1. Update on PH training in the UK
Premila Webster
Assistant Academic Registrar
Faculty of Public Health

2. The session The role of the Faculty in training PH training in the UK
The new curriculum
These are the areas that this roadshow will cover.
We need to look at the background which sets the work in context and consider the process for development and engagement of stakeholders.
We will look at the products in some detail and discuss the delivery mechanisms for the new curriculum
This leads to consideration of what this will mean for programmes and trainers
Finally we need to understand what work continues and what further changes we expect in the next few years.

3. Role of the Faculty
The Faculty of Public Health oversees the quality of training and maintains the professional standards in the discipline.

4. Assessing competence
Responsibility for this lies with the Faculty of Public Health and is achieved by:
assessing specific knowledge (through the Part A exam)
assessing the ability successfully to apply knowledge to carry out the functions of public health - 'shows how' competence (through the Part B exam and in work assessment by public health accredited trainers).

5. PH training in the UK Who can specialise?
The higher specialist training programme in public health is open to both qualified medical doctors and those from other public health disciplines.
How long does training take?
Training usually lasts five years, full-time. Part-time training is proportionately longer. The five years usually includes one year (full or part time) on an academic course, and 48 months in higher specialist training posts.

6. Specialist registration
On completion of the five-year training programme:
medical doctors will be recommended to the Postgraduate Medical Education and Training Board (PMETB) for inclusion on the Specialist Register
those from other disciplines will be recommended for registration with the UK PH Register for Public Health Specialists.
This qualifies them to work at consultant-level
in the NHS.

7. Routes to the register Training Experience (‘Article 14’) 7
Designed to ensure trainees awarded a CCT achieve all core learning outcomes in LOF. LOs designed to allow competence in all areas of practice expected of a newly qualified consultant in public health. A public health consultant should be able to:
* Quantitatively and qualitatively assess the population’s health and heath needs and develop effective action
* Critically assess the evidence, apply this to practice and improve services and interventions through audit and evaluation
* Influence the development of policies, implement strategies and assess the impact of policies on health
* Lead teams and individuals, build alliances, develop capacity and capability, work in partnership and effectively use the media
* Promote and protect the health of populations
* Support commissioning, clinical governance, quality improvement, patient safety, equity of service provision and prioritisation of health and social care services.
* Collect, generate, synthesise, appraise, analyse, interpret and communicate intelligence that measures the health.
* Teach and research in public health
It recognises some trainees will wish to focus their competence development beyond the core by
taking their competence within a key area (or areas) a stage further (through optional special interest learning outcomes) or
by refining their generalist skills within specific specialist settings. (This reflects the broad church of public health practice which requires a working knowledge and practice of core competence but also requires consultants to practice in a wide range of settings, both in terms of organisation type and work focus which require specific and particular knowledge and skills.
Trainees will develop a working understanding of the delivery of healthcare in general practice, primary care, the acute hospital, the community and in partnership with other agencies.
The broad areas within which competence may be taken beyond the core through focussed learning are:
* Health protection
* Health improvement
* Health and social service quality
* Public health information and intelligence
* Academic public health 7

8. The 2007 curriculum

9. Why did we need a new curriculum?
Modernising Medical Careers
PMETB
RITA consistency
The context for this work is complex and interlocking.
Modernising Medical Careers has seen a sweeping reform of post graduate medical education and the PMETB, in existence since October 2005, has required all Royal Colleges and Faculties to develop new curricula in line with these changes.
UKVRPHS opened in 2003 for generalist specialists through retrospective portfolio application and has now opened for defined specialists. The approach to assessment has shaped early work already adopted by TPDs on the collection and presentation of evidence to support claims of competence
The Knowledge and Skills Framework under A4C set us thinking about the competency framework for our other graduate trainees as well as PH competencies for the whole workforce and drove us to think clearly how we can satisfy the needs of our other graduate trainees to comply with the prescribed career progression framework
And as if this wasn’t enough, Programme Directors were increasingly concerned about the gap between a new curriculum and assessment method being developed and what was perceived to be a major issue with inconsistencies in assessment through the RITA process. From this the mandatory requirement, from January 2007, for trainees to be able to evidence claimed competence was born together with a recommended template for inclusion in the trainee portfolio
Look in a little more detail at MMC and the PMETB

10. Modernising Medical Careers
Foundation programmes
Run-through
National standardised recruitment
The proposals to reform PG medical education accepted 2003.
Basic principle was to replace the lost tribe of SHOs with a broad based basic education (so called Foundation) followed by speciality training. Very briefly, Foundation consists of 2y X 3 X 4m posts working to a generic Foundation curriculum which can be delivered in any specialty. This of course builds on undergraduate training which, under the revision of the GMC’s Tomorrow’s Doctors have strengthened the inclusion of public health in curricula.
We have two major successes in FPs. Firstly most programmes now have PH F2 slots; 2ndly PH learning outcomes now strengthened in the new FP curriculum from Aug 2007 through FPH involvement in the AoMRC Foundation Programme Training Committee
Run through specialty training is curriculum and competency driven and not based on time served. The first graduated medical students entered Foundation in August With no SHO base, most specialties will recruit directly from Foundation, some going through a common stem programme before sub specialisation
A further significant change is the move to a single portal annual national recruitment for all specialties.

