Foundation
Background
Radical
reorganisation of training of doctors commenced in August of this
year. This is known as "Modernising Medical Careers" which
has been accepted in all regions of the UK. This
removes the old system of GP and hospital training completely and
replaces it with a more transparent and efficient system.
So PRHOs
and SHOs go but are replaced with essentially the same names but a
different and more organised system.
After
graduation from medical school the new doctor will enter the Foundation
Programme. This two year scheme is essentially the PRHO year with
full registration with the GMC on completion of year one, and the
F2 - Foundation Achievement of Competency Document (FACD) issued after
Foundation Year 2 (previously SHO1).
Each
doctor will be in an organised individual foundation programme which
will be in six 4 month attachments. In the second year some of these
will be in General Practice, and because of the problems of manpower,
we are fortunate that in Tayside there will be more of these posts
than in other regions.
The ethos
of training in Foundation is to provide a generic learning environment
in different specialties to produce a competent basically trained
doctor at the end who is then fit to enter a programme of specialty
training in hospital or general practice.
These
doctors theoretically could be thinking of a career in any specialty
although realistically those keen on General Practice or some related
specialty are more likely to take up these posts.
During
their attachment, training will not be specific for general practice,
but to acquire defined core skills which are outlined in the foundation
curriculum; which along with other information can be found at www.mmc.nhs.uk.
What
is stressed is that a majority of their learning is work based and
so should have a substantial service commitment. They will all have
at least one year's experience and will be able to prescribe independently.
Supervision
during the training period needs to be from named educational and
clinical supervisors. These can be the same person who has previous
educational experience either undergraduate or postgraduate, or separately
from one person providing educational support and other senior clinical
staff providing clinical supervision. They require specific assessments
which are not onerous. They will also be out of practice for day release
and other teaching and will have to do some out-of-hours work. Initially
there may only be one trainee for 4 months in any one year although
this could be extended to two at some stage
The benefits
of these attachments are:
- A payment
to the practice likely to be equivalent a GP Trainer's grant pro rata
for period of attachment
- A supply
of potential doctors to enter GP training in the area, particularly
useful if the practice becomes involved in GP training in the future.
- Extending
the teaching and training in the practice to the benefit of all doctors
for appraisal, revalidation, personal development and improved job
satisfaction!
- A bargaining
tool for attracting extra finance for the practice from external sources,
which will be providing comprehensive undergraduate and postgraduate
training
Foundation
Background
| Broad Aims | Supervisory Roles
Expections from GP Foundation Trainees | What
does General Practice Offer to Foundation?
FY2 Sample Timetable| Assessment Process | Top
Broad
Aims of a Foundation Programme
- To build
upon the undergraduate training to produce a doctor who is a sound clinical
decision maker and can initiate safe/appropriate medical care in a variety
of clinical situations.
- To produce
a doctor who is aware of his/her professional obligations as described
in "Good Medical Practice"
- To expose
doctors to broad range of clinical experience over a variety of specialties,
including both hospital and community environments
- To encourage
doctors to become better skilled in communication with both patients
and colleagues
- To assist
doctors in their awareness of different specialties and counsel them
in their future career direction
- To satisfy
the requirements of the GMC for full registration normally at the end
of the first year
- To produce
doctors who are "fit for purpose" in terms of entry into specialty
training programmes
Foundation
Background
| Broad Aims | Supervisory Roles
Expections from GP Foundation Trainees | What
does General Practice Offer to Foundation?
FY2 Sample Timetable| Assessment Process | Top
The
Role of the Clinical and Educational
Supervisors
The GMC updated version of "The New Doctor" which outlines
training, discusses the abilities required of trainers. Supervisors
need educational competences to undertake supervision. This
includes competence in educational appraisal and feedback, and in assessment
methods. They
need knowledge of specific in-work assessment tools and how they are
used. The
supervisors need to be trained in giving career advice. Separate
educational and clinical supervisors for trainees is possible only if
they meet regularly to exchange information on progress and performance
The
Role of Clinical Supervisors
- Need to
confident in their own clinical care and patient safety
- They are
involved in supervision of clinical activity - appropriate to experience/competence
of the trainee
- They should
not allow a trainee to do anything they are not competent in
- Trainees
should perform tasks on their own only if competent
- The supervisor
can delegate supervision to other senior personnel
- The supervisor
should be trained to teach, provide feedback, and in competence assessment
The Role of Educational Supervisors
- They should
be prepared for the role, and have understanding of educational theory
& practical educational techniques
- They should
be trained and accredited as competent to offer educational supervision
& undertake competence assessment for foundation training
- The supervisor
should provide regular reviews and appraisal
- They need
to ensure trainees keep assessment records, and they should contact
the Foundation Tutor with any concerns
Foundation
Background
| Broad Aims | Supervisory Roles
Expections from GP Foundation Trainees | What
does General Practice Offer to Foundation?
