WALES DEANERY

Supervising the Route to Excellence

Educational Supervision Agreement Formerly known as the ‘Educational Supervision Tripartite Agreement’

Frequently Asked Questions The Wales Deanery is rolling out an Educational Supervision Agreement between Educational Supervisors, Local Education Providers (Health Boards or Trusts) and the Wales Deanery. The Agreement is a key element of the Wales Deanery’s approach to formal trainer recognition (as defined by the General Medical Council) and demonstrates the signatories’ commitment to delivering high quality postgraduate medical education and training. It identifies the mechanisms to support the provision of high quality postgraduate medical education and training by defining the role and responsibilities of the three parties.

The Educational Supervision Agreement is available to view at -www.walesdeanery.org/wales-deanery-trainers/trainer-recognition

This booklet has been produced to provide Educational Supervisors with answers to the most frequently asked questions regarding the Agreement.

Wales Deanery (‘School of Postgraduate Medical and Dental Education’)

Cardiff University, Heath Park, Cardiff, CF14 4YS

(029) 2068 7491 walesdeanerysre@cardiff.ac.uk @WalesDeanery Wales Deanery

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The Background

What is ‘trainer recognition’? In August 2012 the General Medical Council (GMC) released the details of their new arrangements for the formal recognition of trainers in secondary care.

1 The new arrangements will apply to all

Educational Supervisors (and Named Clinical Supervisors) for postgraduate trainees. The GMC is working to secure legislative change so that the process of recognition becomes a statutory approval process as is the case in primary care. The GMC’s implementation plan for trainer recognition can be viewed at www.walesdeanery.org/wales-deanery-trainers/trainer-recognition The trainer recognition process is a key component of the GMC’s regulatory framework designed to provide assurance to patients and others that medical education and training produces doctors with the appropriate knowledge, skills and behaviours. What is the process for the formal recognition of trainers by the GMC? The process for the formal recognition of trainers consists of two parts; each of which must be completed in order for the Deanery to recommend an individual to the GMC for recognition:

1. Trainers must be formally identified by the Deanery 2. Trainers must meet the recognition requirements set out by the Deanery.

What is the Educational Supervision Agreement? The Educational Supervision Agreement underpins the Wales Deanery’s approach to the recognition of Educational Supervisors. In order to be recognised as an Educational Supervisor in Wales, trainers will need to sign the Agreement and meet the requirements of the Agreement. The Agreement sets out the mechanisms for, and support of, the provision of postgraduate medical education and training by defining the role and responsibilities of Educational Supervisors, as well as their employing Health Boards or Trusts (‘Local Education Providers’) and the Wales Deanery. Has consultation been undertaken during the development of the Agreement? The project group responsible for developing the Agreement included representation from five NHS Wales Local Health Boards (including individuals who were themselves Educational Supervisors, a Specialty Training Committee Chair, Postgraduate Organiser and Postgraduate Centre Manager), the BMA Cymru Wales and senior Deanery staff.

Consultation on the Agreement has been ongoing since its inception, and it was piloted at five sites (Ysbyty Gwynedd, Morriston, Prince Charles, Prince Philip, and Withybush Hospitals) in 2011 to ensure that it was ‘fit for purpose’. Since the pilot an ‘All Wales Trainer Recognition Group’ comprising representatives including Faculty Leads for Trainers has worked to refine the Agreement. It has received the approval of BMA Cymru Wales and the All Wales Medical Directors’ Group (chaired by the Chief Medical Officer for NHS Wales).

1 General Medical Council – ‘Recognising and approving trainers: the implementation plan’ (August 2012)

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How did the Agreement pilots go? Piloting provided an opportunity to check that the format, content and process for signature of Agreements was appropriate, and provided feedback on any barriers to its implementation. The response to the piloting at all five sites was very positive with the vast majority of Educational Supervisors signing up to the Agreement and providing the Deanery with useful and constructive feedback. The outcomes of the pilot evaluation exercise informed the adaptation of the Agreement in readiness for rollout across Wales. It has also been revised to reflect publication of the GMC’s implementation plan for trainer recognition. Why was the Agreement established? External drivers included the GMC’s ‘Standards for Trainers’