11. Medical school – 4-6 years F2 competences achieved
Run-through training
Continuing Professional Development
Medical school – 4-6 years
Undergraduate medical training
in medical schools
Career posts F1
F2 competences achieved
UK MMC Career Framework
Postgraduate Medical Training
Senior Appointments
CCT route
Foundation training in foundation schools
Article 14/11 route
Fixed Term Specialist
Training Appointments
Arrows indicate competitive entry
REGISTRATION GMC Specialist Register/UKVRPHS
Specialty training in Specialty schools
Talk briefly through
Explain blue box
Explain yellow box
Two routes to registration
Certificate of Eligibility for the Specialist Register through Article 14. Will this mean a mixed route through portfolio AND certification of approved training.
NB No longer can doctors expect that they have a right to a consultant post. Policy is to ensure high quality training to deliver FFP and individuals better able to compete in the market. Training will deliver registration not consultant appointment. Not all graduates will be guaranteed specialty training

12. PMETB PMETB is an independent statutory body.
It is responsible for promoting the development of postgraduate medical education and training for all specialties, including general practice, across the UK.
PMETB aims to improve UK medical education.
PMETB assumed its statutory powers on 30 September 2005.

13. PMETB
It took over the responsibilities of the Specialist Training Authority of the Medical Royal Colleges and the Joint Committee on Postgraduate Training for General Practice.
Responsibilities include:
Establishing standards and requirements for postgraduate medical education and training.
Making sure these standards and requirements are met.
Developing and promoting postgraduate medical education and training across the country.
The PMETB assumed powers in October Is responsible for PG medical education across the UK
The PMETB is responsible for setting and monitoring standards for post graduate medical education.
They have set standards for training and standards for curricula
Curriculum development had to fit in with the MMC timetable so curriculum approved in time for the 07 recruitment.
Curricula have to include prescribed elements: purpose, how developed, learning models and educational strategies, delivery, content and outcomes (including link to GMP), appropriateness, links to training stages, supervision, feedback, remediation, review and evaluation and compliance with antidiscriminatory requirements
Current trainees do not have to move across – there will be a period of double running (which could be as long as ten years)

14. PMETB prescribed elements for Curricula
Purpose
How developed
Learning models and educational strategies
Delivery, content and outcomes
Appropriateness
Links to training stages, supervision
Feedback, remediation, review and evaluation
Compliance with anti discriminatory requirements
The PMETB set clear standards for curricula containing these elements.

15. Curriculum principles
What does a consultant need to know?
Clarity about what needs to be learned and when
Clarity about assessment method and triangulation
We followed some general principles of developing a curriculum that followed a spiral pattern, one that allows the trainee to gain competence in areas of practice expected of a newly appointed consultant and one which expects that every trainee will wish to be able to take their learning a stage beyond the core. This therefore begins to reflect the broad church of the practice of public health
We wanted to develop a curriculum that makes absolutely clear to the trainee and their trainer exactly what should be learned, when, in what range of settings, with what potential vehicles for gaining competence and how this would be assessed with confidence.
We wanted there to be clear phases of training which allows graded progression and also allows a clear route for identification of failure to progress and remediation support put in place.
We checked this out with significant numbers of trainers and trainees throughout the process

16. Curriculum development
Since 2005, work on the curriculum
In 2006, workshops, key leads, iterative development
Parallel work
We have been working on the new curriculum since C&AC established to represent broad range of trainers, specialists in key areas, trainees, TPDs
The work started with consideration of key areas 5-9 and the additional competencies that made these areas’ defined areas of practice.
The concept of the learning outcomes framework was born and populated through a series of iterative workshops building upwards from existing RITA competencies and downwards from a clear understanding of what a consultant needs to know/show
Individuals developed written documentation detailing elements of programme delivery based on current good practice and taking a clear lead from PMETB requirements
Parallel work: Assessment blueprint and methodology, this will take at least a further 3 years to work up properly.
The Part A syllabus needs a further review and this will fit with the assessment timetable, this will be led by David Strachan
A series of regional road shows will roll out the curriculum
A microsite for potential applicants with information on application and careers in PH. Downloadable pdf

17. All trainees in specialty training, from 1 August 2007 follow the new PMETB-approved 2007 curriculum. Trainees appointed prior to this can transfer to the 2007 curriculum as well.

