1. Departments in Difficulty: how can we identify and improve
Departments in Difficulty: how can we identify and improve? Ms Jessica Lichtenstein Dr Ciaran Crowe Professor Peter Johnston

2. TImings 15 mins – introduction and background
5 mins – questions and clarification
30 mins- group work
What makes you worried about a programme or department?
What do you do about your concerns and when?
10 mins- feedback and conclusions

3. Promoting excellence - new standards

4. Framework for new standards
Standards and requirements are organised around five themes:
• Learning environment and culture
• Educational governance and leadership
• Supporting learners
• Supporting educators
• Developing and implementing curricula and assessments
Patient safety is the first priority and is set out in a statement at the beginning of Promoting excellence. Patient safety is inseparable from a good learning environment and culture that values and supports learners and educators. Patient safety runs through our standards and requirements; it is no longer a separate domain.
In each theme there are standards (ten in total) and a number of requirements setting out what an organisation must do to show us they are meeting the standards.
I will now briefly describe the standards we have set under each theme.

5. Enhanced Monitoring
When medical schools, deaneries and HEE are concerned about the experience medical students or doctors in training are receiving, they need to work with trusts and health boards to make improvements. Some training environments require regulatory attention:
Persistent and serious patient safety concerns
Educational concerns where progression of trainees is at risk
Improvement is not forthcoming via local management

6. Enhanced Monitoring- headlines
Number of GMC EM visits has increased exponentially since 2012
Most cases are in acute specialties- emergency medicine, acute medicine, general surgery, paediatrics, obstetrics & gynaecology
Common themes:
Increased work pressures
Short-staffing
Clinical supervision
Lack of learning-positive culture
Understand the pathway of progression towards and out of EM
Development of research on the proportionality of current indicators

7. Developmental work
Identify early indicators associated with a higher risk of units entering enhanced monitoring
Identify national trends in EM
Understand the pathway of progression of units towards and out of EM
Development of research on the proportionality of current indicators

8. Emerging themes
Geographical variation in EM generally and by speciality
Correlation with number of FTP cases
Different NTS indicators have different levels of associated risk e.g. feedback is often the first indicator white – pink
Concerns raised by FY doctors first

9. What makes you worried about a programme or department?
What do you do about your concerns and when?