2 and ‘The Gold Guide’

3 which place

demands on the individual and the Deanery to deliver and support the educational supervision role. In addition, Sir John Temple’s report – ‘Time for Training’

4 observed that “Supervised training

is key to ensuring patient safety and medical workforce development to provide for future service needs, yet is not always, prioritised, routinely facilitated or adequately supported and rewarded.” Following the publication of the GMC’s implementation plan for trainer recognition the Agreement has a key role in the formal recognition of Educational Supervisors in secondary care. Recognition as an Educational Supervisor in Wales is dependent upon trainers signing the Educational Supervision Agreement and meeting the requirements of the Agreement. Why is an Agreement needed? By signing the Agreement all parties are demonstrating their commitment to the important Educational Supervisor role and the provision of high quality educational supervision, as well as contributing to a suitable learning environment for trainee doctors, ultimately leading to improved trainee and patient safety and enhanced quality of patient care. The Agreement will also enhance communication and accountability between those responsible for delivering and supporting educational supervision. It will raise the profile of postgraduate medical training in Wales, increasing its attractiveness as a graduate destination and improving recruitment and retention. The Agreement is fundamental to enhancing the quality of postgraduate medical training in Wales by raising the profile and visibility of the role of the Educational Supervisor and recognition of the workload involved in supervising trainees. What is the timescale for rollout of the Agreement? Phased rollout of the Agreement by sites and specialties will be undertaken by the Wales Deanery in conjunction with Local Education Providers commencing from September 2013.

2 General Medical Council – ‘The Trainee Doctor (Foundation and specialty, including GP training)’ (February 2011)

3 NHS Modernising Medical Careers – ‘A Reference Guide for Postgraduate Specialty Training in the UK’ (‘The Gold Guide’) (June 2010)

4 Professor Sir John Temple – ‘Time for Training: A Review of the impact of the European Working Time Directive on the quality of training’ (May 2010)

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The Agreement and Me What is the difference between an Educational Supervisor and a Named Clinical Supervisor? The GMC defines an Educational Supervisor as – a trainer who is selected and appropriately trained to be responsible for the overall supervision and management of a trainee’s trajectory of learning and educational progress during a placement or series of placements. Every trainee must have a named educational supervisor. The educational supervisor helps the trainee to plan their training and achieve agreed learning outcomes. He or she is responsible for the educational agreement and for bringing together all relevant evidence to form a summative judgement at the end of the placement or series of placements.

A Named Clinical Supervisor is defined as – a trainer who is responsible for overseeing a specified trainee’s clinical work throughout a placement in a clinical or medical environment and is appropriately trained to do so. He or she will provide constructive feedback during that placement. He or she will lead on providing a review of the trainee’s clinical or medical practice throughout the placement that will contribute to the educational supervisor’s report on whether the trainee should progress to the next stage of training. Sometimes, both roles may be performed by one person.

Why choose to be an Educational Supervisor? Educational governance is closely related to clinical governance: good teaching and educational supervision makes better doctors. Trainees are entitled to be supervised by individuals who teach well, who engage with their learning needs, and support their development and progression. Patients are entitled to be attended by doctors who are well taught, supervised and supported. Does the Agreement apply to me? The Agreement defines the role and responsibilities of Educational Supervisors working in hospital-based Foundation, Core and Higher Specialty training in Wales (including less than full time training), but not General or Dental Practitioners. All Educational Supervisors should be doctors who have a clear expressed interest in the training, assessment and development of postgraduate medical trainees. Eligibility to undertake the role of Educational Supervisor in Wales is as follows – Substantive consultant - for Foundation, Core and Higher trainees

Locum consultant - not eligible

Staff, associate specialist or specialty (SAS) doctor with Certificate of Completion of Training (CCT) - for Foundation, Core and Higher trainees

Staff, associate specialist or specialty doctor without CCT – for Foundation and Core trainees In instances of exceptional circumstances, eligibility will be considered on a case by case basis by the Wales Deanery.

