Developing teachers and trainers in undergraduate medical education

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1 Developig teachers ad traiers i udergraduate medical educatio This documet is uder review With the itroductio of Promotig excellece: stadards for medical educatio ad traiig we are reviewig our supplemetary guidace ad cosiderig if there are areas where further supplemetary guidace is eeded. I the meatime it will still be available for referece. The supplemetary guidace ca be foud at supplemetary guidace for medical schools ad icludes: Assessmet i udergraduate medical educatio Cliical placemets for medical studets Developig teachers ad traiers i udergraduate medical educatio Patiet ad public ivolvemet i udergraduate medical educatio

2 Developig teachers ad traiers i udergraduate medical educatio Advice supplemetary to Tomorrow s Doctors (2009) Cotets Page Key poits 02 Itroductio 03 Backgroud to the GMC s productio of supplemetary advice 03 What does Tomorrow s Doctors (2009) say about developig teachers ad traiers? 03 Purpose of the supplemetary advice 04 Who is the advice for? 04 Who are teachers ad traiers? 05 Selectig teachers ad traiers 06 Support ad recogitio 07 Dedicated teachig ad developmet time 07 Support etworks 07 Recogitio ad reward 09 Resources 09 Page Staff developmet ad traiig 09 Importace of faculty developmet 09 What makes for a competet teacher? 10 Teacher developmet programmes 11 Studets as teachers 12 Appraisal 12 Evaluatig teachig effectiveess 12 Carryig out appraisal 13 Aexes 14 Extracts o developig teachers ad traiers from Tomorrow s Doctors (2009) 14 Related documets 15 Local examples 15 Selectig teachers ad traiers 15 Support ad recogitio 16 Teacher developmet programmes 19 Studets as teachers 24 Appraisal 25 Refereces 25 Edotes 26 Guidace uder review 01

3 Developig teachers ad traiers i udergraduate medical educatio Key poits The GMC s requiremets i relatio to udergraduate teachers ad traiers are outlied i Tomorrow s Doctors (2009) i Domai 6 at paragraphs 122, 128, 148 ad 149, as well as Domai 2 at paragraphs 41 ad 51, Domai 3 at paragraph 58 ad Domai 7 at paragraphs 152, 156 ad 157. This documet sets out supplemetary advice. It does ot cotai ay ew regulatory requiremets or stadards. The advice icludes the followig major compoets. a b c d Medical schools should esure that appoitmets to teachig roles are made o the basis of competece, aptitude ad the ability to be a good role model rather tha experiece or cliical traiig aloe (paragraphs 21 24). Teachers ad traiers should have dedicated time i their job plas (or juior doctors traiig schedules) to deliver their educatioal resposibilities ad udertake their ow traiig ad developmet (paragraphs 26 27). Schools should strive to establish ad maitai the ifrastructure that will eable ad ecourage formal ad iformal workig relatioships betwee schools, uiversities, placemet providers ad idividual teachers ad traiers (paragraphs 28 33). Schools should support ad ecourage recogitio ad reward of teachig excellece through a variety of meas, icludig teachig awards, academic promotio ad formal educatio programmes ad qualificatios (paragraphs 34 38). f g Schools should cosider itroducig developmet programmes which are varied ad tailored to the eeds of each teacher ad traier. The programmes could iclude some stadardised core compoets supplemeted by developmet which is focused o the topic the traier is deliverig ad o their developmet eeds (paragraphs 47 52). Obtaiig the views of a wide rage of idividuals is the best way of deliverig a objective ad comprehesive evaluatio of performace. More formal measures of quality assessmet by traied assessors could supplemet iformal feedback, measurig both teachig kowledge ad skills ad iterpersoal qualities (paragraphs 56 58). h The teachig performace evaluatio ad 360 degree feedback, together with the teacher s persoal reflectio, should feed ito appraisal. Teachers ad traiers may be appraised by schools/uiversities or by other educatio providers. Educators employers should work together to eable joit appraisals of both cliical ad educatioal activities. If a joit appraisal is ot appropriate or possible, iformatio relatig to teachig or cliical performace should be sought from ad shared with the other party to facilitate whole practice appraisal ad miimise duplicatio. The outcome should iform the educatioal elemets of the teacher s persoal developmet pla or ay other actio (paragraphs 60 63). Guidace uder review e Teachig should be appropriately resourced. Medical schools should take every opportuity to raise the profile of teachig locally ad esure robust maagemet ad icreased trasparecy i accoutability for the use of teachig fuds (paragraphs 39 40). 02

