2011 and 2012 which wi achieve the foowing. (a) Empoy a mixed and fexibe mode to QA for medica schoos, deaneries, themes (for exampe, assessment) and sma speciaties against the GMC standards, requirements and outcomes. (b) Take a regiona approach to visiting, so that a medica schoos and deaneries within a particuar geographica area wi be visited within the same cyce. (c) Bring together the QA of foundation and speciaty incuding GP training into one process. (d) Use time and resources appropriatey so that the benefits of the process to medica schoos and deaneries outweigh the burden of preparing for a visit. (e) Recognise that there needs to be some differences between the QA of undergraduate and postgraduate medica education and incorporate this in the process. (f) Take into account evidence from a eements of the QIF and from other reguatory bodies and reduce the need for the provision of evidence immediatey before a visit. Orientation documents provided by the schoos and deaneries before a visit wi be reduced in size to refect this. (g) Target areas for consideration where appropriate, rather than examination of areas that the evidence base shows are aready working we. (h) Have the capacity and fexibiity to respond where the evidence base suggests there is a need with more and enhanced QA activity where there is greater risk, particuary to patients, students and trainees. (i) Be subject to continuous evauation and improvement. 102 Whie the individua unit being reviewed wi remain the medica schoo or deanery, we wi coordinate our work across stages to give a regiona view of both undergraduate and postgraduate medica education and training and so wi aso engage with more LEPs. Where ony a sma or a few risk/s has/have been identified this wi be refected in the size of team and the duration of the visit. 103 Themes for exporation, identified through the evidence base, may form part of the action pan for a visits or a discrete visit. 104 The visit process wi be suppemented by a range of activities. The GMC is aware that a meeting may not be the best and most cost effective means of exporing a potentia risk. So we wi aso empoy technoogy with the use of videoconferencing, podcasts and onine forums for visit teams to share anaysis. Genera Medica Counci 21

22 105 The piot visits to medica schoos wi verify schoos compiance with Tomorrow s Doctors (2009), particuary in areas where the new edition of Tomorrow s Doctors sets standards that differ significanty from the previous edition. Visits wi aso address schoos QM of cinica pacements and student assistantships within LEPs and wi inform postgraduate visiting. 106 The piot visits to deaneries wi cover foundation training, and speciaties where the evidence base suggests that there is a need for verification of the deanery s compiance with the standards. There wi aso be an increased focus on deanery QM of QC within LEPs, how this is monitored and how deaneries ensure that probems identified have been resoved. Regiona visits 107 The piot visits to deaneries and medica schoos wi achieve the foowing: (a) externa scrutiny and verification of sef assessment made in schoo/deanery reporting to the GMC (b) peer review, incuding the benefit of ay, student, trainee and empoyer visit team membership (c) pubished reports which inform students, trainees and the pubic about the quaity of the provision of undergraduate and postgraduate medica education and training (d) consider improvements made by medica schoos and deaneries in response to visit reports. Thematic quaity assurance 108 Thematic QA sits within the visits eement of the QIF, but can aso be addressed through the evidence base, incusion of items within regiona visits to medica schoos and deaneries, discussion at regiona or nationa meetings and research. Thematic QA wi be bespoke and proportionate to the risk identified. 109 Themes for investigation are identified through the outcomes of visit reports, the nationa surveys, suggestions that there are UK wide areas for investigation and targeted anaysis of medica schoo, deanery and speciaty reports. Checks 110 An additiona way that the GMC may monitor the quaity of training and the compiance of medica schoos, deaneries and LEPs is through the use of targeted and random checks, which wi be outside the norma cyce of visits. Checks made through random seection are in ine with the principes of good reguation and are a usefu too to examine the effectiveness of the QIF as we as monitor a specific area of interest when a regiona visit is not imminent but concerns do not warrant a triggered visit. The GMC wi conduct such checks with medica schoos, deaneries or LEPs to expore, for exampe, the identification of exceptions, progress on agreed actions, or to examine information that is being coected. Targeted checks wi aow the GMC to respond to areas of risk, rather than a concern, which warrant exporation outside of the cyce of visits but do not require a triggered visit. Genera Medica Counci 22

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