final framework of outcomes for intern training in … · 2015-11-20 · executive summary the...

1 DraftFramework:EndofInternship(Irl)DocDaingeanTeoranta,Galway

DraftFrameworkofOutcomesforInternTraininginIreland

Boland,J.O’Connor,P.,Offiah,G.,Byrne,D.

DocDaingeanTeoranta,Galway

CommissionedbytheMedicalCouncil

October2015

ExecutiveSummaryTheinternyearisthefirstyearofclinicalpracticefollowinggraduationfrommedicalschoolandisakeypointinthetransitionfromstudenttodoctor.Uponsatisfactorycompletionoftheinternyear,theMedicalCouncilissueaCertificateofExperienceandthisallowsprogressiontothegeneralorspecialisttraineeregister.InternshipisanimportantyearinthecontinuumofmedicaleducationandassurancesthataninternhasachievedcompetenciesrequiredtoprogresstothenextleveloftrainingarerequiredbytheMedicalCouncilandotherstakeholdersincludingtheinternnetworks,postgraduatetrainingbodies,patientsandthepublic.

In2009,withtheestablishmentofinterntrainingnetworksinIreland,theNationalInternTrainingProgrammewasdeveloped.TheNationalInternTrainingProgramme(2011)outlinesthecurriculum,standardsfortrainingandrequirementsforcertification.TheInternCurriculumisaccompaniedbyaNationalInternAssessmentFormcompletedbyclinicalsupervisorsandaligningwiththethreecoremodulesdescribedintheInternCurriculumdocument:(i)clinicaljudgment;(ii)professionaldevelopment;and(iii)communication.Atthetimeofwriting,internshiptraininginIrelandcanbebestdescribedasatimebasedapprenticeshipmodel.

TheinternyearrequiresreforminordertoalignitwithinternationalequivalentsandtoensurethattheissuingofaCertificateofExperience(CoE)isbasedontheachievementofaminimumlevelofcompetencytoensurepatientsafety.Competency-basedmedicaleducation(CBME)hasbeenadoptedinternationallytobringclarityandtransparencytoexpectationsregardingknowledge,skills,attitudesandthebehavioursnecessaryforeffectiveandsafepractice.Themovetowardsacompetencybasedframeworkisalsoaprerequisiteforcurriculumreformtoensurecomparabilityacrossinternnetworksintheeducationalexperienceandinworkbasedassessment,usingprocessessuchascurriculummappingandassessmentblueprinting.

HavingidentifiedtheneedforCBME,theprojecttodeviseadraftframeworkforoutcomesforinterntrainingwascommissionedbytheMedicalCouncil.Buildingonareviewofinterntrainingandanalysisofneedswithinthesectoranddrawingoninternationalpracticeandliterature,EntrustableProfessionalActivities(EPAs)wereadoptedastheorganisingframeworkforcompetenciesrequiredforeffectiveandsafepracticebyinternsinIrelandattheendoftheirtraining(seeAppendixE).

ThegroupingofcompetenciesintoanEPAframeworktranslateswellintoaone-yeartrainingprogrammeasitorganisescompetenciesintounitsofworkor“professionalactivities”.AnEPAisacoreunitofprofessionalpracticethatcanbefullyentrustedtoatraineeassoonasheorshehasdemonstratedthenecessarycompetencetoexecutetheactivityunsupervised.

TheseEPAsweredevelopedbyagroupofwell-informedstakeholdersandvalidatedbyalargergroup.TheseEPAswillrequirevalidationbyawidergroup.Beyondthescopeofthisreport,butrequiringconsideration,ishowdefinedcompetenciescanshapethedeliveryofanationaltrainingprogramme;howwecandeterminethatcompetencieshavebeenbeachieved;therolethatstakeholderswillhaveinenablinginternstoachievecompetenciesandhowthesestakeholderswillbesupported.Furthermore,significantinvestmentwillberequiredtosupporttheinfrastructureandinformationtechnologyrequiredtodeliveraworkinganduseablecompetencybasedframeworkthatcanmonitorinterns’progress,facilitatethecompletionofworkbasedassessmentsandsupportthecompilationofresults.

Contents

No. Section

1. Introduction 4

2. NeedsAnalysis-Ireland 5

3. AppraisalofReferenceSystemsforInternship 7

4. EntrustableProfessionalActivities 8

5. ProcessofDevelopingEPAsforEndofInternship(Irl) 13

6. ValidationProcess 17

7. ForConsideration 21

Bibliography

TeamBiographies

Appendices

A. TheNationalInternEducationandTrainingAgreement(NIETA)B. NationalInternAssessmentFormC. MedicalCouncilEightDomainsofGoodProfessionalPracticeD. EntrustableProfessionalActivitiesfromOtherContextsE. DraftFrameworkofEPAsforEndofInternship(Irl)

1. Introduction

1.1 Background:

Theinternyearisakeypointoftransitionfromstudenttodoctoralongthecontinuumofmedicaleducation.In2015,theMedicalCouncilisfocusingonthequalityofinterntraininginIreland.TheMedicalCouncil’s“YourTrainingCountsReport”of2014identifiedareasforimprovementintheinternyearandtheInternNetworksExecutiveiscommittedtocurriculumreformandthedeliveryofconsistent,qualityeducationandtrainingprogrammesacrossthenetworks.Anysubsequentreformofinterntrainingneedstobebasedonclearunderstandingofwhatistobeachievedanddemonstratedbythetraineeattheendofinternship.Clarityaroundthe“signing-off“processthatcurrentlyexistsisrequiredforqualityassuranceandfortheissuanceofaCertificateofExperience(CoE)bytheMedicalCounciluponsuccessfulcompletionoftheyear,enablingthetraineetoprogresstogeneralorspecialisttraineeregistration.

1.2 MedicalCouncilspecificobjectives:

ThisreporthasbeenpreparedattherequestoftheMedicalCouncil.Thespecificobjectiveswereto:

• EstablishandappraisethecurrentapproachtodefinitionoflearningoutcomesforinterntraininginIreland

• Appraiseapproachestooutcomesforinterntraininginasmallsetofnamed“reference”healthsystems(UK,NewZealand,Australia,CanadaandtheUS)

o includingthemerits[orotherwise]ofEntrustableProfessionalActivities(EPA)• Deviseadraftframeworkofoutcomesforinterntraining(Irl)

o makerecommendationsforimplementationo reasonableassurancethatdefinedoutcomeshavebeenachievedleadingtoissue

ofCoEbytheMedicalCouncil

1.3 Tenderbrief:

Inpreparingthisreport,theteamcarriedoutathoroughreviewofthedocumentsrelatingtostandardsandtrainingofinterns(orequivalent)intheIrishcontextandinternationally.Infulfilmentofthebrief,theteamdevisedadraftframeworkofoutcomesforinterntraininginIrelandtakingaccountof:

• goodpracticeinoutcome-basedmedicaleducationandtraining;• thecurrentstateofinterntraininginIreland;and• contextoftheIrishhealthsystem

Thisdraftreportissubjecttoconsultation,finalisationandimplementationbytheMedicalCouncil.

