SouthThamesFoundationSchool

QUALITYMANAGEMENTOF FOUNDATIONTRAININGINHEKSS & HESL

  1. Introduction

The General Medical Council (GMC) is the independent statutory body that regulates undergraduate and postgraduate medical education and training in the UK. TheGMC QualityAssurance oftheFoundation Programme(QAFP) framework defines the standards for foundation training and quality assures the delivery of training against those standards.

The South Thames Foundation School (STFS), on behalf of HE KSS and HESL, is responsible for the quality management of the foundation programme; ensuring that local education and training providers are meeting the GMC standards, through robust reporting and monitoring mechanisms,andsharing evidence ofeducationaldelivery.

Localfoundationfacultygroups will be expectedtoreviewandmaintainthequality standards offoundationtrainingwithintheLEP andSTFSwill undertaketoverifyand validatetheprocess oflocal qualitycontrol.

Anyqueries regardingthis processorfoundationqualityissues should bedirectedto

  1. Standardsfor postgraduate training

The GMC has published two documents that set out all of its standards and requirements: The Trainee Doctor and Standards for curricula and assessment. These include the following domains:

  • Domain 1 - Patient safety
  • Domain 2 - Quality management, review and evaluation
  • Domain 3 - Equality, diversity and opportunity
  • Domain 4 - Recruitment, selection and appointment
  • Domain 5 - Delivery of approved curriculum including assessment
  • Domain 6 - Support and development of trainees, trainers and local faculty
  • Domain 7 - Management of education and training
  • Domain 8 - Educational resources and capacity
  • Domain 9 - Outcomes
  1. Objectives

Our objective is to improve the quality of education and training by:

  • Ensuring that the GMC Standards for the Foundation Programme are being met
  • Identifying areas of concern, common issues and notable practice in foundation training across LEPs
  • Working collaboratively with LEPs to develop and implement Specific, Measurable, Appropriate, Realistic, Timely (SMART) actions for improvement
  1. Evidence

The following evidence will be used to determine whether the GMC standards have been met:

  • Data collected by HEKSS and HESL as part of their quality management processes, and LEPs as part of the quality control responsibilities
  • Surveys of trainees and trainers: annual UK-wide GMC trainee and national trainer surveys
  • The STFS Foundation Doctor Annual Questionnaire (FDAQ)
  • Evidence from progression statistics, for example assessments including examinations, and career progression after successfully completing the programme
  • Data collected by other healthcare regulators and inspectingauthorities across the UK (e.g. CQC) in particular, issues affecting patient safety and patient care
  • Data collected from other GMC functions, including fitness to practise and registration
  • Information from visits carried out by the GMC to LETBs and LEPs, whetheras part of the planned cycle of quality assurance and improvement or as the result of a visit triggered by evidence of failure or concerns regarding poor practice.
  1. STFS Foundation Faculty visiting process - HE KSS LEPs

There are two types of school QM visits; planned visits and exception “focused” visits. STFS visiting teams will usually visit all HE KSS LEPs providing foundation training programmes as part of a planned visiting programme on a three-year cycle.

The HESL visiting process is currently under review. The Pan London Quality and Regulation Unit manage the visit process and liaise with STS on south London issues.

5.1 The visiting cycle

The schedule of planned visits for the next academic year (1 August – 31 July) will usually take place in the period from January to April and will be published before the start of the academic year.

5.2 STFS visiting teams

Visitor / Responsibility
Lead Visitor (STFS Director/Associate Director) / Lead visitor
Broader clinical context.
Reporting systems and processes.
Signing-off the visit report
FTPD / Broader clinical context.
Curriculum, teacher education, supervision, careers
STFS Quality Manager
(Foundation School Manager) / Management of the STFS quality process including analysis of evidence
Preparation of the draft report in consultation with the lead visitor
STFS Quality Administrator (Administrative Officer) / Preparation of visit bundle and collation of data,
including FDAQ
Provision of admin support on the visit day
Foundation doctor (F2) representative / Foundation doctor context/voice
Foundation doctor education experience
Service representative (e.g. DME/
MEM from another LEP) / Broader management and administrative aspects, including learning resource
Lay visitor / A lay representative to provide externality

5.3 Pre-visit documentation

A bundle of relevantdocuments and information will be collated by the quality administrator and this will be circulated,together with a summary overview document, to the LEP via the Director of Medical Education (DME) and the Medical Education Manager (MEM) in advance of the visit. The DME is requested to complete an LEP self-assessment for return within 3 weeks. This will then be included in the bundle of pre-visit documentation sent to the visiting team in advance of the visit. Information in the bundle may include:

