Foundation Programme Curriculum: Key Changes for 2016 David Kessel Chair AoMRC Foundation Programme Committee Clare van Hamel Special Advisor UKFPO New Improved? Approved by GMC March 2016 Improved following feedback from FS stakeholders alongside input from Royal Colleges, NICE, Resus Council, Patient groups and many others

Regulator’s requirements Generic Professional Capabilities Framework The Curriculum needed to be aligned to a few GMC publications Tomorrow's doctors, The Trainee Doctor, Good Medical practice In addition we had to meet the new Promoting excellence and also the Generic Professional Capabilities Framework which has only very recently been approved by the GMC

Purpose of Foundation No Change

Terminology Level of performance Minimum standard of practice to be ‘met or exceeded’ Foundation Professional Capability = Outcomes of foundation training Descriptor Expectation / Indicative example of practice Sign off will be at the Foundation Professional Capability level (FPC) Foundation Doctors do not have to provide evidence of meeting all descriptors; these are possible examples of how the FPC might be evidenced

High level descriptors for F1 and F2 Level of Performance High level descriptors for F1 and F2 Minimum level which must be met or exceeded for progression at the end of each year of training Sign off dependent on evidence of achievement in each of the 20 foundation professional capabilities New!

Level of Performance F1 Has worked effectively to establish him or herself in clinical practice in his or her role as a doctor in training Has established him or herself as a member of the healthcare team Has been able to adapt practice to suit the clinical setting in each placement Has demonstrated the ability to learn in the workplace Has demonstrated the knowledge, skills and behaviours necessary to apply the professional duties, principles and responsibilities set out in Good Medical Practice, Generic Professional Capabilities Framework, other professional guidance and statutory legal requirements. Is competent to perform the core procedures mandated by the GMC These are phrases that describe at high level how an F1 should be performing

Successful Completion F1 Foundation Year 1 Certificate of Completion (F1CC) Recommendation to the GMC that the foundation doctor be granted full registration Eligible for progression into F2 training. New! Certificate renamed but impact of F1 completion unchanged

Level of Performance F2 F1 plus Has taken additional responsibility for decision making in clinical practice Has started to develop a leadership role within the healthcare team Has been able to adapt practice to new clinical settings with new challenges e.g. outpatient clinics Has demonstrated the ability to teach as well as learn in the workplace Has demonstrated progressive increase in knowledge, skills and behaviours applied across the professional duties, principles and responsibilities set in accordance with Good Medical Practice, Generic Professional Capabilities Framework, other professional guidance and statutory legal requirements. Has increased their ability to perform the core procedures mandated by the GMC e.g. can perform them in more challenging circumstances and has increased the scope of procedures they are able to perform. In addition to the F1 high level performance the f2 is expected to demonstrate …..

Successful Completion F2 Foundation Programme Certificate of Completion (FPCC) Eligible to enter a core, specialty or general practice training programme. New! New name of certificate impact of completion of programme unchanged

Organisation of Curriculum Contents Introduction Purpose of the Foundation Programme Progression through foundation training How to use the curriculum in the workplace Resources: foundation doctors Resources: trainers, supervisors and placement supervision group The educational framework and recognising learning styles Curriculum design Educational framework Educational culture and practice How to use the syllabus Learning and teaching Supervised learning events (SLEs) Assessment Syllabus Bibliography Appendices A Changes since 2012 and future development B Ensuring quality in foundation programmes C Mapping the foundation programme curriculum 2016 to GMC standards D Curriculum development and list of contributors

Remove to Improve! The Syllabus 2012-2015 2 sections 12 subsections 40 subheadings > 100 outcomes Competences Remove to Improve!

Key Structural Changes 2012-2015 2 sections 12 subsections 40 subheadings > 100 outcomes Competences 2016 4 sections Ooops! Within the 2012-2015 curriculum there were 2 sections and within the 2016 curriculum there are 4 sections which has increased however as highlighted within the following slides, outcomes (now named foundation professional capabilities) have reduced from 100 to just 20!

