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Title: Tomorrow’s Doctors 2009 Implementation Workshop Scotland


1
Tomorrows Doctors 2009 Implementation Workshop
Scotland
2
Tomorrows Doctors 2009 implementation
Martin Hart Assistant Director, Education
6 May 2010
3
Health and Safety
4
Purpose for the day
  • To enable medical schools, deaneries, employers
    and other stakeholders to jointly review progress
    towards the implementation of Tomorrows Doctors
    2009 and to discuss local key challenges and
    responses
  • To discuss areas for additional guidance and
    support and options to enhance the quality
    assurance of basic medical education

5
Scotland
  • Five Medical School
  • The Scottish Doctor
  • NHS Education for Scotland
  • Four Deaneries
  • One Foundation School

6
Programme
  • 1000 GMC presentations
  • 1040 School, Scottish Government/Employer and
    Deanery presentations
  • 1230 Question and answer session
  • 1300 Lunch
  • 1400 Break out sessions
  • 1530 Coffee break
  • 1545 Feedback
  • 1615 Questions
  • 1630 Workshop finishes

7
GMC update - Merger of PMETB into the GMC and
Patel Review
8
Context for merger
  • February 2008, the Secretary of State announced
    that PMETB would be merged with the GMC,
    following a recommendation from Sir John Tooke's
    Independent Inquiry into Modernising Medical
    Careers
  • PMETB should be assimilated in a regulatory
    structure within GMC that oversees the continuum
    of undergraduate and postgraduate medical
    education and training, continuing professional
    development, quality assurance and enhancement
  • Following the merger on 1 April, all stages of
    medical education and training are now part of
    the GMC's remit.

9
Benefits of the merger
  • Simplified regulatory structure
  • Single point of contact for key interests
  • Sharing best practice
  • Integrated approach to education and training
    across continuum
  • Greater access to resources of GMC, and
    efficiencies from one organisation

10
Patel Review
  • Lord Naren Patel commissioned to lead review of
    the regulatory framework for medical education
  • Working group set up, chaired by Lord Patel,
    comprising members of GMC and PMETB
  • Wider reference group of key interest groups to
    enable us to test emerging thinking

11
Patel Review considered
  • Understanding the continuum
  • Stages of education and training particularly
    the transitions
  • Quality assurance
  • Legislation

12
Patel Review
  • Preliminary conclusions of the review were
    consulted on in January to March 2010
  • The final report was published in April 2010 and
    is available on our website www.gmc-uk.org
  • Recommendations and Options for the Future
    Regulation of Education and Training

13
Implementation of Tomorrows Doctors 2009
  • Professor Jim McKillop

Scotland, 6 May 2010
14
Tomorrows Doctors 2009
15
Why Tomorrows Doctors was reviewed
  • Changes
  • Foundation Programme
  • PMETBs approach to standards and QA
  • Pressures due to student numbers, EWTD, patient
    throughput, move from old-style firm,
    community-based training
  • Patient and employer expectations
  • Challenges, real or perceived
  • Prescribing and practical skills
  • Scientific knowledge
  • Professionalism, leadership, team-working
  • Assessment

16
Tomorrows Doctors Consultation
  • Sources for review
  • QABME
  • GMC guidance, new educational frameworks,
    research Dr Jan Illing, How prepared are medical
    graduates to begin practice?
  • Responses
  • Wide engagement with key stakeholders
  • 634 written submissions, Skills for Health survey
    of 230 NHS staff
  • UK wide events

17
Consultation meetings in Scotland
  • Stonewall Scotland
  • Edinburgh and Lothian Racial Equality Council
  • Voluntary Health Scotland
  • Medical Students from the five Scottish Medical
    Schools
  • BMA Scotland

18
Tomorrows Doctors 2009 structure
  • Foreword by the Chair of GMC
  • Introduction responsibilities of GMC, schools,
    NHS organisations, doctors, students
  • Outcomes for graduates
  • Standards for delivery
  • Appendices
  • Practical procedures for graduates
  • What the law says
  • Related documents and links throughout
  • Glossary

19
Overarching outcome
  • Medical students are tomorrows doctors. In
    accordance with Good Medical Practice, graduates
    will make the care of patients their first
    concern, applying their knowledge and skills in a
    practical and ethical manner and using their
    ability to provide leadership and to analyse
    complex and uncertain situations.