1.4 Overviewofphasesoftheproject:

Phase1: Carryoutaneedsassessmentofoutcomesforinterntraining

Phase2: Establishcompetenciesandoutcomes

Phase3: Makerecommendationsforimplementationandassessmentstrategies

Phase4: DesignafirstdraftframeworkforreviewinconsultationwithMedicalCouncil

Postproject:

Phase5: PrepareadraftframeworkfollowingreviewandconsultationbytheMedicalCouncil

Phase6: Consultation,recommendationsandimplementationbytheMedicalCouncil

2. Needsanalysis

2.1 Methodology:

Inperformingtheneedsanalysis,theteamperformedanextensivereviewofthecurrentIrishinternshipandNationalInternTrainingProgrammeandofsimilarsystemsfromotherjurisdictions,namelyUK,NewZealand,Australia,CanadaandtheUS,takingintoconsiderationthefollowingrequirements:

• AsetofcompetenciesisrequiredtoissueaCoE,acknowledgingthatitishighstakesandatraineecannotprogresstothespecialistorgeneralregisterwithoutit

• Aframeworkisrequiredforthedesignofo locallydevisededucationandtrainingprogrammeso workbasedassessment

• Aqualityassurancesystemisnecessaryforallstakeholders(MedicalCouncil,InternNetworks,clinicalandeducationalsupervisorsandpostgraduatetrainingbodies,patientsandthepublic)

• Atransparentmethodthatidentifiestraineeswhorequiresupportisrequiredforfeedbackanddocumentationpurposesandtoimplementremediation/extensionofinternshipasrequired

IndevisingaframeworkofoutcomesforinternshipinIreland,theframeworkmustalsotakeintoaccounttheimplementationrequirementsthatwillfollow:

• Theadministrationandmanagementofaconsistentnationalprogramme• Theprovisionoflearningopportunitiestoachievecompetencies• Themanpower,trainingandsupportrequiredtofacilitateworkbasedassessment• Thetimerequiredtoimplementsuchasystem• Theadditionalworkloaddemandsonclinicalandeducationalsupervisors• Thetechnologytosupportdesign,implementation,deliveryandassessment• Themechanismforprogrammereviewandadaptationtothechanginghealthcare

environment

2.2 Ireland–CurrentNationalInternTrainingProgramme(NITP)overview:

InIreland,internshipis12monthsandconsistsoffour3-monthrotations.TheeligibilitycriteriaforapplicationforinternshipinIrelandaredeterminedbytheDepartmentofHealth,HealthServiceExecutive(HSE)andNationalRecruitmentServiceHSE.Currentlythereare727one-yearinternpostsinsixInternNetworks(2015)centeredaroundthesixmedicalschools.EachInternNetworkisoverseenbyoneInternCoordinatorandinterntutors/lecturersateachtrainingsite.Mostinternrotationsareingeneralhospitals,withasmallnumberingeneralpractice(11)andafewinspecialisedunits(e.g.orthopaedics,rheumatology,psychiatry).

Uponcompletionofinternshipalistofnamedinternswhohavebeen“signedoff”(seebelowforprocess)bytheirinternnetworkissentbytheInternCoordinatorstotheMedicalCouncilwhothenissuetheCoEtotheinternsonthelist.

Atthetimeofwriting,internshiptraininginIrelandcanbebestdescribedasatimebasedapprenticeshipmodel.

Therequirementsandstandardsforinterneducationandtrainingareoutlinedinthefollowingdocuments:

• StandardsforTrainingandExperienceRequiredforGrantingofaCertificateofExperience2011(https://www.medicalcouncil.ie/Education/Career-Stage-Intern/Standards-of-training.pdf)

• GuidelinesforMedicalEducationandTrainingforInterns2011(https://www.medicalcouncil.ie/Education/Career-Stage-Undergraduate/Your-Questions-Answered/Guidelines-on-Medical-Education-and-Training.pdf)

• NationalInternTrainingProgramme(NITP)InternCurriculum2011(http://www.medicalcouncil.ie/Education/Career-Stage-Intern/National-Intern-Training-Programme-.pdf)

• TheNITPInternCurriculumisorganisedaroundtheMedicalCouncil’s8domainsofGoodProfessionalPractice(seeAppendixC),intothreemodules:

o clinicaljudgmento professionaldevelopmento communication

• TheNationalInternEducationandTrainingAgreement(NIETA)(seeAppendixA)is

signedbyeachinternatthebeginningofinternshipanditoutlinestheeducationalrequirements(prescribedcoursesandworkshopsthatmustbeattended,e.g.ACLS,proceduralskillstrainingworkshops)foreachinterntoachieve“signoff”bythenetwork.

2.3 Ireland–NationalInternTrainingProgramme(NITP)-Currentassessmentprocess:

ANationalInternTrainingProgrammeAssessmentForm(seeAppendixB)iscompletedbytheclinicalsupervisorattheendofeachrotationandsignedbytheinterntutor/coordinator.The

assessmentformrequirestheclinicalsupervisortorecordtheinternas“competent”or“requiringsupport”infiveareasbroadlyrelatedtotheMedicalCouncil’s8DomainsofGoodProfessionalPracticeandtheInternCurriculum’sthreemodules.

Insummary,therequirementsforaninterntobe“signedoff”attheendofinternshipandsubsequentlybeissuedwithaCoEbytheMedicalCouncilare:

• FoursatisfactoryNITPassessmentforms• Evidenceofattendanceatanetworks’prescribedrequirementsforteaching/courses

outlinedintheNIETAdocument

Currentlytherearenoe-portfolios,technologytosupporttheeducationalprogramme,centraladministrativeorganization/bodyorworkbasedassessmentsinuseandtheassessmentformsarepaperbased.

3.Appraisalofreferencesystemsforinternship

3.1 Referencesystems:

Specificinternationalsystemsandprogrammeswereidentifiedforappraisalinthetermsofreferenceforthisproject.Theywere:

(i) UnitedKingdom(FoundationProgrammeF1andF2)www.foundationprogramme.nhs.uk/

(ii) NewZealand(Pre-VocationalYear1)https://www.mcnz.org.nz/news-and-publications/prevocational-training/

(iii) AustralianInternshiphttp://www.amc.org.au/accreditation/prevoc-standards

(iv) Canadian(PGY1)Note:MDgraduatesproceeddirectlyintoresidencywithoutaninternshipstephttp://www.carms.ca/en/

3.1 Summaryoftheappraisalofthereferencesystems:

Theaboveprogrammesareofoneortwoyearsdurationandarecompetencybased.Outcomesandcompetenciesareclearlydefinedandaregroupedinavarietyofwaysforclarity.Therearebetween20(Australia)and397(UK)competenciesdefined.Thesecompetenciesaremappedtorolesordomainsdefinedbymedicalcouncilsorsimilargoverningortrainingbodies.Competenciescanbemapped,forexample,topredefineddomainssuchasscholarship,communication,professionalism,skills,safetyandmanagement.Allofthereferencedinternationalsystemshaveverydetailedprogrammeoperationaldocumentsinplacesuchasorganisationaldocuments,curriculumdocumentsandintendedoutcomesdocuments.Largeprogrammeoffices,operationalsupportsandstaffareinplacewithdefinedroles(i.e.programmeadministrators,clinicalsupervisors,educationalsupervisors,tutorsetc.)toadministeranddelivertheprogramme.Furthermore,theassociatedworkbasedassessmentprogrammeanddocumentationthatcomeswithacompetencybasedprogrammeissupported

byanITteam,programmeofficeandcomplexadministrativeplatforms;inmostcasesviaane-portfoliothatiscompatiblewithallmobiledevices.Theprogrammesarereviewedonaregular(annualorbiennial)basisandadjustedtoalignwithchanginghealthcaredemands.