Sections 1) Professional Behaviour and Trust 2) Communication, Team-working and Leadership 3) Clinical Care 4) Safety and Quality

Key Structural Changes 2012-2015 2 sections 12 subsections 40 subheadings > 100 outcomes Competences 2016 4 sections 20 foundation professional capabilities (outcomes) Section 1 Foundation Professional Capability 1 Foundation Professional Capability 2…

Professional Behaviour and Trust Foundation Professional Capabilities: Acts professionally Delivers patient centred care and maintains trust Behaves in accordance with ethical and legal requirements Keeps practice up to date through learning and teaching Demonstrates engagement in career planning

Communication, Team-working and Leadership Foundation Professional Capabilities: Communicates clearly in a variety of settings Works effectively as a team member Demonstrates leadership skills

Clinical Care Foundation Professional Capabilities: Recognises, assesses and initiates management of the acutely ill patient Recognises, Assesses and manages patients with long term conditions Obtains history, performs clinical examination, formulates differential diagnosis and management plan Requests relevant investigations and acts upon results Prescribes safely Performs procedures safely Is trained and manages cardiac and respiratory arrest Demonstrates understanding of the principles of health promotion and illness prevention Manages palliative and end of life care

Safety and Quality Foundation Professional Capabilities: Recognises and works within limits of personal competence Makes patient safety a priority in clinical practice Contributes to quality improvement

Syllabus Changes 2016 Emphasis on physical and mental health management in all clinical descriptors Emphasis on chronic as well as acute health conditions Emphasis on illness prevention Inclusion of NHS organisational understanding Descriptors help to identify this change in emphasis

Syllabus Changes 2016 Specific symptom management has been removed Evidence provided by F1/2s to be signed off at the end of the year should include acute and chronic health; mental and physical health The programmes encompass a wide range of specialities which will to an extent determine the opportunities available to F1/2s

Key Structural Changes 2012-2015 2 sections 12 subsections 40 subheadings > 100 outcomes Competences 2016 4 sections 20 professional capabilities Descriptors Section 1 Foundation Professional Capability 1 Descriptors F1 / F2 Foundation Professional Capability 2

Indicative examples and general expectations Descriptors Indicative examples and general expectations Web Based

Indicative examples and general expectations Descriptors Indicative examples and general expectations Foundation doctors do not have to provide evidence for every descriptor. The supervisor's are assessing the overall performance of the foundation doctor and the descriptors may help supervisor's to articulate/identify when a foundation doctor's performance is falling short of expectations

No Change Assessment Clinical Supervisor’s Reports Educational Supervisor’s Reports TAB Informed by: Observation of practice Feedback from PSG Evidence of achievement of 20 outcomes No Change The assessments remain as CS and ES reports and TAB and these are informed

Supervisors’ reports 2012-15 Sign off outcome level Based on achievement of >100 outcomes

Supervisors’ reports 2016 Supervisors Comment at section level Is the foundation doctor on course to meet or exceed the minimum level of performance in each of the 20 foundation professional capabilities required for sign off by the end of the year of training?

On Track! Supervisors’ reports No Concern Indicates that this doctor is performing at the expected level for this stage of foundation training, that there are/have been no issues which still need to be addressed and is on course to meet/exceed minimum expected level of performance required for sign off across all 20 foundation professional capabilities (Foundation Programme training outcomes) by the end of the year of training Issues which have been satisfactorily resolved should be recorded in the e-portfolio On Track!

Needs Support Supervisors’ reports Some Concern Indicates that there are or have been aspects of performance which are ongoing and considered to need extra support in order to meet/exceed minimum expected level of performance required for sign off across all 20 foundation professional capabilities (Foundation Programme training outcomes) by the end of the year of training Needs Support

Risks not being signed off Supervisors’ reports Major Concern Indicates that there are or have been aspects of performance which if not corrected may not meet the minimum expected level of performance required for sign off across all 20 foundation professional capabilities (Foundation Programme training outcomes) by the end of the year of training and may impact on this doctor’s ability to satisfactorily complete the current year of Foundation training Risks not being signed off

Concerns regarding performance? Supervisors’ reports Comments in support of rating for each section Concerns regarding performance? Drop down menu Select outcome/s +/- descriptor/s where concerns exist Narrative to justify Discuss with trainee and document Note: Screenshot available on the following slide for CS section sign off on ePortfolio.

CS section sign-off screenshot

End of Year ES end of year report ARCP Review of evidence whether the foundation doctor has met or exceeded the minimum level of performance in each of the 20 foundation professional capabilities to allow them to progress to the next stage of training?

TAB changes TAB will include foundation doctors but will still require sufficient senior input to be valid E-portfolio will now identify to foundation doctors what ‘rater’ feedback is required to make it a valid round TAB will no longer show as incomplete if ES overides mix and deems TAB round valid Column colours will change to be red for major concern and green for no concern

New Reference Guide