20
Outcomes for graduates
21
Outcomes for graduates key elements
  • Biomedical and other sciences
  • Diagnosis and managing presentations
  • Safe prescribing skills
  • List of diagnostic and therapeutic procedures
  • Teamworking and leadership
  • Working in the NHS and improving healthcare

22
Standards for delivery of teaching, learning and
assessment
23
Standards for delivery some key themes
  • Patient safety
  • Practical experience
  • Placements planned and structured
  • Agreements between schools and providers
  • Student Assistantships
  • Shadowing and induction into F1
  • Assessment
  • Student support, health, equality
  • Quality control and input from patients and
    employers

24
Tomorrows Doctors 2009
  • Published in September 2009
  • Standards and outcomes will apply to all UK
    medical schools from 2011/12
  • GMC Undergraduate Board has agreed to produce
    additional guidance on
  • Assessment
  • Clinical placements
  • Standards for teachers and trainers

25
Enhanced Annual Return (EAR)
  • All schools reported to be on track for
    compliance
  • All schools have identified areas to work on
  • Key challenges for all schools
  • Patient and employer feedback in quality
    management
  • Delivery and management of clinical placements
  • MPET Review funding

26
The State of Basic Medical Education
  • March 2010 The State of Basic Medical Education
    published
  • Summarises key findings of QABME
  • Shares examples of schools practice
  • Shares experiences from schools and visitors
    involved in QABME
  • Includes comments from a range of perspectives on
    recent developments, and future opportunities and
    challenges

27
Options for the Enhancement of QABME Survey
  • https//gmc.e-consultation.net/econsult/default.as
    px

28
Options for the Enhancement of QABME Survey
  • Seeking views on options to enhance QABME to
    ensure it remains fit for purpose.
  • Survey presents a number of issues and options,
    and asks for feedback on a number of options to
  • Enhance sharing good practice between schools
  • Quality assure outcomes for graduates
  • Enhance consistency and comparability in
    judgements about schools
  • Also asks for input on how the role of students,
    employers and those involved in Foundation
    Training, and patients and the public can be
    enhanced in QA activities

29
Can you remind me just what were looking for?
30
Contact us
  • Website www.gmc-uk.org
  • Email quality_at_gmc-uk.org
  • QA Survey ends 28 May 2010

31
Tomorrows Doctors Implementation Workshop
  • University of Dundee Medical School
  • Gary Mires

32
Medical Schools consideration of TD2009 approach
  • Workshop
  • Self reflection on compliance
  • Generation of a series of action points

33
(No Transcript)
34
Well placed
  • Patient safety
  • Patient safety lead
  • Quality assurance
  • Local working relationships with NHS / DoME
  • Local SLA / job planning
  • ACT funded QA lead
  • Student selection
  • MMI

35
Well placed
  • Design / delivery / assessment
  • Range of learning opportunities
  • Foundation apprenticeship placements
  • New acute care module to include prescribing
  • SSC programme
  • Portfolios
  • Assessment of outcomes
  • Common shadowing

36
Well placed
  • Support and development of students and teachers
  • Staff development officer
  • Tiered programme according to needs
  • Professional Development Awards
  • Educational resources
  • New education build

37
Work required
  • Quality Assurance
  • Feedback from patients
  • Feedback form employers
  • Peripheral placement monitoring and SLAs
  • Equality and diversity
  • Equality and diversity training
  • Design / delivery / assessment
  • Feedback provision
  • Support and development of students and teachers
  • Training, support and appraisal for teachers and
    defining expectations of Medical School

38
Outcomes for Graduates
Overall Compliant 65 Partially compliant
32 Work required 3
39
Outcomes for graduates issues
  • Areas most work required relate to
  • Global health issues
  • Health service management / organisation
    /economics / regulation
  • Doctors as managers / leaders
  • Psychological outcomes e.g. adaptation to life
    changes
  • Prescribing

40
Examples of actions to deliver TD2009 and provide
evidence of compliance
  • NHS responsibilities and expectations of Medical
    School
  • Roles responsibility pack for clinical teachers
  • User friendly distillate of TD for NHS /
    clinicians highlighting areas relevant to them
  • Engage NHS teaching leads to support delivery
  • Staff training and support
  • Targeted programme of work on staff development
    including equality and diversity training
  • Student assistantships
  • Build on current Foundation Apprenticeship blocks
  • Look at examples from Foundation training for
    assessing competence