18. Curriculum consists of three broad sections
How you learn
What you learn
How you are assessed
The curriculum for specialist training in public health describes all the required components of training that to lead to a certificate of completion of training (CCT) in public health.

19. PH training
Training in PH covers nine key areas of public health practice across the three domains of public health (health protection, health improvement and service quality), as well as ethical and professional practice.

20. What does the curriculum do?
The curriculum provides a framework within which trainees and trainers can determine and understand the knowledge, skills, attitudes and behaviours which will allow a trainee to achieve the level of competence required of a specialist in the field.

21. Curriculum 2007
It defines and describes the processes (recruitment, induction, assessment and remediation), phases of training , settings , learning methods and learning outcomes.

22. Recruitment Single annual recruitment Electronic portal
Backgrounds other than medicine
National person specification
National application form
Longlisting
Assessment centres
Shortlisting
Selection centres
All specialty training begins in August
Recruitment across UK in all specialties starts December/January.
Electronic portal , on line application form with specialty specific questions derived from person specification and generic career and motivation questions.
National person specification
BOTM allowed access through this portal
Eligibility criteria: Foundation or equivalent and no more than 60m PH experience, eligibility for GMC registration or good first degree/relevant higher degree plus minimum 3y relevant service experience for BOTM applicants
Applicants allowed four choices
Assessors must be trained
Shortlisting in pairs, numbers of applications to each deanery has been enormous and shortlisting takes hours.
Programmes are clustering for assessment centres – LKSS, NE/Y&H/EM/EoE, Wales/ SW/HIoW/Oxford/WM/NW, Scotland, NI
Questions based on PS. Minimum 2x 15m face to face. Some clusters adding group exercises to test behaviours and verbal/numerical testing plus face to face interviews in small panels
Assessment scores are returned to MTAS and applicants with highest scores are offered places at their highest place of choice until all places are filled
Unfilled places will be offered in a second application round in the early summer.

23. Learning areas Learning outcomes23

24. Learning areas Surveillance Effectiveness Strategy Leadership
Health improvement
Health protection
Health services
Health intelligence
Academic 24

25. Learning Outcomes Framework
Details the learning outcomes expected in each key area including ethical management of self and professionalism.
Lists a total of 184 learning outcomes (16 ethical management of self; 121 core; 47 trainee selected) each linked to:
The target phase of training
suitable assessment methods
knowledge base
other key areas

26. Learning outcomes framework
Overall descriptor provides learning aims
Learning experiences
Describes level of learning at each phase of training
Describes in which situations trainees may achieve learning outcomes
Supports trainers and trainees in planning learning activities
Links to KSF
Knowledge and Skills Framework mapped for trainees from disciplines other than medicine
Knowledge base and know how
Details the knowledge needed to achieve the learning outcomes 26

27. Learning outcomes
Learning outcomes fall within nine broad key competency areas relate to the three domains of public health practice. These learning outcomes are outlined in the Learning Outcomes Framework and are available on the faculty website.
The knowledge base which underpins them is based on the MFPH Part A syllabus.

28. Learning Outcomes 184 learning outcomes 121 core
16 ethical management of self
47 optional (special interest) 28

29. LOF – the learning outcomes
Split by phase to enable progression of learning, appropriate assessment and remediation
Some are required at increasing levels throughout training
Standard vocabulary to aid understanding
Many can be gained together or in short periods of time
Later phase outcomes are likely to be gained on projects crossing many Key Areas 29

30. Delivering the framework. 30

31. Model of learning Educational strategies
Three phases of learning
Competence based
The curriculum designed to deliver staged achievement of learning outcomes through knows/knows how/shows how/does.
Core elements of what constitutes good public health practice have strong focus; opportunity to demonstrate in service both confidence and competence needed for increasing levels of expertise in subsequent specialised professional practice.
Public health trainees are expected to know about good public health practice and show can do it or apply it in a protected setting. Also to undertake and actually do daily work with required levels of knowledge and understanding and at increasing levels of complexity.
Work based experiential learning delivered through staged complexity of service work with regular feedback and opportunity for reflection. Mentoring support is given by an accredited educational supervisor, more experienced trainees or other senior public health professionals.
Reflective practice encouraged through feedback of formative assessment and ownership of educational objectives, clear definition of training needs and negotiation of experiences to meet these needs.
The curriculum has been developed around a model of three phases of learning. These phases reflect an early induction and basic grounding in public health; acquisition of the knowledge base; basic skills training; consolidation of core advanced skills and an option for trainee selected components which will allow development of defined interest or practice within a specified setting. The curriculum has been designed to allow the trainee a graded or spiral progression through competency acquisition with increasing levels of complexity and responsibility, leading to an ability to integrate competencies across work areas to demonstrate complex consultant level practice.

