framework for specialty training – the gold guide professor shelley heard incoming director of...
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Framework for specialty training – the
Gold Guide
Professor Shelley Heard
Incoming Director of Training and Standards
RCPath
19th October 2007
The Gold Guide
setting the context describing the process gaining consensus key changes process for amendment the future
The context (1) need to respond to policy change set out by
Modernising Medical Careers (2003)
Orange Book needed up-dating and “modernising” to reflect change from specialist training to specialty training
Orange Book described specialist training as set out by STA and JCPTGP
Gold Guide describes specialty training to approved curricula, agreed by the Postgraduate Medical Education and Training Board (PMEB)
The context (2) Four Health Departments
Commissioned by UK Strategy Group (4 CMO Group)
editor and 4 HD officials supported by stakeholder reference group
recognise transitional arrangements for those already in SpR (specialist) training and those who would be entering specialty (ST) training
not about terms and conditions so no mention of pay, extension of contracts (“period of grace”), study leave arrangements
Reference Group
Academy of Medical Royal Colleges
Academy Trainee’s Doctors’ Group
BMA – JDC COPMeD COGPED GMC
NHS Employers Patient representative PMETB Service stakeholders
from four devolved administrations
Workforce Review Team
The Process DH document iterative with reference group and their stakeholders (at
least 3 iterations) detailed responses from reference group –e.g. Academy,
COPMeD, PMETB, Academy trainees, JDC, NHS Employers and others
expert input from PMETB, educationalists from 3 Royal Colleges
workshop with health department officials from devolved administrations – acceptable to DH
legal review 4 DH review Ministerial sign-off
Gaining consensus – was it successful?
considerable task hard to know in current climate not always agreement amongst constituencies a bit of who shouted loudest stay within regulatory framework political environment
Specialty training as a specialty registrar (StR)
Becoming a ST
Progressing as a ST
Being an ST and an employee
Becoming a StR
recruitment issues being dealt with as 2008 and then 2009 and beyond
NTNs – for all those in run-through programmes, not FTSTAs
flexible training arrangements – competitive entry; ad personam programmes; achieve competences and minimum time required
academic training in integrated programmes taking time out of programme (OOP) inter-deanery transfers
Out of programme
Time out of programme for approved clinical training (OOPT)
Time out of programme for clinical experience (OOPE)
Time out of programme for research (OOPR)
Time out of programme for career breaks (OOPC)
Inter-deanery transfers
process has evolved and has been agreed by postgraduate deans
no automatic right well-founded reasons capacity in programme significant change since appointment may require an interview since will be
competition for available places NTN from receiving deanery
Progressing as an StR
underpinned by appraisal, Annual Review of Competence Progression (ARCP), annual planning
progression defined through assessment strategy in curriculum assessment is a formal process which assesses progress
through the curriculum measured using a range of defined/validated assessment tools
and triangulated judgments formal process resulting in an Outcome based on available written evidence, especially from structured
report from educational supervisor which summarises assessment evidence
trainee should not normally attend unless problems anticipated
EducationalAppraisal
Review of Competence Progression
Outcome
Annual Planning
1. Learning agreement:aims & intended learning outcomesbased on specialty curriculum
2. Advice on portfolio3. Regular feedback (2 way)4. Personal Development Plan5. Trainer’s structured report6. Workplace based (NHS) appraisal
Educational supervisor and/or TPD meet with trainee to
review competence outcome with trainee plan next part of training
Based on paper from PBETB workplace assessment group (2005)
Workplace based (NHS)
appraisalARCP
A. Evidence1. Assessment of performance e.g
workplace based assessments and observational methods eg mini-CEX, DOPS, video,CBD examinationsstructured report
2. Assessment of experience, e.g.portfolio/log bookauditresearchcritical incidents
B. Annual Competence Review Appropriately constituted panel considers evidence
Outcome
•Review of evidence of progress•Outcome of review•Educational Planning
The Annual Review of Competence Progression Gold Guide, 2007
Purpose of ARCP provide a for recording the evidence of the trainee’s progress
within the training programme or in a FTSTA provide a means whereby the evidence of the outcome of formal
assessment, through a variety of PMETB agreed in-work assessment tools and other assessment strategies, including examinations, are coordinated and recorded to provide a coherent record of a trainee’s progress
provide a mechanism for the assessment of out of programme clinically approved training
to make judgements about the competences acquired by a specialty trainee and their suitability to progress to the next stage of training if they are in a training programme, or to document the competences achieved ay a trainee in a FTSTA
provide a final statement of the trainee's successful attainment of the competences for the specialty and thereby the completion of the training programme.
Annual Review of Competence Progress (ARCP) - Outcomes
Satisfactory Progress1. Achieving progress and the development of competences at the expected rate
Unsatisfactory or insufficient evidence – trainee required to meet with thePanel (Outcomes 2, 3, 4)2. Development of specific competences required – additional training time not required3. Inadequate progress by the trainee – additional training time required4. Released from training programme with or without specified competences 5. Incomplete evidence presented – additional training time may be required
Recommendation for completion of training6. Gained all required competences; will be recommended as having completed the training programme and for award of a CCT or CESR/CEGPR Outcomes for trainees in FTSTAs, out of programme, or undertaking “topup” training within a training Programme 7. Outcome for Fixed-term Specialty Trainee (FTSTAs)
8. Out of programme for research, approved clinical training or a career break
9. Outcome for doctors undertaking top-up training in a training post
Being a Specialty Registrar and an employee
accountability as an employee as well as a trainee (Trust, Assurance and Safety – the Regulation of Health Professionals in the
21st Century) training always within the context of employment employers must be aware of performance and progress of
postgraduate trainees employers must ensure that mechanisms are in place to
support the training of trainees transfer of information where there are on-going
needs/issues – trainee has right to know workplace based (NHS) appraisal (for employers)
Protocol for changing the Gold Guide The Gold Guide will be reviewed on annual basis. Membership of the review group is be confined to officials from the four UK
Health Departments. Individual country Programme Boards/Steering Groups are invited to submit
requests for changes/amendments to the review group, with reasons. Comments regarding changes and/or amendments must be received by the
review group in April/May each year. The Review group will meet, consider requests and write the relevant
changes, subject to testing of impact of any additions. All changes/amendments will be published as supplements to the Guide
(with relevant date of implementation) in June of each year. The Review group could be requested to consider urgent amendments on
an ad hoc basis. A separate recruitment supplement will be issued each year.
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