4 Developig teachers ad traiers i udergraduate medical educatio Itroductio Backgroud to the GMC s productio of supplemetary advice 1 The GMC sets requiremets for medical schools i Tomorrow s Doctors. The 2009 editio reflects lessos from the first full cycle of the GMC s process of Quality Assurace of Basic Medical Educatio (QABME) ad respods to issues that emerged sice the 2003 editio. It aims to esure that ew graduates will be fit to practise ad prepared for traiig i the Foudatio Programme ad employmet i the NHS ad for their further educatio ad traiig beyod that. The 2009 editio followed a extesive period of developmet, egagemet ad cosultatio ad drew o research o the preparedess of graduates commissioed by the GMC. 2 Medical schools are required to be compliat with the stadards ad outcomes i Tomorrow s Doctors (2009) by academic year 2011/ The GMC has supported medical schools i implemetig the ew requiremets. This has ivolved a series of implemetatio workshops across the UK ad askig schools to produce Ehaced Aual Returs (EARs) o their progress. The workshops brought together represetatives from the medical schools i a regio as well as studets, postgraduate traiig bodies ad employers. They served as a chace for schools to discuss their progress i becomig compliat with Tomorrow s Doctors (2009) ad to highlight ay challeges they were facig. 4 It became clear that the schools felt that they eeded extra advice from the GMC as to how certai requiremets i Tomorrow s Doctors (2009) should be take forward. 5 The GMC has therefore udertake to develop a series of advisory documets supplemetary to Tomorrow s Doctors (2009) i the followig areas: a b assessmet cliical placemets, particularly studet assistatships c d developig teachers ad traiers ivolvig patiets ad the public. The documets have bee developed with draftig advice from experts i these fields. Their support is gratefully ackowledged. 6 A aex cotais some examples of local arragemets, as described by the medical schools or istitutios ivolved or as set out i previous publicatios. These are icluded as sapshots which may be of iterest ad use to other schools as they develop arragemets appropriate for their ow eeds ad circumstaces. 7 Schools are free to make use of this advice isofar as they fid it helpful i light of local circumstaces. It covers relevat issues ad icludes suggestios. The advice is expressed as steps that schools could or should take, but it does ot idicate ay ew regulatory requiremets or stadards. What does Tomorrow s Doctors (2009) say about developig teachers ad traiers? 8 Tomorrow s Doctors (2009) emphasises the eed for all those ivolved i educatig medical studets, whether or ot employed by the school, to be appropriately prepared for ad supported i their role. The uderlyig requiremet is set out i Domai 6 o Support ad developmet of studets, teachers ad the local faculty, amely that: Guidace uder review 128. Everyoe ivolved i educatig medical studets will be appropriately selected, traied, supported ad appraised. 9 Tomorrow s Doctors (2009) specifies particular requiremets for traiig ad evaluatio of teachig delivery, ad the formal steps which medical schools should take to esure support of teachig at ay teachig locatio. These iclude the eed for teachers to have kowledge of Tomorrow s Doctors (paragraph 148) ad traiig i equality ad diversity (paragraph 58), ad to recogise their resposibilities as role 03

5 Developig teachers ad traiers i udergraduate medical educatio models (paragraph 149). The medical schools are expected to put i place formal agreemets with other educatio providers i ad mechaisms for moitorig the quality of teachig ad staff developmet programmes (paragraphs 41, 51 ad 148). Beyod these requiremets, Tomorrow s Doctors (2009) allows flexibility i how the local faculty is prepared ad supported, as log as they have the ecessary kowledge ad skills for their role (paragraph 148). 10 More detailed extracts from Tomorrow s Doctors (2009) ca be foud i a Aex to this documet. Purpose of the supplemetary advice 11 This advice sets out possible approaches to selectig, supportig, traiig, developig ad appraisig teachers ad traiers. 12 The GMC recogises that most teachers ad traiers provide high quality educatio, ad may medical schools ad other orgaisatios have mechaisms for developig ad supportig them. The GMC seeks to ecourage a appropriate framework of faculty developmet that supports those who teach ad uderpis excellece i educatio delivery for all medical studets i the UK. This would bear i mid the ecessary differeces i approaches ad the resource challeges that schools, uiversities ad other educatio providers experiece. 13 This documet outlies some core attributes ad areas of kowledge ad skill required by everyoe ivolved i educatig medical studets. These reflect the views of the may experts we have cosulted. Teachers ad traiers play a crucial role i the delivery of the curriculum ad i ifluecig studets attitudes ad behaviours by beig their role models. There is a rage of professioal stadards frameworks, developed by various orgaisatios, to which schools could refer for further detail. The GMC is developig its framework for approval of traiers who support ad evaluate udergraduate, foudatio ad postgraduate learers. The GMC framework will recogise a variety of existig accreditatio frameworks alogside other sources of possible evidece for approval ad maiteace of approval. 14 May teachers ad traiers ivolved i educatig medical studets i cliical settigs are also traiers ad supervisors of postgraduate traiees. Therefore, they are subject to the Stadards for traiers set out i the The Traiee Doctor. 1 The GMC traier approval framework aims to put i place oe system across the cotiuum. Through its differet ature ad scope, the advice i this documet does ot compromise the madatory Stadards for traiers but rather supplemets them where appropriate. Where this advice touches upo a aspect which is covered elsewhere i the postgraduate cotext, this is icluded for ease of referece. However, this documet is midful of some fudametal differeces betwee academic ad cliical learig eviromets, ad betwee the skills required of teachers of udergraduate medical studets ad those supervisig more experieced traiees. 15 This advice is writte o the premise that the majority of medical studets educators are doctors. The GMC, however, welcomes the learig opportuities delivered by other health professioals ad by patiets ad the public, ad aspects of this advice may apply to o-medical teachers ad traiers of medical studets. Who is the advice for? 16 Medical schools are the primary audiece of this advice. Other parties ivolved i deliverig of medical studets educatio, such as NHS bodies ad idividual teachers ad traiers, may also fid it useful. Guidace uder review 17 Tomorrow s Doctors (2009) assigs a umber of resposibilities to medical schools, NHS orgaisatios ii ad idividual doctors, for example: a Medical schools are resposible for providig support ad traiig to teachers ad supervisors (paragraph 3(g)) 04

