Tomorrow’s Doctors 2009
Implementation Workshop Scotland
Tomorrow’s Doctors 2009 implementation
Martin Hart
Assistant Director, Education
6 May 2010
Health and Safety
Purpose for the day
To enable medical schools, deaneries, employers
and other stakeholders to jointly review progress
towards the implementation of Tomorrow’s 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
Scotland
Five Medical School
The Scottish Doctor
NHS Education for Scotland
Four Deaneries
 One Foundation School
Programme
 10:00 GMC presentations
 10:40 School, Scottish Government/Employer
and Deanery presentations
 12:30 Question and answer session
 13:00 Lunch
 14:00 Break out sessions
 15:30 Coffee break
 15:45 Feedback
 16:15 Questions
 16:30 Workshop finishes
GMC update - Merger of PMETB
into the GMC and Patel Review
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.
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
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
Patel Review considered
Understanding the continuum
Stages of education and training – particularly
the transitions
Quality assurance
Legislation
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’
Implementation of
Tomorrow’s Doctors
2009
Professor Jim McKillop
Scotland, 6 May 2010
Tomorrow’s Doctors 2009
Why Tomorrow’s Doctors was reviewed


Changes:

Foundation Programme

PMETB’s 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
Tomorrow’s 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
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
Tomorrow’s 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:
1. Practical procedures for graduates
2. What the law says
3. Related documents [and links throughout]
4. Glossary
Overarching outcome
‘Medical students are tomorrow’s 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.’
Outcomes for graduates
Overarching
outcome
The doctor as a
scholar
and scientist
The doctor as a
practitioner
The doctor as a
professional
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
Standards for delivery of teaching, learning and assessment
Standards
for
delivery
Patient
safety
Quality
assurance,
review
and
evaluation
Equality,
diversity
and
opportunity
Student
selection
Design &
delivery
of
curriculum
including
assessment
Support &
development of
students,
teachers &
local
faculty
Management of
Educational
teaching,
resources
learning
and
and
capacity
assessment
Outcomes
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
Tomorrow’s 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
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
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
Options for the Enhancement of QABME Survey
https://gmc.e-consultation.net/econsult/default.aspx
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:
1. Enhance sharing good practice between schools
2. Quality assure outcomes for graduates
3. Enhance consistency and comparability in judgements
about schools
4. 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
“Can you remind me just what we’re looking for?”
Contact us
Website: www.gmc-uk.org
Email: quality@gmc-uk.org
QA Survey ends 28 May 2010
Tomorrows Doctors
Implementation Workshop
University of Dundee Medical School
Gary Mires
Medical Schools consideration of
TD2009: approach
• Workshop
• Self reflection on compliance
• Generation of a series of action points
Domain
Criteria
Compliant
Some work
required
Significant
change required
1.Patient safety
5
5
0
0
2.QA, review and
evaluation
8
3
4
1
3.Equality, diversity
and opportunity
5
4
1
0
4.Student selection
5
3
2
0
5.Design, delivery
and assessment of
curriculum
9
6
3
0
6.Support and
development of
students and
teachers
6
4
1
1
7.Management of
teaching and learning
3
2
1
0
8.Educational
resources and
capacity
3
0
3
0
9.Outcomes
4
1
3
0
Overall
48 (100%)
28 (58%)
18 (38%)
2 (4%)
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
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
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
Work required:
• Quality Assurance:
– Feedback from patients
– Feedback form employers
– Peripheral placement monitoring and SLA’s
• 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
Outcomes for
Graduates
Diagnostic /
therapeutic
procedures
Scholar and Scientist
Overall:
Compliant 65%
Partially compliant 32%
Work required 3%
Professional
Practitioner
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
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
• 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
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
Tomorrow’s Doctors 2009
GMC Workshop
Prof Hamish McKenzie
University of Aberdeen
www.abdn.ac.uk/dit
Tomorrow’s 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
www.abdn.ac.uk
TD2009
- What are we doing
- What do we need help with
- Doubts and concerns
www.abdn.ac.uk
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
www.abdn.ac.uk
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....”
www.abdn.ac.uk
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......”
www.abdn.ac.uk
Doubts and concerns
- Assessment of competences
- Student assistantships
- Feedback from patients
www.abdn.ac.uk
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”
www.abdn.ac.uk
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.”