Doc / Content / Source
1 / Quality Management of Foundation Training in KSS Foundation
Faculty Visiting Process summary / STFS
2 / QIT review – background, management audit & action plan / HEKSS
3 / Local foundation faculty handbook / STFS
4 / Most recent LFG annual audit and review / STFS
5 / Minutes of 3 most recent local academic board meetings. / STFS
6 / Minutes of 3 most recent local foundation faculty group meetings. / STFS
7 / GMC national trainee survey data / STFS
8 / Previous foundation faculty visit report / STFS
9 / Summary and analysis of responses to the annual trainee questionnaire (FDAQ) / STFS
10 / LEP self-assessment / STFS
11 / CQC information / CQC
12 / Foundation post and programme details / STFS
13 / Other relevant information/intelligence / STFS
14 / Summary of key issues prepared by the QM / STFS

The visiting team will review this documentation and note any areas of concern on a pro forma. Each visitor will return their pro forma to the STFS quality administrator within 2 weeks of dispatch and responses will then be forwarded to the lead visitor within 2 weeks of the visit. The faculty may be required to provide further information prior to the visit on any areas or issues that emerge from the pre-visit documentation.

5.4 Visitor training

Team members will be expected to be familiar with the following documentation reference to which will be included in the training:

  • GMC The Trainee Doctor
  • GMC Outcomes for Full Registration
  • Foundation Programme Curriculum
  • Foundation Programme Reference Guide
  • Foundation Programme e-Portfolio
  • HEKSS Graduate Education & Assessment Regulations (GEAR)
  • STFS Policies/Procedures – see STFS Website - in particular:
  • Foundation Doctor Role and Minimum Requirements for Clinical Supervision
  • STFS Checklist of Quality Standards
  • Delivery of the Foundation Programme Curriculum through Formal Teaching Programme

A visitor training module is available on the ETFT website (see STFS website for information).

5.5 On the day of the visit

The visit will include structured focus group discussions with:

  • Foundation doctors (F1s and F2s will usually be as discrete groups)
  • Hospital faculty leads (e.g. DME, Clinical Tutor, Foundation Training Programme Directors, Medical Education Manager)
  • Educational supervisors

Local LEP administrative staff will be responsible for arranging appropriate accommodation and refreshments for the visit. They will also arrange for faculty group members and foundation doctors to attend the relevant sessions. An example visit timetable is below:

Time / Session / Required
10:00 - 10:30 / A. Visiting team pre-meeting and final briefing / Visiting team
10:30 - 11:00 / B. Meet faculty to discuss faculty development / DME/CT/FTPD/MEM
11:00 - 12:15 / C. Meet F1 doctors / To include a rep from each specialty
12:15 - 12:30 / Break / -
12:30 - 13:15 / D. Meet focus group of hospital faculty leads/foundation programme directors/educational supervisors / FTPDs/educational supervisors (rep from each dept if possible)
13:15 - 13:45 / Lunch / -
13:45 - 15:00 / C. Meet F2 doctors / To include a rep from each specialty
15:00 - 15:45 / D. Collate information and prepare feedback / Visiting team
15:45 - 16:15 / E. Feedback session / LEP Chief Executive/DME/ MEM/Medical Director/ FTPD

A. Visiting team briefing

The lead visitor will provide a 30-minute briefing/training session to the visiting team including:

  • A brief review of the documentation
  • Identification of the main issues to discuss/clarify
  • Identification and exploration of patient/trainee safety issues
  • A qualitative assessment of the trainee experience
  • Exploration with trainers of any concerns raised by them
  • Identification of areas of faculty development and training environment needs
  • Allocation of questions to the visiting panel members with appropriate regard for their experience of different members of the team - it is usual for the Lead Visitor to start the questioning and to summarise where appropriate
  • set rules for the day (e.g. telephones should be switched off during the meetings).

B. Meeting with Faculty group

The agenda for this meeting will be an opportunity for a discussion to identify themes for the visit and will include items to be presented by the LFG, for example to set out the structure of training at the LEP, including any recent changes that are proposed or have been implemented; any perceived challenges in the delivery of education for discussion with the visiting team; feedback on the results of the GMC NTS and the STFS AQ.

C. Meetings with foundation doctors

The visiting team should aim to meet a wide range of foundation doctors from all specialties, including full-time, LTFT, academic and military where appropriate. Foundation doctors should be assured of confidentiality by the Visit Team at the beginning of each meeting and offered an opportunity to meet with the Visiting Team on a one-to-one basis should this be required.

During the visit the visiting team will triangulate the documentary evidence using interviews with foundation doctors and those delivering and facilitating the training.

As a guideline a minimum number of 25 Trainees should be interviewed or 25% of foundation doctors whichever is higher. Foundation doctors out of the main hospital site (e.g. in GP practices or Mental Health Trusts) should be included.

D. Collation of feedback

The visiting team meets to discuss and agree their headline findings, both in terms of notable practice and areas for improvement, agreeing (a) any issues that the LEP has to address immediately; and (b) any issues that should be notified to the Postgraduate Dean (HEKSS or HESL) or the GMC as a matter of urgency.These issues would primarily relate to service issues affecting patient and trainee safety.All reported findings must be supported with clear evidence.