6 Developig teachers ad traiers i udergraduate medical educatio b c NHS orgaisatios are resposible for: i. esurig that performace of teachig resposibilities is subject to appraisal (paragraph 4(b)) iii ii. icludig, whe appropriate, a cotractual requiremet for doctors to carry out teachig (paragraph 4(c)) iii. releasig doctors ad others to complete the traiig eeded to be teachers (paragraph 4(d)) Idividual doctors are resposible for: i. followig the requiremets of Good medical practice, icludig beig willig to cotribute to the educatio of studets (paragraph 5(a)) ii. developig the skills ad practices of a competet teacher if they are ivolved i teachig (paragraph 5(b)) iii. meetig cotractual requiremets, icludig those relatig to teachig (paragraph 5(f)). 18 Tomorrow s Doctors (2009) calls for more structured arragemets for educatioal provisio uderpied by agreemets betwee medical schools ad other educatio providers. This reiforces the role ad resposibilities of the other educatio providers. Medical schools should state clearly their expectatios of provider orgaisatios ad what evidece of teachig quality will be required. Agreemets should iclude arragemets for appoitig teachers ad traiers ad evaluatio of their performace. iv activities i cliical or vocatioal settigs could iclude: formal educatioal activities timetabled evets such as providig tutorials or teachig ward rouds, assessig studets, coductig educatioal appraisals ad beig ivolved i educatioal maagemet, such as co-ordiatig placemets or committee work ad iformal educatioal activities the educatio that occurs i a spotaeous case-specific way withi the cliical role such as supervisig practice, workplace assessmets ad givig feedback, beig observed i theatre or cliic ad providig uplaed explaatios ad iformatio. 20 This advisory documet applies to ay idividual with resposibility for, or a role i, medical studets educatio, icludig cliical academics as well as NHS ad other cliicias. Arragemets would be proportioate to their level of ivolvemet. This advice predomiatly refers to teachers ad traiers, or educators, meaig all those who oversee learers developmet ad practice. However, we recogise that a variety of terms are used, for example: teacher or educator ay idividual with a role i teachig, traiig ad supervisio traier a experieced practitioer who is ivolved i teachig, traiig ad supervisio i the workplace, particularly for traiee doctors 2 Guidace uder review Who are teachers ad traiers? 19 It is easier to defie ivolvemet i teachig i the academic settig tha i the cliical eviromet. Most doctors from as early as their Foudatio Programme traiig, ad some other healthcare professioals, are ivolved i teachig ad supportig medical studets ad juior doctors to some extet. Educatioal medical academic a doctor employed by a uiversity to provide teachig to udergraduate medical studets ad/or postgraduate doctors. They are employed by uiversities or other higher educatio istitutios. Those who also hold hoorary cotracts with NHS istitutios are kow as cliical academics. They may teach studets ad/or traiees i lectures, semiars, practical laboratory 05

7 Developig teachers ad traiers i udergraduate medical educatio demostratios ad cliical attachmets, but could also be resposible for curriculum desig, plaig of assessmets, quality assurace, admissios ad studet support. 3 They will ofte also have research resposibilities educatioal supervisor a doctor resposible for cosiderig the idividual studet s progress agaist learig objectives set either by themselves or by the medical school. The educatioal supervisor should also facilitate the studet s reflective learig by discussig with them the patiets ad procedures they have gaied experiece from durig their placemet. The educatioal supervisor ca either be based withi the placemet provider where the studet is udertakig their placemet or withi the medical school cliical supervisor ay doctor or other healthcare professioal resposible for the supervisio or assessmet of a studet o a placemet v examier or assessor ayoe resposible for markig, assessig or judgig studets performace, regardless of the termiology used i ay particular school. I the postgraduate cotext: The Traiee Doctor icludes the followig defiitios: A cliical supervisor is a traier who is selected ad appropriately traied to be resposible for overseeig a specified traiee s cliical work ad providig costructive feedback durig a traiig placemet. Some traiig schemes appoit a educatioal supervisor for each placemet. The roles of cliical ad educatioal supervisor may the be merged. Selectig teachers ad traiers 21 Not everyoe is aturally good at educatig others. Idividuals stregths may lie elsewhere, for example i research or direct patiet care. With ever icreasig demads o the curriculum ad expectatios regardig graduates, the role ad expertise of traiers is becomig more importat tha ever. Approval of traiers has bee a requiremet i geeral practice for some time, 4 but ot yet i udergraduate settigs or the secodary care sector. While Good medical practice 5 expects all doctors to be willig to cotribute to educatioal activities, it is advisable that teachers ad traiers i academic ad/or cliical settigs be selected for these roles. 22 The GMC will be cosiderig the issues i relatio to selectio of cliical traiers as it develops the framework for approval of traiers. A variety of approaches to selectig educators curretly exist. Some are i favour of selectio o the basis of experiece, 3 others focus more o the educators traiig or qualificatio(s). I the postgraduate cotext: The Stadards for traiers i The Traiee Doctor state: 6.36 Traiers with additioal educatioal roles, for example traiig programme director or director of medical educatio, must be selected agaist a set of criteria, have specific traiig for their role, demostrate ability as effective traiers ad be appraised agaist their educatioal activities GP traiers must be traied ad selected i accordace with the Medical Act Guidace uder review A educatioal supervisor is a traier who is selected ad appropriately traied to be resposible for the overall supervisio ad maagemet of a specified traiee s educatioal progress durig a traiig placemet or series of placemets. The educatioal supervisor is resposible for the traiee s educatioal agreemet. (Edote 2) 23 Medical schools should esure that appoitmets to ad allocatios of teachig roles are made o the basis of competece, aptitude ad the ability to be a good role model 06

