Framework for specialty training – the Gold Guide

1. Framework for specialty training – the Gold Guide Professor Shelley Heard Incoming Director of Training and Standards RCPath 19th October 2007

2. The Gold Guide • setting the context • describing the process • gaining consensus • key changes • process for amendment • the future

3. August2002 February2003 July 2003 April 2004 The Context (1)

4. 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)

5. 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

6. From the Orange Book to the Gold Guide Guide to Specialist Registrar Training The Orange Book 1998

7. Academy of Medical Royal Colleges Academy Trainee’s Doctors’ Group BMA – JDC COPMeD COGPED GMC NHS Employers Patient representative PMETB Service stakeholders from four devolved administrations Workforce Review Team Reference Group

8. 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

9. 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

10. Specialty training as a specialty registrar (StR) • Becoming a ST • Progressing as a ST • Being an ST and an employee

11. 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

12. 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)

13. 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

14. 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

15. 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. Trainer’s 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 evidence of progress • Outcome of review • Educational Planning 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)

16. Purpose of ARCP • provide a for recording the evidence of the trainee’s 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 trainee’s 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.

17. 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

18. 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)

19. 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.

20. The Future • Tooke review • Consultation period • ? back to Specialist Registrar (SpR) training