4. EntrustableProfessionalActivities

4.1 EntrustableProfessionalActivitiesasaresponsetochallengesofimplementingcompetencybasedmedicaleducation:

Thetermsofreferenceforthestudydescribedinthisreportincludeappraisingapproachestooutcomesforinterntrainingincludingthemerits[orotherwise]ofEntrustableProfessionalActivities(EPA).

Competencybasedmedicaleducation(CBME)hasbeenadoptedinternationallytobringclarityandtransparencytoexpectationsregardingtheknowledge,skills,attitudesandbehaviournecessaryforeffectiveandsafepractice(Mulderetal,2010;Chenetal,2015).Competencybasedmedicaleducationhasbeendescribedasanapproachtopreparingphysiciansforpracticethatisfundamentallyorientatedtowardsgraduateoutcomesandabilities.Itisorganisedaroundcompetenciesderivedfromananalysisofsocietalandpatientneeds.Itde-emphasisestime-basedtrainingandpromisesgreateraccountability,flexibilityandlearnercentredness(Franketal,2010).Theprocessofimplementingacompetencybasedtrainingprogramme,however,hasprovedchallenginginternationally,becauseofdifficultiesintranslatingcompetenciesintopracticeandinthedesignofarobustassessmentsystem.

ChallengesassociatedwithimplementingCBME

• Competenciesareoftenverybroadlydefined• Sub-competencedescriptionsaretooanalytical• Riskoftick-boxapproachtoassessment• Riskofinstrumentalistlearning• Onerouslevelofpaperworkandbureaucracy• Disconnectednessfromclinicalpractice

ItisinthiscontextthattheconceptofEntrustableProfessionalActivities(EPAs)hasdevelopedandgainedgroundinrecentyearsinbothundergraduateandpostgraduatetraining(Aylwardetal,2014;EnglanderR.,2014,Gilhooltetal,2014;Rachid,2015).AnEntrustableProfessionalActivityisacoreunitofprofessionalpracticethatcanbefullyentrustedtoatraineeassoonasheorshehasdemonstratedthenecessarycompetencetoexecutetheactivityunsupervised(tenCate,O.etal,2015).EPAsaddresssomeoftheoperationalissuesassociatedwiththeimplementationofcompetencyframeworks.Themodelprovesintuitivetocliniciansasmuchoftheirworkcanbecapturedbytasksorresponsibilitiesthatcanbeentrustedtoindividuals,withdefinedlevelsofsupervision,fromnovicethroughtoindependentpractice.

EntrustableProfessionalActivities:

• aredescriptorsofwork(inaclinicalsetting),ratherthanattributesofadoctor

• requireintegrationofmultiplecompetenciesacrossarangeofdomains

• provideameansoftranslatingcompetenciesintoclinicalpractice

• involvestatingthelevelofproficiencyexpected• providethebasisforwork-basedassessment

4.2 RelationshipbetweencompetencyandEPAs:

TherelationshipbetweencompetencyandEPAshasbeensubjecttoconsiderablescrutiny.OneofthereferencesystemsreviewedforthisstudywastheAmericanAssociationofMedicalColleges(2014)“CoreEntrustableProfessionalActivitiesforEnteringResidency”.Agreeingaconceptualframeworkinvolvedgainingconsensusonshareddefinitionsfor:

1.Competency:Anobservableabilityofahealthprofessional,integratingmultiplecomponentssuchasknowledge,skills,valuesandattitudes.Sincecompetenciesareobservable,theycanbemeasuredandassessedtoensuretheiracquisition.

2.EntrustableProfessionalActivity(EPA):EPAsareunitsofprofessionalpractice,definedastasksorresponsibilitiesthattraineesareentrustedtoperformunsupervisedoncetheyhaveattainedsufficientspecificcompetence.EPAsareindependentlyexecutable,observableandmeasurableintheirprocessandoutcome,andarethereforesuitableforentrustmentdecisions.

ThedistinctionbetweenEPAsandcompetencieshasbeendescribedbytenCateasfollows:

Competencies EPA

PersondescriptorsKnowledge,skill,attitudes,values

WorkdescriptorsEssentialtaskinprofessionalpractice

e.g.Contentexpertise

CommunicationabilityManagementabilityProfessionalattitude

Scholarship

e.g.DischargeapatientCounselapatient

LeadafamilymeetingDesignatreatmentplanLeadaresuscitation

AnumberofwritershaveemphasisedthatEPAsandcompetenciesarenotmutuallyexclusive.Onthecontrary,EPAs,bydefinition,requiresuccessfulintegrationofarangeofcompetencies.Thesecompetenciesarebestassessedinthecontextofspecificperformance,asprovidedforby

anEPAframework.WhiletenCatesuggeststhatgeneralcompetenciesarethefocusofmostgoverningbodiesandeducationalleadersresponsibleforphysiciantraining,

“itisnotnecessarytochoosebetweencompetenciesandactivities.Rather,byacknowledgingthatbotharerelevantpiecesofthetrainingprocessandthateachrepresentsadifferentdimensionofthesameoverallobjectiveofprofessionaltraining,wecanreconciletheconceptsofcompetenceandclinicalpractice.”

tenCateandScheele,2007

Therelationshipbetweenunitsofwork(activities)andabilitiesofaperson(competencies)canbepresentedastwodimensionsofagridindicatingthealignmentbetweenEPAsandsuccessivegenericcompetenciese.g.clinicalskills,professionalismandscholarship.MostEPAsmapontomultiplecompetencies,reflectingtherealityandthecomplexityofprofessionalpractice:

EPA1 EPA2 EPA3 EPA4 Etc.

CompetenceA x x x

CompetenceB x x

CompetenceC x

Etc. x x

AligningEPAsandgenericcompetencies(e.g.elaboratedintheMedicalCouncilDomainsofGoodProfessionalPractice)provideameansofauditingwhereandtowhatextentcompetenciesarebeingdeveloped(andultimatelyassessed)inthetrainingprocess.

4.3 Entrustment:

TheconceptoftrustiscentraltoacompetencyframeworkbasedonEPAs.Traininginaclinicalenvironmentrequiresthatsupervisorsmakedecisionsabouthowmuchindependencetoallowtheirtraineesforpatientcaretasks.(Hauer,etal,2013).Internshiptraininginvolvesaffordingtraineesappropriateandprogressivelygreaterautonomyandresponsibility,whileensuringqualitypatientcare.Clarityaboutexpectations,boundaries,limitationsandexpectedlevelsofproficiencyarecentraltomakingreliableanddefensibledecisionsaboutcompetence.EPAscodifytheconceptoftrustbyelaboratingaseriesoflevelsofproficiencydescribedintermsoflevelofsupervisionrequired,asfollows:

Level Proficiency-levelof‘entrustability’

1Hasacquiredknowledgeandskills,butinsufficienttoperform;notallowedtoenacttheEPA

2Mayperformanactivityunderfull,proactivesupervisioninthesameroom;thesupervisordecidestheintensityofsupervision

3Mayperformanactivityunderqualified,reactivesupervision;thetrainee(intern)asksforsupervision

4Mayperformanactivityindependentlywithbackstage,mainlyinformalsupervision

5Mayprovidesupervisionandinstructiontojuniorlearners

4.4 Overviewofmeritsandlimitations:

TherelativebenefitsandlimitationsofEPAsandcompetencieshavebeensummarisedbytheAssociationofAmericanMedicalColleges(AAMC,2014)asfollows:

Buildingonourreviewofinterntrainingandanalysisofneedswithinthesector,anddrawingoninternationalpracticeandliterature,EPAswereadoptedastheorganisingframeworkforcompetencesrequiredforeffectiveandsafepracticebyinternsattheendoftheirtraining.Finally,oneofthepromisingfeaturesofanEPAapproachinanysinglecontext(e.g.enteringresidencyorinternship)isthepotentialithasforshapingrequirementsatpreviousandsuccessivestageswithinthecontinuumofmedicaleducationandtraining.ThisrelationshiphasbeenrepresentedbytheAAMC(2014)asfollows:

MakingexpectationsforinternshipinIrelandmoreexplicit,intermsofcoreEPAshasthepotentialforinformingexpectationsofundergraduateprogrammes.