8 Developig teachers ad traiers i udergraduate medical educatio rather tha experiece or cliical traiig aloe. Those with a iterest i teachig ad the potetial to become excellet educators should be ecouraged ad give a opportuity to do so, icludig the ecessary support ad traiig. Selectio of teachers should, wherever possible, reflect the diversity of the local studet ad patiet populatio. This ca be especially importat for female studets ad those from miority ethic backgrouds i terms of role models. 24 Selectio o the basis of attributes other tha traiig or qualificatios is a developig area, ad medical schools might cosider sharig their experieces i relatio to criteria ad process. Later i this documet we discuss the characteristics ad skills which it might be helpful for educators to have. However, these should ot be see as madatory selectio criteria, ot least because some skills ca be acquired followig appoitmet ad some characteristics ca oly be evaluated over time. Support ad recogitio 25 A multitude of factors ifluece the medical educatio eviromet. Budgetary costraits ad reductio i time available for teachig lead to icreasig tesios i both cliical ad uiversity settigs, with competig priorities to deliver high quality patiet care, research ad teachig. The GMC would expect medical schools ad uiversities to show cotiuig recogitio of the value of medical educatio ad support for teachers ad traiers. Dedicated teachig ad developmet time 26 Teachers ad traiers should have dedicated time i their job plas (or juior doctors traiig schedules) to deliver their educatioal resposibilities. This would aid recogitio of the value of teachig ad raise its priority. 6 Some professioal orgaisatios have issued guidace o recogitio of teachig resposibilities i job plas 7,8,9 which medical schools should cosider. 27 Teachers ad traiers should also have the time to udertake their ow traiig ad developmet. Agreemets betwee medical schools ad other educatio providers ca offer a lever for the schools to implemet ad moitor the availability of study leave for cliical staff to eable teacher developmet. I the postgraduate cotext: The Stadards for traiers i The Traiee Doctor state: Stadard: Traiers must be supported i their role by a postgraduate medical educatio team ad have a suitable job pla with a appropriate workload ad sufficiet time to trai, supervise, assess ad provide feedback to develop traiees Orgaisatios providig medical educatio ad traiig must esure that traiers have adequate support ad resources to udertake their traiig role Postgraduate deaeries must have structures ad processes to support ad develop traiers, ad must provide traiers with iformatio about how to access traiig ad support to help them to udertake their roles ad resposibilities effectively. Support etworks 28 Schools should establish ad maitai the ifrastructure for close workig relatioships betwee schools, uiversities, placemet providers ad idividual teachers ad traiers, icludig those workig at remote sites. These relatioships could be both formal ad iformal, istillig a degree of owership of ad resposibility for the programme amog teachers ad traiers 10 ad supportig them i their role. Tomorrow s Doctors (2009) requires that: Guidace uder review 152. Teachers from the medical schools ad other educatio providers will be closely ivolved i curriculum maagemet, represeted at medical school level ad resposible for maagig their 07 ow areas of the programme.

9 Developig teachers ad traiers i udergraduate medical educatio 29 Relatioships ad etworks should ivolve the local Foudatio Schools ad postgraduate deaeries. Amog other beefits, this would eable a coordiated approach to teacher support ad developmet, which is highly desirable, cosiderig the sigificat overlap i the teachig faculty membership ad the requiremets of them. 30 Schools should esure that teachers kow what support etworks are available ad how to access them icludig atioal ad iteratioal etworks through bodies such as the Associatio of the Study of Medical Educatio (ASME), the Associatio for Medical Educatio i Europe (AMEE), the Academy of Medical Educators (AoME) ad the Higher Educatio Academy (HEA) subject cetre for medicie, detistry ad veteriary medicie (MEDEV). The etworks should be uderpied by effective two-way commuicatio betwee schools ad teachers, for example relatig to resources or materials, or dealig with problems. Regular updates o developmets should be available to teachers ad traiers, for example aroud curriculum cotet or applicatio of assessmets. Also, there should be mechaisms eablig educators to ifluece the cotet ad methods of delivery of the curriculum, either directly or through their represetatives at medical school level. I the postgraduate cotext: The Stadards for traiers i The Traiee Doctor state: Stadard: Traiers must be ivolved i, ad cotribute to, the learig culture i which patiet care occurs. 31 Schools should facilitate ad ecourage peer support etworks. Some schools hold regular, at least aual, iformal educatio evets such as teachig cofereces. These offer teachers a opportuity to keep abreast of developmets, share good practice ad experieces ad participate i the curriculum plaig. This practice is well received by the schools teachig staff. Networks ivolvig other professioals ad lay people ivolved i teachig medical studets could help develop ew perspectives, iovatio ad collaboratio. 32 Schools should also establish or maitai metorship schemes for teachers ad traiers, particularly for those ew to the role or the curriculum. Schools should cosider the possibility of formally egagig metors i teachers appraisal ad developmet plaig, with appropriate support ad developmet provided to the metors. 33 To facilitate commuicatio betwee medical schools ad other educatio providers there should be a udergraduate dea/lead withi each provider resposible for coordiatig ad promotig medical studets cliical traiig. This perso should be resposible for delivery of the agreemet with that placemet provider, for the appoitmet ad developmet of faculty ad for providig support ad directio for studets. vi The udergraduate dea/lead may be assisted by a variety of udergraduate co-ordiators ad departmet leads i the overall maagemet of educatio locally. The udergraduate dea/ lead should be closely ivolved i curriculum developmet ad be kept regularly iformed about ay chages ad the results of studet evaluatio of the locality for which they are resposible. They should be formally appraised i their role to discuss both the provider ad their idividual performace ad developmet eeds. They should hold a positio which eables them to ifluece the provider o educatioal matters. Guidace uder review 6.32 Traiers must esure that cliical care is valued for its learig opportuities; learig, assessmet ad teachig must be itegrated ito service provisio Traiers must liaise as ecessary with other traiers both i their cliical departmets ad withi the orgaisatio to esure a cosistet approach to educatio ad traiig ad the sharig of good practice across specialties ad professios. 08

