The Association of Medical Education’s (ASME) response to the Future Forum request for views on education and training

Topic / Incentives / Accountabilities / Implementation
How can we ensure that education and training in the new system is flexible and fit-for-purpose for the new way that care is delivered and enables training beyond the job, for example stimulating a culture of continuing professional development or academic and research development? / The roles of health professionals have changed over recent times. It is no longer acceptable to define education and training activities and outcomes from a purely professional perspective. It has to be about training the right person to deliver the care. Training should be multi-professional or interprofessional when at all possible. This is both to affect economies of scale and to enhance the education/ training episode.
Local commissioning bodies will be able to identify specific training issues, thereby ensuring the correct skill set and skill mix in each health provider organisation.
All healthcare workers, registered and non-registered, should maintain a portfolio. The portfolio will provide the reflective evidence of education and training and help individuals and consequently organisations, set professional development goals. Assessment and discussion about the portfolio should be the starting point to annual appraisals. Nurses, AHPs and doctors are already using portfolios and the model could be extended to others.
This is as true for research skills as other more clinical skills. / Corporate accountability
To develop an education and training strategy based on national benchmarks and meeting local needs.
To fund and deliver training to the relevant staff where patients are included where appropriate.
To provide an electronic portfolio system for staff to capture and reflect upon education and training.
To provide mentors to advise staff on appropriate education and training
To incorporate discussion of the portfolio at annual appraisals.
Individual accountability
To participate in relevant education and training and maintain a reflective portfolio (which may contain elements of observed assessment)
To be prepared to discuss the portfolio and education and training at annual appraisals / By 2017/18 English health professionals paying fees while at university on undergraduate programmes will have incurred large student debts from the new funding regime. This may have a knock on effect on their appetite for further fee payment for postgraduate study when postgraduate fees in England, more especially, postgraduate training are also likely to rise. This will have an impact on employers who might have sponsored study.
NHS trusts should have an overall education and training strategy which should be reviewed by the Board. It will inevitably be developed with input from local higher and further education providers and health commissioners. The education and training strategy should reflect the more global goals of the trust in terms of patient involvement, patient safety and the development of its staff to provide high quality care.
See corporate and individual accountabilities for additional detail
The “Professional Standards”1 and “Framework for Professional Development” 2 as defined by the Academy of Medical Educators provides consensually determined guidelines which can inform implementation.
How can we ensure the right balance of responsibilities and accountability and line of sight throughout the new system (for example, Health Education England and the provider-led networks, employers / professions / education sector, whole workforce) including for research training? / There are 3 major incentives to transparent, nationally benchmarked and evaluated education and training within the NHS. Firstly, the confidence it gives the healthcare professionals that they have a good understanding of what and how they should deliver safe care and that their skills are transferrable across organisations. Secondly, organisations do not have to design all education and training packages themselves and can attain economy of scale when delivering the training shared with other organisations. Thirdly and perhaps most importantly, is that patients will be able to see the kind of skills that those who care for them should have and can compare the standards to those they receive, empowering them. / The accountability should follow a pathway:
The individual healthcare professional to undertake relevant training and to maintain a reflective portfolio which can be discussed at annual appraisals
Commissioning bodies to influence local training agendas within the national benchmarks to ensure mobility of staff.
Employing organisations to deliver relevant training and to appraise staff
Regulatory bodies to ensure that their members uphold the standards set out in any national benchmarking
Health Education England will have statutory responsibilities, especially those which address national workforce issues / HEE can develop the benchmark standards for education and training as well as manage the workforce issues related to numbers of various specialist professionals.
Trusts can then implement the standards for its workforce, influenced by local commissioners through the training it offers and the appraisal processes.
The role of an ‘education supervisor’, or similar, will be the responsibility of the individualand the trust and both parties will need to engage with the processes.
Individual healthcare professionals would ensure they have a portfolio of education and training to fit their existing (and where appropriate, extended) roles. Discussion of education and training would be part of annual appraisals
How do we best ensure an effective partnership with health, education and research at a local level? / Health, education and related research are part of a tripartite structure that many who work in the field are already familiar with. However it is often at the individual, rather than the organisational level that cross-cutting thinking and activity occur. This has been in part because of the competitive nature of some of the funding associated with various organisations and some of the activities within. This has been seen in higher education where funding which originally is allocated for education and training, especially at the under-graduate level, is actually used to fund clinical research.
Over time resentments arise when organisations feel that they are not getting a good deal in terms of funding.
To overcome this historic separation, NHS trusts and the local universities (including the Deaneries) must seek to find new ways of collaborating with transparency and shared activities. This will not only break down some existing barriers but will also offer opportunities to work in more cost effective ways by reducing duplication of training activities. This kind of collaboration is about trust between organisations and belief in when they say they will deliver education and training they will do that and to a satisfactorily high standard. / To ensure accountability of the health community, both its education and training element and the provider side, all organisations have to agree processes of engagement.