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Does the Agreement include descriptors for my other roles – Clinical Supervisor? College Tutor? The Agreement relates specifically to the educational supervision of Foundation, Core and Higher postgraduate medical training (including less than full time training), but not training in General or Dental Practice. An Educational Supervisor may act additionally as a Named Clinical Supervisor for a trainee or trainees and whilst signing the Agreement also confers recognition as a Named Clinical Supervisor and there may be some degree of overlap in these roles, the role and responsibilities of the Named Clinical Supervisor and other roles relating to the management and delivery of postgraduate training including, but not limited to Local Faculty Lead and College Tutor, are outwith the scope of the Agreement. You may also have a role in delivering undergraduate education in which case you will additionally need to be recognised by the undergraduate Education Organiser i.e. the medical school. The Wales Deanery and Cardiff University’s School of Medicine are working towards harmonisation of their processes for recognition of those involved in supervising postgraduate trainees and undergraduate students. If I am an Educational Supervisor and a Named Clinical Supervisor, will I need separate recognition for these roles? The recognition process for Named Clinical Supervisor is subject to consultation, but key principles will apply; foremostly, those who sign the Educational Supervision Agreement and meet its requirements will not require separate recognition as a Named Clinical Supervisor. In due course, the Named Clinical Supervisor role will also need to be recognised in job planning and appraisal and, in accordance with the GMC’s plans for trainer recognition Clinical Supervisors will need to undertake professional development activity that meets the GMC’s standards in relation to areas 1. – 4. and 7 in the Academy of Medical Educators’ Framework for the professional development of postgraduate medical supervisors

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5 Academy of Medical Educators – ‘A Framework for the Professional Development of Postgraduate Medical Supervisors’ (November 2010)

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Signing the Agreement

Why should I sign the Agreement? By signing the Agreement you will be demonstrating your commitment to the role of Educational Supervisor and the provision of high quality supervision for training grade doctors as well as demonstrating to the Deanery provision of a suitable, supportive learning environment for trainees, including the potential for early detection of trainees with performance-related concerns. Ultimately, this will contribute to safer patient care. Use of the Agreement across NHS Wales should lead to increased recognition of the role of Educational Supervisor within the Consultant job planning process and eventual consistency of approach to the role within and between Health Boards through clearer articulation of the rights, roles and responsibilities of those providing educational supervision and those supporting Educational Supervisors, leading to a uniform understanding across the Wales Deanery and NHS Wales.

I’ve been an Educational Supervisor for a number of years; do I need to sign the Agreement? Yes. In order to be recognised as an Educational Supervisor in Wales by your Local Educational Provider, the Wales Deanery and the General Medical Council you will be required to sign the Educational Supervision Agreement and meet the requirements of the Agreement.

The Agreement aims to raise the profile and visibility of the role of Educational Supervisors and recognition of the workload involved in supervising trainees via a statement of the role and associated responsibilities, and lines of accountability and support mechanisms. In addition, we hope to achieve enhanced links and communication between the Deanery and those who have been responsible for delivering postgraduate medical education and training in Wales for some years, but have received limited recognition of their contribution.

What will I gain by signing the Agreement? Doctors who are required to supervise trainees, or choose to do so, are entitled to learn how to do it well and to have access to appropriate support and resources to undertake the role. The Agreement should ensure that you receive protected time and resources to deliver the Educational Supervisor role, professional recognition and satisfaction, and access to appropriate training and professional development for the role.

In fulfilling the requirements of the Agreement you will be eligible for formal recognition as an Educational Supervisor by the GMC. The recognition process is only the first step in a programme of work designed to ensure that job planning, resource allocation and service load all reflect the responsibilities undertaken by trainers on a daily basis.

Are there any additional benefits to signing the Agreement? Signing the Agreement will allow you access to Cardiff University library services which includes access to an extensive collection of web based Cardiff University e-resources including eJournals, eBooks and major databases such as MEDLINE, Cochrane and PsycINFO.

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What’s in it for my employer and the Deanery? Fulfilment of the Agreement should contribute to consistency and transparency around the provision of a single system of educational supervision across Local Education Providers in Wales, co-ordinated and quality managed by the Wales Deanery on behalf of the Welsh Government and NHS Wales. It should also enable parties to provide evidence of meeting the requirements defined in the GMC’s ‘Standards for Trainers’, thereby enabling the Wales Deanery and Local Education Providers to meet statutory obligations. In addition, the Agreement should support Local Education Providers and the Wales Deanery in their quality control as they support, manage, audit and resource the educational role of Educational Supervisors. It will also help Local Health Boards demonstrate compliance with the Welsh Government’s ‘Standards for Health Services in Wales’.

