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MMC Inquiry – Professor Sir John Tooke. RCP London Open Forum 29/05/07. MMC Inquiry - methodology. An inquiry into MMC not just MTAS On –Line Consultation open to all www.mmcinquiry.org.uk Written and oral evidence from stakeholders Draft report to be published for consultation in September

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mmc inquiry professor sir john tooke

MMC Inquiry – Professor Sir John Tooke

RCP London Open Forum 29/05/07

mmc inquiry methodology
MMC Inquiry - methodology
  • An inquiry into MMC not just MTAS
  • On –Line Consultation open to all www.mmcinquiry.org.uk
  • Written and oral evidence from stakeholders
  • Draft report to be published for consultation in September
  • Final Report to be published in December
mmc inquiry terms of reference abridged
MMC Inquiry Terms of reference (abridged)
  • The extent to which MMC has engaged with the profession
  • The extent to which the implementation date has met the needs of trainees etc
  • The governance structures underpinning MMC
  • Implementation including selection and recruitment
  • Impact of the wider professional, workforce and service environment on the programme
mmc inquiry specific issues raised by stakeholders
MMC Inquiry – specific issues raised by stakeholders
  • Effective engagement with the profession
  • Appropriate relationship between the acquisition of competence and the pursuit of excellence
  • Assessment methodologies used in selection
  • The use of Assessment centres
  • The level of choice on offer at application
mmc inquiry specific issues raised by stakeholders 2
MMC Inquiry – specific issues raised by stakeholders (2)
  • Lack of flexibility of run-through programmes
  • The role of FTSTA posts
  • Relative roles of Deans/Colleges in Programme delivery
  • Need for flexible implementation across the UK
mmc inquiry panel members
MMC Inquiry – Panel Members
  • Prof Sir John Tooke
  • Sue Ashtiany
  • Sir David Carter
  • Dr Allen Cole
  • Sir Jonathon Michael
  • Prof Aly Rashid
  • Prof Peter Smith
  • Prof Stephen Tomlinson
mmc inquiry initial questions to colleges
MMC InquiryInitial Questions to Colleges
  • What is your College’s view of MMC and the principles that underpin it?
  • What amendments would your college like to see to facilitate the best possible specialist training in the UK?
  • In what practical way would your constituency best contribute to that process?
draft rcp response 1 selection and recruitment
Draft RCP Response (1) Selection and Recruitment
  • Any new process must be piloted
  • We support a national application process but for 2008 selection should be at deanery level to allow time for pilots etc
  • An “exam” similar to that used by GPs might provide a useful ranking for short listing
  • “White Box” competencies should be assessed – but perhaps most appropriately at interview.
  • Clinical experience and academic performance should be appropriately weighted
  • Alternatives to the simultaneous annual appointment round should be considered
draft rcp response 2 mmc implementation
Draft RCP Response(2) MMC Implementation
  • Flexibility and Duration of training are key issues
  • We wish to restore the flexibility of career pathways envisaged in the early iterations of MMC
  • This could be achieved by de-coupling Core Medical Training from Higher Medical Training so that run-through for Physicians begins at ST3
  • We should be more flexible about the duration of CMT programmes
why de couple cmt and hmt
Why de- couple CMT and HMT?
  • Current selection tools are inadequate for “high stakes” selection out of F2
  • De- coupling allows FTSTAs equal access to ST3 – this allows us to deal with both “late developers” and “poor performers” in the CMT cohort.
  • De-coupling gives access to training in Medicine to potential Radiologists, GPs etc
  • De- coupling may make access to useful experience “out of programme” easier
mmc implementation
MMC implementation
  • We should take the opportunity of reviewing the appropriateness of MMC structures for Flexible Training and Academic Training
mtas phoenix from the flames