10 Developig teachers ad traiers i udergraduate medical educatio Recogitio ad reward 34 While adequate paymet for teachig resposibilities is essetial, reward is ofte about recogitio. Job plas should reflect relevat activities. There are a variety of ways i which teachig excellece could be rewarded, ad schools should support ad ecourage these. 35 For example, various recogitio schemes could be cosidered, whether local, such as UCL medical school s Top Teacher Awards, or atioal, such as the Natioal Teachig Fellowship Scheme Idividual Awards or fellowships of the Academy of Medical Educators or the Higher Educatio Academy. 36 Also, uiversities should be ecouraged to use academic titles such as Hoorary Lecturer i Medical Educatio to recogise NHS staff, ad to publicise the achievemets of staff that have bee awarded prizes for teachig distictio, just as staff are recogised for research achievemet The academic promotio of teachers is key to icetivisig ad rewardig those ivolved i medical educatio. Traditioally, most uiversities have rewarded research excellece over teachig excellece i promotio procedures. Recetly, the regulatios aroud academic promotio have bee updated i may istitutios, ad the problems are ot with the lack of ackowledgemet of educatio i the criteria, but with their implemetatio. There should be clear guidace o promotio criteria ad medical schools may offer advice to teachers o how promotio criteria ca be met. The schools should also be aware that some groups of teachers may have additioal barriers to promotio, such as family commitmets restrictig their availability out-of-hours, ad cosider whether these could be mitigated. Subject to performace, cliical educatioalists should be promoted at a rate similar to that of 9, 11 cliical researchers. 38 Teachers ad traiers should be ecouraged ad supported i pursuig formal medical educatio programmes ad qualificatios, 12,13 which may help with evidece for recogitio ad career progressio. Resources 39 Esurig that adequate resources are available for teachig is icreasigly importat i the curret eviromet of fiacial challeges. Allocatio of fudig, traditioally, is perceived to be biased towards research or delivery of direct patiet care. 3, 9, 14 While research ad patiet care are crucial, it is also importat to raise the status of teachig ad traiig. High quality teachig is fudametal to developig the ext geeratio of academics ad cliicias, ad therefore the quality of patiet care i the log term. May teachig skills, such as listeig, are trasferable to, ad erich the quality of, patiet care ad are therefore immediately beeficial to the health service providers. There is icreasig recogitio of the resposibility ad accoutability of healthcare providers for educatio ad traiig of their staff. Medical schools should take every opportuity to raise the profile of teachig locally. 40 The fudig that has bee allocated to supportig educatio i the academic ad i cliical settigs should be used for this purpose oly. 15 Robust maagemet ad icreased trasparecy i accoutability for the use of teachig fuds, facilitated by agreemets with other educatio providers, would help medical schools moitor this. Guidace uder review Staff developmet ad traiig Importace of faculty developmet 41 Tomorrow s Doctors (2009) highlights the importace of staff developmet, ad developmet of teachig skills i particular, both at medical school ad at other educatio providers. 09

11 Developig teachers ad traiers i udergraduate medical educatio 148. The medical school must esure that staffdevelopmet programmes promote teachig ad assessmet skills. All staff (icludig those from other educatio providers) should take part i such programmes. 42 Tomorrow s Doctors (2009) sets out the uderlyig expectatio that these developmet programmes should aim for preparedess for the role Medical schools must make sure that everyoe ivolved i educatig medical studets has the ecessary kowledge ad skills for their role The medical school must esure that appropriate traiig is provided to these people to carry out their role Doctors with particular resposibilities for teachig studets must develop the skills ad practices of a competet teacher 43 This requiremet is also mirrored i Good medical practice: 16. If you are ivolved i teachig you must develop the skills, attitudes ad practices of a competet teacher Beig a good teacher ad role model is ot iate ad the skills ad attributes ca usually be acquired. But this will to some extet deped o a aptitude ad a wish to teach. With the right developmet, traiig ad support, more teachers ad traiers ca be eabled to provide 3, 16 high quality teachig Traiers must uderstad ad demostrate ability i the use of the approved i-work assessmet tools ad be clear as to what is deemed acceptable progress Traiers must regularly: review the traiee s progress through the traiig programme; adopt a costructive approach to givig feedback o performace; esure the traiee s progress is recorded; idetify their developmet eeds; advise o career progressio; ad uderstad the process for dealig with a traiee whose progress gives cause for cocer. Stadard: Traiers must uderstad the structure ad purpose of, ad their role i, the traiig programme of their desigated traiees Traiers must have kowledge of, ad comply with, the GMC s regulatory framework for medical traiig Traiers must esure that all ivolved i traiig ad assessmet of their desigated traiee uderstad the requiremets of the programme. What makes for a competet teacher? 45 All doctors should gai a basic uderstadig of ad skills i teachig ad learig durig their udergraduate ad postgraduate educatio ad traiig. However, those with sigificat ivolvemet i teachig ad traiig will eed more specialised skills. Exact requiremets will vary accordig to the eeds of the role ad the local structures. For example, teachers ivolved i iterprofessioal educatio may eed particular attributes or skills i reflectig ad givig feedback. A umber of detailed frameworks have bee developed which set out the kowledge, skills ad characteristics required of teachers i various roles ad eviromets. 12, 13, 17, 18, 19 Medical schools should refer to these as they desig their staff developmet programmes. Guidace uder review I the postgraduate cotext: The Stadards for traiers i The Traiee Doctor state: Stadard: Traiers must provide a level of supervisio appropriate to the competece ad experiece of the traiee Traiers must eable traiees to lear by takig resposibility for patiet maagemet withi the cotext of cliical goverace ad patiet safety. 10

