A Guide to the organisation of Postgraduate Medical Education

1
Proposals for the Organisation of
Postgraduate Medical Education
at the provider level
A NACT UK Document
August 2007
Registered Charity no. 295172
Supporting Excellence in Medical Education

Foreword
This document has been compiled by Liz Spencer and the Council of NACT UK
following extensive discussions within NACT UK, many external bodies and individuals.
For the valuable ideas and advice, our thanks, go to some individual Postgraduate &
Undergraduate Deans, COPMeD, The Training Committee of PMETB, The Specialty
Training Committee of the Academy of Medical Royal Colleges, NAMEM, The Medical
Workforce Forum of NHS Employers and many Royal Colleges.
NACT UK is involved in continuing discussions with COPMeD as to how best to reflect
locality variations in a final position statement on this critical aspect of the organisation
and management of postgraduate medical education. These proposals have been
reviewed by the Medical Workforce Forum of NHS Employers and as such give rise to
a best practice guide. Implementation by individual organisations will be in line with
their internal strategies.
Attempting to compile a model to suit all specialties, in all Organisations delivering
Postgraduate Medical Education, all regions of England and all countries of the United
Kingdom, was predictably challenging. However it is timely to circulate these proposals
to all stakeholders to promote debate on how we can provide a learning environment
where high quality supervised workbased training is valued and occurs within service
delivery and safe patient care.
August 2007
2

Proposals for the Organisation of Postgraduate Medical Education
Table of contents
Page number
Executive Summary 4
Background 5
Department of Medical Education 7
Fig.1 Organisation chart of Medical Education
Communication between Trust/Board & Deanery 9
Fig. 2 Communication Wheel ; linking Trust to Postgraduate School
Management of Foundation Programme 10
Management of Specialty Programmes 11
Fig. 4Demonstrating a pathway for career progression
Primary Care & Mental Health 13
Faculty Development 14
Careers in Medical Education 15
Fig.3 Professional Spine linking local tutors to Colleges
Quality Control 16
Communication & Governance within the Organisation 17
Pastoral Support & Career Management 18
Undergraduate Medical Education 18
SASG, Trust doctors & Consultants 19
Multi-professional Education 20
Finance 21
NACT UK 22
References 23
Appendix 1 Job description of Director of Medical Education 24
Appendix 2 Job description of Medical Education Manager 27
Appendix 3 Foundation Programme Committee 30
Appendix 4 Medical Education Committee 31
Appendix 5 Job descriptions of Tutors and Supervisors 32
Appendix 6 Organisation Chart of Mental Health Medical Education 36
Appendix 7 Multi-professional Education & Training 37
3

Executive Summary
a. The purpose of this document is to suggest a terminology and structure that could
be implemented, with local adjustment, in all parts of the United Kingdom to raise
the profile of medical education, particularly postgraduate clinical training, and those
responsible for managing it within the hospital, GP practice or department.
b. In all organisations delivering Postgraduate Medical Education there should be
i. a named Executive Director to represent medical education at Board or
Divisional level.
ii. a named individual (Director of Medical Education) should be the Head of
the Department of Medical Education, with appropriate resources, and be
supported by a Medical Education Manager. This individually will be
managerially responsible to the CEO in the Trust/Health Board, and
professionally responsible to the postgraduate dean.
c. All those engaged in the delivery of PGME within the local organisation should be
appointed jointly by Trust, Deanery/College or appropriate Postgraduate Specialty
or Foundation School and should have clear roles and responsibilities. They need
support and leadership from the Postgraduate Dean and his/her team within the
Deanery to ensure systems of delivery and quality control of training are consistent
between specialties and across organisations. Clear lines of communication should
exist between all those involved in overseeing Postgraduate Medical Education
(PGME).
d. The structure for medical education within the organisation should encompass
medical students, doctors on recognised training programmes (including FTSTA), all
Career/Trust posts, SASG and consultants. NHS appraisal, pastoral support and
continuing professional development for all medical staff should be included in this
structure. The organisation should identify resources to support the development of
this structure.
e. The requirements for education and training should be understood by the local
organisation, integrated with service delivery and valued as part of the
organisation’s core business. Creating a local learning environment is beneficial for
all members of the clinical team and leads to a competent motivated workforce with
enhanced recruitment and retention, a no-blame culture of clinical governance and
high quality patient care.
f. Issues within and the culture of clinical governance need to become integrated into
medical education. The Director of Medical Education should support the
organisation in complying with the Standards laid down by all External Regulators
regarding the education and training of medical staff.
4

