Training for Public Health Trainers

Prof. John Collins’ report ‘Foundation for Excellence’ highlighted many positive aspects of the Curriculum but also these particular areas of concern:

1) The purpose of Foundation Training2) The value of F2 training3) Long term condition management4) Excessive assessments

To align to the GMC Trainee Doctor (2011)

The AoMRC were tasked to address these matters and as a result produced the FP Curriculum 2012.

Changes implemented for August 2012

Feedback

Supervised Learning Events

Clinical supervision

The FP Curriculum syllabus headings have been rationalised from 16

(as listed below) to 12 overarching headings.

Professionalism Relationship and communication with patients Safety and clinical governance Ethical and legal issues Teaching and training Maintaining good medical practice Good clinical care Recognition and management of the acutely ill patient Resuscitation and end of life care Patients with long-term conditions

• Health promotion, patient education and public health Investigations Procedures

High level descriptors separating the differences between the outcomes for satisfactory completion of F1 and F2

1.2 Time management

F1 outcome• Is punctual and organised

F2 outcome (in addition to F1)• Delegates tasks and ensures that they are completed

Competences• Is punctual for all duties, including handovers, clinical commitments and teaching

sessions • Integrates Supervised Learning Events and other learning responsibilities into the weekly

programme of work• Keeps a list of allocated tasks and ensures that all are completed • Organises and prioritises workload regularly and appropriately• Delegates or calls for help in a timely fashion when falling behind• Demonstrates the ability to adjust decision-making in situations where staffing levels and

support are reduced (e.g. out of hours) 

Learning and assessment in the clinical environment: the way forward (November 2011)

Proposals for discussion include introduction of new terminology to distinguish between two purposes of assessment

Assessment used for feeding back on progress (formative) through Supervised Learning Events (SLEs)

Assessment used to determine progress (summative) which would be referred to as Assessments of Performance (AoPs)

Immediate / early Appropriate One to one 2 models:

•Pendletons rules•ALOBA

Clarify any points of information/fact

Ask the trainee what they did well

Discuss what went well

Ask trainee what went less well

Discuss what went less well.

Agenda Led Outcome Based Analysis Start with trainees agenda Look at the outcomes they are trying to achieve Encourage self assessment and problem solving Use descriptive feedback to encourage a non-

judgemental approach Provide balanced feedback Generate alternatives Be well intentioned, valuing and supportive Opportunistically introduce theory, research

evidence etc Structure and summarise learning

Local structures for programme delivery should enable and encourage trainees to identity learning needs and plan SLEs with their supervisors throughout each period of training

Trainee ownership is essential

Informed and constructive feedback – trainees should view process as opportunity to improve performance, rather than threat to progression

Feedback is vital, including a specific educational action plan to guide further learning and be included as part of the record

Trainees role in process (active and reflective) is essential and should prompt self-assessing their performance

Important that SLEs (including reflection, and related learning plan) are recorded in the trainee’s e-portfolio

The individual SLE will not be scored, and individual’s outcomes will not determine decisions for training progression, although engagement with SLEs and using the portfolio as a whole will be relevant

Educational supervision must encourage reflective feedback, set goals and support trainee development over the short term whilst keeping the longer term progression goals in mind

AoPs should be recognised as a planned series of events, identified as part of the relevant curriculum (with level descriptors where appropriate), not as ends in themselves in the way that traditional formal examinations can be seen

There should be multiple AoPs by a range of appropriately trained clinicians (trainers) covering a range of workplace contexts that are blueprinted to and fully integrated into the curriculum

They must be based on observable performance and assessed against specific criteria (eg using anchor statements)

Analogy to driving lessons (SLEs) and driving tests (AoPs) – although important not to attempt to press this analogy too far

Learner drivers would not be happy if they did not receive feedback from their instructor (trainer) during and at the end of a driving lesson (which is assessment for learning)

When learners feel ready, they take the driving test. This is a real pass/fail test and a practical assessment based in the real work, ie equivalent to an AoP

Formal judgement, not simply adding up the demonstrated competencies

Take into account multiple items of evidence, including results of assessments, professional judgements of clinical and other supervisors, trainee’s portfolio of achievement and evidence of appropriate professionalism

End of placement assessments drawn together to form basis of recommendation regarding satisfactory completion

SLE tool Recommended minimum number

(may increase/vary locally)

Direct observation of doctor-patient interaction:Mini-CEXDOPS

3 or more per placement*Optional to supplement mini-CEX(9 per year; at least 6 using mini-CEX)

Case-based discussion (CBD) 2 or more per placement*

Developing the clinical teacher 1 or more per year

Remember: SLEs should provide immediate feedback.

Previously introduced as formative assessments

BUT graded 1- 6

Feedback often left blank

Trainees used to leave all WBA’s to the end of a placement

‘A trainer who is responsible for overseeing a specified trainee’s clinical work for a placement in a clinical environment and is appropriately trained to do so.

He or she will provide constructive feedback during that placement, and inform the decision about whether the trainee should progress to the next stage of their training at the end of that placement and/or series of placements.’

GMC 2012

The Placement Supervision Group consists of trainers nominated in each placement by the named clinical supervisor. Their observations and feedback will inform the clinical supervisor’s end of placement report. The makeup of the Placement Supervision Group will vary depending on the placement, for example:

Doctors more senior than F2, including at least one consultant or GP principal.

Senior nurses (band 5 or above)

Allied health professionals

In a general practice placement the faculty may be limited to one or two GPs.

Observing the foundation doctor’s performance in the workplace.

Undertaking and facilitating SLEs.

Providing feedback on practice to the foundation doctor.

Providing structured feedback to the clinical supervisor.

Considered changes

SLEs

AoPs

Placement supervision group

Feedback.