The Future of Psychiatric Training Dr Gareth Holsgrove Medical Education Adviser Royal College of Ps

1
The Future ofPsychiatric TrainingDr Gareth
HolsgroveMedical Education AdviserRoyal College
of Psychiatrists(February 2005)
Royal College of Psychiatrists
2
Royal College of Psychiatrists

• Major developments in postgraduate medical
  education
• The Postgraduate Medical Education and Training
  Board (PMETB)
• Modernising Medical Careers (MMC)
• European Working Time Directive (EWTD)

3
Royal College of Psychiatrists

• PMETB involvement by College members and staff
• Training Committee (Mike Shooter)
• Sub committees
• Curricula
• Foundation Programmes
• Specialist Programmes (Joe Bouch)
• Environments
• Academic Medicine

4
Royal College of Psychiatrists

• PMETB involvement by College members and staff
• Assessment Committee
• Sub committees
• Standards and Outcomes
• (Anne Bird)
• Workplace Based Assessment
• (Raja Mukherjee Gareth Holsgrove)
• Examinations
• (Femi Oyebode Dinesh Bhugra)
• Articles 14 and 11
• (Kandiah Sivakumar)

5
Royal College of Psychiatrists

• Remit of PMETB
• Responsible for all postgraduate medical
  education and assessment of doctors completing
  final postgraduate training
• It will also be in charge of establishing,
  maintaining and monitoring standards relating to
  medical training in the NHS and elsewhere

6
Royal College of Psychiatrists

• Implications
• Royal Colleges will no longer have independent
  control over training approval visits
  curriculum exams and CCST decisions
• They will probably retain these roles (initially,
  at least) but as agents of PMETB
• Service level agreements being drafted

7
Royal College of Psychiatrists

• Implementation
• Originally intended to go live in October 2004
• Now delayed until September 2005
• Will have to carry out all its legal
  responsibilities immediately it goes live

8
Royal College of Psychiatrists

• Developments
• PMETB educational requirements
• Emphasis on workplace based learning and
  assessment
• Trainees will become increasingly responsible for
  their learning and assessment
• Learning and assessment must focus on performance
  (what doctors actually do) rather than just
  knowledge
• These requirements will apply to both training
  and assessment

9
Royal College of Psychiatrists

• Modernising Medical Careers
• Reform of SHO training
• Leading on from Tomorrows Doctors and
  Unfinished Business
• First 2 years after graduation will be a
  Foundation Programme
• Proposes a run through model

10
Royal College of Psychiatrists

• Foundation Programme
• Common curriculum for F1 and F2
• Will be the same for the whole UK
• F1 must map to GMC requirements (The New Doctor)
• F2 must meet PMETB requirements
• To be published on 31 March

11
Royal College of Psychiatrists

• Foundation Programme
• 4 assessment methods identified
• All workplace based (none are traditional exams)

12
Royal College of Psychiatrists

• Foundation Programme Assessment
• Mini-CEX
• Case based discussion
• Multi-source feedback
• Direct observation

13
Royal College of Psychiatrists

• Mini-CEX
• Whole or part of clinical encounters observed and
  rated on a Likert-type scale
• Reckoned to take about 20 mins
• Has proved problematic in psychiatry F2 pilots

14
Royal College of Psychiatrists

• Case-based discussion
• Developed from chart stimulated recall
• Similar to a structured, case-based oral
• Nick Brown et al are developing this as a
  multi-disciplinary leaning method as well as an
  assessment method

15
Royal College of Psychiatrists

• Multi-source feedback
• Provides feedback from a range of co-workers (and
  possibly patients, carers etc) across the domains
  of Good Medical Practice

16
Royal College of Psychiatrists

• Direct observation
• DOPS Direct Observation of Procedural Skills
• Similar to mini-CEX but specifically assesses
  practical skills

17
Royal College of Psychiatrists

• The 4 assessment methods
• 3 national workshops have been run (Gareth
  Holsgrove was a facilitator)
• College plans to provide additional training and
  support

18
Royal College of Psychiatrists

• Run through
• Selected for entry only (ie no mid-point
  reselection)
• Therefore, selection criteria for entry to
  programmes beyond F2 will be extremely important

19
Royal College of Psychiatrists

• MMC timeline (a)
• Foundation Programme curriculum published -31
  March 2005
• Purple Guide published (Operational framework,
  similar to the Orange Guide for Calman) - April
  2005
• Rough Guide to the Foundation Programme (for
  trainers and medical students) - May 2005

20
Royal College of Psychiatrists

• MMC timeline (b)
• Selection methods for specialist training agreed
  in principle -June 2005
• Foundation Programme begins - August 2005
• SAS grade restructuring plan agreed - September
  2005
• Specialty review conclusions - September 2005

21
Royal College of Psychiatrists

• MMC timeline (c)
• Workforce transition management arrangements
  agreed - October 2005
• Application process for specialty selection
  agreed - August 2006
• 1st MMC cohort enters specialist training -
  August 2007

22
Royal College of Psychiatrists

• EWTD
• Reduction in SHO hours
• Will make classroom teaching difficult to
  organize and attend
• Likely to increase SpR workloads

23
Royal College of Psychiatrists

• College responses to change in postgraduate
  medical education
• Appointment of Medical Education Adviser (Gareth
  Holsgrove)
• Curriculum development
• Recognises implications for training
• Plans to appoint Head of Training

24
Royal College of Psychiatrists

• The New Curriculum
• Based on same principles as HST curriculum
• Patient centred
• Competency/performance based
• Outcome defined

25
Royal College of Psychiatrists

• The HST Curriculum
• competency areas used at present
• A - Clinician
• B - Professional
• C - Educator
• D - Leader and Team Worker
• E Researcher
• F Health Advocate
• G - Information manager
• H Communicator
• I - Specialist

26
Royal College of Psychiatrists

• The New Curriculum
• Will use different categories of
  competencies/professional performance
• Mapped to Good Medical Practice (PMETB
  requirement)
• Modular

27
Royal College of Psychiatrists

• Good Medical Practice
• competency/performance headings
• Good clinical care
• Maintaining good medical practice
• Teaching, training, appraising and assessing
• Relationships with patients
• Dealing with problems in professional practice
• Working with colleagues
• Probity and health

28
Royal College of Psychiatrists

• The New Curriculum
• It will be designed for run-through training
• It will be highly flexible to suit specialty
  interests (eg CA plus Forensic)
• and work patterns (eg part-time career breaks)

29
Royal College of Psychiatrists

• The New Curriculum
• It will be accessible by non-psychiatrists (eg
  GPs)
• It will be accessible for CPD

30
Royal College of Psychiatrists

• The New Curriculum
• Could lead to a single CCT in Psychiatry