41
  • Outcomes for graduates
  • Implement recent review of basic science teaching
    to reflect shift towards more comprehensive
    teaching of biomedical and social science in TD
    2009
  • Acute care module implementation
  • Continue prescribing teaching enhancement work
  • Evidence
  • Establish Tomorrows Doctors database with
    ongoing collection of evidence of compliance
  • Work on approaches to provide evidence of
    compliance e.g. students working within capability

42
Further guidance / support
  • Support and development of teachers and local
    faculty (TD 128 and 148)
  • Nature and process for quality data from
    employers about preparedness of graduates (TD 43)
  • Nature and process for quality feedback data from
    patients (TD 43)
  • Expectations of Student Assistantships (TD 109)
  • Shadowing period (TD 110)
  • Non compensation in assessment versus integration

43
  • Tomorrows Doctors 2009GMC WorkshopProf
    Hamish McKenzieUniversity of Aberdeen

44
Tomorrows Doctors
  • Curriculum review commenced in 2004/5
  • New final year in 2008/9
  • New years 1 3 rolled out from 2009/10 onwards
  • Many of the changes of TD2009 anticipated
  • Curriculum Steering Group reviewed TD2009 in
    February and identified areas for further work

45
TD2009
  • What are we doing
  • What do we need help with
  • Doubts and concerns

46
TD2009 what are we doing
  • Outcomes for graduates
  • Psychological principles (para 9)
  • Social science principles (para 10)
  • The doctor as a professional (paras 20 -23)
  • Staff development
  • Quality management

47
TD2009 help
  • Domain 9. Outcomes
  • Para 172 Quality management will
    involve..collection and use of information about
    the subsequent progression of graduates in
    relation to the Foundation Programme and
    postgraduate training, and in respect of any
    determinations by the GMC....

48
TD2009 help
  • Domain 5 Design and delivery of the curriculum,
    including assessment
  • Para 121 - medical schools should make
    arrangements so that graduates areas of relative
    weakness are fed into their Foundation Programme
    portfolios......

49
Doubts and concerns
  • Assessment of competences
  • Student assistantships
  • Feedback from patients

50
Doubts and concerns
  • Domain 6 Support and development
  • of students, teachers and local faculty
  • Para 128
  • Everyone involved in educating medical students
    will be appropriately selected trained, supported
    and appraised

51
Doubts and concerns
  • Domain 9 Outcomes
  • Para 169
  • Schools must track the impact of the outcomes
    for graduates and the standards of delivery as
    set out in TD against knowledge, skills and
    behaviour of students and graduates.

52
Doubts and concerns
  • External factors
  • New arrangements for selection into Foundation
    Programme
  • NHS teaching resource

53
(No Transcript)
54
Tomorrows Doctors Implementation Workshop
  • University of Glasgow Medical School
  • Approach to the Challenge of TD3
  • Prof. Jill Morrison
  • Head of Undergraduate School

55
Consideration at Committees
  • Medical Education Committee Standing item
  • Education Strategy Committee
  • Faculty of Medicine
  • Senior Curriculum Management Team

56
Strengths
  • Preparation for Practice (Student Assistantship)
    implemented 2008-09
  • Involvement in NES projects
  • Clinical Skills

57
Challenges
  • Relationship with NHS partners
  • Selection, support, appraisal and training of all
    staff involved in teaching
  • Full mapping of curriculum

58
Planning and Implementation
  • Course leaders identify areas of work
  • Summary of work prepared
  • Allocation of tasks
  • Monthly review at Medical Education Committee and
    Senior Curriculum Management Team

59
Further support or guidance required
  • Support for negotiations with NHS
  • Guidance about detail of implementation e.g. SSCs

60
Tomorrows Doctors Implementation Workshop
University of Edinburgh Medical School Professor
Allan Cumming
61
  • MANY CHALLENGES
  • Focus on two
  • Outcome-based education and assessment
  • The Student Assistantship

62
GMC QABME, University of Edinburgh 2008/9
Review and simplify the curriculum structure
. Rationalise the vertical themes running
through the curriculum
63
Outcome-based education and assessment
64
Curriculum model (Edinburgh)
  • Spiral
  • Core and options
  • Integrated
  • Systems-based
  • Discipline-based
  • Problem-based
  • Case-based
  • Task-based
  • Outcome-based
  • Student-centred
  • Self-directed
  • Multi-professional
  • Community-centred

