Approval and Re-approval
of
GP Trainers and GP Training Environment
Mohan Kumar
2007
1. Introduction
1.1 The Postgraduate Medical Education and Training Board (PMETB) took over the responsibility
from the Joint Committee on Postgraduate Training for General Practice (JCPGTP) in September
2005. Its key roles include (a) Setting standards (b) curricula review (c) approval of curricula,
programs, posts and GP Trainers (d) recommendation of doctors to be admitted to the specialist
and general practitioners registers1.
1.2 Under the New Medical Order, approval of the specialty training programmes, posts and GP
Trainers rest with the PMETB. However, during this transitional phase PMETB has established a
new system which relies on Post Graduate Deans sponsoring training programmes and posts in
conjunction with advice from the local representatives of Royal Colleges and the Deanery
Specialty Training Committee1
1.3 A new Training organisation called the Post Graduate School of General Practice (PSGP) is being
established within the North West Deanery in response to the COPMed and Academy of Royal
Colleges Discussion Document2 This will in turn be responsible for Quality assurance of GP
Trainers and Training practices under guidance from the Deanery.( Appendix 3)
1.4 There is a move towards multi-professional arrangements with inter-professional training as set
out in the Post Graduate Deanery configuration and workforce development documentation. This
is influenced by the proposals set out by the Department of Health in March 20063 . It encourages
primary care learning environments to incorporate a multidisciplinary theme.
1.5 The unified end point assessment to the GP Specialty Training (CCT and nMRCGP) and the new
GP Curriculum represent significant changes to GP Training and its provision by Trainers and
Training Practices.
1.6 The new GMS contract, the Quality and Outcomes Framework, Annual Appraisal for GPs have all
been milestones in GP service provision and Quality assurance of GPs and practices. There is a
significant overlap of evidence between those collected and provided for Primary Care
Organisations and those for the Deanery process of Approval and Re-accreditation of Training
Practices.
1.7 With the expansion of Training, there has been an exponential increase in new Trainers and new
Training environments. There is also an emerging model of primary care training environment
which includes Trainers at various levels of seniority and experience, supervising Trainees at
various stages of training. This requires closer local scrutiny and quality assurance within
individual programs and Academy, under the supervision of the Post Graduate School of General
Practice.
1.8 With approved Training environments hosting more than one Trainer, the system of approval and
re-approval should take into account the difference between Trainers seeking approval within an
already approved Training environment and to those that are seeking approval for a new Training
environment.
1.9 In response to Department of Health guidance4, there is already a move towards commissioning
services from independent sector providers and these services include provision of General
practice. These sites may offer General practice Training and Deanery processes of approval and
re-approval should take into account newer models of training provision
1.10 There is an increasing need to collate and integrate information regarding Trainers and
Training environments in a format that is accessible, easy to update and maintain, and of a
quality that is conducive to audit and research. This can only be achieved by effective use of
Information Technology.
1.11 The current processes for approval and re-approval of Training Practices and Trainers need
updating in response to these changes. These processes need to withstand PMETB scrutiny and
need to be rigorous and streamlined. They must also respond to feedback from Trainers, their
Practices and GP Specialty Trainees, so there is a cycle of change that involves all stakeholders.
(Appendices 1, 2)
2. Overview of key proposed changes to Approval and Re-approval
process
2.1 Parallel approval processes for Trainer and Learning Environment
2.1.1 The current formal processes of approval and re-approval do not formally distinguish between
Trainer and Training environment and does not always acknowledge their independent approval
status. This needs to made clear. The revised process should emphasise independent approval status
of learning environment versus the Trainer(s)
2.1.2 This would streamline approving multiple subsequent trainers with appropriate qualifications
within an already established training practice. Approval visit for a new Trainer in an established and
currently approved training practice will officially place greater emphasis on the Trainer and their
development.