32. Training phases
The curriculum consists of three phases of learning. These phases reflect:
an early induction and basic grounding in public health;
acquisition of the knowledge base;
basic skills training;
consolidation of core advanced skills
an option for trainee selected components which will allow development of defined interest or practice within a specified setting.

33. The phases of training Phase 1 Phase 2 Phase 3
Induction; knowledge; basic ‘show’ in simple settings
Phase 2
Increasing complexity, lead for simple areas; communication skills, HPU; on call;
Phase 3
Complex work; significant lead; consolidation; special interests (depth/breadth/settings);
not defined by time but successful acquisition of LOs for each phase. Learning outcomes linked to target phase; This does not preclude early achievement.
Phase 1 combines early induction to training and introduction to basic core public health skills with acquisition of knowledge. The induction will include workplace and human resources policies and practice. Trainees may attend courses of academic study Academic courses combine face to face teaching with self directed learning and this is complemented by work place based experiential learning, putting into practice early knowledge.
also be assessed on small pieces of work using developing academic base through reflective summaries and production of formal written documents for real life use (eg letters, reports, data analyses etc). Passage from phase 1 to phase 2 requires a pass at the examination for Part A MFPH and a satisfactory assessment in phase 1 learning outcomes in the workplace.
Phase 2 sees trainees begin to develop further their basic practical competence, typically through clearly defined service work which uses their knowledge base and applies this in increasingly complex practical settings. In this phase trainees will be expected to take the lead for simple areas of work and develop their skills of presentation and debate. During phases one or two trainees will spend three months (wte) on an attachment to a health protection unit or in health protection work and, when assessed as competent, will start out of hours duties. Out of hours experience does not begin until the knowledge base is secured, as evidenced through a pass at Part A MFPH and satisfactory local workplace based assessment of knowledge of on call procedures.
The end of this phase is completed after a satisfactory performance at the Part B MFPH and satisfactory assessment of phase 2 learning outcomes in the workplace.
Phase 3 allows the trainee to consolidate core skills and to develop specific interests to enhance career opportunity. mainly experiential learning with new advanced theoretical knowledge covered by formal courses and conferences, mainly at a national level (eg advanced critical appraisal skills, specialist health protection skills). Trainees are encouraged to use their study leave allowances to support their educational and career objectives.
This phase allows those trainees progressing well in training to select optional special interest learning outcomes to add to their core competence. These options will have been planned during phase two and through regular discussions between trainer, trainee and programme director. Some trainees will choose to remain within a generalist public health setting and consolidate their core skills. Some will wish to develop a defined interest which may require concurrent extended experience in a specific key area (eg health protection, health improvement etc) or may choose to consolidate and extend experience of general core public health within a defined placement setting (eg public health genetics). Phase 3 learning outcomes can be developed in these defined fields/settings. These trainee selected components will allow an individual to develop specific competence for defined practice or promote their generalist skills within specific settings (either a core NHS organisation or highly specialist location) thus enhancing their particular career aims.
Time out of programme, for example for Walport (or equivalent) academic training or relevant experience abroad, may be possible. This phase is assessed through multiple source feedback, work based discussion, direct observation of practice, structured assessment of components of daily public health practice (mini CEX) and the trainee’s portfolio of work. 33

34. Underpinning theory - Miller’s Triangle
Phase 3
Demonstration of integrated practice of complex competencies and assessed through the workplace
Does
Phase 1 & 2
Learning through service experience and assessed through WBA and paper 2 Part A MFPH
Shows how
Phases 2 & 3
Learning through increasingly complex service work and assessed through Part B MFPH and WBA
The Miller Triangle is the model we have used as the basis for our educational strategy.
It takes a trainee from basic knows, assessed in paper 1 Part A through knows how, assessed in paper 2 Part A and WPBA, to shows how assessed in Part B and WPBA and leading to the does of early consultant level practice which is refined in the final phase of training and assessment of ability to integrate knowledge and complex competence
Knows how
Phase 1
Learning through formal study and assessed through WBA and paper 1 Part A MFPH
Knows 34