12 Developig teachers ad traiers i udergraduate medical educatio 46 However, some key attributes for all teachers ad traiers ca be idetified, reflectig the requiremets i Tomorrow s Doctors (2009) ad evidece we have received. This is either a comprehesive or a detailed list. Key attributes ad skills of teachers ad traiers Appropriate professioal behaviour towards patiets,colleagues ad others (Tomorrow s Doctors (2009), paragraph 149) Ability to support, motivate, ecourage ad metor studets, ad ethuse them about carig for patiets Good commuicatio, icludig presetatio ad listeig skills Commitmet to teachig Awareess of the curriculum ad their role withi it, icludig kowledge of the learig objectives ad aims Uderstadig ad applicatio of Tomorrow s Doctors (2009) Kowledge of assessmet tools ad ability to assess objectively Ability to aalyse someoe s performace ad give costructive feedback Ability to utilise a rage of commuicatio, learig ad teachig styles ad methods, such as developmet of problem-solvig skills ad learig through active participatio Awareess of the priciples of equality ad diversity ad the relevat school policies, ad ability to treat studets fairly ad impartially, with regard to disabilities ad the variety of cultural, social ad religious backgrouds Keepig up to date with evidece ad developmets i medical educatio, adoptig a flexible approach ad beig ope to chage Followig other guidace set out i Good medical practice, icludig keepig up to date with kowledge of cliical practice ad academic advaces i the relevat field, ad recogisig ad workig withi the limits of oe s competece. Teacher developmet programmes 47 The required kowledge ad skills ca be acquired by teachers ad traiers i a umber of ways, such as: formal traiig metorship experiece self-directed learig. 48 Uiversities usually have requiremets for traiig of teachers ad assessors, ad formal traiig remais oe of the key methods of teacher developmet. A variety of medical educatio courses are available to those with or itedig to take up a teachig role, from courses leadig to a teachig qualificatio to short focused local traiig sessios. Medical schools ad other educatio providers should support teachers i pursuig medical educatio courses ad teachig qualificatios whe appropriate, 12, 13 but they should also esure that staff developmet is ot limited to formal traiig. Medical schools should make sure that appropriate traiig is provided or arraged for cliical teachers employed by NHS bodies ad other educatioal providers. Guidace uder review 49 A developmet programme for someoe with a role i teachig ad traiig medical studets could iclude these broad themes: iductio, icludig requiremets of the role ad the school s support ifrastructure (this should be compulsory o appoitmet to the role) priciples of teachig ad learig 11

13 Developig teachers ad traiers i udergraduate medical educatio expected outcomes of learig, icludig the stadard ad the acceptable level of variatio methods of curriculum delivery such as the spiral curriculum, group work ad selfdirected learig assessmet methodology ad givig feedback priciples of equality ad diversity. 50 Schools should cosider whether it is feasible to itroduce developmet programmes which are tailored to the eeds of each teacher ad traier. The programmes could iclude some stadardised core compoets, for example as part of iductio or refresher traiig. These ca the be supplemeted by a rage of subject-specific traiig which is focused o the topic the traier is deliverig ad o their developmet eeds. 51 The programmes should strive to accommodate a variety of approaches to traiig appropriate to a particular local teachig eviromet, provided the expected outcomes are met. Some schools use iovative ways of deliverig traiig to staff. For example, a umber of schools are takig stadardised courses to regioal sites ad traiig departmets. This approach is provig effective whe a cliical placemet/traiig uit is located some distace from the school that provides traiig, ad it is difficult for traiers to travel to atted courses. Also, some schools have developed web-based materials for teachers ad traiers to access wheever required. However, it is importat that these approaches supplemet rather tha replace face-to-face traiig ad developmet. 52 Schools could cosider usig systems which would allow easy recordig ad trackig of the traiig received by teachers, ad facilitate its recogitio across the local educatio provider boudaries. Studets as teachers 53 The role of the doctor as teacher has received 5, 20 wide ackowledgemet ad recogitio. To prepare graduates for this role, Tomorrow s Doctors (2009) emphasises the importace of developig medical studets core skills i educatio ad teachig: 21(f). [A graduate will be able to] fuctio effectively as a metor ad teacher icludig cotributig to the appraisal, assessmet ad review of colleagues, givig effective feedback, ad takig advatage of opportuities to develop these skills. 54 Some medical schools are offerig opportuities which urture teachig skills i studets beyod those required to meet the outcome i Tomorrow s Doctors (2009). These iclude a variety of teachig courses ad opportuities to deliver teachig to peers, subject to appropriate supervisio, ad to receive feedback ad metorig. All schools should cosider whether this is somethig their course could beefit from. Appraisal Evaluatig teachig effectiveess 55 Tomorrow s Doctors (2009) requires the quality of teachig, learig ad assessmet to be evaluated i uiversity ad cliical settigs. This ot oly measures a importat aspect of quality of the educatio programme, but also idicates where teacher developmet ad traiig is most required, facilitates recogitio of teachig ad eables quality improvemet. Guidace uder review 41. The medical schools will have systems to moitor the quality of teachig ad facilities o placemets. 51. There must be procedures i place to check the quality of teachig, learig ad assessmet, icludig that i cliical/vocatioal placemets, ad to esure that stadards are beig 12