Brief verbal feedback will be given to the LEP CEO and DME and other relevant staff at the end of the day. Any areas requiring an immediate response will be communicated to the LEP CEO, DME and the Postgraduate Dean(HEKSS or HESL) by the lead visitor via e-mail as a matter of urgency.

E. Feedback meeting

The feedback meeting takes place at the end of the visit, and provides the headline findings of the visit. The Lead Visitor should:

  • Thank LEP staff for their time and patience
  • Highlight positive points about the LEP and notable practice that has been noted in the Feedback Form, both where they match the Standards and where they represent innovative practice
  • Reconfirm the purpose of the visit and go through issues found, matching these to the GMC Standards
  • Pay particular attention to issues requiring immediate action
  • If possible, agree an action plan/timescale to be incorporated in the visit report
  • Ask the participants if they have any questions
  • Explain that the process of drafting and agreeing the report factually should be complete within one month of the visit; the full report of the visit will contain a full list of recommendations and requirements.
  • The report will be accompanied by a pre-populated action plan drawn from the requirements and recommendations in the report, with required deadlines for response to the School.

5.6 Preparation of the visit report

A draft written report will be produced by the STFS Quality Manager within two weeks of the visit. This is reviewed and finalised in liaison with the Lead Visitor. Thisdraft is sent to the DME to check for factual accuracy. Once agreed, the report is signed off by the STFS Director and the report will be formally sent to the LEP within one week.The final report will highlight examples of notable practice and set out any mandatory and desirable developmental areas for the LEP to respond to with time-limited action points. The final report is included in the papers for the next scheduled monthly meeting of the HEKSS Quality Management Group.

5.7 Preparation of the action plan

The full report will be accompanied by a pre-populated action plan template for completion by the LEP, drawn from the requirements and recommendations in the report, with suggested timescales of completion of action by the LEP. The LEP will be asked to complete the action plan as part of their response to the report findings. It will include clear specification of key deliverables, timescales for action to take place, timescales for updates, details of when actions are signed off as complete including the required evidence, and details of monitoring to take place in the longer term (e.g. through the LEP Annual Report). Both mandatory requirements and recommendations must be SMART and refer back to the section of the report from which they derive.

TheLEP response will be delivered by the DME on behalf of the local faculty group and local academic board for consideration by the STFS Director on behalf of the HEKSS Quality Management Group. The report will also be available to the GMC when required for their quality assurance process.

5.8 Visit follow-up activity

Evidence of progress in meeting the requirements and recommendations made in the report will be evaluated by the Lead Visitor from the written documentation submitted to the School according to the deadlines agreed. This will then be presented to QMG for final approval for sign off or for agreement on any further evidence required. This may include a further follow up visit.

At the end of each yearSTFS will publish a summary of notable practice and areas for improvement for dissemination across all LEPs.

There may be rare occasions when the concerns about patient and/or trainee safety necessitate further consultation with the GMC and possible removal of trainees on a temporary or permanent basis.

5.9 Exception (focused) visits

In addition to planned visits, the results of the FDAQ may indicate that there are issues of major concern then STFS reserves the right to schedule an earlier visit which may have a specific focus, e.g. a visit to review the delivery of foundation training in surgical or medical specific specialties

A request to schedule an exception visit is made to the Postgraduate Dean (HEKSS) or via the Pan-London Quality and Regulation Unit, in liaison with the Trust Liaison Deans (HESL). It may also be appropriate to consider whether there other means of exploring any issue(s), for example a “conversation of concern” with the local foundation faculty group; a focused visit to e.g. surgical or medical specialties It may also be helpful to consider whether such as tailored questionnaires for trainees and supervisors.

Exception visits are visits to local education providers that are outside of the normal foundation faculty visit cycle.They may be initiated because of:

  • A serious clinical incident, which may or may not have involved a trainee, but that might have implications for training.
  • A serious trainee complaint either directly to HEKSS/HESL /STFS, or via a Specialty School which raises a serious question about current training that cannot be managed through usual mechanisms.
  • Evidence from any other source which raises serious questions about potential service problems which could affect trainees.
  • Concerns arising from the STFS foundation doctor annual questionnaire - issues arising will be considered by the STFS Director.
  • Exception visits will usually follow a similar process to that described above; however, an external representative will be required to join the visiting team.
  • The report will be reviewed at to the Quality Management Group for discussion and approval of action, following which the Postgraduate Dean (or delegate) will write to the Chief Executive of the LEP.
  • The response of the LEP will be followed up and discussed at the Quality Management Group until adequate evidence of resolution is provided.
  • Where serious problems cannot be resolved it will be normal to approach the GMC for advice

If at any stage serious problems are uncovered which put trainees or patients at risk, the Postgraduate Deanmay take immediate executive action.

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