Martin HartAssistant Director Education

Case study on accreditation: the GMC’s

perspective

Agenda

What GMC does

How doctors are educated and trained

How we accredit and quality assure

Strengths of our process

Issues and challenges

Our purpose

‘to protect, promote and maintain the health and safety of the public by

ensuring proper standards in the practice of medicine’

Our aim

To secure a regulatory system which:

Enhances patient safety

Fosters professionalism

Commands the confidence of all stakeholders

Is independent, fair, efficient and effective

General Medical Council

A new council took office at the beginning of 2009:

All appointed by the Appointments Commission

12 lay members

12 medical members

Our functions

Education

Standardsand Ethics

Fitness to Practise

Registration

Medical School

(4-6 years)

F1 year

(1 year)

F2 year

(1 year)

Specialty/

GP training

(3-8 years)

Specialist/GP register

Provisional registration

Full registration

Certificate of completionof training (CCT)

Medical School

(4-6 years)

F1 year

(1 year)Career stage

Employment/regulatorystatus

Student, not licensed

Employed, in training, licensed by GMC Employed, licensed

Structure of UK education and training

Education standards

The GMC’s role in medical education

Responsible for promoting high standards of medical

education

In April 2010 PMETB will merge with the GMC

For the first time, one organisation will be responsible

for regulating all stages of medical education and

training

Medical School

Medical School

(4-6 years)

32 medical schools in the UK

35,000 medical students (60% female)

Have own approaches to curricula, teaching, assessment etc

But must all meet standards and outcomes in Tomorrow’s Doctors

Subject to fitness to practise, graduates receive provisional registration with GMC

GMC quality assures (QABME)

Foundation Programme

F1 year and F2 year

(2 years)

Foundation programme is a two year programme of general training with placements within various specialties and healthcare settings (hospital bias)

Foundation Programme has national application scheme (UKFPO) and is overseen by postgraduate deaneries

Curriculum developed by Academy of Medical Royal Colleges, approved by GMC and PMETB

F1 has outcomes set by the GMC which must be achieved to receive full registration

GMC and PMETB jointly quality assure Foundation Programme (QAFP)

14,000 junior doctors in Foundation Programme (2009)

Specialty training

Specialty/GP training

(3-8 years)

Medical royal colleges draw up criteria for specialist and GP training and assessments, which are approved by PMETB

National competition for selection, training overseen by postgraduate deans

PMETB* certifies completion of training, leads to entry on GMC GP or specialist register and eligibility to work as a consultant

PMETB* quality assures specialist training

*GMC from 2010

Maintaining Standards: Quality Assurance

Two quality assurance processes:

Foundation Programme (QAFP)

Medical Schools (QABME)

Focussed on the institution, not students and trainees

Key elements are analysis of documentation, interviews with academic staff, students and clinicians

Quality assurance of specialty training currently undertaken by PMETB

Quality Assurance of Medical Education

Make sure institutions comply with standards

Identify examples of innovation and good practice

Identify concerns and help to resolve them.

Identify changes institutions need to make to comply with and a timetable for their implementation

Promote equality and diversity in medical education

QA Visit Processes

QABME Medical Schools Quality

Management Curriculum content Examination framework 8 – 10 visitors Minimum 4 days visit over

6 months

QAFP Joint process with

PMETB Postgraduate Deaneries

quality management 6 visitors 4-day visit over 4 sites in

one week

QA Reports and institutions’ replies publish on website

QA Visit Teams

Undergraduate/ postgraduate deans & school/deanery staff

Medical education specialists

Clinicians

Students/ junior doctors

Lay Visitors

All are ‘full and equal members’ of visit teams

QA visit teams

Consistent approach to recruitment Same contracts (responsibilities, payment and

time) Mandatory annual training Same performance management framework Annual appraisal Share competencies

QA Monitoring Process

Targeted action plans & updates

Annual Returns of information

PMETB Survey of Trainees (for QAFP)

Data from all three sources published on GMC website

Strengths of QABME at the end of 5 years

In depth evaluation of School

Wide range of team expertise

Interactive with School

Triangulation from multiple sources

Seen as important and generally supportive by Schools

Transparent process and status of schools’ progress on requirements is available to students and the public

Strengths of QAFP midway through

Has galvanised postgraduate deaneries to evaluate and demonstrate improvements in quality management

Has given trainees a greater voice in the quality management and assurance of their training

Has identified areas where improvements are needed particularly in the supervision of trainees

Postgraduate deaneries have reported the process as challenging and helpful – perhaps particularly the self assessment

Issues in GMC accreditation

QABME & QAFP:

Resource intensive – GMC and institutions

Maintaining team focus/knowledge over cycle

Potential variability of teams

Potentially insufficient involvement of employers and patients in the QA process

Disseminating good practice/innovation

Challenges for accreditation generally

Is the QA focus on institutions sufficient for maintaining a register of professionals?

Sanctions – ‘nuclear option’: removal of accreditation

Reliance on others: can the GMC’s QA processes effectively identify areas of poor practice? Deaneries and Schools measure the quality of

individual students and junior doctors Health systems regulator measures quality of

care (and by extension doctors)

Issues for the future: Student Registration?

Medical students are not registered with the GMCBUT guidance for schools and a significant programme of student engagement

Has the challenge of keeping in touch with students and instilling professional values been met?

Could student registration strengthen the link between the GMC and students?

www.gmc-uk.org/education