Framework for specialty training – the Gold Guide Professor Shelley Heard Incoming Director of Training and Standards RCPath 19 th October 2007.

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

August2002

February2003 July 2003

April 2004

The Context (1)

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

From the Orange Book to the Gold Guide

Guide to Specialist Registrar Training

The Orange Book 1998

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.

The Future

Tooke review Consultation period ? back to Specialist Registrar (SpR)

training