2.1.3 This will emphasise Practices participation in the Training process and suggests a whole
practice approach to training
2.1.4 Fully involves the Practice manager in the approval and re-approval process and allows
clarification of employment issues
2.1.5
Allows the practice to retain its training status if there is a loss of trainer and
gives flexibility and ease in replacing trainers and/or appointing new ones to continue as a training
environment
2.1.6 The constitution of the visiting teams may reflect the purpose of visit: i.e., incorporate a
practice manager if there is a learning environment approval needed.
2.1.7
2.1.8
However in many cases the approval processes can and will coincide and is a cohesive
process.
Deanery has an obligation to provide PMETB with a list of approved trainers and in the future
may be expected to provide a list of approved multi-professional learning environments
(Appendix 4)
2.2 Post Graduate School of General Practice will hold the database of Trainers and Training
Practices that indicates their approval status and is updated as changes occur
2.2.1
This database will be accessible to relevant personnel within the Academies and Deanery
allowing planning and placements, re-approval visits and data gathering for Quality assurance.
2.2.2
An e-portfolio of Trainers could be linked to their database entries that incorporate their
attendance of trainer’s conferences, master classes, participation in PSGP processes and
involvement in Trainer’s Groups. Trainers can update their entries to reflected further
education and link their PLPs where there is emphasis on educational qualifications and
learning.
2.2.3
The Practice database needs to be updated by respective practice managers and/or Academy
administrators to reflect changes to the building, personnel, teams, services and anything else
that may have a direct impact on training provision.
2.2.4
The administrator time spent on copying, storing and retrieving paper based information will be
freed up. Remote accessibility would facilitate ease of work for Academy and Program
personnel.
2.3 The visiting teams will be developed within individual programs using a combination of
Program Directors, Primary Care Medical Educators, Experienced Trainers and Practice
Managers from Training Practices with support from the patch Associate Directors
2.3.1 Historically visits have been lead by the patch Associate Directors in conjunction with Course
organisers, scheme organisers and GP tutors. The constitution of the visiting teams has varied from
patch to patch within the Deanery with varying involvement from the Primary Care Medical Educator
team and no involvement from GP Trainers or Practice Managers. With the establishment of PSGP
and its academies there will be transformational process where a pool of visitors will be developed and
supported by the patch Associate Directors within each programs/ academies.
2.3.2
There will be of cross academy calibration for Quality assurance
2.3.3 Involvement of trainers and Practice managers will include a supportive and formative element
creating cross fertilization of good practice and develop a community feel to the network of Training
providers.
2.3.4 A network of Practice managers from the Training practices will be expected to convene
parallel to their Trainer’s groups to discuss their roles and from a mutually supportive network that
shares good practice in delivery of training and employment issues of learners.
2.4 Educator re-approval interviews will be reflective and will assess the quality of the
educational process and the trainer's understanding of the core competencies of Trainers.
2.4.1
The Trainer interview will be of a shared agenda based on Trainer’s own reflection and self
evaluation of past teaching.
2.4.2
The interview will help monitor, support and raise standards of teaching
2.4.3
Will encourage reflection of Trainers own practice as a teacher and facilitator
2.4.4
Objective evidence of Trainers knowledge of teaching, skills of teaching and organisation and
delivery of the training program will be sought.
2.4.5
Will take into account Trainers understanding of the new assessment tools, review processes
and the nMRCGP / CCT components.
2.5 Annual Learner exit feedback and exam outcomes to feed into the process of re-approval of
Trainer and Learning Environment.
2.5.1
Current Learner interviews aren’t always timely as an annual exit feedback as the amount of
time the current Learner has spent with the Trainer or the practice may be minimal at the time
of the re-approval visit
2.5.2
Learner feedback is an essential aspect of Quality assurance of the Learning environment and
experience.
2.5.3
Compiling feedback from multiple learners allow for pattern recognition and could be shared
with the Trainer/ Practice without breaking confidentiality for developmental purposes and
ironing out any concerns.
