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Aspiring to excellence

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Title: Aspiring to excellence


1
Aspiring to excellence
  • To deal with many of the deficiencies
    identified and to ensure the necessary concerted
    action, the creation of a new body, NHSMedical
    Education England (NHSMEE) is proposed. NHS MEE
    will relate to the revised medical workforce
    advisory machinery and act as the professional
    interface between policy development and
    implementation on matters relating to PGMET. It
    will promote national cohesion in England as well
    as working with equivalent bodies in the Devolved
    Administrations to facilitate UK wide
    collaboration. The Inquiry has charted a way
    forward and received a strong professional
    mandate. The Recommendations and the aspiration
    to excellence they represent must not be lost in
    translation. NHSMEE will help assure their
    implementation

2
  • The NHS Next Stage Review describes a vision
  • for the NHS that delivers high quality for all
    and
  • gives staff the freedom to focus on quality.
  • Achieving this vision requires us to provide the
  • best possible education and training for future
  • generations and to ensure that our existing
  • staff get the support they need to continuously
  • improve their skills.

3
Chapter 3 A high quality workforce We will
improve key aspects of workforce planning at
national level by establishing an independent
advisory non-departmental body, Medical Education
England (MEE)
4
Sir John Tookes response to A high quality
workforce
  • I am particularly pleased to see the creation of
    Medical Education England which will give the
    profession the strong voice and the scrutiny
    function that it needs

5
Structure of MEE

Board
29 members 6 meetings per annum
6
Structure of MEE
Board
Med
D
P
HS
7
NHS NSRA high quality workforce MEE agenda 1
  • Suggest more valid and reliable selection methods
  • Commission a formal evaluation of the 2 year
    Foundation programme and consider an alternative
    model linked to wider reform of postgraduate
    medical education
  • Look at the balance between generalist/core
    training and specialty training
  • Reach a consensus on PGME and training structure
    by August 2010
  • Continue discussions with Royal Colleges,
    deaneries, junior doctors, patients, employers,
    trade unions, SHAs and other stakeholders on how
    to take PGME and Training forward.

8
NHS NSR A high quality workforce MEE Agenda 2
  • Work with the Royal College of General
    Practitioners to develop cost- effective
    proposals for training at least half of doctors
    going into specialty training as GPs.
  • Strengthen the public health workforce and
    produce a system of dual accreditation
  • Be responsible for the development of modular
    credentialing
  • Advise on how the training of dentists should
    reflect the changing pattern of dental needs
  • Develop modular training for healthcare
    scientists leading to the post of accredited
    specialist
  • Promote the incorporation of leadership and
    management training into undergraduate curricula

9
NHS NSR A high quality workforce MEE Agenda 3
  • Ensure that educational supervisors in secondary
    care undergo mandatory training and review of
    their performance
  • Promote the incorporation of academic pathways as
    per the Walport report.
  • Develop the modernising scientific careers
    programme (Life Sciences, Physiological Sciences,
    Physical Sciences and Engineering each with a
    rotating training programme)
  • Take responsibility for the development of the
    training programme for pharmacists with the new
    emphasis on promoting health and well-being and
    giving life-style advice
  • Take on the responsibility for low volume
    specialties that require national planning
  • Take on the job of working with the newly
    established HIECs to develop a model interface
    between universities and the NHS for innovation
    in education, training, certification, local
    workforce development and translational research.

10
Additional items suggested by Board members
  • Quality of training agenda developing trainers
    metrics and incentives effect of EWTD
  • Disseminating information on workforce planning
    working with CoE
  • Development of a national simulation strategy
    including collaboration with MoD
  • Ensuring that all final year medical students
    have an opportunity to shadow in the hospital in
    which they will be working

11
The 2007 / 08 PMETB survey showed the following
implementation rates for F1 shadowing.
  • Lowest
  • Highest
  • Warwick            48
  • Cambridge         45
  • Oxford               42
  • Keele                42
  • Birmingham      37
  • Belfast              96
  • Glasgow            86
  • Aberdeen         81
  • Barts                 78
  • Dundee            78

12
Kieran Seyan et al BMJ 2004
Definition of the standardised admission ratio
for applicants to medical school No of
admissions from a particular population subgroup
as a proportion of all admissions ________________
___________________ Proportion of the general
population that belongs to that subgroup
13
Kieran Seyan et al BMJ 2004
  • Asians Social Class 1 6.07
  • Whites 0.73
  • Blacks Social Class IV 0.07
  • No black people from Social Class V were admitted
    to Medical School
  • Females 1.15
  • Data from 1996-2000

14
Gender balance in Medical Schools
I could not find any information on male to
female ratio of current medical students at
Newcastle medical school . Grateful for any
information
In our year the ratio is about 21,
femalesmales. In my seminar group of 20, for
example, 14 are female and 6 are male. This is
the same with the majority of seminar
groups. __________________ Third year Medical
Student at Newcastle University, Tyne Clinical
Base Unit
15
Graduate entry into Medicine
  • Normal mode of entry in USA for many years
  • 1997 Four Australian Medical Schools changed
    exclusively to graduate entry
  • Ireland has now changed to an increase in
    graduate entry