35. The training pathway On-call CCT Knows/knows howF2
ST1
ST3
ST5
ST4
ST2
CONSOLIDATION
ACADEMIC
On-call
CCT
Phase 1
Phase 2
Phase 3
Knows/knows how
Advanced shows/shows how
Foundation
Higher Specialist Training
Health protection unit attachment by the end of phase 2 F1
Basic
shows
Pt B MFPH
The move between the three phases is dependant both on exam success and achievement of learning outcomes. The timing is not exact
Selection
through MTAS*
Pt A MFPH
Time out of training for research leading to a PhD under the Walport initiative, or equivalent for other graduate entrants, is taken after completion of phase 2 with re-entry after three years to complete phase 3
Other graduates are also selected through this portal
* Medical Training Application Service
As well as the required core, trainees may select special interest options during phase 3
I want to spend a couple of minutes going through the training pathway
Entry part way through F2, means raising the profile of PH in undergraduate and Foundation training. Training normally lasts, as it does now, five years
The three clear phases allow a trainee and their trainer to plan learning opportunities to fit their level of experience and needs. The phases follow the Miller model of learning with a base of knowledge and simple experience developing into more complex integration of competence in shows how and does.
The gateways are not about time served although there is an indicative time ascribed to each. Gateways are passed after satisfactory assessment of both examined and workplace based assessed elements
Time out of training could be allowed at the second gateway, on call is started after a Part A pass and satisfactory local assessment of on call competence.
Consolidation of competence in phase 3 may be taken in one of three was to allow a trainee to develop their career aspirations
* Consolidation in a generalist setting
* Consolidation in a specialist setting
* Addition of trainee selected special interest learning outcomes (OSILOs)
Training time can be reduced by evidenced previous competence in any of the required LOs 35

36. Products Application form Part A syllabus mapped to LOs Document guide
Map to Good Public Health Practice
Learning outcomes framework
LOF cut by phases
Glossary
Portfolio templates
Consultation comments
Application form
Document guide
Curriculum statement
Entering public health
Training pathway
Programme Delivery
3D model of learning
KSF levels guide
These are the products of the work
The curriculum is web based and includes both a pdf version and an interrogatable data base of the learning outcomes which can be cut by phase and by key area and allows searching by key word.
The next section of this presentation will take you through the documentation that every trainer and trainee is supposed to understand and comply with. The programme delivery document describes training in nine broad areas from the design of the curriculum and its basis in educational theory through its knowledge base, ways of learning and all aspects of support from assessment through supervision, feedback and remediation.
We describe learning experiences in detail including the variety of PH settings and the different ways in which competence may be gained and consolidated and apportion programme time to these styles of learning
We describe supervision both in terms of support for learning and for safety
Different forms of feedback are described including the emphasis on self appraisal and 360 degree appraisal

37. Knowledge
The knowledge base has been mapped to the nine key areas of public health practice and every learning outcome has a clearly identified knowledge base (other than those which define attitudes and behaviours).
Knowledge platform
Delivery of knowledge
Part A syllabus
Advanced knowledge
Academic learning in phase 1 is delivered through formal Masters, self directed study, learning sets, top up modules and exam preparation courses
Part A syllabus under review – must contain only what is needed for the curriculum LOs and what a consultant should be expected to know.
Knowledge significantly different to previous clinical knowledge and unlikely to be gained on the job but there are different ways of acquiring the necessary knowledge base
Public health skills are built on a knowledge base which is detailed in the MFPH Part A syllabus, including:
* Basic and clinical sciences including research method, epidemiological and statistical method, health needs assessment and evaluative technique
* Disease causation and prevention including health promotion, screening, communicable disease and environmental hazard control and social politics
* Organisation and delivery of health care including health intelligence
* Knowledge of the law as it affects the population's health
* Leadership and management skills including change management and health economics
This knowledge base has been mapped to the nine key areas of public health practice and every learning outcome has a clearly identified knowledge base (other than those which define attitudes and behaviours).
In phase 3 new advanced theoretical knowledge covered by formal courses and conferences, mainly at a national level (eg advanced critical appraisal skills, specialist health protection skills). Trainees are encouraged to use their study leave allowances to support their educational and career objectives.

38. Recommended learning experiences
First placement in PCT or equivalent
Specialist options
National treasures
Time abroad
At least two placements plus HPU
LOF includes examples of vehicles and settings
Programmes are delivered on a deanery or multi deanery basis with a range of approved posts at Primary Care Trust/Health Board level. New recruits placed in these for first 2 phases. These posts are similar across the UK. The Faculty of Public Health recognises that most consultants will work in a PCT/Health Board and therefore the majority of training and provision of key learning experience is in this setting.
All programmes also hold a number of specialist posts (eg health protection, academic public health, Department of Health/NHS regional tier, Public Health Observatory etc) which allow trainees to develop special interests in defined settings.
Several programmes also hold a number of 'national treasure' posts which are available by negotiation and/or competitive allocation during the final phase of training. These posts include highly specialist public health functions such as NICE, public health genetics units, central DH, other Government departments etc. Placement abroad may be possible if appropriate to career intention provided slots hold prospective training approval and fulfil educational need.
Some consultants practice public health in highly specialised areas, the greater proportion of who work in the Health Protection Agency. Trainees expressing interest in developing special interests and who move onto this path of Stage 3 training will be able to achieve additional learning outcomes in certain areas of the curriculum through trainee selected special interest options and experience specialist settings while also consolidating their more advanced core competence.
Whether trainees choose to develop focussed interests or not, all trainees are required to gain experience in at least two different training locations, in addition to health protection experience, in order to be exposed to a wide range of organisational cultures and public health issues.
The LOF includes descriptions of potential vehicles and settings for demonstration of competence in each key area

