Royal College of Obstetricians & Gynaecologists Principles and processes for externality in specialty education and training Introduction 1. The aims of this document are to: explain why externality is important outline the principles for externality in O&G specialty postgraduate medical education describe the processes to which these definitions and principles apply provide a role description for RCOG Specialty Assessors (SAs) describe the internal process for appointing and allocating SAs describe the ways in which SA outputs will be used to improve the quality of training outline the principles for dealing with serious concerns list the documents and resources for SAs Why externality is important 2. The use of external experts is recognised to be a beneficial method of providing objectivity in some of the processes undertaken by deaneries to manage the quality of education and training and is a formal requirement of the General Medical Council s (GMC) Quality Improvement Framework for all specialties i. Although the onus is on deaneries to engage active external scrutiny for these processes (assessing a trainee s progress through the Annual Review of Competence Progression [ARCP], quality visits, School Board membership and recruitment), the GMC and the medical Royal Colleges collectively agree that there should be a clearer understanding of what that engagement means. 3. Specialty externality is particularly important in the processes used for managing the quality of postgraduate medical education, where it has three main functions: as an objective guarantor of the way the quality of education is managed by deaneries as a conduit for conveying patient and trainee safety concerns arising from educational quality assurance activity to other healthcare regulators, relevant service providers and medical Royal Colleges clinical standards departments as a collector and disseminator of good practice in education and training. 4. There are, of course, other dimensions to externality lay and geographical but this document is concerned principally with the way in which the RCOG engages with the LETB quality management processes of assessing trainee progress (Process 1, below) and quality visits (Process 2, below), specifically through the contribution of SAs. Policy statement on externality 5. The overarching principles for externality are derived from the GMC s standards in The Trainee Doctor 1 and the Gold Guide 2 and are approved by the RCOG Education Board as part of the College s developing Education Quality Strategy. The administrative support for externality is located in the Directorate of Education Policy & Quality (EPQ). 6. The RCOG will: appoint suitable individuals to act as SAs on its behalf 1 Standards for Deaneries 4.1 4.7, The Trainee Doctor, GMC 2 Para 7.51, The Gold Guide, Fourth Edition
by focussing on the experience and achievement of trainees and trainers, verify that appropriate standards are being attained by trainees and so help deaneries maintain the quality of O&G provision seek to confirm that assessment processes are sound and operated fairly collect, record and disseminate good practice identified, so as to promote comparability of the trainee and trainer experience between deaneries seek to confirm that the curriculum is able to be effectively delivered contribute to the deaneries effective management of educational quality, including the development of trainers provide standards for SAs so that they undertake their responsibilities in a consistent manner and in accordance with the RCOG s education policy expect SAs to adhere to extremely high standards of probity, in particular taking care to declare any conflicts of interest, whether professional, personal or geographical engage with the RCOG Quality & Knowledge Directorate, GMC and other stakeholders on patient and trainee safety issues arising from the experience of RCOG SAs recognise the professional contribution of SAs by awarding five Continuing Professional Development (CPD) points for each external activity (maximum 25 in a five-year cycle). Process 1: Assessing trainee progress ARCP/RITA and appeal panels 7. The Gold Guide (June 2010) lays out the requirements for ARCP/RITA and appeal panel membership 3,4. There are three purposes for engaging an external representative in assessing trainee progress: to provide an independent perspective of the conduct of the ARCP process to assess whether there are any issues with the delivery of the curriculum to determine whether an individual trainee s progress is assessed consistently against the objectives described in the RCOG Matrix of Educational Progression and associated Guidance for ARCP outcomes. 