Tomorrow’s Doctors 2009 Implementation Workshop Scotland

1. Tomorrow’s Doctors 2009 Implementation Workshop Scotland

2. Tomorrow’s Doctors 2009 implementation Martin Hart Assistant Director, Education 6 May 2010

3. Health and Safety

4. Purpose for the day • To enable medical schools, deaneries, employers and other stakeholders to jointly review progress towards the implementation of Tomorrow’s Doctors 2009 and to discuss local key challenges and responses • To discuss areas for additional guidance and support and options to enhance the quality assurance of basic medical education

5. Scotland • Five Medical School • The Scottish Doctor • NHS Education for Scotland • Four Deaneries • One Foundation School

6. Programme • 10:00 GMC presentations • 10:40 School, Scottish Government/Employer and Deanery presentations • 12:30 Question and answer session • 13:00 Lunch • 14:00 Break out sessions • 15:30 Coffee break • 15:45 Feedback • 16:15 Questions • 16:30 Workshop finishes

7. GMC update - Merger of PMETB into the GMC and Patel Review

8. Context for merger • February 2008, the Secretary of State announced that PMETB would be merged with the GMC, following a recommendation from Sir John Tooke's Independent Inquiry into Modernising Medical Careers: • PMETB should be assimilated in a regulatory structure within GMC that oversees the continuum of undergraduate and postgraduate medical education and training, continuing professional development, quality assurance and enhancement • Following the merger on 1 April, all stages of medical education and training are now part of the GMC's remit.

9. Benefits of the merger • Simplified regulatory structure • Single point of contact for key interests • Sharing best practice • Integrated approach to education and training across continuum • Greater access to resources of GMC, and efficiencies from one organisation

10. Patel Review • Lord Naren Patel commissioned to lead review of the regulatory framework for medical education • Working group set up, chaired by Lord Patel, comprising members of GMC and PMETB • Wider reference group of key interest groups to enable us to test emerging thinking

11. Patel Review considered • Understanding the continuum • Stages of education and training – particularly the transitions • Quality assurance • Legislation

12. Patel Review • Preliminary conclusions of the review were consulted on in January to March 2010 • The final report was published in April 2010 and is available on our website www.gmc-uk.org: • ‘Recommendations and Options for the Future Regulation of Education and Training’

13. Implementation of Tomorrow’s Doctors 2009 Professor Jim McKillop Scotland, 6 May 2010

14. Tomorrow’s Doctors 2009

15. Why Tomorrow’s Doctors was reviewed Changes: Foundation Programme PMETB’s approach to standards and QA Pressures due to student numbers, EWTD, patient throughput, move from old-style ‘firm’, community-based training Patient and employer expectations Challenges, real or perceived: Prescribing and practical skills Scientific knowledge Professionalism, leadership, team-working Assessment

16. Tomorrow’s Doctors Consultation Sources for review: QABME GMC guidance, new educational frameworks, research Dr Jan Illing, How prepared are medical graduates to begin practice? Responses: Wide engagement with key stakeholders 634 written submissions, Skills for Health survey of 230 NHS staff UK wide events

17. Consultation meetings in Scotland • Stonewall Scotland • Edinburgh and Lothian Racial Equality Council • Voluntary Health Scotland • Medical Students from the five Scottish Medical Schools • BMA Scotland

18. Tomorrow’s Doctors 2009 structure Foreword by the Chair of GMC Introduction: responsibilities of GMC, schools, NHS organisations, doctors, students Outcomes for graduates Standards for delivery Appendices: Practical procedures for graduates What the law says Related documents [and links throughout] Glossary

19. Overarching outcome ‘Medical students are tomorrow’s doctors. In accordance with Good Medical Practice, graduates will make the care of patients their first concern, applying their knowledge and skills in a practical and ethical manner and using their ability to provide leadership and to analyse complex and uncertain situations.’

20. Outcomes for graduates

21. Outcomes for graduates: key elements Biomedical and other sciences Diagnosis and managing presentations Safe prescribing skills List of diagnostic and therapeutic procedures Teamworking and leadership Working in the NHS and improving healthcare

22. Standards for delivery of teaching, learning and assessment

23. Standards for delivery: some key themes Patient safety Practical experience: Placements planned and structured Agreements between schools and providers Student Assistantships Shadowing and induction into F1 Assessment Student support, health, equality Quality control and input from patients and employers

24. Tomorrow’s Doctors 2009 Published in September 2009 Standards and outcomes will apply to all UK medical schools from 2011/12 GMC Undergraduate Board has agreed to produce additional guidance on: Assessment Clinical placements Standards for teachers and trainers

25. Enhanced Annual Return (EAR) All schools reported to be on track for compliance All schools have identified areas to work on Key challenges for all schools: Patient and employer feedback in quality management Delivery and management of clinical placements MPET Review & funding