MTAS – Phoenix from the Flames

Sarah Thomas

Postgraduate Dean

overview
Overview
  • MMC and MTAS
  • Policy
  • Lessons
  • Next steps
mmc and mtas
MMC and MTAS
  • MMC overarching broad initiative -CMO
  • New curricula
  • Run-through training
  • Competency –based, not time served
  • Early selection
slide16
MTAS
  • Electronic portal
  • Coordinated timetable for recruitment
  • National standards
  • Local deanery/specialty selection
external factors
External factors
  • PMETB
  • Legal and HR
  • Devolved Administrations UK policy
  • Global recruitment
  • Workforce planning
  • Service needs
  • 5 years SHO into ST1 and ST2
  • Timescale
current position
Current position
  • > 40,000 interviews 1a
  • Appointability average 75% all specialties
  • >17,000 interviews 1b
  • Transition plan
  • Judicial review
  • 80%filling
  • Round 2
  • Applicant support package
lessons
Lessons
  • High volume system requires consistency
  • Implementation has been variable
  • Governance
  • Resources
  • Timescale
next steps
Next steps
  • Constructive Review
  • Transition arrangements
  • Political issues
  • Revision for 2008
slide25

Introduction

  • Background to Remedy
  • Who we are
  • Aims and objectives
  • Campaigns and action points
  • MTAS – what are we left with
  • MMC
  • The next steps
  • Questions
slide26

Who we are:

Mat Shaw Orthopaedic SpR, Stanmore

Matt Jameson-Evans Orthopaedic Clinical Fellow, Stanmore

Judy King Clinical Research Fellow, Royal Free Hospital

Louise Bayne CEO Ovacome

Chris McCullough Renal SpR, Royal Free Hospital

the problem reforms are rushed unfair and unsafe
The problem: reforms are rushed, unfair and unsafe

Immediate

  • MTAS: unfit for purpose

Short term

  • 32,000 doctors applying for 20,000 posts: shortfall of 12,000
  • “best and brightest” lost to the NHS
  • Lack of information at every stage – how will MMC work?
  • Reduction in standards under MMC (e.g. Orthopaedics: 22,000 hours versus 6,000 hours under MMC)
  • Concerns regarding single entry per year/patient safety on August 1st changeover

Long term

  • No job security (sub consultant grade)
  • 200 excess SpRs this year - 3,200 SpRs without Consultant posts by 2010-11
  • Medical school intake has not been reduced
slide28

Aims and objectives

1a. Halt Round 1/revert to old appointments system

1b. Appoint LATs

2. Expansion of training posts

3. Independent review of workforce planning (including review of medical school intake)

These objectives would be achieved through:

  • Information campaign (Website, emails, newsletters, local reps)

2. Press campaign

  • Political campaign
  • Action
slide30

Political campaign

Jan ‘07:

  • Meeting with Dr Ian Gibson MP (Labour) of the Commons Health Select Committee
  • Tabled Early Day Motion 737 (130 signatures)
  • Letter writing campaign

March ‘07:

  • Briefed both Shadow Health Secretaries
  • Briefing meeting with MPs
  • Ongoing parliamentary questions

April ‘07:

Rally at House of Commons

Mass Lobby of 200 MPs

slide32

Judicial Review: 17th May 2007

  • Justice Goldring concluded that “the premature introduction of MTAS has had disastrous consequences”
  • acknowledged that doctors had been treated unfairly and had reason to feel aggrieved
  • However, he felt powerless to intervene in the context of a judicial review
  • Suggested that there would be a good case for individuals at employment tribunal

Sympathetic media coverage

Evidence from the trial that has come to light:

Round 1a and 1b were very different

Correlation between shortlisting and interview scores: 0.3

Matching algorithm was abandoned because it didn’t produce the expected results and hadn’t been tested

Process overall tended to work better in smaller UoAs.

slide33
Software needs to be validated, tested and reliable

Pilot

Shortlisting criteria validated

Secure system

Need clear guidance on who to ask for help

Smaller UoAs

More than one entry point (e.g. August and Feb) per year

MTAS – what are we left with?

slide34

What about MMC?

Change from experience based to competency based training

What if competencies aren’t achieved?

What about Royal College exams?

Run through training following Foundation Years 1 & 2

Too early for trainees to make career decisions?

Too early to differentiate between candidates?

What if you change your mind/want to work abroad/undertake research?

Flexibility: separate CMT from HMT?