www.abdn.ac.uk
Doubts and concerns
External factors
- New arrangements for selection into
-
Foundation Programme
NHS teaching resource
www.abdn.ac.uk
www.abdn.ac.uk
Tomorrow’s Doctors Implementation
Workshop
• University of Glasgow Medical School
• Approach to the Challenge of TD3
• Prof. Jill Morrison
• Head of Undergraduate School
Consideration at Committees
• Medical Education Committee – Standing item
• Education Strategy Committee
• Faculty of Medicine
• Senior Curriculum Management Team
Strengths
• Preparation for Practice (Student Assistantship)
implemented 2008-09
• Involvement in NES projects
• Clinical Skills
Challenges
• Relationship with NHS partners
• Selection, support, appraisal and training of all
staff involved in teaching
• Full mapping of curriculum
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
Further support or guidance required
• Support for negotiations with NHS
• Guidance about detail of implementation e.g.
SSCs
“Tomorrow’s Doctors”
Implementation Workshop
University of Edinburgh Medical School
Professor Allan Cumming
MANY CHALLENGES
Focus on two
• Outcome-based education and
assessment
• The Student Assistantship
GMC QABME, University
of Edinburgh 2008/9
“Review and simplify the curriculum
structure …….”
“Rationalise the vertical themes
running through the curriculum……”
Outcome-based education and assessment
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 ****
****
****
**
***
**
**
Curriculum outcomes
= preparedness for practice
What to learn - content
How to learn –
educational strategy
teaching and learning tools
Assessment
Educational environment
Student
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
• “Tomorrow’s Doctors 2009” outcomes are
the primary basis of the new structure - with
appropriate additions to reflect the character
of the Edinburgh graduate
EDINBURGH MBChB OUTCOMES
GMC TOMORROW’S DOCTORS
2009
OVERARCHING OUTCOME
An Edinburgh medical graduate will be a caring,
competent, confident, ethical and reflective
practitioner, equipped for high personal and
professional achievement, able to provide leadership
and to analyse complex and uncertain situations.
GMC 7. Medical graduates are tomorrow’s
doctors. In accordance with Good Medical
Practice, graduates will make the care of
patients their first concern, applying their
knowledge and skills in a competent and
ethical manner and using their ability to
provide leadership and to analyse complex
and uncertain situations.
THE DOCTOR AS SCHOLAR AND SCIENTIST
Ability to apply to medical practice:
1. BIOMEDICAL AND CLINICAL SCIENCES
GMC 8. Apply to medical practice the
biomedical scientific principles, method and
knowledge relating to: anatomy, biochemistry,
cell biology, genetics, immunology,
microbiology, molecular biology, nutrition,
pathology, pharmacology and physiology.
2. PSYCHOLOGICAL ASPECTS OF
MEDICINE
GMC 9. Apply psychological principles,
method and knowledge to medical practice.
3. SOCIAL SCIENCES AND PUBLIC HEALTH
GMC 10. Apply psychological principles,
method and knowledge to medical practice.
GMC 11. Apply to medical practice the
principles, method and knowledge of
population health and the improvement of
health and health care.
4. EVIDENCE-BASED MEDICINE AND
RESEARCH
GMC 12. Apply scientific method and
approaches to medical research.
THE DOCTOR AS PRACTITIONER
Ability to:
5. Carry out a CONSULTATION WITH A
PATIENT
GMC 13. Carry out a consultation with a
patient.
6. DIAGNOSE AND MANAGE CLINICAL
PRESENTATIONS
GMC 14. Diagnose and manage clinical
presentations.
7. Undertake CLINICAL COMMUNICATION
GMC 15. Communicate effectively with
patients and colleagues in a medical context.
8. Carry out EMERGENCY CARE, FIRST AID,
RESUSCITATION AND PRACTICAL
PROCEDURES
GMC 16. Provide immediate care in medical
emergencies.
GMC 18. Carry out practical procedures safely
and effectively.
9. Apply principles and knowledge of
PHARMACOLOGY AND THERAPEUTICS,
GMC 17. Prescribe drugs safely, effectively
and economically.
including prescribing.
10. Apply principles and knowledge of MEDICAL
INFORMATICS
GMC 19. Use information effectively in a
medical context.