39. Learning experiences Learning from practice Learning with peers
Formal learning
Personal study
Teacher input
Learning from Practice From early stages trainees undertake guided and supported service work with regular feedback on specific learning outcomes; majority of their time in experiential work based learning closely supervised by their supervisor; apply academic knowledge to public health problems of increasing levels of complexity and weight shadowing their supervisor, providing elements of the overall task later taking the lead for an area of work
Concentrated practice
Some learning outcomes best achieved or consolidated through periods of more focussed, repeated and directed practice which may be possible at any point during training.
The later years of training allow concentrated practice during consolidation and development of special interests; this may require experience outside the deanery programme. Concentrated practice is also available as a routine during all phases of training for specific elements eg sophisticated data handling and development of major public health emergency management skills. Concentrated practice is also available as a part of a remediation plan.
Learning with peers
Trainees, particularly in the first two stages of training, will generally be placed alongside other trainees. Regional postgraduate teaching opportunities will allow trainees group learning. Examination preparation, self-help groups and learning sets. Self directed trainee groups develop and practice specific skills such as critical appraisal, presentation, on call debrief etc.
Learning in formal situations
university based academic courses; regional and national opportunities courses and conferences; formal assessment of progress; regional cohort learning sets;
Personal study
Study leave allocation managed in accordance with CoPMED principles. May be taken as self directed learning to support educational objectives/exam preparation or formal courses in support of their stage in training, special interests and career aims.
Specific teacher inputs
Every trainee is allocated an educational supervisor and academic supervisor; support and input from other supervisors and more senior trainees is available. Some supervisors have particular expertise and trainees may work to link with them. Supervisors deliver specific packages of training. All supervisors are accredited for their training role and fully conversant with the requirements of the curriculum and with assessment method.
Each programme has a representative amongst the body of national examiners for the OSPHE who are able to bring expertise in process and performance to their trainees. The pool of examiners for Part A MFPH is too small to allow this but programmes will have an individual identified to take the lead in supporting a group through this element of training.
Proportions of time spent in various learning methods
Across the five years a trainee would expect to spend up to 150 days in off the job programme education or in independent self directed learning. The remaining time would be spent in experiential learning. During phase 1 a greater proportion of time is spent in academic study taken in lieu of formal study leave. The remainder of the five years is spent in work based experiential learning

40. Learning from practice
From early stages of training, trainees undertake guided and supported service work with regular feedback on specific learning outcomes . Trainees, with their trainer, develop an educational plan through which they identify specific outcomes to achieve and develop and then negotiate and agree work in support of this. Trainees are given exam preparation practice in groups and individually.

41. Continued……
Trainees spend the majority of their time in experiential work based learning through delivery of service work closely supervised by their trainer. Initially this work is focussed around the needs of the population served by a PCT/Health Board.

42. Learning with peers
Trainees are encouraged to learn with their peers. Trainees, particularly in the first two phases of training, will generally be placed alongside other trainees. Regional postgraduate teaching opportunities will allow trainees at different phases of training to come together for group learning.
Examination preparation for both parts of MFPH will encourage the formation of self-help groups and learning sets. Self directed trainee groups are also encouraged to meet and work together as a peer group to develop and practice specific skills such as critical appraisal, presentation, on call debrief etc. Learning sets may be facilitated by public health specialists and senior trainees.

43. Learning in formal situations
Formal learning in phase 1 is generally delivered through university based academic courses.
In subsequent phases of training there are regional and national opportunities to attend courses and conferences which meet educational needs.

44. Personal study
Study leave allocation is managed in accordance to deanery principles. During all stages of training, trainees have opportunity for study leave which may be taken as self directed learning to support educational objectives/exam preparation or to attend formal courses in support of their stage in training, special interests and career aims.

45. Specific teacher inputs
Trainers work in settings where, normally, there are other trainers. While every trainee is allocated a specific trainer, there will be support and input from other trainers and more senior trainees in that location.
Some trainers have particular expertise and trainees may either request placements with these individuals or undertake work that links across to them.
Named academic supervisors provide an academic focus to all elements of the trainees' educational progress including support in examination preparation, maintaining an academic rigour for service work and in encouragement to publish and disseminate their work.