14 Developig teachers ad traiers i udergraduate medical educatio maitaied. These must be moitored through a umber of differet systems, icludig studet ad patiet feedback, ad reviews of teachig by peers. 56 A umber of schools are already usig a rage of strategies to evaluate differet aspects of the quality of teachig. These measure the quality of the programme more geerally, such as whether objectives are beig met ad assessmet methods reflect the course, 19 as well as the quality of teachig delivered. The methods iclude peer observatio, studet feedback questioaires ad formal visits. Some schools, depedig o the educatioal structures, also seek the views of teachers metors ad udergraduate medical educatio leads at the cliical ad vocatioal placemet providers. 57 It may be challegig to obtai the views of a wide rage of idividuals i relatio to teachig provided by every teacher, but it is the best way of deliverig a objective ad comprehesive evaluatio of performace. More formal measures of quality assessmet could supplemet iformal feedback, ad should measure both teachig kowledge ad skills ad iterpersoal qualities. Those evaluatig teachig performace should themselves be prepared ad traied i assessmet methodology, especially i case of formal assessmets. A multi-faceted ad fair approach to evaluatig the quality of teachig ca idetify stregths ad weakesses ad allow teachig excellece to be rewarded or additioal traiig or remediatio to be provided where appropriate A umber of frameworks have bee suggested for evaluatig the effectiveess of teachig, which may be utilised by schools ad other educatio providers i additio to existig 3, 19, 21 methods. 59 Appraisal is a opportuity to review idividuals commitmet to the developmet of their teachig skills. Carryig out appraisal 60 While processes will vary betwee employers, appraisals of those with roles i teachig ad traiig should iclude the educatioal activities they udertake, as suggested i Tomorrow s Doctors (2009): 51. Appraisals should cover teachig resposibilities for all relevat cosultat, academic ad other staff, whether or ot employed by the uiversity. 4(b). NHS orgaisatios vii are resposible for esurig that performace of teachig resposibilities is subject to appraisal. 61 Depedig o their employmet status ad the proportio of their commitmets i academic ad cliical settigs, teachers ad traiers may be appraised by schools/uiversities or by other educatio providers. Educators employers work together to eable joit appraisals of both cliical ad educatioal activities, as agreed i the Cosultat Cliical Academic Cotract 2004 ad outlied i the Follett Review report. 22 If a represetative from the other employer caot be preset or a joit appraisal is ot appropriate, iformatio relatig to teachig or cliical performace should be sought from ad shared with the other party to eable whole practice appraisal ad miimise duplicatio The result of the teachig performace evaluatio ad 360 degree feedback, together with the teacher s persoal reflectio, should feed ito appraisal. The outcome should iform the educatioal elemets of the teacher s persoal developmet pla or ay other actio. This approach would eable schools to target traiig ad resources where there is most eed. Guidace uder review 63 I time, such arragemets will also support the revalidatio of medical teachers ad traiers. 13

15 Developig teachers ad traiers i udergraduate medical educatio Aexes Extracts o developig teachers ad traiers from Tomorrow s Doctors (2009) Domai 2 Quality assurace, review ad evaluatio Criteria 41 The medical school will have agreemets with providers of each cliical or vocatioal placemet, ad will have systems to moitor the quality of teachig ad facilities o placemets. Detailed requiremets ad cotext 51 There must be procedures i place to check the quality of teachig, learig ad assessmet, icludig that i cliical/vocatioal placemets, ad to esure that stadards are beig maitaied. These must be moitored through a umber of differet systems, icludig studet ad patiet feedback, ad reviews of teachig by peers. Appraisals should cover teachig resposibilities for all relevat cosultat, academic ad other staff, whether or ot employed by the uiversity. Domai 3 Equality, diversity ad opportuity Detailed requiremets ad cotext 58 Staff will receive traiig o equality ad diversity to esure they are aware of their resposibilities ad the issues that eed to be take ito accout whe udertakig their roles i the medical school. Domai 6 Support ad developmet of studets, teachers ad the local faculty Stadard 122 Everyoe teachig or supportig studets must themselves be supported, traied ad appraised. Criteria Detailed requiremets ad cotext: Support for educators 148 Medical schools must make sure that everyoe ivolved i educatig medical studets has the ecessary kowledge ad skills for their role. This icludes teachers, traiers, cliical supervisors ad assessors i the medical school or with other educatio providers. They should also make sure that these people uderstad Tomorrow s Doctors ad put it ito practice. The medical school must esure that appropriate traiig is provided to these people to carry out their role, ad that staff developmet programmes promote teachig ad assessmet skills. All staff (icludig those from other educatio providers) should take part i such programmes. 149 Every doctor who comes ito cotact with medical studets should recogise the importace of role models i developig appropriate behaviours towards patiets, colleagues ad others. Doctors with particular resposibility for teachig studets must develop the skills ad practices of a competet teacher ad must make sure that studets are properly supervised. Domai 7 Maagemet of teachig, learig ad assessmet Criteria 152 Teachers from the medical school ad other educatio providers will be closely ivolved i curriculum maagemet, represeted at medical school level ad resposible for maagig their ow areas of the programme. Guidace uder review 128 Everyoe ivolved i educatig medical studets will be appropriately selected, traied, supported ad appraised. Detailed requiremets ad cotext 156 Medical school teachers ad other educatio providers ad their staff should be ivolved i maagig their ow areas of the curriculum, ad should be represeted o medical school committees ad groups. 14

