Martin Hart - GMC

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Case study on accreditation the GMCs
perspective
Martin Hart Assistant Director Education
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Agenda

• What GMC does
• How doctors are educated and trained
• How we accredit and quality assure
• Strengths of our process
• Issues and challenges

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Our purpose
to protect, promote and maintain the health and
safety of the public by ensuring proper standards
in the practice of medicine
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Our aim

• To secure a regulatory system which
• Enhances patient safety
• Fosters professionalism
• Commands the confidence of all stakeholders
• Is independent, fair, efficient and effective

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General Medical Council

• A new council took office at the beginning of
  2009
• All appointed by the Appointments Commission

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Our functions
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Structure of UK education and training
Provisional registration
Full registration
Certificate of completion of training (CCT)
Medical School (4-6 years)
F1 year (1 year)
F2 year (1 year)
Specialty/ GP training (3-8 years)
Medical School (4-6 years)
F1 year (1 year)
Specialist/GP register
Career stage
Employment/ regulatory status
Student, not licensed
Employed, licensed
Employed, in training, licensed by GMC
Education standards
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The GMCs role in medical education

• Responsible for promoting high standards of
  medical education
• In April 2010 PMETB will merge with the GMC
• For the first time, one organisation will be
  responsible for regulating all stages of medical
  education and training

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Medical School

• Medical School
• (4-6 years)

• 32 medical schools in the UK
• 35,000 medical students (60 female)
• Have own approaches to curricula, teaching,
  assessment etc
• But must all meet standards and outcomes in
  Tomorrows Doctors
• Subject to fitness to practise, graduates
  receive provisional registration with GMC
• GMC quality assures (QABME)

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Foundation Programme

• F1 year and F2 year
• (2 years)

• Foundation programme is a two year programme of
  general training with placements within various
  specialties and healthcare settings (hospital
  bias)
• Foundation Programme has national application
  scheme (UKFPO) and is overseen by postgraduate
  deaneries
• Curriculum developed by Academy of Medical Royal
  Colleges, approved by GMC and PMETB
• F1 has outcomes set by the GMC which must be
  achieved to receive full registration
• GMC and PMETB jointly quality assure Foundation
  Programme (QAFP)
• 14,000 junior doctors in Foundation Programme
  (2009)

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Specialty training

• Specialty/GP training
• (3-8 years)

• Medical royal colleges draw up criteria for
  specialist and GP training and assessments, which
  are approved by PMETB
• National competition for selection, training
  overseen by postgraduate deans
• PMETB certifies completion of training, leads
  to entry on GMC GP or specialist register and
  eligibility to work as a consultant
• PMETB quality assures specialist training

GMC from 2010
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Maintaining Standards Quality Assurance

• Two quality assurance processes
• Foundation Programme (QAFP)
• Medical Schools (QABME)
• Focussed on the institution, not students and
  trainees
• Key elements are analysis of documentation,
  interviews with academic staff, students and
  clinicians

Quality assurance of specialty training currently
undertaken by PMETB
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Quality Assurance of Medical Education

• Make sure institutions comply with standards
• Identify examples of innovation and good
  practice
• Identify concerns and help to resolve them.
• Identify changes institutions need to make to
  comply with and a timetable for their
  implementation
• Promote equality and diversity in medical
  education

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QA Visit Processes

• QAFP
• Joint process with PMETB
• Postgraduate Deaneries quality management
• 6 visitors
• 4-day visit over 4 sites in one week

• QABME
• Medical Schools Quality Management
• Curriculum content
• Examination framework
• 8 10 visitors
• Minimum 4 days visit over 6 months

• QA Reports and institutions replies publish on
  website

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QA Visit Teams

• Undergraduate/ postgraduate deans
  school/deanery staff
• Medical education specialists
• Clinicians
• Students/ junior doctors
• Lay Visitors
• All are full and equal members of visit teams

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QA visit teams

• Consistent approach to recruitment
• Same contracts (responsibilities, payment and
  time)
• Mandatory annual training
• Same performance management framework
• Annual appraisal
• Share competencies

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QA Monitoring Process

• Targeted action plans updates
• Annual Returns of information
• PMETB Survey of Trainees (for QAFP)
• Data from all three sources published on GMC
  website

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Strengths of QABME at the end of 5 years

• In depth evaluation of School
• Wide range of team expertise
• Interactive with School
• Triangulation from multiple sources
• Seen as important and generally supportive by
  Schools
• Transparent process and status of schools
  progress on requirements is available to students
  and the public

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Strengths of QAFP midway through

• Has galvanised postgraduate deaneries to evaluate
  and demonstrate improvements in quality
  management
• Has given trainees a greater voice in the quality
  management and assurance of their training
• Has identified areas where improvements are
  needed particularly in the supervision of
  trainees
• Postgraduate deaneries have reported the process
  as challenging and helpful perhaps particularly
  the self assessment

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Issues in GMC accreditation

• QABME QAFP
• Resource intensive GMC and institutions
• Maintaining team focus/knowledge over cycle
• Potential variability of teams
• Potentially insufficient involvement of employers
  and patients in the QA process
• Disseminating good practice/innovation

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Challenges for accreditation generally

• Is the QA focus on institutions sufficient for
  maintaining a register of professionals?
• Sanctions nuclear option removal of
  accreditation
• Reliance on others can the GMCs QA processes
  effectively identify areas of poor practice?
• Deaneries and Schools measure the quality of
  individual students and junior doctors
• Health systems regulator measures quality of care
  (and by extension doctors)

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Issues for the future Student Registration?

• Medical students are not registered with the GMC
• BUT guidance for schools and a significant
  programme of student engagement
• Has the challenge of keeping in touch with
  students and instilling professional values been
  met?
• Could student registration strengthen the link
  between the GMC and students?

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www.gmc-uk.org/education