Martin Hart Assistant Director Education Case study on accreditation: the GMC’s perspective

Agenda  What GMC does  How doctors are educated and trained  How we accredit and quality assure  Strengths of our process  Issues and challenges

Our purpose ‘to protect, promote and maintain the health and safety of the public by ensuring proper standards in the practice of medicine’

Our aim  To secure a regulatory system which:  Enhances patient safety  Fosters professionalism  Commands the confidence of all stakeholders  Is independent, fair, efficient and effective

General Medical Council A new council took office at the beginning of 2009: All appointed by the Appointments Commission

Our functions Education Standards and Ethics Fitness to Practise Registration

Medical School (4-6 years) F1 year (1 year) F2 year (1 year) Special ty/ GP training (3-8 years) Speciali st/GP register Provisional registration Full registration Certificate of completion of training (CCT) Medical School (4-6 years) F1 year (1 year) Career stage Employment/ regulatory status Student, not licensed Employed, in training, licensed by GMC Employed, licensed Structure of UK education and training Education standards

The GMC’s role in medical education  Responsible for promoting high standards of medical education  In April 2010 PMETB will merge with the GMC  For the first time, one organisation will be responsible for regulating all stages of medical education and training

Medical School (4-6 years)  32 medical schools in the UK  35,000 medical students (60% female)  Have own approaches to curricula, teaching, assessment etc  But must all meet standards and outcomes in Tomorrow’s Doctors  Subject to fitness to practise, graduates receive provisional registration with GMC  GMC quality assures (QABME)

Foundation Programme F1 year and F2 year (2 years)  Foundation programme is a two year programme of general training with placements within various specialties and healthcare settings (hospital bias)  Foundation Programme has national application scheme (UKFPO) and is overseen by postgraduate deaneries  Curriculum developed by Academy of Medical Royal Colleges, approved by GMC and PMETB  F1 has outcomes set by the GMC which must be achieved to receive full registration  GMC and PMETB jointly quality assure Foundation Programme (QAFP)  14,000 junior doctors in Foundation Programme (2009)

Specialty training Specialty/GP training (3-8 years)  Medical royal colleges draw up criteria for specialist and GP training and assessments, which are approved by PMETB  National competition for selection, training overseen by postgraduate deans  PMETB* certifies completion of training, leads to entry on GMC GP or specialist register and eligibility to work as a consultant  PMETB* quality assures specialist training *GMC from 2010

Maintaining Standards: Quality Assurance  Two quality assurance processes:  Foundation Programme (QAFP)  Medical Schools (QABME)  Focussed on the institution, not students and trainees  Key elements are analysis of documentation, interviews with academic staff, students and clinicians Quality assurance of specialty training currently undertaken by PMETB

Quality Assurance of Medical Education  Make sure institutions comply with standards  Identify examples of innovation and good practice  Identify concerns and help to resolve them.  Identify changes institutions need to make to comply with and a timetable for their implementation  Promote equality and diversity in medical education

QA Visit Processes QABME Medical Schools Quality Management Curriculum content Examination framework 8 – 10 visitors Minimum 4 days visit over 6 months QAFP Joint process with PMETB Postgraduate Deaneries quality management 6 visitors 4-day visit over 4 sites in one week  QA Reports and institutions’ replies publish on website

QA Visit Teams  Undergraduate/ postgraduate deans & school/deanery staff  Medical education specialists  Clinicians  Students/ junior doctors  Lay Visitors  All are ‘full and equal members’ of visit teams

QA visit teams  Consistent approach to recruitment  Same contracts (responsibilities, payment and time)  Mandatory annual training  Same performance management framework  Annual appraisal  Share competencies

QA Monitoring Process  Targeted action plans & updates  Annual Returns of information  PMETB Survey of Trainees (for QAFP)  Data from all three sources published on GMC website

Strengths of QABME at the end of 5 years  In depth evaluation of School  Wide range of team expertise  Interactive with School  Triangulation from multiple sources  Seen as important and generally supportive by Schools  Transparent process and status of schools’ progress on requirements is available to students and the public

Strengths of QAFP midway through  Has galvanised postgraduate deaneries to evaluate and demonstrate improvements in quality management  Has given trainees a greater voice in the quality management and assurance of their training  Has identified areas where improvements are needed particularly in the supervision of trainees  Postgraduate deaneries have reported the process as challenging and helpful – perhaps particularly the self assessment

Issues in GMC accreditation QABME & QAFP:  Resource intensive – GMC and institutions  Maintaining team focus/knowledge over cycle  Potential variability of teams  Potentially insufficient involvement of employers and patients in the QA process  Disseminating good practice/innovation

Challenges for accreditation generally  Is the QA focus on institutions sufficient for maintaining a register of professionals?  Sanctions – ‘nuclear option’: removal of accreditation  Reliance on others: can the GMC’s QA processes effectively identify areas of poor practice?  Deaneries and Schools measure the quality of individual students and junior doctors  Health systems regulator measures quality of care (and by extension doctors)

Issues for the future: Student Registration?  Medical students are not registered with the GMC  BUT guidance for schools and a significant programme of student engagement  Has the challenge of keeping in touch with students and instilling professional values been met?  Could student registration strengthen the link between the GMC and students?