5. DevelopingendofinternshipEPAsforIreland

5.1 AnEPAtemplate:

ThefirststageintheprocesswastodevelopabespoketemplatewithguidelinesforEPAdevelopers.DrawingonguidelinesfromtheinternationalliteratureandexistingpracticeinIreland,(tenCate,2014,tenCate,2015,AAMC,2014)anEPAtemplatefordevelopmentofEPAsatendofinternshipwasdraftedandrefined.

ComponentsofanEPA(SeeEPAtemplateforendofinternshipinAppendixE);

1. Title:ashorttitlewhichnamestheactivity

2. Description:anarrativeaccountoftheactivity,itsrangeandscope

3. Prerequisites:anyqualifications/experienceswhichneedtobeachieved/completedinadvanceofcommencingtheEPA

4. Competencies:therangeofcompetencieswhicharerequiredinordertobeabletoexecutetheactivity(categorisedintermsofbothtypeandlevel)

Typesofcompetencies:

Typesofnestedcompetencies

Description

Knowledge Requiredunderpinningknowledgewhichisappliedtotheperformanceoftheprofessionalactivity

Clinicalskills Genericandspecialty-specificclinicalskillsrequiredtocompletetheprofessionalactivity

Attitudes/behaviour Attributesandattitudesassociatedwithprofessionalcompetenciessuchasrelatingtopatients,communication,interpersonalskills,taskmanagement,collaboration,teamworking,situationawareness,decisionmakingandscholarship

Levelsofproficiency:Level ExpectedProficiency-levelof‘entrustability’

1Hasacquiredknowledgeandskills,butinsufficienttoperform;notallowedtoenacttheEPA

2Mayperformanactivityunderfull,proactivesupervisioninthesameroom;thesupervisordecidestheintensityofsupervision

3Mayperformanactivityunderqualified,reactivesupervision;theinternasksforsupervision

4Mayperformanactivityindependentlywithbackstage,mainlyinformalsupervision

5Mayprovidesupervisionandinstructiontojuniorlearners

5.2 ThemethodologyfordeveleopingdraftEPAsforendofinternship:

AfacilitatedworkshoponEPAdevelopmentwasheldinGalway(03July2015)bringingtogetherarangeofparticipantswithvaluable,importantandcomplementaryperspectivesonwhatisandwhatshouldbeexpectedatendofinternship.TheEPAworkshopparticipantswereasfollows:

• 4internsattheendofinternship• 3seniorhouseofficers• 2consultants• 1chiefacademicofficer• 2internnetworkcoordinators• 2medicaleducators• 1researchmethodologist• 1specialistregistrar

Stage1:DeterminingalistofEPAs;Whatinternsdo:

IdentifyingEPAsasappropriateandrelevantunitsofprofessionalpracticeisusuallycarriedoutasaniterativeprocessamongstprofessionals.Activities(unitsofwork)canbelargeorsmallandthereisno‘right’numberofEPAsforanycontext.TenCate(2015)suggeststhatEPAsshouldrepresentdiscretetaskswhicharesuitableforentrustmentdecisionsandshouldbeseperablefromotherEPAs.Thetitleshoulddescribetheactivityratherthaneducationalobjectivesandavoidanyreferencetoproficiencylevel(e.g.skillfullyadmitpatient)

Usingflexiblebrainstorming,rankingexercisesandconsensusbuilding,acoresetofEPAswereidentified(andsubsequentlyre-titled)forendofinternship,asfollows:

No. EPATitle Level

1 Admitapatient 4

2 Requestandinterpretinvestigations 4

3 Performbasicproceduralskills 4

4 Managetheworkofin-patientcare 4

5 Prescribeandmonitordrugsandfluids 4

6 Recogniseandmanagethedeteriorating/acutelyunwellpatient 4

7 Transitionanddischargepatientcare 4

8 Engageinpersonalandprofessionaldevelopment 4

9 Identifycompromisestopatients’care 4

Thislistwasgeneratedinagroundedmanner,drawingontheexperienceandexpertiseofparticipatingprofessionals.Followingtheworkshop,theEPAsandcompentencieswererefined

bythereportauthorsandauditedagainstthetwomostcomparableEPAframeworks(EPAsidentifiedbytheAAMCforendofresidencyandthepan-CanadianEPAsforendofclerkship-seeAppendixD).Morecommonalitiesthandifferencescanbediscerned.CertainAAMCEPAshavebeensubsumedwithinEPAsfortheIrishframeworke.g.competencesassociatedwithEPA10(AAMC)“obtaininginformedconsent”areincludedinEPA1(Irl)“admittingapatient”.

AllEPAsfortheendofinternshipinIrelandweredesignatedasLevel4,reflectingthelevelofresponsibilityaffordedi.e.internsshouldbeabletoperformtheactivitiesindependentlywithbackstage,mainlyinformalsupervision.

Stage2:DraftingindividualEPAs:

Smallgroupsof2-3participantsworkedoneachEPAtoprepareadraftincluding:

• EPAnarrativedescription• Competencies(knowledge,skillsandattitudes/behaviour)• Proficiencylevelforeachcompetence

SomecompetencieswithinindividualEPAsweredesignatedatalevelotherthanlevel4,whereappropriate;level3whereahigherlevelofsupervisionwasrequired(qualified,reactivesupervisionwheretheinternasksforsupervision)orlevel5whereitwasdeemedreasonabletoexpectinternstoprovidesupervisionandinstructiontojuniorlearnerse.g.medicalstudents.(seeAppendixEfordetailsofeachEPA.)

Stage3:AligningEPAswithMedicalCouncilDomainsofGoodProfessionalPractice:

AligningEPAsforendofinternshipandthegenericcompetencieselaboratedintheMedicalCouncilDomainsofGoodProfessionalPracticeprovidesameansofauditingwhereandtowhatextentcompetenciesarebeingdeveloped(andultimatelyassessed)inthetrainingprocess:

EPANo.

EntrustableProfessionalActivity

1 2 3 4 5 6 7 8

PatientSafetyandQualityofPatientCare

RelatingtoPatients

CommunicationandInterpersonalSkills

CollaborationandTeamwork

Managem

ent(includingSelf

Managem

Scholarship

Professionalism

ClinicalSkills

1 Admitapatient

xx xx x xx

2 Requestandinterpretinvestigations

xx xx xx x

3 Performbasicproceduralskills

xx xx xx x

4 Managetheworkofin-patientcare

xx xx xx

5 Prescribeandmonitordrugsandfluids

xx xx xx

6 Recogniseandmanagethedeteriorating/acutelyunwellpatient

xx xx xx

7 Transitionanddischargepatientcare

xx xx xx

8 Engageinpersonalandprofessionaldevelopment

xx xx xx

9 Identifycompromisestopatients’care

xx x xx xx

Code Indicates

Shading

XX Strong/explicitrelationshipwiththerelevantdomain(max3domains) xxX Weaker/implicitrelationshipwiththerelevantdomain(max2domains) x

Insummary,theoutcomeofthisprocesswasnineEPAsfortheendofintershipstructuredaroundinternworkandeducationalpracticesandalignedtoMedicalCouncildomains.EachEPAhasbetween11and18nestedcompetenciesdefinedbytype(knowledge,skill,attitude)andlevelofproficiency(1–5)wherelevel4wastheagreedlevelof“entrustability”forallEPAsattheendofinternship.

