Who is involved with training now

1
Who is involved with training now?

• Nick Brown

2
Outline

• Structures
• People
• Relationships
• Handbooks

3
Training Schools?

• Changes described beg restructuring of the way in
  which Postgraduate Medical Education is organised
  and managed
• Need systems which
• Enable partnership deaneries, college and
  service
• Can support new curricula and assessments
• Can support nationally co-ordinated selection
  methods
• Incorporate QA/QC systems
• Can implement large scale change!

4
Training Schools

• Resources clearly identified
• Clear governance arrangements
• Joint Deanery/College appointments
• Headed by a Director of PG Training with
  appointed manager
• Director chairing School Board
• Programme directors (or equivalent)
• University/ Academic
• Lay Representation
• Representatives of NHS Employers

5
Training Schools

• Training in all psychiatric specialties will be
  managed by School
• FTSTAs
• Career Grades
• Liaise with leads for related medical specialties
  and non-medical specialties e.g. psychology and
  nursing

6
Training School - responsibilities

• Single recruitment process
• Manage RITA for all trainees
• Smooth transition from core to advanced phases of
  training
• Identification of training placements
  (?accreditation of trainers?)
• Develop local trainers, teachers and assessors
• Deliver curriculum
• Deliver workplace assessments
• Ensure systems for trainee appraisal
• Develop systems for trainees in difficulty
• Manage clear and consistent quality assurance and
  quality control systems
• Evaluate all school activities
• Develop relationships with Deanery, Trusts,
  Strategic Health Authorities
• Maintain publicity systems

7
Training Schools

• ?Just existing training committees with some
  extras?
• Part of SHA
• New lines of responsibility and accountability
• Quality agenda (will include service quality) is
  at Deanery/SHA level
• Handling budgetary change
• Implementing large change
• Service training tension

8
Elements of the proposed system for QA/QC-Data
Collection

• Annual report from each educational faculty-
  process and outcome information including
  self-assessment
• Induction, job descriptions, educational
  objectives, appraisal systems, teaching
  programmes, teaching/learning programme,
  educational resources, supervision, trainee
  feedback, health, safety and well-being,
  management of scheme or faculty
• Other relevant information
• National patients survey, Generic audit
  information, Healthcare commission reports, PEAT
  data
• PMETB will need the analytical capacity to make
  use of this data
• Deanery Quality control reports

9
Evidence to be used

• Data from deaneries
• Surveys of trainees
• Surveys of trainers, those managing training and
  education
• Log book evidence, exam success
• visits

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Educational Supervisors

• All (nearly all) consultants
• One hour
• Content unspecified
• Academic wrap around to clinical experience
• Support documents
• Handbook
• Exam syllabus

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Educational Supervision

• Basic Specialist Training Handbook (P9-11)
• educational supervision must be provided on a
  regular basis for one hour per week and this
  should form part of the trainees timetable
• the time should be regarded as belonging to the
  trainee..and should be used for educational
  rather than clinical purposes
• should not be delegated except when ..on leave

12
Clinical Supervision

• Basic Specialist Training Handbook
• clinical supervision must be provided at a level
  appropriate to the needs of the individual
• normally include supervision of both inpatient
  and outpatient work and.. Supervision for
  emergency consultations..
• trainees not expected to conduct ward rounds or
  outpatient clinics alone on a regular basis..or
  appear at MHRTs without close supervision

13
Educational Supervisors

• Often little/no specific preparation or learning
• 1970s notion of teacher as managing learning
  rather than merely providing information
• 1976 Teaching the Teachers (Anaesthesia
  Intensive Care, Hore), concern at standard of
  clinical teaching in UK hospitals
• 1992 SCOPME commissioned working party to examine
  ways in which the teaching of postgraduate
  educational methods to hospital doctors can be
  facilitated
• 1993 Calman, structured programmes, emphasis on
  in-training assessment
• 1997 GMC Tomorrows Doctors (recommendations on
  General Clinical Training)

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Educational Supervisors - Professionalisation

• Training the new grade of specialist registrars
  will involve new knowledge and skills for their
  teachers, the consultants WM PGDeanery response
  to Calman reforms
• Colleges
• Percentage of CPD to teaching, some colleges
  since late 90s
• Cotterill (APT,1999)
• it is difficult to see how modern consultants
  will be able to fulfill their educational
  commitments to undergraduates, postgraduates and
  to themselves without a fairly thorough grounding
  in educational theory and practice

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Drivers Tasks as Educator

• Supervision
• Multiplicity of roles, responsibilities and
  expectations
• ? An increased emphasis on teaching and
  systematising clinical experience (especially
  as attachments decrease in length -4/12 vs.6/12
  EWTD c.)
• Record keeping
• Assessment of need
• Educational cycle
• Assessment of performance
• Workplace based assessments
• Giving constructive feedback
• Appraisal
• Managing postgraduate education
• Building good educational climate, course design,
  budget management
• Teaching skills
• Small-group teaching, lectures, seminars,
  workshops, problem-based learning,
  computer-assisted learning and so on and when to
  use which!

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PMETB Standards

• Domain 5 Delivery of Curriculum
• Domain 6 Support and Development of Trainees,
  Trainers and Local Faculty

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Domain 5

• Relationship of post (educational and clinical
  experience) to curriculum
• Delivery of assessment schedule
• Trainees must have feedback on progress

18
Domain 6

• Induction
• Signed learning agreement (each post)
• Meetings with educational supervisor to discuss
  progress, outstanding needs and how to meet them
• Educational supervisors must have been trained
  and selected for the role.
• Resources and time must be made available in
  their (educational supervisors) job and personal
  development plans

19
Educators

• Should all consultants be educators?
• New or increased emphasis on teaching and
  assessment in the workplace that demands a more
  consistent and more sophisticated level of input
• Could/should educational supervision be less
  synonymous with consultant attachment (e.g. one
  supervisor through first year c.)
• Effect on service quality of an individual (or a
  unit) not being involved in medical education
• Danger of creating elitist group?

20
Educators

• Accreditation
• Basic teaching, supervisory and assessment skills
• Knowledge of relevant structures, educational
  theory
• Specific College roles, responsibilities
• Higher level assessment skills, greater variety
  of teaching techniques
• Training scheme management
• Ability to plan, manage and implement programmes
  of learning

21
Tutors

• Currently local, organising, specialty, taught
  course as well as TPDs
• Emergent Directors of Medical Education

22
Tutors

• Trainees will need
• Local induction, organisation, troubleshooting
• Local support, advocacy
• Teaching programme
• Clinical skills development
• Monitoring of progress, appraisal, assessment
• Career and personal development advice

23
Tutors

• Trainers will need
• Help with department and team induction
• Local organisation, troubleshooting
• Local support, advocacy
• Teaching programme
• Clinical skills development
• Monitoring of progress, appraisal, assessment
• Personal development advice

24
Quality and business systems

• Accountability and responsibility need to be
  aligned
• Trust and SHA/Deanery must deliver and clearly be
  seen to deliver on Generic Standards
• Begs relationship of School/Deanery Lead with
  tutors and DMEs

25
New World?

• Is it?
• Do we need new descriptions?
• Incorporate into new handbook