16
HIECs
  • Health Innovation and Education Clusters (HIECs)
    are aimed at more rapidly translating research
    and innovation into clinical practice, and
    linking workforce planning to a quality framework
    of education.
  • HIECs could be one of the key ways in which MEE
    is plugged in at a local level

17
HIECs
  • A partnership between
  • NHS organisations (primary, secondary and
    tertiary)
  • HE sector (universities and colleges)
  • Industry (healthcare and non-healthcare)

18
Principles of HIECs
  • Span settings (Trusts, FTs, private sector
    primary, secondary and tertiary care)
  • Span sectors (NHS, HE, Industry)
  • Span professions (i.e. Multi-professional)
  • Deliver measurable impact in innovation
  • Focus on quality
  • Support the purchaser-provider split in education
    and training

19
HIEC 2009 timetable
  • May distribution of national prospectus to
    outline HIECs concept, application process
  • May- July regional stakeholder events run by SHA
  • Early September completion of pre-qualification
    questionnaire
  • October submission of formal applications
  • November presentations to National selection
    panel
  • December first wave of HIECs announced

20
Selection into Foundation Programme
  • MSC leading on 2 stage project to review methods
    of selection
  • Stage one literature review, full stakeholder
    engagement, international expert panel, cost
    benefit analysis panel.
  • 26th June identify proposed new selection method
  • 31st July DoH policy impact assessment
  • 3rd August submit report to MEE
  • 25th September MEE Board meeting to make
    recommendation

21
Steering Group options
  • Current system
  • Structured interviews interview score combined
    with an academic quartile score for ranking
  • National exam all candidates take an exam
    separate from finals
  • Situational judgment test all take an
    invigilated SJT.
  • Common assessment med schools provide scores for
    applicants based on a common scheme of assessment
    that is effectively part of the final examination.

22
EWTD John Blacks February
Newsletter Carpe Diem
I explained that a general reduction to a
48-hour week would in our view have profound
consequences for the provision of local services
and training. Many medium-sized and small
hospitals would not have sufficient staffing
levels to maintain rotas. Surgical services would
become unsustainable and of course without
surgical cover accident and emergency departments
would have to close. The increasing demands on
consultants to keep emergency services going
would inevitably have a serious impact on
elective surgery, with little hope of meeting
government targets on waiting times.
23
EWTD ASiT survey Jan 2009
  • ASiT suggest that to ensure optimal training,
    with adequate time for exposure and high quality
    patient care with increased continuity, it is
    necessary to return to a working week of
    approximately 65 hours. For higher specialty
    trainees (ST3 and above), on-call rotas rather
    than shift working would best protect training
    opportunities, and would be the optimal
    arrangement where workload permits.

24
Evaluation of the Introduction of the
Intercollegiate Surgical Curriculum Programme
  • Professor Michael Eraut
  • University of Sussex

25
JCST discussion document of the Eraut report
  • ..disturbing insight into the current condition
    of surgical training in the UK. Many factors are
    identified as being responsible for this
    unwelcome state, not all of them obviously
    remediable.
  • Allowing for the environmental factors
    identified in the Eraut report is the ISCP fit
    for purpose as a curriculum for surgical
    training? (these factors included the EWTD and
    the MTAS disaster)

26
Annual Specialty Report Overview JCST
  • ISCP
  • despite its many strong points, the ISCP
    continues to generate a degree of discontent
    amongst some trainees and trainers, and
    engagement with both groups, in some areas, is
    less than the JCST would wish to see
  • Opportunities for training in operative surgery
  • 29 ST1 trainees have access to less than two
    operating sessions per week JCST would like to
    see a commitment to innovative training methods
    such as simulation to help offset this reduction
    in clinical experience
  • Support for trainers
  • ..widespread evidence that surgical trainers are
    poorly supported by their employing Trusts.
    Urgent action is needed to correct this before
    consultant surgeons become completely disengaged
    from the training process.

27
Review of Foundation Year 1 and 2
  • MEE charged to do this as part of the NSR
  • Concern from the MSC that this should be an
    independent review
  • No decision taken as yet with regard to timetable
    for doing this
  • Need to identify key individuals who might take
    part in this review

28
Summary
  • The creation of MEE is an opportunity to produce
    a more coherent approach to manpower planning and
    the promotion of excellence in the education and
    training of doctors, dentists, pharmacists and
    healthcare scientists
  • If we are to tackle the very challenging agenda
    then the MEE Board, Subcommittees and many other
    stakeholder organisations will need to work
    closely together to produce a consensus which
    best represents the interests of the professions,
    trainees and, above all, patients
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