5.3 EPAsandcurriculumdevelopmentandassessment:

Finally,acomprehensiveapproachtodesignofatrainingprogrammeusinganEPA-basedcompetencyframeworkinvolvesaseriesofinterrelatedstepsasfollows:

1. Determiningtheworktobedone.Ø Describingtheactivity

2. Statingwhattrainees(interns)mustdemonstratebeforewecantrustthemtodothework.

Ø Identifyingcompetenciesassociatedwiththatactivity

3. Decidinghowtraineesshouldbepreparedtomeettheserequirements.

Ø Designingthecurriculum:whatkindofteachingandlearningopportunitiesneedtobeprovidedinordertoenabletraineestoachievetheEPA

4. Determininghowweassesstrainees’readinesstopassthethresholdofentrustment.

Ø DevelopingtoolsofassesmenttodetermineifEPAshavebeenachievedtorequiredlevelofproficiency

AgreementontherangeandcontentofEPAsforendofinternshipisanessentialprerequisitetothedevelopmentofaNationalInternTrainingProgrammewithaqualityassuredsystemofworkbasedassessment.Stages1and2above,however,havebeenthefocusofthisproject.

ThedescriptionandelaborationofanEntrustableProfessionalActivityshouldprovidesufficientinformationtofacilitaterobustanddefensibledecisionsaboutcompetenceoftrainees.Ultimately,withtheuseofappropriateworkbasedassessment,theassessorshouldbeabletouseEPAsforbothformativefeedbackandsummativedecisions.OptionsforprovidingfeedbackonEPAsincludeusinga‘trafficlight’systemtoindicate:

Competent Wherethetrainee(intern)hasachievedthecompetenciestothelevel

ofentrustabilityrequiredatendofinternshipNotthereyet Wherethetrainee(intern)ismakingappropriateprogresstowards

thelevelofentrustabilityrequired,butisnotthereyet.Notcompetent/causeforconcern

Wherethecompetencieshavenotbeenmetandyouhavecauseforconcernaboutthelevelofprogressbeingmadebythetrainee(intern)

N/A Notapplicable/Noopportunitytoassess

Note: Identificationofassessmentstrategiesisoutsidethescopeofthisproject

6. ValidationProcess

6.1 Overviewofvalidationprocess:

AnimportantpartoftheEPAdevelopmentprocesswasthevalidationoftheworkbyawidergroupofstakeholders.ThedraftEPAs,nestedcompetencies,typesofcompetenciesandlevelsofproficiencywerecirculatedelectronicallyin2separatesurveys,toworkshopattendees,interncoordinatorsandinterntutorsforcomment.EachofthesurveyswasaccompaniedbyashortexplainervideooutliningtheEPAframework,thedraftingprocessandwhatwasrequiredofeachstakeholder/respondentduringeachsurvey.

6.2 Surveyround1:

ThepurposeofthesurveywastoobtainfeedbackfromstakeholdersonthedraftframeworkofnineEPAsand124competenciesdevelopedattheworkshop.Theparticiantswereaskedwhether:

• theythoughteachofthenineEPAswasakeyactivitywhichaninternshouldbeabletoperformindependentlybytheendoftraining;

• anyoftheEPAswereinappropriate,andtheirreasonforthisopinion;• theythoughttherewasaneedforadditionalEPAs;• eachcompetencywasappropriatefortheEPAwithwhichithadbeenlinked;• anyofthecompetencieswereinappropriate,andtheirreasonforthisopinionand• theythoughtherewasaneedforadditionalcompetencies

Results: Atotalof9doctorscompletedthesurvey(2interns,2SHOs,2registrarsand3consultants)-3wereinternnetworkcoordinatorsandoneaninterntutor.

EPA%agreethatEPAisacorecompetency

%ofcompetenciesforwhich>90%ofrespondentsagreedshouldbeperformed

byanintern

1 Admitapatient 90.9% 85.2%

2 Requestandinterpretinvestigations 100% 100%

3 Performbasicproceduralskills 100% 81.4%

4 Managetheworkofin-patientcare 100% 88.2%

5 Prescribeandmonitordrugsandfluid 100% 82.3%

100% 84.6%

7 Transitionanddischargepatientcare 90.9% 54.5%

8 Engageinpersonalandprofessionaldevelopment 100% 100%

9 Identifycompromisestopatientcare 100% 100%

ItcanbeseenfromtheabovetablethattherewerehighlevelsofagreementfromthesurveyrespondentsthattheEPAswereappropriateforinterns.AdditionalEPAsthatweresuggestedincluded:

• Workaspartofateam• Abilitytoformclinicalquestionsthatwillaffect/improvepatientcare• Communicatingwithfamilies• Interdisciplinary/interprofessionalrelations• Presentandcommunicatewithinateamstructure• Capableofworkingwithinamultidisciplinaryteam

• Communicationwithfamily/nextofkin• Prescribing• Assesspatients’ongoingcareneeds

Summaryofcommentsoncompetencies;therewasalsobroadagreementwiththecompetencies:

• ForEPA1‘admitapatient’thefivecommentswereconcernedwithissuesregardingduplicationofcompetencies,thefactthatconsentshouldbelimitedtoparticularproceduresandthatprescribingshouldbeanindividualEPA.

• ForEPA3‘performbasicproceduralskills,’thesixcommentswerecentredonwhetherornottheinternhastheexpertisetoperformcertaintasks(e.g.‘shouldinternsbeabletodoalumbarpuncture?’;‘Idon'tthinkinternsshouldbeinstigatingNIVwithoutsenior/anaestheticinput’).

• ForEPA4‘managetheworkofin-patientcare,’thethreecommentswereconcernedwiththefactthattheinternwasunlikelytoleadawardround(e.g.‘seniormemberofteamshouldleadround’).

• ForEPA5‘prescribeandmonitordrugsandfluid,’thethreecommentswereconcernedthatnon-invasiveventilation(NIV)wasaskillthataninternwouldnotbeexpectedtocarryout(e.g.‘NIVisunlikelytobeatanindependentskilllevel’).

• ForEPA6‘recogniseandmanagethedeteriorating/acutelyunwellpatient,’thethreecommentswereconcernedwithpatienttransferbeingtheresponsibilityofmoreseniormembersofstaff(e.g.‘seniormemberofstaffshouldbeinvolvedintransferofpatient’).

• ForEPA7‘transitionanddischargepatientcare,’thethreecommentswereconcernedwithissuesaroundlimitingtheroleoftheinternaroundpatientdeath(e.g.‘notappropriateforinterntoberingingthecoronerorarrangingpost-mortem’).

• NocommentsweremadeonthecompetenciesfortheremainingtwoEPAs(‘engageinpersonalandprofessionaldevelopment’and‘identifycompromisestopatientcare’).

Basedupontheresponsestothissurvey,someamendmentsweremadetotheEPAsbutnoadditionalEPAswereincluded.Theamendmentsmadeincludedaddingsomeadditionalcompetenciesandalterationstosometerminologyandthelevelsofproficiency.