Background
1. Traditionally, Postgraduate or Clinical Tutors were full-time consultants who received a
sessional payment to oversee the PRHO year, the postgraduate centre and its staff and
provide pastoral support to trainees and trainers. They were responsible for the local
delivery of the Education Contract, provided the link between the Deanery and the Trust;
representing the Trust in the Deanery and the Deanery in the Trust.
2. The recent changes in service delivery, external regulation and Modernising Medical
Careers, require the structures and systems around the management, delivery and quality
control of training programmes to be reviewed. Many Clinical Tutors have had minimal
involvement with SpRs, the RITA process or College visits. The College Tutor role has not
been “valued” by some departments or associated with the Clinical Tutor; with variable
expectation from the Deanery and Trust that Clinical Tutors oversee all postgraduate
medical training.
3. Acute Trusts or divisions are now large organisations (30-60 F1s and 200-350 consultants)
across multiple sites. They are increasingly being run as “Businesses” where national
targets, financial balance and external regulation are the priority. The prime focus is the
delivery of healthcare. Attitudes towards training and education, support and funding are
variable.
4. Many Mental Health Trusts have separated from Acute Trusts, creating both opportunities
and problems. Some resources remain shared – such as deanery-funded libraries and
post-graduate centres. Mental Health Trusts share the training of Foundation doctors,
GPVTS and others but are responsible for the management of psychiatric specialty training.
5. Clinical Tutors no longer just have responsibility for the education of trainees. Several
organisations have already created, and paid for, Directors of Medical Education. This
reflects their increasing extended roles and their involvement in general training issues for
all doctors such as:-
a. the training requirements detailed by the external regulators e.g. Healthcare
Commission,
b. new models of working e.g. Hospital at Night
c. workforce planning issues
d. training the trainers in preparation for MMC
e. liaising with other leads in training and education to develop multi-professional
education, training records, websites, e-learning, induction & mandatory training
and knowledge management centres
6. The Educational Environment within the hospital has changed. Increased clinical workload
and more complex systems and processes of delivery of patient care may pull consultants
from their commitment to supporting and teaching their trainees. Tutors have used their
personal, negotiating and persuasive skills to encourage colleagues to adopt the
Foundation Programme. The Specialty Training Programmes will be more challenging due
to the diverse learning needs of trainees within the same department on different training
programmes. The new consultant contract has limited many consultants’ opportunities for
getting involved in medical education.
7. Modernising Medical Careers requires a clearer structure for training with a curriculum
based approach and explicit framework of work-based assessments. The previous informal
system of supervision needs to be replaced by formal Educational and Clinical Supervisor
roles undertaken by clinicians who understand the roles and have clearly defined
responsibilities and lines of accountability.
8. The re-badging of SHO posts, the conversion of trust posts into training posts and the
creation of a clear database of posts requires negotiation between medical staffing, finance
and individual departments. The creation of core (CMT, ACCS and CST) and GP rotations
which involved many different specialties requires a corporate overview and liaison with
Primary Care and Mental Health.
5

9. The Foundation Programme received central funding which enabled the appointment of
Foundation Programme Directors/Tutors locally. In most places these come under the
leadership of the Clinical Tutors and require education, support and personal development
by the Clinical Tutors.
10. There is an increase in medical students in most District Hospitals with an associated
increase in consultant undergraduate tutors. In many places the Clinical Tutor has an
overarching co-ordinating role for both tutors and students. The increased emphasis on
career guidance with MMC requires the Clinical Tutor to liaise with tutors and students
locally, the medical school and to educate and advise students on these changes.
11. The Generic and Professional Skills aspect of the curricula of both the Foundation and
Specialty Programmes may alter the type of educational provision required within Trusts.
Increasingly, knowledge and skills are being dealt within the work-place and the subjects
covered by the Educational Programme provided centrally in the Postgraduate Centres, are
more of a generic nature. The new education programme for the Foundation Programme
has required a co-ordinated, cross-specialty and multidiscipline approach for delivery.
12. Historically the lines of communication have been confusing and variable between key
players in PGME both within the hospital e.g. between College, Specialty and Clinical Tutors and
between the hospital, training committees and Deanery. This needs to change as PMETB
has stated that all organisations providing PGME must have clear structures for supporting
medical training programmes, setting out responsibilities and accountabilities for training
and for producing processes to address underperformance in medical training.
13. The encorporation of the Deanery into the SHAs in England has shifted the finances and
remit of PGME to SHAs who now have a more central role. The PGME Contract, which was
between Deanery and Provider, is now encorporated within the multi-professional Learning
& Development Agreement between SHA and Provider. This will require those involved
locally in training and education to work collaboratively across professions.
14. There has, in many places, been a large expansion in Trust doctors due to the restrictions
imposed by the Working Time Directive. These doctors are often poorly served in terms of
educational and professional development. The recent changes, led by PMETB, of the
Article 14 route to the specialty register have led to an increased Trust requirement to
support these doctors.
15. Consultants, particularly new consultants, need mentoring, developing and supporting
during their consultant career. They have training needs e.g. leadership and management,
training the trainers, understanding the appraisal and revalidation processes etc The
medical director in large merged organisations where finance and targets are the priority is
distracted from this important role of supporting and developing the expanding body of
permanent medical staff. In some Trusts many of these roles are already undertaken, either
officially or unofficially, by the Clinical/Postgraduate Tutor.
16. The current position of Clinical Tutors paid one session but undertaking an
expanding variety of responsibilities, many of which are Trust requirements, is no
longer sustainable.
17. Professionalising medical education as proposed in Modernising Medical Careers
requires the creation of a structure in all organisations delivering PGME with clearly
defined responsibilities and lines of accountability of all involved.
6

