Framework for specialty training the Gold Guide

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Framework for specialty training the Gold Guide

• Professor Shelley Heard
• Incoming Director of Training and Standards
• RCPath
• 19th October 2007

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The Gold Guide

• setting the context
• describing the process
• gaining consensus
• key changes
• process for amendment
• the future

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The Context (1)
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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)

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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

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From the Orange Book to the Gold Guide

Guide to Specialist Registrar
Training
The
Orange Book
1998
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Reference Group

• Academy of Medical Royal Colleges
• Academy Trainees Doctors Group
• BMA JDC
• COPMeD
• COGPED
• GMC

• NHS Employers
• Patient representative
• PMETB
• Service stakeholders from four devolved
  administrations
• Workforce Review Team

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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

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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

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Specialty training as a specialty registrar (StR)

• Becoming a ST
• Progressing as a ST
• Being an ST and an employee

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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

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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)

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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

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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

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Educational Appraisal

• 1. Learning agreement
• aims intended learning outcomes
• based on specialty curriculum
• 2. Advice on portfolio
• 3. Regular feedback (2 way)
• 4. Personal Development Plan
• 5. Trainers structured report
• 6. Workplace based (NHS) appraisal

Workplace based (NHS) appraisal
The Annual Review of Competence
Progression Gold Guide, 2007

• ARCP
• A. Evidence
• 1. Assessment of performance e.g
• workplace based assessments
• and observational methods
• eg mini-CEX, DOPS, video,CBD
• examinations
• structured report
• 2. Assessment of experience, e.g.
• portfolio/log book
• audit
• research
• critical incidents
• B. Annual Competence Review
• Appropriately constituted panel considers
  evidence
• Outcome

Review of Competence Progression Outcome

• Educational supervisor and/or TPD meet with
  trainee to
• review competence outcome
• with trainee
• plan next part of training

Annual Planning
Based on paper from PBETB workplace
assessment group (2005)
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Purpose of ARCP

• provide a for recording the evidence of the
  trainees 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 trainees progress
• provide a mechanism for the assessment of
  outofprogramme 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.

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Annual Review of Competence Progress (ARCP) -
Outcomes

• Satisfactory Progress
• 1. Achieving progress and the development of
  competences at the expected rate
• Unsatisfactory or insufficient evidence trainee
  required to meet with the
• Panel (Outcomes 2, 3, 4)
• 2. Development of specific competences required
  additional training time not required
• 3. Inadequate progress by the trainee
  additional training time required
• 4. Released from training programme with or
  without specified competences
• 5. Incomplete evidence presented additional
  training time may be required
• Recommendation for completion of training
• 6. 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 top
• up 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

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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)

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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.

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The Future

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