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West of ScotlandRegional Trainers Day 2013
“Just when we thought we had a handle on it….!”
Looking ahead!
“To improve is to change; to be perfect is to change often.”Winston Churchill
“Any change, even a change for the better, is always accompanied by drawbacks and discomfort.”
Arnold Bennett
Changes within NES
John McKay
Assistant Director for Quality Improvement and Performance Management
David Cunningham
Assistant Director for Continuous Professional Development
NES Vision Project
Professional Development Training Management Business Support Quality Multi-Professional leadership and external
engagement
Throughout Scotland all Deaneries should be doing the same things the same way.
2014 Single Scottish Deanery
5 Regional offices Glasgow Edinburgh Dundee Aberdeen Inverness
Scottish Wide ES and Training Practice Accreditation and re-accreditation standards and process
National Strategy for CPD
“NES should be the first port of call for all Doctors in Scotland meeting CPD needs”
2CQ Reconfiguration
Recruitment
Stage 2 Cut off score increasing
2012 6%
2013 11%
2014 14% Candidates Demonstrated Round 1
2012 74%
2013 84%
StART Alliance: Scotland’s Strategy for Attracting and Retaining
Trainees After round 2 - still 25 vacancies in Scotland Scotland: Home of Medical Excellence NES + stakeholder groups Improve recruitment and retention in specialty
training Revamped advertising, use of social medial Newly commissioned work on what ‘attracts’
trainees Trainee Ambassadors: Word of mouth is strongest
influence
Recruitment
Alternative Foundation Competency Certification more robust
ALS certification before commencing in training
NES will become Tier 2 Visa sponsor for whole programme from February 2014
RCGP
E-portfolio!
Curriculum update Oct 13:Prescribing Safety – Based on GMC commissioned survey More focus on knowledge of therapeutics and
demonstration of skills for safe/appropriate
prescribing and medication reviews Improved skills in management of polypharmacy
Mental Health – Co-morbidity of physical conditions in metal health Assessment and safety planning for suicidal
patients Promote hope and demonstrate compassion
Exam Changes:
AKT Wide selection of
questions Every AKT drug
calculations Free text to replace
choosing from lists Content shaped
towards prescribing safety
CSA At least 2 cases with
major prescribing component
New tests of prescribing behaviour
Child actors cases from Nov 13
may include paediatric prescribing
Handwritten scripts
WPBA: COT/CBD/SEA/Audit/Learning Log
Future Assessment Changes GMC mandated there should not be assessment for
assessments sake All assessments should have meaningful formative
feedback DOPS to be replaced by Integrated Clinical Skills
August 2014 Structured Learning Event (SLE) format in
development for August 2015 Will allow wider use of material for assessment
e.g prescribing, SEA/audit discussions in addition to existing WPBA
Focused CBD pilot due for reporting
How to pass the CSA?
A year of Reports!
Francis Report
Report into failing standards of care in Mid Staffordshire
290 recommendations 20 refer directly to medical
education
Impact of Medical Education: GMC set standards for educational
environments/approved practice settings Prioritisation of Patient Safety within Quality Assurance
Training Visits Routine quality visits to training environments Trainees actively encouraged to provide feedback on
standards of patient safety and quality of care (GMC survey and trainee post assessment questionnaires)
More information sharing between service providers and Deaneries
Any visit identifying patient safety concerns to be shared with PCOs
Clinical Leadership Training for all trainees (LaMP)
GMC Recognition and Trainer Approval:
Traditionally in place for GP Trainers
From 2013-14 will be extended to cover secondary care named ES/CS’s and undergraduate teachers
Based on standards already set out in ‘The Trainee Doctor’ and ‘Tomorrow's Doctors’
Academy of Medical Educators:7 Framework areas used to set standards – Ensure safe and effective patient care through
training Establish and maintain and environment for learning Teaching and facilitating learning Enhancing learning through assessment Supporting and monitoring educational progress Guiding personal and professional development Continuing professional development as an
educator
Adapted for GP by RCGP
New Self Submission Documentation for ES and Training Practice approval/re-approval
Scotland wide document Referenced to standards set in RCGP version of
AoME Framework areas More detailed document for each ES Approval for individual ES’s and the Practice as an
educational environment Re-focusing of questions and visits to meet set
standards GP Training in West of Scotland is already well
placed to comply will all requirements
Shape of Training Report
Why change?
Needs of patients are changing fast Increasing multiple-morbidity Super-specialisation can be a
hindrance in some instances to good patient care
Consensus opinion:
More generalists able to work across specialties Better preparation for working in multi-professional
teams Greater career flexibility Training needs to be tailored to meet changing
patient need Training should be based on what kind of doctors
are needed
More doctors capable of providing general care across a range of different settings
Doctors will progress to credentialing in specialist areas (including GP).
More opportunities for doctors to change roles Local workforce and patient need should drive
opportunity Full registration should move to the point of
Graduation with measures in place to demonstrate Graduates are fit for purpose
So what may it look like?
Two year Foundation Programme to remain initially Doctors will enter ‘themed’ broad based specialty
training e.g. ‘Community’ might include GP, Psychiatry, Paediatrics, COTE
Will last between 4 and 6 years Transferable competencies between specialties Exit point will be a CST (Certificate of Specialty
Training) Further career enhancement via ‘credentialing’ Delivery Board to be established
All Doctors to develop generic skills in:
Patient safety Communication with patients and
colleagues Teamwork, Management and
Leadership Evaluation and application of
research
19 Recommendations: 8. Appropriate organisations, including employers
must introduce longer placements for doctors in
training to work in teams and with supervisors
including putting in place apprenticeship based
arrangements.
9. Training should be limited to places that provide
high quality training and supervision, and that are
approved and quality assured by the GMC.
So where does this leave EGPT?
Educational case for UK 4 year GP Training widely accepted
RCGP still pressurising for 2 years in GP Cost neutrality imposed Re-focusing of some existing posts
towards ‘community’ slant
On a very positive note:
May CSA 3rd best pass rate in UK for 1st attempt takers
2013 GMC Survey West of Scotland Deanery rated 3rd top of 20 UK Deaneries for overall satisfaction for GP Training
1st among large Deaneries in UK
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