2.5.4
The exit questionnaire could be available electronically and form part of the Trainer/ Practice
database held by the PSGP.
2.6 Evidence to be collated and triangulated from (a) Trainer and Practice self reported
information (b) Deanery Database (c) Multi –Source and Peer Feedback (d) Trainee
Feedback and (e) the practice visit
2.6.1
This methodology will be formalised and streamlined
2.6.2
Input from Trainers Group and Peer appraisal to be incorporated with transparency
2.6.3
Robust systems to ensure all information is centralised and accessible to relevant personnel
yet ensuring confidentiality
2.7 Criteria for Training to be divided into four broad domains (a) Trainer as a Doctor
(b) Trainer as a Teacher (c) The Educational Program (d) The Learning Environment
2.7.1 Although there may be overlap in the evidence and in the broad domains, this helps to reduce
the burden of evidence collection by the practice and trainer by using he wealth of existing evidence
to populate the approval/ re-approval criteria.
2.7.2 This allows for planning the visit timetable with emphasis on Trainer as a Teacher and an
overview of the other domains based on pre-visit information.
2.7.3 Quality assurance and feedback will be domain specific and facilitates problem solving.
2.8 The visitor forms to be redesigned to be fit for purpose and allow ease of electronic input
2.8.1 The Report could be populated using quality pre-visit evidence thus allowing ease of finalising
the report based on information gathered during the visit.
2.9 The visit and re-approval process in turn quality assured using feedback from Trainers
and Practices.
2.9.1
Each visit should trigger a formal feedback from the recipient of the visit. This information will
be collated and analysed by the individual Academies/ PSGP and fed into Deanery Processes
2.9.2
Visits could incorporate an observer/ future visitor for training purposes. This person could
feedback on the format of the visit and the visitor skills.
2.9.3
Feedback to be used to further develop visitor skills and visit processes
2.10 Improved online resources for Educators from Deanery Website
2.10.1 Incorporates ‘Guide to Developing as an Educator’ and a ‘Guide to developing a multiprofessional Learning Environment’
2.10.2 Clearer descriptors of ‘criteria for training’ standardised with PMETB guidance
2.10.3 One stop resource to documentation and useful links for educators and Managers of the
Learning environments (Appendix 5)
Exposure to Teaching and
mentoring during GP Specialist
Training – provision of ‘Nuts &
Bolts’ of teaching and assessment
as part of GP Training curriculum
Successful completion of CCT/
nMRCGP and becomes GP
Principal
2 years post CCT
Wishes to become GP Trainer.
Applies for Basic Trainers
Course while continuing to
participate in teaching
opportunities
Successful completion of BTC/
certificate / formal application to
become trainer
Formal visit from Deanery visiting
team and preparation of report.
Prospective trainer ‘mock’
interview during visit.
Practices skills on other learners including
undergraduates, FY1 & 2, Group skills in
small group work throughout ST1,2 & 3 and
reflects on teaching and training with own
Trainer
Ongoing CPD activities including HPE . If
working in an established training practice to
participate in supervision of learners
( undergraduate/ FY2 & Registrar)
Opportunity to become educational supervisor
/ Associate Trainer. If not part of an
established training practice to look at
Deanery criteria for learning environment and
establish links with established training
practices / Trainers Groups and contact with
local PCME/ Program Director
Informal pre-visit from PD, PCME, Senior
trainers from Trainers groups. If not
established Training practice identification of
areas to develop using Deanery Criteria for
Learning Environment
If unsatisfactory report addresses
issues in educational prescription and
practice development to fulfil criteria for
training
Applies for GPEC/STC
interview
Successful in interview
Unsuccessful in interview – Looks
at feedback from panel, liaises with
PD/ patch AD
Appendix 1: Path to approval as New Trainer
TRAINER!
If newly approved: revisit after one year to
assess progress as Trainer and reflect on first
year.