6.3 Surveyround2:

Thepurposeoftheroundtwosurveywastoobtaininformationfromstakeholdersontheclassificationofthetypeandlevelofcompetenciesmadebytheresearchteam,foreachofthe129competenciesintherevisedframework.Eachcompetencywasclassifiedasoneormoreofthefollowingtype(s)ofcompetency:

• Knowledge:Requiredunderpinningknowledgewhichisappliedtotheperformanceoftheprofessionalactivity

• Clinicalskills:Genericandspecialty-specificskillsrequiredtocompletetheprofessionalactivity

• Attitudes/behaviours:Attributesandattitudesassociatedwithprofessionalcompetenciessuchasrelatingtopatients,communication,interpersonalskills,task

management,collaboration,teamworking,situationawareness,decisionmakingandscholarship

Eachcompetencywasalsoclassifiedatoneoffivelevels(seelevelsofproficiencytablepage13).Forexample,thecompetency‘establishrapportwithpatient’wasclassifiedasanattitudinalcompetencyatlevel4(mayperformanactivityindependentlywithbackstage,mainlyinformalsupervision).

Therespondentswerepresentedwiththeclassificationofthetypeofcompetencyandlevelandaskedwhethertheyagreedordisagreedwiththeopinionsoftheresearchteam.Iftheydisagreed,theywereaskedtoprovideamoreappropriateclassificationoftypeand/orlevel.

Results:Atotalof10doctorscompletedthesurvey(2interns,2SHOs,4registrars,and2consultants).Oftheserespondents,2wereinternnetworkcoordinators,and1aninterntutor.ThetablebelowshowsthepercentageoftherespondentswhoagreedwiththeproficiencyandratingofthetypeofcompetencyineachEPA.Itcanbeseenfromthetablethatthelevelsofagreementbetweentheratingscarriedoutbythebrainstorminggroupandthestakeholderswasrelativelyhigh.Anycommentsthatweremadebytheparticipantsgenerallyreferredtoaddinganothertypeofrating,and/oradjustingthelevelupordownonelevel.

EPA %ofrespondentwhoagreedwithalloftheproficiencyratingsofthe

competenciesintheEPA

%ofrespondentwhoagreedwiththeratingsofthetypeofcompetency

ineachEPA

1 Admitapatient 83.3% 58.3%

2 Requestandinterpretinvestigations 90.9% 90.9%

3 Performbasicproceduralskills 72.7% 81.8%

4 Managetheworkofin-patientcare 70.0% 90.0%

5 Prescribeandmonitordrugsandfluid 90.0% 90.0%

90.0% 90.0%

7 Transitionanddischargepatientcare 100.0% 90.0%

8 Engageinpersonalandprofessionaldevelopment 90.0% 90.0%

9 Identifycompromisestopatientcare 80.0% 90.0%

7. ForConsideration

Thegoalofthisprojectwastodeviseaframeworkofoutcomesforinternship.Thisreportrepresentsadraftofapotentialframeworkdevelopedinconsultationwithasmallgroupofwellinformedstakeholders.Whileaoneyearinternshipprogramme,wheretheinternhasawelldefinedrole,lendsitselfwelltoCBMEorganisedasanEPAframework,theimplementationofthiswillrequireconsiderablebuy-inandresources.

Firstly,thereisaneedforcommentandfeedbackfromawiderrangeofstakeholdersbeforeadoptinganEPAframeworkforinterntraining.UponagreementofEPAsandcompetenciesforinternship,thenextstepwillbetoseehowthiscanshapethedeliveryofaNationalInternTrainingProgrammethatiscomparableacrossallnetworks.ThisrequiresconsiderationofhowlocalproviderscanbesupportedinthedesignoftrainingprogrammestoensureinternshaveappropriatelearningexperiencestoenablethemtoachievethenestedcompetenciesforeachEPA.Further,thekindsofteachingandlearningopportunitiesrequiredandtobeprovidedtoalignwithcompetencieswillrequirediscussionandinvestment.

Inadditiontoobtainingabroadlevelofagreementfromstakeholders,therearegovernanceimplicationswhenadoptingacompetencybasedEPAframework.TheMedicalCouncilasthegoverningbodywillhavetoconsiderhowthisframeworkmightbeusedasafoundationforstandards,trainingandworkbasedassessment.

Tobeassuredthatcompetenciesareachievedrequiresrobustworkbasedassessmenttoolsandconsiderationshouldbegiventothedevelopment,useabilityandalignmentofthesewithEPAsandcompetencies.Thedevelopmentofthesewilltaketimeandconsultationandiftheyaretobeused,theymustbefitforpurpose,appropriatelytimedandaccessibleonmobiledevices.

Theinternsthemselvesarestakeholdersandwillbeexpectedtohavesomeresponsibilityforengaginginandseekinglearningopportunitiesandworkbasedassessment.

Theroleofkeystakeholdersintheimplementation,organisationanddeliveryofacompetencybasedprogrammethatincludesworkbasedassessmentneedstobeclear.Thetrainingandinfrastructurerequiredtosupportthemisacriticalpartofimplemetation.TherolesoftheHSENationalDoctorsTrainingandPlanning,theInternNetworksExecutive,interncoordinators,clinicalandeducationalsupervisorsandinternadministratorsneedtobedefinedandsupported.Additionaladministrativeandorganisationalstaffwillberequiredandconsiderationshouldbegiventoanationalprogrammeoffice.

Theresourcingofinformationtechnologyisrequiredtofacilitateinternsandsupervisors.Toillustrate,someinternationaltrainingbodieshavedevelopedelectroniclogbooks,portfoliosandmobiletechnologytosupportbothsupervisedlearningactivitiesandworkbasedassessment.

Insummary,thedevisingofadraftframeworkofcompetencybasedtrainingforinternshipisnotsomethingthatcanbedoneinisolation.Thereneedstobeconsiderationgiventoteachingandlearningopppotunitiesandtheworkbasedassessmentthatwillfollow.Moreover,theimpactofthisonallstakeholders,theresourcesandeducationalsupportsrequiredandthegovernanacestructuresnecessarytoensuredeliveryoftheprogrammeareequallyimportantelements.

TeamBiographies

DocDaingeanTeorantaisahealthcaresolutionscompanybasedinGalway.Thefollowingteammemberswerecontractedtofulfilstrategicprojectroles.Dr.DaraByrneFRCSI,MCh,MMedEd,CHSEDrByrneistheprojectlead.SheisCEOofDocDaingeanTeorantaandInternCoordinatorfortheWestNorthwest InternNetwork.She isaSeniorLecturer inMedicalEducationatNUIGalwayandDirectorofSimulationfortheSaoltaUniversityHealthCareGroup.Shehasauthoredover50conferencepapersandpublicationsintheareaofinterneducationandtraining.Dr.JosephineBolandPhDDrJosephineBolandisanindependentmedicaleducationalistandresearcher,withaDoctorateinEducation(EdinburghUniveristy)andoverthirtyyearsexperienceinfurther,higher,teacherandmedicaleducation.Shespecialisesincurriculumdevelopment,assessmentdesign,qualityassuranceandfacultydevelopment.AsSeniorLecturerinEducationintheSchoolofMedicine,NUIGalway(2011-2015)shewasdirectoroftheMastersinClinicalEducationandacademicleadforcurriculummappingandtechnologyenhancedlearning.AsmedicaleducationalistwiththeCollegeofAnaesthetists(2014-present)shesupportsthedevelopmentandimplementationofacompetencybasedcurriculumandworkbasedassessment.