65
Curriculum outcomes
preparedness for practice
What to learn - content
How to learn educational strategy teaching
and learning tools
Assessment
Educational environment
Student
66
What are we doing?
  • Edinburgh curriculum is being structured and
    described in terms of twelve Curriculum Outcomes
  • The assessment strategy is being aligned with
    these outcomes
  • Tomorrows Doctors 2009 outcomes are the
    primary basis of the new structure - with
    appropriate additions to reflect the character of
    the Edinburgh graduate

67
(No Transcript)
68
(No Transcript)
69
OUTCOMES END PRODUCT OF THEMES
  • Each Outcome supported by an Outcome Theme (OT)
  • Each OT has a Theme Head and team
  • Curriculum content and assessments related to
    each OT planned and tracked electronically

70
a caring, competent, confident, ethical and
reflective practitioner, equipped for high
achievement, able to provide leadership and
analyse complex and uncertain situations
12 CURRICULUM OUTCOMES
12 THEMES
The Edinburgh MBChB curriculum
PRIOR LEARNING
71
OUTCOMES PLUS
equipped for high personal and professional
achievement
RESEARCH
RECOGNITION OF EXCELLENCE
MOBILITY
STUDENT CHOICE
caring, competent, confident, ethical and
reflective practitioner
EXTRA-CURRICULAR
HUMANITIES
12 CURRICULUM OUTCOMES
12 THEMES
SAFE PATIENT CARE
SAFE PATIENT CARE
PRIOR LEARNING
72
Examples
the Edinburgh graduate will be
Scientist/scholar Practitioner Professional
Ability to apply principles and knowledge of
pharmacology and therapeutics, including
prescribing
Provide a safe and legal prescription
Describe the adverse effects of warfarin
Levels of outcome in the Edinburgh MBChB degree
programme. Course refers to any subdivision of
the curriculum such as a module or clinical
attachment.
73
Outcome-base assessment and compensation
  • Tomorrows Doctors 2009, Para 117
  • Medical schools must have appropriate methods
    for setting standards in assessments to decide
    whether students have achieved the outcomes for
    graduates. There must be no compensatory
    mechanism which would allow students to graduate
    without having demonstrated competence in all the
    outcomes.
  • Most integrated assessment systems have some
    degree of compensation as an integral feature of
    their design. Ensuring that each of the outcomes
    has been passed by every student will require
    investment in resources and time to alter systems
    of assessment, data gathering and remediation.

74
BLUEPRINTINGTracking Assessment of Outcomes
75
Student Assistantship (StA) some questions
  • Could the StA be considered an approach to
    teaching and learning lasting throughout final
    year?
  • If the StA is a discrete period of time within
    final year, how long should it last?
  • Even within a StA, students may not undertake
    activities that require provisional registration.
    This is interpreted in a variety of ways by
    clinical staff and NHS management. ? Is there
    guidance on how students should gain real-life
    experience in, for example
  • Prescribing drugs and fluids
  • Injecting drugs into patients
  • Injecting drugs into bags of fluids for IV
    infusion
  • Accessing IT systems in hospitals and practices

76
(No Transcript)
77
Professionalised teaching
  • Quality and quantity of teaching measured and
    recognised, linked to appraisal, job planning,
    and to funding
  • Systematic drivers to participate in staff
    development activities

78
  • Paragraph 112, Tomorrows Doctors 2009
  • Medical schools must ensure that all graduates
    have achieved all the outcomes set out in
    Tomorrows Doctors, that is
  • each of the five outcomes under The doctor as a
    scholar and a scientist
  • each of the seven outcomes under The doctor as a
    practitioner
  • each of the four outcomes under The doctor as a
    professional
  • every practical procedure listed in Appendix 1.
  • This must involve summative assessments during
    the course that cumulatively demonstrate
    achievement of each outcome. The medical school
    must have schemes of assessment that map the
    outcomes to each assessment event and type,
    across an appropriate range of disciplines and
    specialties (blueprinting). Students
    knowledge, skills and professional behaviour must
    be assessed. There must be a description of how
    individual assessments and examinations
    contribute to the overall assessment of
    curricular outcomes, which must be communicated
    to staff and students.
  • Paragraph 117 Tomorrows Doctors 2009
  • Medical schools must have appropriate methods
    for setting standards in assessments to decide
    whether students have achieved the outcomes for
    graduates. There must be no compensatory
    mechanism which would allow students to graduate
    without having demonstrated competence in all the
    outcomes.

