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Developments in postgraduate medical education. Prof Elisabeth Paice Dean Director London Deanery. MTAS. What was MMC Trying to Fix?. Curricula out of date for modern service needs New consultants not fit for purpose - obstacles rather than enablers of change

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developments in postgraduate medical education

Developments in postgraduate medical education

Prof Elisabeth Paice

Dean Director

London Deanery

what was mmc trying to fix
What was MMC Trying to Fix?
  • Curricula out of date for modern service needs
  • New consultants not fit for purpose - obstacles rather than enablers of change
  • SHOs over-specialised, under-skilled
  • SHO, Trust doctor and ‘honorary SHO’ posts burgeoning
  • Bottleneck at entry to SpR training
  • New UK graduates crowded out by IMGs
the aims of mmc
The Aims of MMC
  • To produce enough trained doctors to provide safe frontline care - ie reduce dependency on trainees
  • To streamline training and make it more efficient
  • To produce doctors fit to play their part in a modern, safe, first-class patient-centred health service
to reach those aims we need to modernise
To reach those aims we need to modernise…
  • the structure of training
  • the content of training
  • the delivery of training
  • the assessment of trainees
  • the support for trainers
  • the management of training
  • the QA of training programmes
our health our care our say
Our Health, Our Care, Our Say
  • Services closer to home
  • Closer working between health and social care
  • Plurality of provision
  • Payment by results
  • More emphasis on public health and self-care
  • Reconfiguration
pmetb qa
PMETB QA
  • PMETB sets generic standards for post-Foundation training
  • PMETB approves college-developed specialty curricula
  • PMETB quality assures programmes by monitoring local Deanery QC processes
  • Deaneries responsible for Quality Management
qa process placements and product
QA –Process, Placements and Product
  • Process – recruitment, assessment, RITA, rotational planning. Is the curriculum covered?
  • Placement – Does each placement offer adequate induction, supervision, appraisal, assessment and access to educational resources – eg trained trainers and educational resources
  • Product – Has the trainee achieved the competences required? Does the trainee perform to the required standard in practice?
pmetb copmed national survey of doctors in training
PMETB/COPMeD National Survey of Doctors in Training
  • All trainees in Senior House officer or Specialist Registrar posts in UK, 2006
  • Purpose of the survey to determine whether hospitals etc met the national training standards (PMETB’s Generic Standards for Training)
  • Questions developed from interviews with trainees, validated by University of Winchester
data collection
Data Collection
  • Deaneries used one or more of the routes of administration (all with the same items):
      • Portable standalone electronic survey units
      • PMETB – web invitation by email
      • PMETB – web invitation by letter
      • PMETB – scannable paper form
  • Response rate was 65% (N = 24,880)
points from survey
Points from Survey
  • 62% of trainees were using a learning portfolio
  • 69% were using a log book
  • 70% were involved in clinical audit
  • 33% were participating in research
  • 10% had made a serious or potentially serious error in last month
the challenge
The Challenge:
  • To train specialists in a shorter working week…
  • …while shortening the duration of training
  • …maintaining educational standards
  • …and improving the quality of patient care
  • …while at the same time reducing the hours of consultants…

A tall order

no time to waste
No Time to Waste
  • Trainees at best service-neutral
  • Eliminate duplication, waiting around, inappropriate duties
  • Wet-labs, drills, rehearsals, simulators
  • Easy access to e-learning material
  • Trainees learning whenever they are working
the role of the doctor
The Role of the Doctor
  • Diagnosis and skilled clinical interventions
  • Handling the unknown, uncertain and high-risk aspects of patient care
  • Critical appraisal of available evidence - seeking evidence where there is none
  • Leadership, innovation and research
  • Championship of change
  • With a depth and breadth of education and training to support all the above
specialty schools
Specialty Schools
  • Bringing colleges, deanery, medical schools, service and trainers together
  • Joint (college/deanery) appointments of school heads
  • Financed by & accountable to deaneries
  • Manage selection, training, quality control, assessment
  • Educational governance stakeholder boards
trainer development and support
Trainer Development and Support
  • Training and role clarity for supervisors, assessors, appraisers, tutors, mentors,coaches, career advisors, educational leaders
  • Time to do the job
  • Tools to support the various activities – e-portfolios, courses, assessment instruments etc
  • Educational technology
what s happening in london
What’s Happening in London?
  • Restoration of medical education funds
  • Closer working with SHA and Trusts
  • Infrastructure for deanery
  • Investment in training for trainers
  • Medical education fellows
  • Distributed simulation technology
  • Investment in e-learning and PDAs