8. The requirement for O&G is that 10% of ARCPs, constituting a representative sample from all years of training, are reviewed by an SA. The reviews will usually be conducted face-toface but the sampling of standard or routine ARCPs, where no major issues are anticipated, may be conducted through a review of paperwork or their eportfolio. This would not be the case where there are known performance issues, in which case a face-to-face ARCP or RITA is expected. The SA answers specialty-based queries, identifies issues that arise from the ARCP or training processes, provides advice and direction on concerns about individual experiences of training as they arise and provides advice on a decision, if invited to do so. The SA will also specifically review the ARCP/RITA process in relation to the RCOG standards, as set out in the Matrix and ARCP Guidelines. 9. A standardised report has been developed by the RCOG, which is available on the website or through the Department of Education Policy & Quality (EPQ). SAs are required to submit their completed form to EPQ and the LETB as soon as possible. Failure to submit a form will mean that the agreed RCOG CPD points will not be awarded. 10. In cases of appeal panels, the deaneries may request a SA to ensure assessment of the process and the training opportunities. As such, these situations are trainee-identifiable and, thus, there is no RCOG report template. SAs are only required to provide the LETB with whatever report the LETB requires. If however there are issues of concern relating to patient or trainee safety, SAs should report directly to EPQ by an individual confidential report or letter but only after consultation with the Postgraduate Dean. The RCOG will request that 3 Para 7.129, The Gold Guide, Fourth Edition 4 Para 7.51 7.56, The Gold Guide
deaneries notify EPQ to confirm the SA s attendance after the panel has met so that the requisite CPD points are awarded. Process 2: LETB visits to Local Education Providers (LEPs) 11. Deaneries undertake assessments of Local Education Providers (LEPs) through a process of internal visiting that is specific to each LETB to comply with the GMC s Quality Improvement Framework. Visits may be organised on a routine basis or as part of a targeted assessment. SAs represent the RCOG on the visit team and, as such, provide feedback to the RCOG, including the LETB s own visit report. While it is anticipated that external advice will definitely be required for targeted visits 5, this is not necessarily the practice for routine monitoring visits. Deaneries vary in whether external advice is sought for such visits, although good practice would be to ensure that a sample of routine visits should involve external advisors. 12. Targeted visits will be led and undertaken by deaneries in conjunction with college involvement and may result from concerns from a variety of sources, such as: lack of compliance with GMC training standards outcomes of GMC trainee and trainer surveys LETB quality management systems information (e.g. annual reports) specific concerns raised by individuals. 13. As deaneries have a variety of documentation and the RCOG wishes to minimise the additional burden on SAs, the LETB visit report is considered sufficient information for the RCOG to collate issues from a national perspective. It is essential that the LETB is made aware that the final visit report is a requirement of the RCOG in supplying an SA. The LETB s visit report may include the direct input of the SA or the LETB may request a separate report. If the SA has to provide a separate report to the LETB, the SA should use the standardised template, which is available on the website or through EPQ. Whatever is reported to the LETB should be submitted to EPQ. This should be done as soon as possible after the visit. No trainee- or trainer-identifiable data or information should be included. As for Process 1, no CPD points will be awarded if a report is not submitted. Managing serious concerns 14. Responding to concerns is the fourth element of the GMC s Quality Improvement Framework and supports the RCOG s role in maintaining safe training environments 6. 15. The College is required to have a process in place for identifying serious issues when they arise and mechanisms for reporting to the LETB and regulator. If an SA identifies a serious issue (for example, pertaining to patient or trainee safety), this should be referred directly to the Postgraduate Dean as soon as possible and EPQ should be informed. If the issue has been assessed inadequately at local level and cannot be taken up by the Postgraduate Dean for whatever reason, the issue may be reported by the College to the GMC via the Vice President (Education) or to the Care Quality Commission (CQC) via the Vice President (Standards) through the published response to concerns processes. The RCOG reserves the right to contact the Trust Chief Executive Officer jointly with the relevant Postgraduate Dean where service reviews and education quality visits have come to similar conclusions. 5 Terminology varies for these kinds of visits, which are essentially undertaken in response to concerns. The GMC refers to triggered visits. 6 Para, 126 ج 115 Quality Improvement Framework, GMC