Dr.GozieOffiahFRCSI,MMedEdDr. Offiah is a Senior Clinical Lecturer in Surgery in the RCSI, Dublin. Dr. Offiah studied atQueen’s University Belfast and was awarded a Masters in Medical Education. She is internlecturerintheDublinNorthEastInternNetwork.Asafulltimemedicaleducationalist,sheisamemberofthecurriculumreviewcommitteeintheundergraduateprogrammeinRCSIandalsoinvolved in the development of a competency based curriculum for the Human Factors inPatientSafetyprogrammedeliveredintheNationalSurgicalTrainingCentre.Dr.PaulOConnorPhDDr.PaulO’Connor isaLecturer inPrimaryCare inNUIGalwayandaResearchMethodologist.He has a Ph.D. in Psychology from the University of Aberdeen,M.Sc. in ResearchMethods inPsychologyfromtheUniversityofStrathclyde,ScotlandandB.Sc.(Hons)inPsychologyfromtheUniversity of Aberdeen, Scotland. His research is concerned with improving humanperformanceandsafetyinhighriskworkenvironments.Hehascarriedoutresearchinawiderangeofhighriskindustriesandthemilitary.Morerecentlyhehasbeencarryingoutresearchinhealthcarewithinterns.

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AppendixATheNationalInternEducationandTrainingAgreement(NIETA)

NationalInternEducationandTrainingAgreement

(Forperiod13July2015to10July2016)

InternName: XXXXXXXXXXXX

TrainingProgramme: NationalInternTrainingProgrammeInternTrainingNetwork: AdministrativeBody: InternNetworkCoordinator: TrainingPeriod: 13July2015–10July2016TrainingPostNumber: XXXXXXMedicalCouncilRegistrationNumber: Manycongratulationsonyourgraduationandwelcometothemedicalworkforce.Mostdoctorshavegoodandhappymemoriesoftheirinternshipyearandhopefullyyourexperiencewillbenodifferent.InsigningthisNationalInternEducationandTrainingAgreement(NIETA)youandtheschoolofMedicine,NUIG(theadministrativebodyfortheWestNorthwestInternTrainingNetwork)committotheeducationandtrainingprinciplescontainedtherein.EachInternisbeingaskedtosigntheagreementatthecommencementofinternship.InternswhohavecompletedsomeinternshippriortoJuly2015arerequiredtosigntheNIETAinrespectofthedefinedperiodoftrainingremaining.PleasenotethatthisNIETAdoesnotrelatetoemploymentmatters,whicharegovernedbytheNCHDContract2010,betweentheInternandtheirindividualemployer(s).InternsshouldconsulttheNationalInternTrainingProgramme(NITP):EducationandTrainingintheInternYear,approvedbytheMedicalCouncilinMay2011,,andrevisedinMay2012,whichoutlinestheprofessionalcompetencerequirementsforinterns.TheNITPisappendedtothisAgreementinAppendixA.TheInternNetworkCoordinatorscoordinatetheirresponsibilitiesonanationalbasisthroughtheInternNetworksExecutive(INE)establishedin2011.TheINE,incollaborationwiththeCouncilofDeansfortheMedicalSchoolsinIreland(CDFMSI),ensuresthatthereisacoordinatedapproachtointeractionwiththosebodieshavinganinterestandresponsibilityintheprovisionofmedicaleducationandtrainingincludingtheMedicalCouncil,theHealthServiceExecutive,theForumof

PostgraduateTrainingBodiesandtheDepartmentofHealth&Children.TheInternNetworksExecutivemeetsatleastsixtimesperannum.TheWestNorthwestInternTrainingNetworkisresponsiblefortheprovisionandcoordinationofthistrainingprogrammeandisaccreditedbytheMedicalCouncil(ofIreland)forthispurpose.IntheWestNorthwestInternNetwork,NUIGisthebodyresponsiblefortheadministrationoftheprogramme.EachInternTrainingNetworkisledbyaconsultant-gradeInternNetworkCoordinatorwho,incollaborationwiththeInternTutors,isresponsibleforoverseeinginterntrainingintheirNetwork.ThecontactdetailsfortheInternNetworkCoordinator,theInternTutorsandtheAdministrativeofficeintheWestNorthwestInternNetworkareprovidedinAppendixB.The12-monthinternshipintheWestNorthwestInternTrainingNetworkcomprises4x3-monthrotationsTheWestNorthwestInternTrainingNetworkiscommittedtosupportingyouthroughouttheyear.Ifdifficultiesdoariseyoushouldseeksupport,inthefirstinstance,fromyourdesignatedspecialistTrainer,nextyourInternTutorand,ifnecessary,theInternNetworkCoordinator.ThepurposeofinterntrainingistoeducateandtrainthenewlyqualifiedmedicalgraduatetoalevelwhichwillleadtobeingawardedaCertificateofExperiencebytheMedicalCouncilofIreland.Thegrantingofacertificateofexperienceisdependentontheinternsatisfactorilycompletingtheeducationandtrainingprogramme.TheInternNetworkCoordinatorwillrecommendinternstotheMedicalCouncilfortheawardoftheCertificateofExperiencebasedontheintern’sprogressionthroughtheInternTrainingProgramme,includingthecompletionofmandatoryandothertrainingelementsandthecompletionofassessmentstotherequiredstandardasoutlinedbelow.TheissuanceoftheCertificateofExperiencebytheMedicalCounciltestifiesthattheInternhassatisfactorilycompletedtheInternTrainingProgramme.Theareasthatwillbeincludedintheassessmentofeachintern’soverallperformanceinclude:

1. Attendingthe5/7-dayinductionprogrammeinGalwayUniversityHospital(GUHs),GalwayClinic,BonSecoursHospitalorinSligo.Letterkenny,Mayo,RoscommonorPortiunculaHospitalspriortocommencinginternship.Thedetailsofthiswillbesenttoyouatthetimeofjoboffer.Theface-to-faceinductionismandatoryandincludesmanualhandling,occupationalhealthappointmentandspecifictraining.AllinternsintheWNWwillberequiredtocompleteanonlineinductionprogrammePRIORtotheface-to-aceinduction–thelinktothiswillbesenttoyouatthetimeofjoboffer.

2. Achievinga70%attendancerateatthededicatedintern-specificlunchtimeteachingsessions.Thetimingandnumberofthesesessionsinanyone-weekvaryfromsitetosite.IntheWestNorthwestNetworktheyareeveryMonday,TuesdayandWednesdaybetween1pmand2pmandarevideo-conferencedtoallsitesinthenetwork.Asigninsheetisinoperation.

3. Attainingcompetencyinthe8DomainsofGoodProfessionalPracticeandcapturedintheInternAssessmentForm(acopyofwhichisprovidedinAppendix4oftheNationalInternTrainingProgrammealreadyreferredtoinAppendixAbelow).