79
Producing tomorrows doctors a schools approach
to meeting the challenge.
  • Bute Medical School
  • University of St Andrews

80
Background to St Andrews Programme .
  • Offers a B.Sc. Honours Degree in Medicine
  • The new programme delivers the foundations of
    medical science through an integrated curriculum
    with a strong clinical context and early clinical
    contact.
  • Students continue their clinical training at 5
    partner clinical schools Manchester, Aberdeen,
    Dundee, Edinburgh and Glasgow.
  • 5 separate liaison committees have been
    established with these partner schools.

81
Consideration of TD(2009) to date
  • School Teaching Away day-focus of discussions.
  • Teaching Management Group-standing item.
  • Enhanced QABME Annual Return-self assessment
    sections.
  • Curriculum Review Sub-committee-charged with
    addressing these issues.

82
Challenges
  • Ensuring that the curriculum at St Andrews
    attains as many of the outcomes for graduates and
    the standards in the 9 domains as is practicable
    and appropriate in its particular 3 year
    preclinical programme.
  • Liaising with its 5 clinical partners in terms of
    achieving overall the outcomes and standards.
  • Electronic Mapping of our curriculum to both
    Scottish Doctors 3 and Tomorrows Doctors 3.
  • Integration of sociology with health psychology
    and public health medicine and appropriate input
    into this review.

83
Challenges
  • Development of standardised SLA for all medical
    schools and health boards in Scotland
  • Staff development programme for clinical staff
    teaching medical students on a Scotland-wide
    basis.
  • Equality, diversity and opportunity issues to
    ensure adherance to legislation. Equality Impact
    Analyses

84
How is the school approaching planning and
implementation of the new standards by 2011/2012
  • Curriculum review to identify and fill gaps and
    improve curriculum integration.
  • Identification of vertical themes and tagging of
    these to make them explicit.
  • Curriculum and assessment mapping via our online
    curriculum management system (Galen) to TD3
    outcomes and domains.
  • Consultation with our clinical partner schools.

85
Areas for support and further guidance.
  • Reasonable adjustments that need to be made for
    students with disabilities in accordance with
    current legislation and guidance.
  • The nature of the data to be collected and
    analysed to monitor equality and diversity
    issues.
  • The University policies necessary to permit the
    School to meet the standards set out in Domain
    3-Equality, Diversity and Opportunity.
  • What would be viewed as reasonable staff
    development programmes for clinicians teaching
    students on placements or on campus

86
PRODUCING TOMORROWS DOCTORS A SCOTTISH
GOVERNMENT AND EMPLOYERS PERSPECTIVE
  • DR HARRY BURNS
  • CHIEF MEDICAL OFFICER

87
Key issues
  • THE CHANGING CONTEXT OF CLINICAL PRACTICE
  • THE CONTINUUM OF MEDICAL TRAINING IN THE UK
  • THE NEEDS OF NHS SCOTLAND

88
CONTEXT
  • FINANCIAL CONSTRAINTS
  • RECENT GROWTH IN RESOURCES AND STAFFING LIKELY TO
    SLOW OR EVEN REVERSE
  • NEED TO IMPROVE EFFICIENCY AND PRODUCTIVITY
  • ALTERED SKILL MIX INEVITABLE IMPACT ON DOCTORS
    ROLES

89
National income vs expenditure
90
CONTEXT
  • BROAD HEALTH AGENDA
  • AGEING POPULATION
  • ADVANCING TECHNOLOGY
  • PATIENT EXPECTATIONS
  • PERSON CENTRED CARE
  • PATIENT SAFETY
  • CLINICAL EXCELLENCE
  • ADDRESSING HEALTH INEQUALITIES

91
THE AGEING POPULATION
92
What matters most to patients
  • A clean ward
  • Staff cleaning their hands before touching
    patients
  • Being treated quickly in an emergency
  • Getting the best treatment for my condition
  • Doctors knowing enough about my condition and
    treatment
  • Clear explanations about what will happen during
    an operation or procedure
  • Being told the risks and benefits of any
    treatment in a way I can understand
  • Clear explanations of my condition or treatment
  • Being treated with dignity and respect
  • Being told how my operation has gone in a way I
    can understand