FY2 Sample Timetable| Assessment Process | Top
What
to Expect From a GP Foundation Trainee?
There have
been a number of pilots in England of Foundation GP trainees but most
experience in the past has been with GP PRHOs. A recent paper discussed
this latter experience and how it might influence Foundation training.
The following is a summary.
- It is
important to avoid too many acute or on the day appointments.
- The trainee
can sit in with the trainer seeing evidence of chronic illness care
and terminal care but there needs to be sensitivity to needs of trainer
and the patient.
- Case continuity
is a problem with a short time in practice and trainee should be allowed
to make own follow-up appointments.
- The foundation
trainee should get experience of a range of different consultations
as he/she undergoes the role change from passive observer to active
participant
The consulting
process could be developed as follows:
1. The
trainee will need to OBSERVE - with doctors and members
primary health care team
2. SHARED CONSULTING will occur during the introductory
period
3. SIT-IN ON TRAINEE CONSULTATIONS by educational/clinical
supervisors
4. WITHDRAWL (of supervisor sitting in) FOR INDEPENDENT
CONSULTATIONS
5. BUILD UP OF NUMBER OF PATIENTS SEEN
6. MONITORING
- Needs or concerns during a surgery
- Checking outcomes - prescriptions, referrals, follow up etc
- Inter-office phone calls, e mails, discrete knocks on door, post surgery
debrief meetings
7. HALF HOUR CONSULTATIONS initially can be reduced as
able to 20 or 15 minutes
Trainee Concerns - that were noted in this study
were -
- not knowing
enough
- not knowing what to do
- making mistakes
Consulting
development needs to address the dichotomy of -
Organic, formulaic, illness centred vs. holistic, focussed, patient-centred
References
:
Scallan
S - Training for general practice in the foundation programme: lessons
from the pre-registration house officer experience - Education for Primary
Care (2005) 16: 256-264
Scallan S & Bell J - Training pre-registration house officers in
general practice: strategies needs and barriers - Education for Primary
Care (2005) 16: 275-282
Foundation
Background
| Broad Aims | Supervisory Roles
Expections from GP Foundation Trainees | What
does General Practice Offer to Foundation?
FY2 Sample Timetable| Assessment Process | Top
What
Has General Practice to Offer in Foundation Training?
COMMUNITY / LEARNING / EXPERIENCES
The following
opportunities, many unique to general practice will be available:-
- continuity
of care
- seeing
patients in their own environment
- seeing
several members of the family
- effect
of illness on the family
- early
sign of disease
- spectrum
of disease not normally seen in hospital
- complement
hospital teaching
- interaction
between primary and secondary care from general practice viewpoint
- see what
happens to patients post-discharge
- context
in which patient and clinician meet
- service
context for the management of chronic disease
- medicine
management
The syllabus of the Foundation Programme curriculum includes many areas
which can be addressed or reviewed appropriately in the primary care
environment, for example in the following areas
Good
Clinical Care
- history,
examination, diagnosis, record keeping, safe prescribing and reflective
practice
-
time management and decision making
-
quality and patient safety
-
health promotion, patient education and public health
Maintaining
Good Medical Practice
- learning,
evidence & guidelines, audit
Relationships
with Patients and Communication Skills
Working
with Colleagues
Foundation
Background
| Broad Aims | Supervisory Roles
Expections from GP Foundation Trainees | What
does General Practice Offer to Foundation?
FY2 Sample Timetable| Assessment Process | Top
The
Assessment Process for the Foundation Programme
Four tools
will be used for the two year foundation programme in Scotland. These
are as follows
1.
Presented Evidence
This will
include three elements
- a significant
event analysis
- an educational log
-
a personal learning plan
2.
Work Place Assessment
This is
a booklet which has skills to be completed and signed as assessed through
the two year period; some have to be completed by the end of first year.
3.
Multisource Feedback
Feedback
on performance by completion of four questionnaires by colleagues and
one by trainee, the summary of which is then fed back and discussed
with the educational supervisor.
4.
Supervisor's Report
This will
completed at the end of each post and will be discussed with the trainee.
The supervisors
report, educational log, personal learning plan, and work place assessment
will be common to all foundation posts. The significant event analysis
and multi-source feedback will alternate between posts.
Foundation
Background
| Broad Aims | Supervisory Roles
Expections from GP Foundation Trainees | What
does General Practice Offer to Foundation?
FY2 Sample Timetable| Assessment Process | Top
|
to
Postgraduate Unit menu