46. Continued……….
Usually each programme has a representative amongst the body of national examiners for the OSPHE who are able to bring expertise in process and performance to their trainees.
The pool of examiners for Part A MFPH is too small to allow this but programmes will have an individual identified to take the lead in supporting a group through this element of training.

47. Trainer accreditation
All trainers are accredited for their training role and should be fully conversant with the requirements of the curriculum and assessment methods.

48. Supervision & feedback
Educational supervisor
Project supervisor
Academic supervisor
Concept of three way handover
Reflective practice
ARCP
Exam feedback
The curriculum is designed to ensure graded learning and responsibility. All trainees have a designated educational supervisor. A project supervisor may take responsibility for supervising specific areas of work, overall responsibility remaining with the educational supervisor. Trainees will work with a level of supervision commensurate with their experience and level of competence.  All trainees also have an academic supervisor who will support preparation for Part A MFPH, provide academic rigour for service work and encourage publication and dissemination of work. Educational supervisors are expected to meet regularly with their trainee to review the learning contract and current service work progress and learning. Regular three way meetings between trainee, academic and educational supervisors are encouraged. All supervisors are accredited appropriately for their level of supervision.
Regular and timely feedback is an essential component of educational progress and development. The curriculum allows rich opportunity for the trainee to develop the ability to seek and act on feedback from a variety of sources. Trainees are also encouraged to self assess. This sets the foundation for compliance with Good Public Health Practice and subsequent revalidation.
Formative assessment and feedback takes place during the required regular service progress meetings between trainee and trainer which measures progress and identifies further educational need and opportunity. Regular informal feedback is given by the trainer as tasks are delivered and formally at dedicated training feedback sessions. Trainees are encouraged to seek formative feedback on their public health practice from other colleagues both over specific pieces of work and more formally through 360 degree appraisal. The use of the portfolio templated summary sheet encourages a reflective approach, incorporating a section for trainer reflection, and requires discussion with the trainer before presentation as evidence to support signing off of competence in a particular area at RITA.
Trainees will have an initial induction appraisal with their supervisor shortly after the start of any placement to identify and agree learning objectives. Progress towards these will be measured through a series of regular appraisals. Structured written feedback is an essential part of this process. At every change of placement an end of placement assessment will be followed by a three way handover – a meeting between the trainee and the old and new supervisor to discuss progress and further educational needs.
Each phase of training has a clearly identified assessment blueprint which includes formal examination with work place based assessment and development of a portfolio log book of experience and reflection. Supervisors discuss their assessment of their trainee and formally offer their views on educational progress and further learning needs in their educational (service and academic) supervisors report at RITA.
Feedback in the form of examination mark breakdown is available for trainees failing either part of the MFPH.
Evidence that feedback has been sought and responded to will form part of the annual RITA, in accordance with the principle that reflective practice is a core element of consultant level competence.

49. What does all this mean? Significant change
New cohort trainers need ‘skilling’ up
Structured training pathway
Double running
New trainees start in August, their trainers will need to be completely familiar with the new curriculum. Learning experiences will need to be based on the LOs in the relevant phase of training. Trainers must be skilled at assessment method and rigorous in assessment.
New trainees should plan their training pathway in line with the schematic. Trainees should not try to rush through phases 1 & 2 but aim to have Part B by half way through training.
Trainers will need training in assessment method
Programmes will need to be highly structured and consider trainees in cohorts to deliver phase based cohort learning. Educational need will require early identification and monitoring with career planning taking place half way through training
Programmes will need to consider a mixed economy of formal training and retrospective assessment of competence particularly for experienced entrants from BOTM leading to a CESR
Current trainees will continue on the old curriculum unless they elect to transfer. Double running may continue for up to ten years.

50. Assessment

51. Assessment of training
There are two aspects:
1. Assessing competence to do the job
Responsibility for this lies with the Faculty of Public Health and is achieved by:
assessing specific knowledge (through the Part A exam)
assessing the ability successfully to apply knowledge to carry out the functions of public health - 'shows how' competence (through the Part B exam and in work assessment by public health accredited trainers).
2. The assessment of satisfactory progress in the training programme
Responsibility for this lies with employing deaneries and is achieved through
An annual review of the progress trainees are making in training - the RITA / ARCP process.