Department of Medical Education
18. In large merged organisations, the delivery of Postgraduate Medical Education to about
300-400 trainees on almost 20 structured training programmes, needs to be well organised
and co-ordinated to ensure robust education, high quality safe patient care and wise use of
limited resources.
19. It is acknowledged that different structures and funding arrangements exist in the four
countries and also in the different regions within England and that not all the suggestions
detailed in this Guide are relevant or appropriate e.g. NES is a Health Board with equal rights
to the other Health Boards which gives education in Scotland more status and funding. These
proposals are offered as a starting point for discussion leading to an appropriate local
solution.
20. PMETB have stated that in all organisations with postgraduate trainees (Acute & Mental
Health Trusts and independent treatment centres), there should be a named individual
responsible for ensuring the delivery of high quality postgraduate medical education and
training. (This individual will be referred to in this document as the Director of Medical
Education (DME) but this title is not prescriptive). The DME should provide professional
leadership and vision for the organisation on medical education issues and develop and
monitor a local medical and dental education strategy. The DME should work closely with
the Postgraduate Dean and Specialty Schools/Boards to develop tutors and educational
supervisors, ensure sharing of good practice between specialties and to deliver the wider
educational agenda.
21. The DME should be appointed jointly by the CEO of the Trust and the Postgraduate Dean.
The DME should be assisted by one or more Deputies as necessary depending on the size
of the organisation. For an example DME job description see appendix 1.
22. The DME should be involved in the appointment of all those engaged in the delivery of
PGME locally e.g. Foundation Programme Tutors/Directors, Programme Tutors and
Specialty/College Tutors etc. The number and configuration of tutors will depend on the
size of the organisation, number of hospital sites and distance between sites. The current
Clinical Tutor funding could be used to create an appropriate local model. All tutors should
have clear roles & responsibilities and be accountable for them to the DME – see Fig. 1.
23. The Department of Medical Education is led by the DME and managed by the Medical
Education Manager and a team of administrative staff. The Medical Education Manager
should be appointed by and be accountable to the DME. They are responsible for the
recruitment and management of their administrative staff, overseeing the educational
facilities and work closely with medical staffing, the library service and other trainers locally.
They liaise with the Deanery Administrative Team and other regional and national
colleagues via the National Association of Medical Education Managers (NAMEM). For an
example MEM job description see appendix 2.
24. Where PGME is delivered in several hospitals within one Trust, attempts should be made to
merge medical education systems across sites with unified policies & procedures and
cross-site working to ensure a sense of cohesiveness and sharing of best practice. This
may entail a change in roles of tutors and administrators.
25. Educational structures within Mental Health may need to be organised differently as there is
only one Speciality per Trust, with relatively few post-graduate trainees at each hospital.
Whereas all the structures above need to be replicated within each Mental Health Trust, on
a smaller scale, many Mental Health economies may wish to create a “virtual post-graduate
centre”, serving several adjacent Trusts within a Deanery, managing study-leave budgets,
mandatory training, RITAs, rotation logistics and other Post-Graduate centre services for
200-300 trainees, as described above.
26. The PGME budget should be managed by the Medical Education Manager to ensure the
specific training needs of these medical postgraduate students are met. Wherever possible
training should be delivered locally and across individual specialties.
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Multi-professional Education
Leads
Specialty
Tutors
Programme Tutors
Foundation
Core Medical Training
Core Surgical Training
ACCS
Primary Care
Undergraduate
Lead
Medical Education
Manager
Director of Quality &
Clinical Governance
Director of Medical
Education
Postgraduate &
Undergraduate
Administration
Working relationship
Line management
GP/Mental Health
Education Leads
Identified
Director/Chief
Executive
Postgraduate
Dean
Deanery
Foundation School
Postgraduate Schools
CPD Lead for
Consultants, Trust
doctors & SASG
8
Fig. 1: Organisation Chart for Department of Medical Education