4. Acquiring sign-off, to thegreatestpossibleextent, in thedomainsdetailed in theNationalInternTrainingProgramme(seeAppendixA);theyinclude:

a. ClinicalJudgementi. ClinicalHistoryandExaminationii. ClinicalSkillsiii. InfectionControliv. ManagingtheAcutelyIllv. Prescribingvi. ContinuousLearning

b. Communicationi. Patientconfidentialityii. ClinicalNoteTakingiii. InformedConsent

c. ProfessionalDevelopmenti. UnderstandthelegalframeworkformedicalpracticeinIrelandii. RegistrationwiththeMedicalCouncilofIrelandiii. ProfessionalApproachiv. Maintainingcompetencev. Ensureappropriateprofessionalindemnityvi. DisciplinaryActionvii. Adheretohighethicalstandardsviii. CompletionofFormalDocumentsix. Developaninformedcareerplanx. EnhanceTeamworkSkillsxi. RecogniseLimitationsandManageStress

5. CurrentcertificationinBasicLifeSupport(BLS)6. AttainingcertificationinAHA/IHFapprovedAdvancedCardiacLifeSupport(ACLS)-tobe

completedatinduction.7. CompletionandcertificationofattendanceattheEarlyWarningScoringSystemcourse

(COMPASS)–theacutemedicalemergencyrecognitionandtreatmentworkshopscurrentlybeingrolledoutthroughoutthecountry.

8. Currentcertificationinamanualhandlingcourse,orcertificationwithin6monthsofemployment

9. EvidenceofsatisfactoryparticipationintheOn-LineNationalInternEducation&Trainingprogramme.TheClinicalJudgementmoduleofthiseLearninginitiativethatincludestutorialsandMCQscoveringthe6headingsoutlinedin4(a)abovearecompleted.ThisOn-LineeducationtoolwillbeavailabletoALLinternsnationwide;eachwillhavetheirownuniqueaccesscode.Participationwillformpartofeachintern’soverallassessmentattheendoftheyear.

10. DetailedinAppendixCareadditionaltrainingcourses/workshopscurrentlybeingprovidedbysomebutnotallInternNetworks.ParticipationintheseeducationalactivitiesismandatoryforInternsaffiliatedtotheseNetworks.AsthenationalprogrammeevolvesandtherequiredfundingismadeavailableitisintendedthatALLInternswillhaveaccessthesetrainingworkshops,regardlessofNetworkbase.

11. Satisfactoryattendanceintheworkplace,withnounexplainedperiodofabsenteeism.12. AsaninternYOUareresponsibleforensuringthattheInternAssessmentFormis

completedandsignedbythesupervisingconsultantandyouattheendofeachrotation.YOUarealsorequiredtobringthisformtotheInternTutorinyourclinicalsiteforreviewandfinalsign-off.IntheWestNorthwestInternTrainingNetworkyouwillhaveaminimumof4InternAssessmentFormstocompleteduringyour12-monthinternship.FailuretocomplywiththisrequirementwilldelayprocessingyourfullregistrationwiththeMedicalCouncil.

I(printnameinBLOCKCAPITALS),............................................................................,agreetoaccepttheconditionsoutlinedabove,formyperiodofinternshipinWestNorthwestInternNetworkSigned:__________________________ Date:______________________________Signed:__________________________ Date:________________________________ InternNetworkCoordinator

AppendixBSampleofCurrentInternAssessmentForm

AppendixC

MedicalCouncilEightDomainsofGoodProfessionalPractice

1. PatientSafetyandQualityofPatientCarePatientsafetyandqualityofpatientcareshouldbeatthecoreofthehealthservicedeliverythatadoctorprovides.Adoctorneedstobeaccountabletotheirprofessionalbody,totheorganisationinwhichtheywork,totheMedicalCouncilandtotheirpatients,therebyensuringthepatientswhomtheyservereceivethebestpossiblecare.

2. RelatingtoPatientsGoodmedicalpracticeisbasedonarelationshipoftrustbetweendoctorsandsocietyandinvolvesapartnershipbetweenpatientanddoctorthatisbasedonmutualrespect,confidentiality,honesty,responsibilityandaccountability.

3. CommunicationandInterpersonalSkillsMedicalpractitionersmustdemonstrateeffectiveinterpersonalcommunicationskills.Thisenablestheexchangeofinformation,andallowsforeffectivecollaborationwithpatients,theirfamiliesandalsowithclinicalandnon-clinicalcolleaguesandthebroaderpublic.

4. CollaborationandTeamworkMedicalpractitionersmustco-operatewithcolleaguesandworkeffectivelywithhealthcareprofessionalsfromotherdisciplinesandteams.He/sheshouldensurethatthereareclearlinesofcommunicationandsystemsofaccountabilityinplaceamongteammemberstoprotectpatients.

5. Management(includingSelfManagement)Amedicalpractitionermustunderstandhowworkinginthehealthcaresystem,deliveringpatientcareandotherprofessionalandpersonalactivitiesaffectotherhealthcareprofessionals,thehealthcaresystemandwidersocietyasawhole.

6. ScholarshipMedicalpractitionersmustsystematicallyacquire,understandanddemonstratethesubstantialbodyofknowledgethatisattheforefrontofthefieldoflearningintheirspecialty,aspartofacontinuumoflifelonglearning.Theymustalsosearchforthebestinformationandevidencetoguidetheirprofessionalpractice.

7. ProfessionalismMedicalpractitionersmustdemonstrateacommitmenttofulfillingprofessionalresponsibilitiesbyadheringtothestandardsspecifiedintheMedicalCouncil’sGuidetoProfessionalConductandEthicsforRegisteredMedicalPractitioners.

8. ClinicalSkillsThemaintenanceofprofessionalcompetenceintheclinicalskillsdomainisclearlyspecialty-specific,andstandardsshouldbesetbytherelevantpostgraduatetrainingbody,accordingtointernationalbenchmarks

AppendixD

EntrustableProfessionalActivitiesfromOtherContexts(i) AssociationofAmericanMedicalColleges(AMMC)–forenteringResidency

1. Gatherahistoryandperformaphysicalexamination

2. Prioritizeadifferentialdiagnosisfollowingaclinicalencounter

3. Recommendandinterpretcommondiagnosticandscreeningtests

4. Enteranddiscussordersandprescriptions

5. Documentaclinicalencounterinthepatientrecord

6. Provideanoralpresentationofaclinicalencounter

7. Formclinicalquestionsandretrieveevidencetoadvancepatientcare

8. Giveorreceiveapatienthandovertotransitioncareresponsibility

9. Collaborateasamemberofaninterprofessionalteam

10. Recognizeapatientrequiringurgentoremergentcareandinitiateevaluationandmanagement

11. Obtaininformedconsentfortestsand/orprocedures

12. Performgeneralproceduresofaphysician

13. Identifysystemfailuresandcontributetoacultureofsafetyandimprovement

(ii) DraftPanCanadianEntrustableProfessionalActivities(EPAs)–forendofClerkship

1. Gatherahistoryandperformaphysicalexaminationadaptedtothepatient'sclinicalsituation

2. Prioritizeadifferentialdiagnosisfollowingaclinicalencounter

3. Formulateaninitialdiagnosticplanbasedonthediagnostichypothesis

4. Interpretresultsofcommondiagnosticandscreeningtests,communicatetopatientandtheteam

5. Formulateorders,prescriptionsandmanagementplansandbeabletoexplainthosetopatients,colleaguesandmembersofthehealthcareteams

6. Report(writtenandoral)onaclinicalencounteranddocumentinthepatientrecord

7. Giveorreceiveapatienthandovertotransitioncareresponsibilityinsimpleandcommonclinicalsituations

8. Recognizeapatientrequiringurgentoremergentcareandseekappropriatehelp

9. Communicatedifficultorbadnewstopatient/familyinasimplecontextofcare

10. Disclosemedicalerrorstothemedicalteam

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