52. Assessment elements Methods Checkpoints Evidence Examinations
Direct observation of practice
Case based discussion
Simulation exercises
Multi source feedback
Checkpoints
RITA/ARCP
Exams/summative assessment
Evidence
Logbook & portfolio
External validation
Direct observation will involve assessment of written documents and of skills in the workplace such as performance at meetings and ability to manipulate and interrogate data
Some elements of the curriculum will be assessed through discussion which will demonstrate a wide understanding of the situational aspects of a work area and ways of handling varying outcomes
Simulation (modelled on the mini clinical exercise) will assess skills with data and communication
Multisource feedback will allow assessment of professional behaviour and team working.
There are key checkpoints during training through which a trainee should not pass without satisfactory assessment of required elements.
Evidence should be gathered in a portfolio and will include attendance at courses, exam certificates, reflective notes and logbooks of experience linked to actual work undertaken for validation of competency claims

53. Assessment methods Part A Part B (OSPHE) Multi-source Workplace
Direct observation will involve assessment of written documents and of skills in the workplace such as performance at meetings and ability to manipulate and interrogate data
Some elements of the curriculum will be assessed through discussion which will demonstrate a wide understanding of the situational aspects of a work area and ways of handling varying outcomes
Simulation (modelled on the mini clinical exercise) will assess skills with data and communication
Multisource feedback will allow assessment of professional behaviour and team working.
There are key checkpoints during training through which a trainee should not pass without satisfactory assessment of required elements.
Evidence should be gathered in a portfolio and will include attendance at courses, exam certificates, reflective notes and logbooks of experience linked to actual work undertaken for validation of competency claims

54. Assessment in the workplace
121 core learning outcomes
assessed locally

55. Workplace assessment Know the standard Know the trainee
Don’t be an impressionist: look at the evidence

56. Assessor training
Training sessions
Guidance manual

57. Guidance manual (1)
2.3 ‘Make use of others in finding and retrieving evidence (e.g. librarians, information specialists)’

58. Guidance manual (2)
8.3 ‘Appraise the validity and relevance of data and data systems in order to assess their quality and fitness for purpose’

59. Glossary (1)
Weight
Complexity
‘Use’
‘Interpret’

60. Glossary (2) - weight
Phase 1: ‘…work aimed at/done for a single manager’
Phase 2: ‘…at a committee’
Phase 3: ‘…at Board level’

61. Evidence
Log books
Reports/CD, etc.

62. Multi-source feedback
‘Keep colleagues well informed when working in partnership…’
‘Respect skills and contributions of colleagues…’

63. Multi-source feedback
Timing – originally thought about 18 months into training
But need for 20 assessors
Consultant x5
Peer x5
Support staff x5
Other organisation x5
So may need to be later to gather required number of assessors

64. On call assessment Assessment of fitness to start on call
Health protection induction/basic skills
Knowledge/Part A pass
On call induction
Have started HPU
Safe on call assessment
On call logbook
Immediate patient safety is a significant issue during the health protection element of training and out of hours work and indirectly in some specific areas of work such as development of patient pathways and services. Trainees are first on call out of hours from phase 2 and always supervised by a consultant second on call. Trainees are not allowed on call until they have fully passed the knowledge element of the curriculum (Part A MFPH), have passed a further specific knowledge test on emergency protocol and are training or have trained in a health protection unit.
Basic skills training introduces trainees to basic history taking, basic microbiological terminology and health service structures
On call induction is expected to cover the procedures for taking and responding to out of hours calls
Assessment of fitness to start on call is conducted at a local level through structured face to face questions
Trainees are required to keep a log book of calls to be presented at RITA.

65. Remediation
Remediation is tailored to the individual and to the particular milestone or learning outcome causing difficulty.
Principles are:
early identification of difficulty and particular need;
focussed support to address identified need;
regular monitoring and feedback to avoid surprises;
appropriate evidence of progress supports all decision taken.
Remediation is particular to the trainee and will be under the overall direction of the Programme Director. The educational supervisor will be pivotal in targeting remediation.

66. What’s to do?
We have until 2010 to develop and refine the assessment system
Assessors/educational supervisors need to be trained
E-portfolio

67. Some implications Re design of training programmes
Training in assessment
Double running
New trainees start in August, their trainers will need to be completely familiar with the new curriculum. Learning experiences will need to be based on the LOs in the relevant phase of training. Trainers must be skilled at assessment method and rigorous in assessment.
New trainees should plan their training pathway in line with the schematic. Trainees should not try to rush through phases 1 & 2 but aim to have Part B by half way through training.
Trainers will need training in assessment method
Programmes will need to be highly structured and consider trainees in cohorts to deliver phase based cohort learning. Educational need will require early identification and monitoring with career planning taking place half way through training
Programmes will need to consider a mixed economy of formal training and retrospective assessment of competence particularly for experienced entrants from BOTM leading to a CESR
Current trainees will continue on the old curriculum unless they elect to transfer. Double running may continue for up to ten years. 67

68. Useful website – Faculty of Public Health – fph.org.uk
Information about training, curriculum, competencies, appraisal, revalidation and framework
Look under professional standards and training

69. With thanks to Steve George & Ed Jessop69