APPROVED TRAINER
Annual submission of Practice
Data and update on any changes
Trainer’s assessment/ update
/ CPD/ Master- classes /
Conference / Attendance of
Trainers Groups
Formal brief application for reapproval with submission of
video of a educational encounter
(CBD/Tutorial/ COT)
Re-approval primarily based
Trainer interviews/ CPD and QA
of learning environment as
appropriate
Report + Recommendation to GP
School Board
Re-approval 1, 2 or 3 years
Appendix 2 : Path to re-approval as Trainer
Learner Exit Feedback /
Interview by PCME at
DRC
Deanery peruses evidence + electronic
documentation and arranges educational
conversation with Trainer. Assess Learning
environment accreditation this is needed
Trainer Educational Prescription and practice
recommendations shared with Trainer for
opportunity to appeal and correct factual
errors
Concerns leading to temporary
cessation of approval. To be
discussed with Head of School/
Director of Post Graduate GP
Education and remedial discussions
subject to level of concern : may
reapply through usual channels
Appendix 3: PMETB Generic Standards of Training
GP TRAINER – APPROVAL AND REAPPROVAL
APPLICATION FORM
For completion by the Deanery
Deanery:
Name of
trainer
Date form completed:
Name of
practice/
surgery
New trainer
(N) or reapproval
existing
trainer(R)?
Date of selection/reselection and period of
approval recommended
Any additional information:
Please detail here any additional information that would be useful for PMETB in
assessing this application for approval
For completion by the GP director (or nominated deputy)
I confirm that the trainers listed in this application have been subject to the Deanery’s
trainer accreditation process and that the trainers and their practices comply with
JCPTGP/PMETB trainer standards. The Deanery recommends to the PMETB that they be
approved.
Signature:
Note
Date:
Many of these applications will be retrospective. However, deaneries need only submit applications for approval for trainers
who have been newly selected or re-selected by the Deanery since 30 September 2005.
Applications are not needed for trainers who were approved by the JCPTGP before 30 September 2005 and whose approval
has not expired.
PMETB
Appendix 4: PMETB GP Trainer Approval form
Appendix 5: Suggested Outline for the GP section of NW Deanery Website
Mohan Kumar 2007
GP SECTION
Introduction /
Welcome note
from Director
( with big /smily
picture!)
Contacts/
Who’s Who
GP Trainers
Director/ AD
team/
Developing a
multidisciplinary
learning
environment
Admin overview/
contacts
GPST School/
Academy
overview
Trainer Approval
Processes
Training visits
Trainer courses/
conferences
Foundation
Links/
Resources
GP Speciality
Training School
Academy
Programs
Program
Directors
GP Speciality
Trainees
Careers
GP Speciality
Trainee
Resources/
Links to College
Careers advice
Recruitment/
PMEB links
GP Retainers/
Returners
OOH
Transfers
Study leave/
Learning
accounts/
Courses
Part time etc.
GP Tutors?
GP Educators
Link to
individual
programs
Training
practices
Database- public
+ password
protected
Links to
Training
practice
database
Trainer
Resources
Interactive
Maps
STC overview
NewsFlash/
Latest
information/
Updates
Transfer/
Complaints/
Grievance
procedures
GPR contracts/
appointments/
performers list
Deanery
Courses
Overview
HPE
PED/ SPED
All deanery
courses/
College links
VLE
Appraisal
Revalidation
Appraisal
Revalidation
Courses
Info/ update
Appraiser
courses
College Links
CPD links
QACPD
Publications/
Newsletter
PSL
REFERENCES
1
Postgraduate Medical Education and Training Board :A guide to specialty training: the Gold Guide: DRAFT verion
2 05/02/07
2
COPMed and Academy of Medical Royal Colleges Developing Post Graduate Schools, a discussion Document.
Conference of Post Graduate Deans and the Academy of Royal Colleges, 2005
3
4
Department of Health: Deanery workforce functions review A Foster, DOH 16 March 2006
Department of Health: Commissioning a patient led NHS London DOH July 2005