UK Shape of Training steering group: report annexes

Annex 11: Process for ensuring that curricula in the future meet the principles of the Shape of Training Review

Proposal for the process whereby curricula changes for postgraduate medical training will be reviewed to ensure change fulfils the principles and benefits envisaged from adoption of the recommendations within the Shape of Training Review ( SoTR).

Purpose of this paper

1. The purpose of this paper is to outline the process whereby future proposals to amend medical training pathways and curricula are reviewed to ensure that they accord with the key principles and benefits envisaged to accrue from implementation of the SoTR.

Background

2. The SoTR was established by UK Ministers to consider how medical training could better meet the present and future needs of patients. The review group reported their findings in October 2013 making 19 recommendations. ( http://www.shapeoftraining.co.uk/reviewsofar/1788.asp). In response to the report, UK Health Ministers approved the establishment of a UK-wide Shape of Training Steering group ( UKSTSG) to assess the report's findings, and make recommendations on how best to proceed. A key task was working with the Academy of Medical Royal Colleges and the General Medical Council ( GMC) to bring forward proposals on how to revise training curricula to meet the requirements envisaged by the SoTR. This is an ongoing process, with some proposals being assessed as more advanced than others.

3. The UKSTSG have now considered in detail two specific proposals relating to new training pathways: for general surgery and general medicine. In determining whether a proposal fulfils the principles and benefits envisaged from the SoTR, the UKSTSG requires to be reassured that the training pathway will equip doctors with the skills and experiences necessary to provide the high quality patient centred care that both patients and service providers will require. Where appropriate, this must include the maintenance of generic skills and the flexibility to enable doctors to move between training pathways.

4. The UKSTSG has confirmed that the proposal for general surgery has fulfilled these requirements. The proposal for a new training pathway for internal medicine is currently being considered by the Group. While the UKSTSG has considered these two submissions, its members recognise it is a short life working group, and that it is necessary therefore to develop a process outwith its core business that enables future submissions to be reviewed to ensure that they accord with the principles and benefits envisaged from the SoTR.

5. It is the General Medical Council ( GMC) which has ultimate responsibility for setting the educational standards for undergraduate and postgraduate education and training for all doctors in the UK. This includes providing approval for all training posts and programs as well as approving all postgraduate curricula and their associated assessment systems. All proposals therefore for new or revised postgraduate curricula and training pathways must ultimately be submitted to and approved by the GMC. The GMC have an established process for this, which includes seeking views from NHS employers, and representatives of the Postgraduate Deans across the UK. Currently, all curricula submitted to the GMC for approval originate from UK Medical Royal Colleges and Faculties, but it should be noted that the GMC can consider curricula submitted by any competent body.

6. The SoTR also identified areas of patient need beyond educational considerations that relate to the provision of sustainable clinical services within increasingly integrated care models and the reality of a more constrained financial climate. These elements that impact on the type of doctor that the service needs will not be addressed by only using an educational/professional/regulatory process. In recognising these wider strategic factors, and not least the desire to maintain the continuity of UK-wide medical education, it is therefore proposed that future submissions for curricular change should be reviewed in a two-stage process to help ensure that these broader strategic aspects have been considered before a submission progresses for consideration by the GMC.

The proposed process for new curricula submissions

7. At present, all proposals for the recognition of curricula that relate to the development of new clinical disciplines are considered in the first instance by the UK Medical Education Reference Group (Reference group), which operates under the auspices of UK Health Ministers. This is to ensure that such developments are necessary, affordable and consistent with the strategic planning and priorities of the UK Health Departments.

8. Given that this process currently exists, and works well, it is proposed that a similar process be used for the consideration of curricula submitted as a result of developments arising from consideration of the SoTR, and for subsequent iterations where the body responsible for the curriculum puts forward proposals for major curricular change Submissions would require to include a brief accompanying document that describes how the new curriculum fulfils the principles and benefits envisaged from the SoTR. A template will be developed for this purpose. The UK Reference group would convene a small panel (or sub-group) to consider each submission and to make recommendations to the Reference group. The remit of this small panel or sub-group would permit the engagement with relevant Royal College representatives, and to require additional information and amended submissions in order to make a recommendation to the Reference group.

9. This prior consideration process is intended to enable the Reference group to expedite a decision that confirms that individual submissions fulfil the principles and benefits envisaged from the SoTR and has the support of all four Countries of the UK. (the GMC will not approve a curriculum that does not have 4 Nation support although recognises that such a curriculum may not be delivered across the UK ) The Reference group reserves the right to seek further views on any submission prior to giving its confirmation. As at present, all submissions would then be submitted to the GMC for regulatory approval against their established standards for curricula and assessments.

Recommendation

10. The UKSTSG are invited to consider this paper at their meeting of the 22nd September 2016.