Role description for SAs 16. Person specification professionally qualified in O&G in the UK (Consultant in O&G) extensive experience of managing training (e.g. as Head of School, Training Programme Director, Director of Medical Education, College Tutor or equivalent) extensive awareness of the O&G curriculum, workplace-based assessment, eportfolio, RCOG Matrix of Educational Progression and guidance for ARCP outcomes trained and recognised as an Educational Supervisor and in procedures for dealing with Doctors in Difficulty experience in educational governance (e.g. member of School Board, Chair of STC) experience in taking part in quality assurance (e.g. member of a LETB visit team, ARCP panel, analysis of quality data in other LETB quality management activities) knowledge of the GMC s Quality Improvement Framework and standards (The Trainee Doctor; Curricula and Assessments) and evidence of engagement in improving the quality of training detailed knowledge of requirements of the Gold Guide. 17. Responsibilities represent the RCOG to ensure that the RCOG s standards regarding delivery and assessment of the curriculum are being implemented provide an independent view of quality management processes (ARCP and visiting) observe the equity of the ARCP process and provide advice on RCOG tools and standards fully participate in the LETB visit process by interviewing trainees and trainers, constructively advising on the training environment and contributing to relevant paperwork prepare and supply appropriate feedback to the RCOG in the form of reports, including how various initiatives to improve training and promote standardisation are being implemented. These include the educational matrix, ARCP guidance and ongoing work regarding assessment and subspecialty training. prepare and supply confidential reports where appropriate and agreed with the Postgraduate Dean complete any training required to become a recognised RCOG SA able and willing to complete at least one external assessment for RCOG per training year. 18. Terms SAs will be approved for a period of three years, renewable on application the RCOG will maintain a Register of Approved SAs via SEAC and review the contribution of SAs on an annual basis. If the SA fails to provide reports or attend visits, they will be removed from the RCOG Register each visit with completed report will result in 5 CPD credits (note that a maximum of 25 credits may be claimed in each five-year cycle for this activity). Internal process for appointing and allocating SAs 19. Individuals wishing to act as SAs should complete an application form and send to the SEAC Secretary, who will scrutinise it against the person specification requirements and make a recommendation to the SEAC Chair. The SEAC Chair will either confirm or otherwise and the individual will be notified accordingly. 20. The RCOG will maintain the Register of Approved SAs. Resources for SAs will be developed and maintained on the RCOG website. 21. Deaneries should contact Penny Payne (RCOG EPQ) at least eight weeks in advance of when an SA is needed, and with a firm confirmed date for the relevant event. Deaneries will be
informed that the RCOG expects to receive the LETB final visit report as a condition of supplying an SA. 22. Penny Payne will then circulate the request with the date to the SAs and ask for expressions of interest to undertake the event, including a declaration of any possible conflicts of interest due to professional or personal relationships. These expressions of interest will be assessed by Tania Chambers (EPQ) and Penny Payne will then confirm the name of the SA to the LETB. 23. All events for which an RCOG SA is requested and allocated will be recorded on a spreadsheet in EPQ. 24. Following the visit/arcp/rita/appeal, the SA will send Penny Payne a report depending on the assessment. EPQ will inform the CPD Office, which will then allocate the CPD points, and a certificate confirming the attendance of the SA will be issued to put into their CPD diary. Improving the quality of training 25. The information that is acquired through these processes will be: recorded and presented annually to the SEAC meetings and Education Board used as evidence for the Annual Specialty Report to the GMC shared with the Quality and Clinical Effectiveness Department if appropriate (where there are clear service and/or patient/trainee safety issues) triangulated with other quality data to review the need for future Global Education Directorate developments. Resources for SAs Process 1 RCOG template for report on ARCP event Process 2 RCOG template for report on LETB visit (note: LETB visit report is required to be attached) Application to be an SA The Trainee Doctor (GMC) Quality Improvement Framework (GMC) The Gold Guide i