16 Developig teachers ad traiers i udergraduate medical educatio 157 The medical school must have agreemets with the other educatio providers who cotribute to the delivery of the curriculum. These should specify the cotributio, icludig teachig, resources ad the relevat curriculum outcomes, ad how these cotributios combie to satisfy the requiremets set out i Tomorrow s Doctors. Yvoe Steiert, Kare Ma, Agel Ceteo, Diaa Dolmas, Joh Specer, Mark Gelula ad David Prideaux, A systematic review of faculty developmet iitiatives desiged to improve teachig effectiveess i medical educatio: BEME Guide No. 8, Medical Teacher, Vol 28, No 6, 2006, pp Related documets Academy of Medical Educators, Professioal Stadards, 2009: aome/?likservid=567ede0b-155d-2b c1c72c7937f&showmeta=0 BMA Board of Medical Educatio, Doctors as Teachers, 2006: foudatio_traiig/doctorsasteachers. jsp?page=1 GMC, The Traiee Doctor, 2011: pdf GMC, Tomorrow s Doctors, 2009: tomorrows_doctors.asp Roald Harde ad Joy Crosby, The Good Teacher is More Tha a Lecturer: The Twelve Roles of the Teacher, Educatio Guide No. 20, AMEE, 2000 Higher Educatio Academy, The UK Professioal Stadards Framework for teachig ad supportig learig i higher educatio, 2006: uiversitiesadcolleges/accreditatio/ukpsf Local examples Selectig teachers ad traiers Aberdee medical school appoitmet of practice-based tutors Geeral practice attachmets take place i practices aroud Scotlad. GPs are appoited o the basis of quality criteria pertaiig to themselves as tutors ad their practices as teachig eviromets. Formal Uiversity status, as Hoorary (Seior) Cliical Tutors, ad as Accredited Teachig Practices, is awarded respectively, reviewable every two years. Machester medical school etwork of GP educatio facilitators The Health Educatio Zoe (HEZ) model is based aroud a teachig hospital ad its related PCTs localcotacts/ We have 22 GP educatio facilitators (GPEFs) coverig each PCT area withi our boudary ad oe who specialises i traiig for ST3s, support practices ad other tutor traiig requiremets should a GPEF be overloaded with other parts of their role. Most GPEFs work 2 sessios per week for us for which they are paid. I geeral, their role covers: Guidace uder review Michelle McLea, Fracois Cilliers ad Jacquelie M va Wyk, Faculty Developmet: Yesterday, Today ad Tomorrow, Guide No. 33, AMEE, 2010 QAA, Code of Practice for the assurace of academic quality ad stadards i higher educatio, updated i sectios: codeofpractice/ tutor recruitmet quality assurace of placemets icludig dealig with studet cocers ad complaits tutor traiig ad developmet all tutors are required by cotract to udertake 2 sessios of traiig per year so they all eed to ru traiig i their local HEZ 15

17 Developig teachers ad traiers i udergraduate medical educatio atted commuity HEZ meetigs at their base hospital with Commuity Based Medical Educatio (CBME) staff to update o progress ad discuss ay arisig matters atted 3 GPEF meetigs per year which eables us (MMS) to deliver traiig they may require ad have discussios aroud progressig commuity placemets ad curriculum issues (such as curriculum chages). Our mai area of focus this year is probably i the traiig of GP tutors. We are workig with MMS staff developmet to improve ad stadardise the traiig the GPEFs deliver to tutors through a more structured model which would hopefully meet the eeds of the tutors ad improve the studets experiece. We are also itroducig a peer appraisal system which will work towards their revalidatio process ad with more teachig fellows i place there will hopefully be a focus o developig the GPEF model tappig ito idividuals stregths, ad the developmet of the coectio betwee the GPEFs ad GP cosortia i Northumbria NHS Foudatio Trust selectio to cosultat teachig posts For formal Uiversity-liked posts, such as Seior Lecturers, we would always have a represetative of the Newcastle Medical School o the pael. For other Trust appoitmets which have a sigificat teachig commitmet, we have oe of our cliical academics. We have a expectatio that all of our cosultats will be traiers. But ow that we have established our ow iteral appraisal of educatio, there is a possibility that i the future, if quality or quatity of educatio delivery was ot satisfactory, some would have this removed from their job pla. This ties i with our system of teachig ad traiig ow beig explicit withi job plas. Our iterviews last for two days. O the first the cadidates complete two psychometric assessmets. The they take part i assessed cliical/teachig/ commuicatio scearios crafted for the particular post. The results of the Psychometrics ad Assessed Exercises are available to the iterview pael. The iterview questio domais will have bee allocated at the plaig meetig followig shortlistig. The weightig score for each competecy will also be agreed ad the questios plaed ad agreed. O the day of iterview, the questios may be modified depedig o the psychometric/assessmet iformatio or if the pael feel areas eed further exploratio or were ot fully aswered. At the ed, the scorig multipliers are applied ad a agreed pael score determied, icludig the scores from the scearios. Appoitmet is by rak order. We have adopted a rule that we do ot appoit if the score is less tha 70%. This system has performed extremely well. All of the cliical maagers feel they have a much better kowledge of the stregths ad weakesses of their ew colleagues ad we are able to tailor their post ad developmet ad support. Support ad recogitio NHS Educatio Scotlad (NES) joit workig across udergraduate ad postgraduate educatio NHS Educatio Scotlad (NES) established a Scotlad-wide Faculty Developmet Project. This had support of the Medical Schools, through the Scottish Deas Medical Educatio Group (SDMEG) ad the Scottish Postgraduate Deas, through the NES Medical Executive Team (MDET). These two groups are liked through the NES Medical Advisory Group. Guidace uder review Three years ago we decided to review our appoitmet system, put out a teder ad, workig with Edgecumbe Cosultig of Bristol, we established a set of competecies for a Northumbria Cosultat through a series of workig groups with a rage of medical ad ursig staff. All iterviews are agaist these competecies weighted for the characteristics of the post. A project pla has bee agreed, with four workstreams, ruig i parallel: Phase 1 to review ad sythesise existig literature ad develop teachig competecies for cosultats ad other teachers i Scotlad who 16

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