This can be done through perhaps a Memorandum of Understanding which is reviewed annually. In addition a cross-sector working group with senior members of all the stakeholders should meet regularly to provide opportunities to explore new issues and to iron out any difficulties that arise.
The lead person for each of the stakeholder organisations should be responsible for the effective collaboration, where necessary to be prepared to negotiate solutions to individual problems and to be personally accountable through the appraisal process for this aspect of their role. / A cross-sector working group should be established in each major locality. It should include the NHS trusts, the higher and further education providers, the Deanery, social care providers and patient representatives. It should ensure that education and training is not compartmentalised within organisations but is considered more broadly. They should seek to share resources, train interprofessionally and fulfil national standards and agree on local issues which are then accepted by all the local stakeholders. This will reduce the amount of repeated training when staff move between employers and from undergraduate to postgraduate stages of education.
How can we ensure appropriate and effective patient and public engagement in the new system? / In line with the aspirations of the NHS in terms of patient involvement in clinical matters they should also be involved in education and training. Patients who are undergoing care and treatment can of course be involved and asked for their views on the clinical and professional activities of those who care for them. However, many patients are vulnerable when they are having care/treatment and therefore the involvement of cadres of “patients” not receiving active treatment is desirable.
In some centres in England there is already varying degrees of involvement through “Patient as Educator” (or similar) programmes. Where these programmes operate, there is a chance for patients to be actively involved in a range of training activities including the provision of feedback to learners. This type of feedback is powerful. There are a number of benefits:
Patients feel their voice is being heard.
Patients’ experiences reflect the reality of being cared for within the NHS and not what healthcare professionals believe the truth to be.
There is a high degree of fidelity in training because they are real and not simulated patients simulated) / A shared patient involvement resource will necessarily have to be hosted by one organisation but it should be actively supported and equally funded, by all the stakeholders.
Annual review of the contractual agreements will ensure all parties remain accountable for the development of the patient involvement programme. / Patient as Educator (or similar) should be developed in localities and agreed through a service level agreement or Memoranda of Understanding. All organisations which provide training should be able to include suitable patients in their education and training programmes. It can be determined locally which organisation will act as host to the programme.
A data base with volunteer patient should be established and actively managed. Funding should be made available to ensure the data is held securely, there is training for the patients and for the administration of the system.
The programme should be evaluated regularly and changes made in response.
How can we improve information on the quality of education and training? / Benchmarking quality is one way to improve education and training, much as clinical effectiveness is determined
In higher education, the Quality Assurance Agency has done this for all subjects 3. A national standard could then be set by Health Education England and made publicly available to demonstrate what is expected of health care professionals in a number of domains. The information this would show that while we have locally provided services, the education and training of staff throughout the country is to the same standard. The QAA’s Framework for Higher Education Qualifications 4 ensures some national uniformity with regard to levels. Higher Education Institutions have autonomy about their own standards but achieve some degree of national uniformity by reference to the FHEQ.
In addition to standards the precise outcomes of various professional courses, e.g. Tomorrows Doctors 5 for undergraduate medical students, will continue to be set by regulators. / Accountability will be to the highest governing committee or board in an organisation. This will demonstrate the organisational commitment to education and training for all staff.
Individual accountability can be through education and training records. Personal and organisational goals can be set as part of professional development and appraisal. / Benchmark standards will have to be set by consultation with relevant academic and professionals. This will take some time but once agreed and adopted, organisations will have to demonstrate that they meet those standards and can then declare that publicly.
If a national standard is to be set by HEE this raises issues about university autonomy and the FHEQ. It also raises the issue of national exams to enforce any standard.
How can we improve information on the quality of education and training and what should be the roles and accountabilities of the key players in this? / Use the new Health Education England organisation as the vehicle to develop the Benchmarks which should not be profession specific but activity specific, concentrating on patient safety etc / HEE would be accountable for delivering the Benchmarks and individual organisations (NHS and HEIs) accountable to ensuring the standards are met locally and then published. / HEE develop the Benchmarks
Organisations submit self assessment documents evidencing that they meet the standards
A kite mark or other indicator that organisations meet the standards would be issued for a period of time
Organisations can display the kite mark to show they meet the education and training Benchmark standards

REFERENCES

1.  Academy of Medical Educators. Professional Standards (2009) http://medicaleducators.org/index.cfm/linkservid/AE86A517-CB91-4FF5-8A9756FE12A607D5/showMeta/0/ accessed 19.9.1

2.  Academy of Medical Educators. A Framework for the Professional Development of Postgraduate Medical Supervisors: Guidance for deaneries, commissioners and providers of postgraduate medical education(2010) http://www.medicaleducators.org/index.cfm/linkservid/C575BBE4-F39B-4267-31A42C8B64F0D3DE/showMeta/0/ accessed 19.9.11

3.  Quality Assurance Agency. http://www.qaa.ac.uk/ASSURINGSTANDARDSANDQUALITY/SUBJECT-GUIDANCE/Pages/Subject-benchmark-statements.aspx accessed 7.9.11

4.  Quality Assurance Agency. Framework for Higher Education Qualifications in England, Wales and Northern Ireland (2008) http://www.qaa.ac.uk/Publications/InformationAndGuidance/Documents/FHEQ08.pdf accessed 19.9.11

5.  General Medical Council. Tomorrow’s Doctors (2009) http://www.gmc-uk.org/static/documents/content/TomorrowsDoctors_2009.pdf (accessed 19.9.11)

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