93
Patient perceptions Scotland is doing well
94
Responding to what patients want and need
95
It can be done
NHS Scotland has undertaken a bold,
comprehensive, and scientifically grounded
programme to improve patient safety.  The
dedication of NHS leadership at all levels to
this endeavor is apparent to me, and bodes well
for success.  In its scale and ambition, the
Scottish Patient Safety Programme marks Scotland
as leader second to no nation on earth in its
commitment to  reducing harm to patients
dramatically and continually.Don Berwick June
2008
96
Alignment of policies an opportunity
97
CONTINUUM OF MEDICAL TRAINING
  • WIDE UNDERSTANDING THAT CURRENT SYSTEM IS NOT
    RIGHT
  • MMC/EWTD
  • DAMAGE TO TRUST IN SYSTEM
  • REDUCED FLEXIBILITY IN WORKING PATTERNS AND
    CAREER PATHS
  • SHIFT PATTERNS DISRUPTING TEAM WORKING AND
    APPRENTICESHIP

98
CONTINUUM OF MEDICAL TRAINING
  • SOME CONCERNS ABOUT PREPAREDNESS FOR PRACTICE AT
    GRADUATION
  • CURRENT REVIEWS OF FOUNDATION AND PATEL REVIEW OF
    REGULATION
  • INCREASING SPECIALISATION IN TRAINING BUT NEED
    FOR MORE GENERALISTS IN SERVICE
  • CREDENTIALLING AND REVALIDATION

99
WHAT THE SCOTTISH NHS NEEDS
  • EXCELLENT DOCTORS
  • PREPARED TO PRACTICE AT FOUNDATION LEVEL ON
    GRADUATION
  • BROAD SCIENTIFIC KNOWLEDGE UNDERPINNING EXCELLENT
    COMMUNICATION AND TECHNICAL SKILLS
  • ALREADY LEARNING HOW TO LEAD A CLINICAL TEAM

100
WHAT THE SCOTTISH NHS NEEDS
  • PROFESSIONAL VALUES THAT PROMOTE QUALITY
    ACCOUNTABILITY
  • PERSON CENTRED CARE
  • PATIENT SAFETY
  • CLINICAL EXCELLENCE
  • READINESS TO MEASURE PERSONAL OUTCOMES AND ACT ON
    THE RESULTS
  • ABILITY TO INNOVATE AND DEVELOP NEW APPROACHES
    AND TECHNIQUES

101
WHAT THE SCOTTISH NHS NEEDS
  • DOCTORS THAT CAN DEVELOP IN DIFFERENT WAYS
  • HIGHLY SPECIALISED TERTIARY CARE CONSULTANTS
    RURAL GENERALISTS
  • BUT WITH CORE VALUES OF QUALITY, LEADERSHIP,
    ACCOUNTABILITY AND EXCELLENCE
  • MEDICAL SCHOOL IS KEY TO ENSURING THOSE CORE
    VALUES

102
Tomorrows Doctors 2009 - the NES Perspective
  • Dr Duncan Henderson Dr Kim Walker
  • Chair, Director,
  • Scottish Foundation Board Scottish Foundation
    School

103
NES Perspective
  • 5 years of Foundation Programme
  • Close partnership with Scottish Medical Schools
  • Feedback from Foundation Trainees on areas for
    improvement

104
TD 2009
  • Preparing for Practice
  • Student Assistantship
  • Shadowing
  • Induction Deanery, Hospital, Unit

105
NES / Deanery Role
  • Assist with implementation of
  • Preparation for Practice
  • Student Assistantship
  • Feedback to Medical Schools

106
Challenges
  • Placements timing, geography
  • IT Access

107
Question and Answer
108
Feedback from breakout groups
  • Group 1
  • Group 2
  • Group 3
  • Group 4
  • Provide a few key points or issues from the
    discussions

109
Next steps
  • Schools will be submitting a further Annual
    Return towards the end of 2010 to show progress
    and implemented plans.
  • Please complete the Options for the enhancement
    of QABME survey on our website before 28 May.
  • May 2010 a summarised note of todays discussions
    will be sent via email.
  • Please take a few moments to complete a feedback
    form.

110
Thank you!
  • Website www.gmc-uk.org
  • Email quality_at_gmc-uk.org
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