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Ultimately, we would hope to increase enthusiasm for, and uptake of, the role of Educational Supervisor among Consultants and recognition of a highly trained, motivated and supported cohort of Educational Supervisors throughout Wales who strive continuously for improvement in the quality of training. What is the process for signature? Agreements pre-signed by the Postgraduate Dean and your Medical Director on the Health Board or Trust’s behalf will be distributed to Health Boards and Trusts. An Agreement will then be passed to you for signature along with two copies of the ‘Terms of Understanding’ of the Agreement. You will retain the Agreement for your records and future reference. Having signed the ‘Terms of Understanding’ you will need to return one to your local Postgraduate Centre and one to the Deanery. Why do you need to me to provide my GMC Number when I sign the Agreement? Your GMC Number is required to provide us with a unique identifier for a signed Agreement and to enable us to record your signing of the Agreement against your record on the Intrepid database in order to recommend to the GMC that you be recognised as an Educational Supervisor. Am I signing a contract? No. Signing the Agreement is not a formal undertaking and there is no remuneration associated with the Agreement. It is however, a requirement for recognition as an Educational Supervisor in Wales. Signing implies that you (and the other signatories) will strive to reach, to the best of your ability, the objectives stated in the Agreement. You will continue to be bound by your contract(s) of employment and job plan and doctors also continue to be bound by the GMC’s professional

guidance on ‘Good Medical Practice’7 and ‘Leadership and management for all doctors’

8. The

arrangements for recognition of Educational Supervisors do not change the standards that trainers are expected to meet as set out in ‘The Trainee Doctor’.

6 Welsh Government – ‘Doing Well, Doing Better – Standards for Health Services in Wales’ (April 2010)

7 General Medical Council – ‘Good Medical Practice’ (March 2013)

8 General Medical Council – ‘Leadership and management for all doctors’ (March 2012)

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Fulfilling the Requirements of the Agreement Will the Agreement require me to do additional work to fulfil my role? No. The Educational Supervisor role descriptor in the Agreement is based as a minimum upon an amalgamation of best practice and descriptors from sources including ‘The Gold Guide’, NACT (National Association of Clinical Tutors) UK and Academy of Medical Educators’ (AoME) guidance; therefore you should not be being asked to do anything over and above your existing role. Rather, the Agreement should ensure that you receive the necessary time, resources and support from your employing Health Board or Trust and the Deanery to fulfil your role effectively. The role descriptor and list of associated responsibilities in the Agreement has been developed to be evidence-based, realistic and achievable. The roles of all three parties have been ‘operationalised’ to make them functional and easy to apply in the working environment. Will the Agreement require me to do additional training for the role? By signing the Agreement you commit prospectively to ongoing engagement and self-development. The Agreement therefore requires that Educational Supervisors commit to undertake a minimum of eight hours of CPD per year (from the effective date of the Agreement) in relation to their educational role. CPD activity must meet GMC standards in relation to all seven areas of the Academy of Medical Educators’ ‘Framework for the Professional Development of Postgraduate Medical Supervisors’ over a five year cycle (and at least two Framework areas per year). These Framework areas are –

1. ensuring safe and effective patient care through training 2. establishing and maintaining an environment for learning 3. teaching and facilitating learning 4. enhancing learning through assessment 5. supporting and monitoring educational progress 6. guiding personal and professional development 7. continuing professional development as an educator

How will the training I undertake be recorded to demonstrate that I am meeting this requirement? Training providers will be responsible for ‘mapping’ their courses, workshops and other CPD activity against the AoME Framework areas. Details will then be uploaded to the Intrepid database maintained by the Deanery and Local Education Providers. The Wales Deanery has developed a new Self Accreditation Module as part of the updated Intrepid system (known as Intrepid Version 10.). After you have signed the Agreement, the Deanery will ensure that you have access to the Self Accreditation Module. If you already use the current Intrepid system for applying for, or approving, leave then you are already registered. If you haven’t previously used Intrepid you will be sent your account details by e-mail. Accessing the Module allows you to select a course attended (from a pre-verified list) and enter the date(s) of attendance. You will automatically be recorded as having covered the Framework area(s) to which the course is ‘mapped’.