THE DOCTOR AS PROFESSIONAL
Ability to:
11. Apply principles and knowledge of MEDICAL
ETHICS, LEGAL AND PROFESSIONAL
RESPONSIBILITIES
GMC 20. Behave according to ethical and
legal principles.
12. Demonstrate PERSONAL AND
PROFESSIONAL DEVELOPMENT
GMC 21. Reflect, learn and teach others.
GMC 22. Learn and work effectively within a
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
“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
OUTCOMES PLUS
equipped for high personal and professional achievement
RECOGNITION OF EXCELLENCE
RESEARCH
MOBILITY
STUDENT CHOICE
HUMANITIES
caring, competent,
confident, ethical and
reflective practitioner
EXTRA-CURRICULAR
12 CURRICULUM OUTCOMES
12
THEMES
SAFE PATIENT CARE
PRIOR
LEARNING
SAFE PATIENT CARE
Examples
Overarching Degree
outcome [1]
Role outcomes
[3]
Curriculum outcomes
[12]
Detailed Curriculum
outcomes [~60]
Course outcomes
[many]
1
2
3
4
5
“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.
Outcome-base assessment and
compensation
•Tomorrow’s 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.
BLUEPRINTING
Tracking Assessment of Outcomes
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
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
Paragraph 112, Tomorrow’s Doctors 2009:
‘Medical schools must ensure that all graduates have achieved all the outcomes
set out in Tomorrow’s 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 Tomorrow’s 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.’
Producing tomorrow’s doctors: a
school’s approach to meeting the
challenge.
Bute Medical School
University of St Andrews
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.
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.
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 Tomorrow’s Doctors 3.
Integration of sociology with health psychology
and public health medicine and appropriate input
into this review.
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
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.
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 3Equality, Diversity and Opportunity.
What would be viewed as reasonable staff
development programmes for clinicians teaching
students on placements or on campus
PRODUCING TOMORROW’S
DOCTORS: A SCOTTISH
GOVERNMENT AND
EMPLOYER’S PERSPECTIVE
DR HARRY BURNS
CHIEF MEDICAL OFFICER
Key issues
• THE CHANGING CONTEXT OF
CLINICAL PRACTICE
• THE CONTINUUM OF MEDICAL
TRAINING IN THE UK
• THE NEEDS OF NHS SCOTLAND
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
2013-14
2008-09
2003-04
1998-99
50
1993-94
55
1988-89
1983-84
1978-79
1973-74
1968-69
1963-64
1958-59
1953-54
1948-49
Percentage of national income
National income vs expenditure
Total Managed Expenditure
Current receipts
45
40
35
30
CONTEXT
• BROAD HEALTH AGENDA
– AGEING POPULATION
– ADVANCING TECHNOLOGY
– PATIENT EXPECTATIONS
– PERSON CENTRED CARE
– PATIENT SAFETY
– CLINICAL EXCELLENCE
– ADDRESSING HEALTH INEQUALITIES
THE AGEING POPULATION
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
Patient perceptions – Scotland is doing well
Responding to what patients want and need
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
Alignment of policies – an opportunity
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
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
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
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
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
Tomorrow’s Doctors 2009
- the NES Perspective
Dr Duncan Henderson
Chair,
Scottish Foundation Board
Dr Kim Walker
Director,
Scottish Foundation School
NES Perspective
• 5 years of Foundation Programme
• Close partnership with Scottish Medical Schools
• Feedback from Foundation Trainees on areas for
improvement
Educational Solutions for Workforce Development
TD 2009
• Preparing for Practice
• Student Assistantship
• Shadowing
• Induction – Deanery, Hospital, Unit
Educational Solutions for Workforce Development
NES / Deanery Role
• Assist with implementation of:
Preparation for Practice
Student Assistantship
• Feedback to Medical Schools
Educational Solutions for Workforce Development
Challenges
• Placements – timing, geography
• IT Access
Educational Solutions for Workforce Development
Question and Answer
Feedback from breakout groups





Group 1
Group 2
Group 3
Group 4
Provide a few key points or issues from the
discussions
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 today’s discussions will
be sent via email.
 Please take a few moments to complete a feedback form.
Thank you!
Website: www.gmc-uk.org
Email: quality@gmc-uk.org