26. The State of Basic Medical Education March 2010: The State of Basic Medical Education published: Summarises key findings of QABME Shares examples of schools’ practice Shares experiences from schools and visitors involved in QABME Includes comments from a range of perspectives on recent developments, and future opportunities and challenges

27. Options for the Enhancement of QABME Survey https://gmc.e-consultation.net/econsult/default.aspx

28. Options for the Enhancement of QABME Survey Seeking views on options to enhance QABME to ensure it remains fit for purpose. Survey presents a number of issues and options, and asks for feedback on a number of options to: Enhance sharing good practice between schools Quality assure outcomes for graduates Enhance consistency and comparability in judgements about schools Also asks for input on how the role of students, employers and those involved in Foundation Training, and patients and the public can be enhanced in QA activities

29. “Can you remind me just what we’re looking for?”

30. Contact us Website: www.gmc-uk.org Email: quality@gmc-uk.org QA Survey ends 28 May 2010

31. Tomorrows Doctors Implementation Workshop University of Dundee Medical School Gary Mires

32. Medical Schools consideration of TD2009: approach • Workshop • Self reflection on compliance • Generation of a series of action points

34. Well placed • Patient safety: • Patient safety lead • Quality assurance: • Local working relationships with NHS / DoME • Local SLA / job planning • ACT funded QA lead • Student selection: • MMI

35. Well placed • Design / delivery / assessment: • Range of learning opportunities • Foundation apprenticeship placements • New acute care module to include prescribing • SSC programme • Portfolios • Assessment of outcomes • Common shadowing

36. Well placed • Support and development of students and teachers: • Staff development officer • ‘Tiered’ programme according to needs • Professional Development Awards • Educational resources: • New education build

37. Work required: • Quality Assurance: • Feedback from patients • Feedback form employers • Peripheral placement monitoring and SLA’s • Equality and diversity: • Equality and diversity training • Design / delivery / assessment: • Feedback provision • Support and development of students and teachers: • Training, support and appraisal for teachers and defining expectations of Medical School

38. Outcomes for Graduates Overall: Compliant 65% Partially compliant 32% Work required 3%

39. Outcomes for graduates issues • Areas most work required relate to: • Global health issues • Health service management / organisation /economics / regulation • Doctors as managers / leaders • Psychological outcomes e.g. adaptation to life changes • Prescribing

40. Examples of actions to deliver TD2009 and provide evidence of compliance • NHS responsibilities and expectations of Medical School: • Roles responsibility pack for clinical teachers • User friendly ‘distillate’ of TD for NHS / clinicians highlighting areas relevant to them • Engage NHS teaching leads to support delivery • Staff training and support: • Targeted programme of work on staff development including equality and diversity training • Student assistantships: • Build on current Foundation Apprenticeship blocks • Look at examples from Foundation training for assessing competence

41. Outcomes for graduates: • Implement recent review of basic science teaching to reflect shift towards more comprehensive teaching of biomedical and social science in TD 2009 • Acute care module implementation • Continue prescribing teaching enhancement work • Evidence: • Establish ‘Tomorrows Doctors database’ with ongoing collection of evidence of compliance • Work on approaches to provide evidence of compliance e.g. students working within capability

42. Further guidance / support • Support and development of teachers and local faculty (TD 128 and 148) • Nature and process for quality data from employers about preparedness of graduates (TD 43) • Nature and process for quality feedback data from patients (TD 43) • Expectations of Student Assistantships (TD 109) • Shadowing period (TD 110) • Non compensation in assessment versus integration

43. Tomorrow’s Doctors 2009GMC WorkshopProf Hamish McKenzieUniversity of Aberdeen

44. Tomorrow’s Doctors • Curriculum review commenced in 2004/5 • New final year in 2008/9 • New years 1 – 3 rolled out from 2009/10 onwards • Many of the changes of TD2009 anticipated • Curriculum Steering Group reviewed TD2009 in February and identified areas for further work

45. TD2009 What are we doing What do we need help with Doubts and concerns

46. TD2009 – what are we doing Outcomes for graduates Psychological principles (para 9) Social science principles (para 10) The doctor as a professional (paras 20 -23) Staff development Quality management

47. TD2009 – help Domain 9. Outcomes Para 172: “Quality management will involve…..collection and use of information about the subsequent progression of graduates in relation to the Foundation Programme and postgraduate training, and in respect of any determinations by the GMC....”

48. TD2009 – help Domain 5: Design and delivery of the curriculum, including assessment Para 121 - ” medical schools should make arrangements so that graduates’ areas of relative weakness are fed into their Foundation Programme portfolios......”

49. Doubts and concerns Assessment of competences Student assistantships Feedback from patients

50. Doubts and concerns Domain 6: Support and development of students, teachers and local faculty Para 128 “Everyone involved in educating medical students will be appropriately selected trained, supported and appraised”