Reduced time taken to complete specialist training

Orthopaedic trainees:

22,000 hours training under the old system vs 6,000 under MMC

slide36

The next steps

Support for juniors. Career advice. Information Article 14 (www.pmetb.org.uk)

Ongoing issues of workforce planning, sub-consultant grade, etc, to be addressed

  • Learn to consult and communicate more effectively (website/email)
  • RCP Open Forum
  • RCS poll of members and fellows
  • Change in the landscape

Encourage a more active role – Royal Colleges, BMA, Remedy, RSM

Sir John Tooke’s review

slide37
Only those who speak up will be heard

http://e-consultation.net/MMCInquiry

www.remedyuk.org

Be part of the solution

slide38

The importance of MRCP in run-through training

Jane Tighe

Chairman MRCP(UK) Part 2 Examining Board

qa and assessment the 9 principles of pmetb
QA and Assessment - The 9 Principles of PMETB
  • The system must be fit for a range of purposes
  • Curriculum based & referenced to good medical practice
  • Methods used relevant to the assessment framework
  • Standard setting must be in the public domain
  • Assessments must provide relevant feedback
  • Assessors trained for performing tasks they undertake
  • Lay input in the development of assessment
  • Standardised documents nationally and internationally
  • Resources sufficient to support assessment
academy of medical royal colleges categorisation of assessments
Academy of Medical Royal Colleges: categorisation of assessments
  • Group 1: assessments of performance – especially in the workplace (what the trainee does or has done in real life)
  • Group 2: written cognitive assessments e.g. of knowledge or aptitude
  • Group 3: assessments of competence in face-to-face, simulated or OSCE-like settings
mrcp uk examinations
MRCP(UK) Examinations
  • Part 1 Examination
    • 2 papers; 100 items per paper
    • Best of five format
    • Criterion referenced
    • Tests basic medical knowledge (of common medical conditions), basic clinical science
    • Uses evidence-based medicine and tests up-to-date knowledge
mrcp uk examinations42
MRCP(UK) Examinations
  • Part 2 Examination
    • 3 papers; 90 items per paper
    • Best of five format
    • Criterion referenced
    • Tests the application of medical knowledge, clinical reasoning and prioritisation of investigations and treatments
    • Mapped extensively to curriculum for general medical training
mrcp uk examinations43
MRCP(UK) Examinations
  • Part 1
    • Set at a level appropriate for graduates of 2 years
  • Part 2
    • Ensures satisfactory standard of knowledge across wide range of medical specialties, to provide essential basis to specialisation
    • Aimed at graduate of 3 years, prior to specialisation ideally
integration of uk royal colleges examinations into training
Integration of UK Royal Colleges’ Examinations into training

CCT Specialty

Credential in Acute

& Internal Medicine

Specialty Training Curriculum

ACUTE & INTERNAL MEDICINE

Level 1

(CMT 1 & 2)

Foundation

F 1 & 2

ACUTE & INTERNAL MEDICINE

Levels 2&3 (ST 3 +)

Generic Curriculum for Medical Specialties

WPBA

WPBA

WPBA

Allocation

Selection

integration of the uk royal colleges examinations into post mmc training
Royal Colleges’ Examinations

Independent national standard

Criterion referenced

Complementary to local formative assessments

Summative tests

Often Pass/Fail

Test large part of curriculum

Work based assessments

On site

Multiple formats to suit different challenges

Mini-CEX involves local clinicians

Instant feedback

Competency based

Tests limited parts of curriculum

Integration of the UK Royal Colleges’ Examinations into “Post MMC” Training
independent assessments group 2 and 3 diploma examinations of the uk royal colleges
Independent Assessments: group 2 and 3 Diploma Examinations of the UK Royal Colleges
  • 4 modules
    • MRCGP
  • 3 part diplomas
    • MRCP(UK)
    • MRCPCH
    • MRCS
  • 2 part diplomas
    • Anaesthetics
    • Psychiatry
    • Pathology
mrcp uk examination objectives
MRCP(UK) Examination objectives

Evaluates competence with regard to:

  • Core clinical knowledge: problem solving,clinical science, epidemiology, statistics
  • Clinical skills: taking and interpreting a clinical history and undertaking a physical examination
  • Attitudes: to patients, including communication skills and ethical obligations

Stimulates approach to long term learning/CPD

examinations of the uk royal medical colleges must be
Examinations of the UK Royal Medical Colleges must be:

relevant

reliable

reproducible

realistic

training in medicine positioning of mrcp uk part 1
Training in Medicine:Positioning of MRCP(UK) Part 1