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Many courses will be verified and added to the Intrepid system before it goes live, however if a course you attended isn’t listed you simply fill in the relevant details online and the Deanery will verify the course, map it to the appropriate Framework area(s) and it will be added to the list of recognised courses. The Framework area(s) covered will automatically be updated in your CPD record. Will CPD I undertook prior to signing the Agreement ‘count’? As a dedicated Educational Supervisor who has voluntarily undertaken training in your role, be it short courses or postgraduate study in medical education, you have demonstrated evidence of past commitment to your personal development. However, skills in education, like skills in clinical practice, need to be constantly revisited and updated as curricula content, assessment methods and expected outcomes change. This is why the approach to trainer recognition in Wales requires a ‘prospective commitment’ to ongoing professional development – it is part of a continuous process designed to support and encourage you in your practice as an Educational Supervisor. Is there a process of ‘appraisal’ for the Educational Supervisor role? Those undertaking the role of Educational Supervisor should receive appraisal for the educational supervision component of their job plans as part of their annual NHS appraisal. This will include consideration of whether you are demonstrating attitudes and behaviours appropriate to delivery of the educational supervision role. Provision of this appraisal is a Local Education Provider responsibility under the Educational Supervision Agreement but you have a responsibility to let your appraiser know that you are an Educational Supervisor, be prepared to talk about your role as a trainer and collect evidence of your commitment to, and achievements in, the education and training of trainee doctors. You are therefore advised to include feedback from trainees in your multi-source feedback required for appraisal. Other evidence could be provided from sources including peers, placement feedback, GMC survey results and teaching evaluation forms, as well as your own reflections and your record of CPD as a trainer. Does the Agreement specify the protected time I should receive to deliver the Educational Supervisor role? Yes. The Agreement states that an Educational Supervisor should typically receive, as a minimum, 0.25 SPA per week per trainee supervised to deliver the role. Local Education Providers should recognise a need for flexibility in the allocation of time for the Educational Supervisor role in accordance with team or departmental requirements and the needs of individual Educational Supervisors. What if I do not meet the Deanery’s requirements for recognition? The GMC states that Deaneries must only recognise Educational Supervisors who they are satisfied meet the standards they set. The Deanery will need to liaise with Local Education Providers and individuals to address any concerns and assess whether remediation may be appropriate or to discuss the possibility of an individual no longer acting in a specific training role. The Deanery has an obligation to establish procedures for appeals against decisions not to recognise individuals as Educational Supervisors, building on existing arrangements.

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Having signed the Agreement, are there any circumstances in which I would not be able to undertake the Educational Supervisor role? Doctors subject to investigation under the GMC’s Fitness to Practise (FTP) procedures may undertake the role of Educational Supervisor unless they are suspended or restricted from practising while investigations are continuing. Your employing Local Education Provider has a responsibility to inform the Wales Deanery accordingly. What if, in the future, I decide I wish to withdraw from the Agreement? As a doctor, you care about providing good patient care. If you also believe that good medical training leads to better doctors who can provide excellent clinical care in the future, and that clinicians have a vital role to play in improving the quality of the education doctors in training receive, then this is a good reason to be an Educational Supervisor (and sign the Agreement). If you decide to withdraw from the Agreement, implicitly you will have also considered, discussed, negotiated and decided that you do not wish to be an Educational Supervisor. This is a decision that has to be negotiated on a completely individual basis. However, if you should decide to withdraw from the Agreement you will need to notify the Deanery and your employer. You will no longer be eligible for recognition as an Educational Supervisor by the GMC or able to undertake this role. As the development of the Agreement is an ongoing process and will be subject to evaluation, the Deanery would welcome your feedback and discussion around your reasons for withdrawal.