CCT Specialty

MRCP(UK)

Credential in Acute

& Internal Medicine

Foundation

F 1 & 2

ACUTE & INTERNAL MEDICINE

Level 1

(CMT 1 & 2)

Specialty Training Curriculum

ACUTE & INTERNAL MEDICINE

Levels 2&3 (ST 3 +)

Generic Curriculum for Medical Specialties

WPBA

WPBA

WPBA

Allocation

Selection

training in medicine positioning of mrcp uk part 2
Training in Medicine:positioning of MRCP(UK) Part 2

CCT Specialty

MRCP(UK)

Credential in Acute

& Internal Medicine

Foundation

F 1 & 2

ACUTE & INTERNAL MEDICINE

Level 1

(CMT 1 & 2)

Specialty Training Curriculum

ACUTE & INTERNAL MEDICINE

Levels 2&3 (ST 3 +)

Generic Curriculum for Medical Specialties

WPBA

WPBA

WPBA

Allocation

Selection

examinations of the uk royal medical colleges must be52
Examinations of the UK Royal Medical Colleges must be:

relevant

reliable

reproducible

realistic

mrcp uk part 2 written examination reliability issues
MRCP(UK) Part 2 Written Examination Reliability Issues
  • Candidates are less heterogeneous
  • Increased reliability with increase in number of items – now 3 x 3 hours
  • Increased length permitted introduction of pre-testing
  • Criterion referenced examination
  • Internal v. External QA
  • PMETB demand a ‘reliability’ of 0.85 – 0.90
examinations of the uk royal medical colleges must be56
Examinations of the UK Royal Medical Colleges must be:

relevant

reliable

reproducible

realistic

slide57
Examiners operate in pairs BUTmark independently

Overall judgement

[ ] clear pass

[ ] pass

[ ] fail

[ ] clear fail

Examiners should “stick to the same script”

The MRCP(UK) Part 2 Clinical ExaminationPractical Assessment of Clinical Examination Skills (PACES)
training in medicine positioning of mrcp uk paces
Training in Medicine:positioning of MRCP(UK) PACES

CCT Specialty

MRCP(UK)

Credential in Acute

& Internal Medicine

Foundation

F 1 & 2

ACUTE & INTERNAL MEDICINE

Level 1

(CMT 1 & 2)

Specialty Training Curriculum

ACUTE & INTERNAL MEDICINE

Levels 2&3 (ST 3 +)

Generic Curriculum for Medical Specialties

WPBA

WPBA

WPBA

Allocation

Selection

mrcp uk examination
MRCP(UK) Examination
  • MRCP(UK) Part 1 Examination
  • MRCP(UK) Part 2 Written Examination
  • MRCP(UK) Part 2 Clinical (PACES)
  • >15 000 candidates in 24 countries annually
  • International standing is recognised
specialist examinations
Specialist Examinations
  • Specialty driven
  • Successful pilot exams
  • Question writing groups
  • Specialist examination boards
  • Standard setting groups
  • MRCP(UK) facilitates introduction
  • and provides post exam statistics
specialist examinations63
Specialist Examinations
  • First Wave (Spring 2008)
  • Dermatology
  • Gastroenterology
  • Geriatric Medicine
  • Neurology
specialist examinations64
Specialist Examinations
  • computer-based format
  • use multiple UK examination centres & selected overseas centres
  • two papers, each up to 100 best-of-five style questions
  • clinical scenarios, including images
  • reliability 0.80 minimum
  •   second wave (Autumn 2008)
specialist examinations65
Specialist Examinations
  • Second Wave (Autumn 2008)
  • Acute Medicine
  • Cardiology
  • Clinical Pharmacology and Therapeutics
  • Endocrinology and Diabetes/Metabolic Medicine
  • Infectious Diseases
  • Medical Oncology
  • Renal Medicine
  • Respiratory Medicine
  • Rheumatology
slide67
GROUP 1: ASSESSMENTS OF PERFORMANCE – (what the trainee does or has done in real life)Workplace-based Assessments
  • Direct observation of a skill e.g. DOPS
  • Patient encounters e.g. mini-CEX
  • Multisource feedback
  • Teaching/presentation skills
  • Case Based Discussions (CbD)
  • Acute Take Assessment Tool (ATAT)