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The Future of the Agreement How will the Agreement reflect changes to national policy, standards or guidance? The Agreement will be reviewed on an annual basis to ensure that the content remains accurate, reflecting changes to, for example, the GMC’s implementation plan for recognition of trainers or the role of Educational Supervisors as detailed in ‘The Gold Guide’. All Agreement signatories will be notified of any amendments to the Agreement content or terms. How will the Deanery know whether the Agreement is fit for purpose? The Wales Deanery is committed to an evaluation of the Agreement and its implementation. The Deanery plans to evaluate the Agreement following phased rollout and has secured the assistance of the Cardiff Unit for Research and Evaluation in Medical and Dental Education (CUREMedE) in this ambitious evaluation project which should be complete by the end of 2014. Having signed the Agreement you may therefore be asked to participate in this evaluative research by, for example, completing a questionnaire or participating in a focus group or one-to-one interview. How will the Deanery know if the Agreement makes a difference to my role? The Deanery is developing a number of mechanisms for quality control of the Agreement allowing us to assess whether or not each party is fulfilling their obligations under it. Obviously we can’t measure compliance with every aspect of the Agreement, but we have identified areas within each party’s responsibilities which are key indicators of the success with which the Agreement is implemented such as monitoring time in job plans for role delivery and checking that Educational Supervisors are fulfilling their commitment to training for the role. Are other Deaneries developing similar Agreements? The Postgraduate Dean for Wales places a very high importance on high quality postgraduate medical education and training and we hope that, ultimately, the Agreement will raise the profile of the Wales Deanery as a lead Deanery in this respect. All Education Organisers in the UK are working to implement the GMC’s plans for trainer recognition. However, as far as we know, Wales is the first Deanery to develop an explicit statement of the role of the employer and the Deanery as well as the individual Educational Supervisor in delivering and supporting high quality educational supervision.

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Sources of Further Information and Support

Who can I approach locally for help and support? The Local Faculty Lead for Trainer Support at your Health Board or Trust will be able to provide you with further information and support. For the name and contact details of your Local Faculty Lead, please contact your local Postgraduate Centre or the Wales Deanery’s Quality and Postgraduate Education Support Unit (walesdeanerysre@cardiff.ac.uk or (029) 2068 7491).

How can I access training relevant to the Educational Supervisor role? There are many sources of training for Educational Supervisors available to suit your needs and preferences, from part time and distance learning, to short courses, workshops and postgraduate award-bearing qualifications, and courses range in duration. Look for courses and educational events that have clear learning outcomes (ideally mapped against the AoME Framework areas), appropriately qualified and experienced leaders, are adequately resourced with a variety of teaching and learning modalities, appropriate and helpful assessment methods, and preferably those which are formally accredited with CPD points granted through an approved educational accreditation system such as that of the Royal College of Physicians. In due course, information on where you may find CPD opportunities will be provided on the Deanery’s ‘Trainer’ web pages at www.walesdeanery.org/wales-deanery-trainers You could also ask for advice on what’s available from your Royal College or NHS employer as well as Training Programme Directors, Faculty Leads, Directors of Medical Education and others. You may also be able to find out about national training opportunities via the AoME (www.medicaleducators.org) and NACT UK’s (www.nact.org.uk) websites. Your local Postgraduate Centre will also be able to let you know about any local training opportunities available to you.

As trainer recognition processes develop, you will find that increasing numbers of trainer development courses are mapped against the Framework areas so you will find it easier to identify CPD opportunities that will refresh and increase your knowledge in particular areas. This will enable you to be more systematic and targeted in your personal development to meet trainer recognition requirements. It will also help employers to identify the learning needs of their workforce and ensure sufficient appropriate training is available and signposted. Where can I find out more about the Intrepid database and the Self Accreditation Module? For more information and a user guide, contact selfaccreditation@cardiff.ac.uk and look out for training sessions advertised in your local Postgraduate Centre. How else can I obtain further information on the Agreement? There are lots of ways to find out more about the Agreement: consult the Deanery’s web pages – www.walesdeanery.org/wales-deanery-trainers/trainer-recognition; e-mail your query to walesdeanerysre@cardiff.ac.uk; or contact the Quality and Postgraduate Education Support Unit on (029) 2068 7491. The Deanery will also keep you updated with regular communications via mechanisms including e-mail, newsletters, our Facebook page (‘Wales Deanery’) and Twitter feed (@walesdeanery).