Communications between Trust/Board and Deanery
27. The DME and team require leadership, direction and support from the Postgraduate Dean
and team within the Deanery. The Deanery require dialogue with the DMEs to ensure they
are aware of what is achievable in the workplace and at what cost. Hence the Postgraduate
Dean should meet regularly with the local DMEs to inform and involve them in strategy and
ensure collaborative working across provider organisations.
28. Clear lines of communication must exist between the Trust and the Deanery, particularly
with the creation of the Postgraduate Schools/boards. Fig. 2 demonstrates how
College/Specialty Tutors are the link between the Specialty Training Committee and
Training Programme Directors at the Deanery and the Medical Education Committee,
Director of Medical Education in the Organisation. Consideration should be made to include
a DME on School Boards.
Fig. 2: Communication Wheel; linking Trust to Postgraduate Schools.
The College/Specialty Tutors communicate with their Training Programme Director at
Deanery level (blue) via the Specialty Training Committee and with the Organisation (red)
via the Medical Education Committee.
9

Management of the Foundation Programme
29. The Foundation Programme involves the whole local healthcare community and
encompasses Primary Care, Mental Health, and the Acute Trust. One of the Trusts (usually
the Acute Trust) should host the Foundation Programme, have overarching operational
management of the programme, receive management funds from the Deanery, employ the
trainees, manage the study leave and expenses. A Foundation Programme Committee is
responsible for the local management, development and quality control of the Foundation
Programme. Appendix 3 suggests membership and Terms of reference of this committee.
30. Foundation Programme Directors/Tutors should be jointly appointed by the DME of the
Host Trust and the Deanery Foundation School and are managerially responsible to the
DME. They are developed and supported in their role by both the Foundation School
Director locally by the DME. There should be one session of Tutor time per 30 Foundation
Trainees. They should have dedicated time in their job plan for this role and receive
sessional payment from MMC money identified for this purpose by the Department of
Health. Job descriptions are available from the purple guide “The Organisational
Framework of the Foundation Programme”.
31. One of the Medical Education Administrative Team should be identified to support the
Foundation Programme Tutors and trainees and liaise with the Deanery-based Foundation
School. There should be sufficient managerial, secretarial and IT support provided.
32. Foundation Programme Tutors should be accountable to the DME of the Host Trust but
liaise professionally with the Foundation School and its Director. They should attend
Foundation School meetings, feeding back locally via the Foundation Programme
Committee.
33. The education programme, portfolio, system of end of year sign-off, educational supervision
and career advice should be agreed collaboratively between the Foundation School and
local organisations delivering the Foundation Programme.
10

Management of the Specialty Training Programmes
34. The Trust is responsible, via the Education Contract, for the delivery of all specialty training
programmes within the organisation and should, via the DME:-
a. create a structure locally to ensure that specialty training happens according to the
requirements of the programme
b. support College/Specialty Tutors and Supervisors in their role
c. ensure communication between College/Specialty tutors to share good practices
between specialties. This would normally be via a Medical Education Committee – see
Fig. 2. Terms of reference and membership is suggested in Appendix 4.
35. The Deanery is developing Postgraduate Schools/Boards in close liaison with the Colleges.
It is likely there will be a Training Programme Director (TPD) and Specialty Training
Committee (STC) for each specialty programme. In the Trust each specialty requires a
professional lead for local co-ordination, for communication with STC within the
Postgraduate School and to be responsible for ensuring the quality control of the
programme. These are College/Specialty Tutors. Fig. 2 demonstrates this relationship. (It
is acknowledged that certain specialties wish to retain the term College Tutor, and in certain
specialties e.g. pathology, the College Tutor has CPD responsibilities.)
36. For the Core Programmes, e.g. Core Medical Training (CMT), Core Surgical Training (CST)
& Acute Care Common Stem (ACCS), there may be a TPD in the Deanery structures. At
Trust level there should be a nominated Tutor to co-ordinate these two-year programmes;
this may be one of the College/Specialty Tutors or for large programmes a designated
Programme Tutor. In Mental Health Trusts these Tutors may overarch several Trusts to
maximise and tailor educational opportunities
37. The appointment of these local tutors should be in line with the principles laid down by the
Academy of Medical Royal Colleges Paper ie. a joint appointment by the Trust and the
specialty. They are managerially accountable to the local DME and professionally
responsible to the Postgraduate School for the delivery of their programme. Suggested job
descriptions are in Appendix 5.
38. Specialty Training Programmes are managed regionally in Postgraduate Schools/Boards
and delivered locally in the individual Trusts and departments. All Programme and
College/Specialty Tutors should have strong professional links to their Specialty Schools (or
Boards) within the Deanery structures and centrally with the relevant College or Specialty
Society. The Colleges should continue to provide guidance and advice on issues around
education and training. Fig. 3 demonstrates that professional communication occurs up and
down the spinal cord from the clinicians locally to their respective specialty body. This
enables the process of training to be strong, relevant and owned by the profession as
depicted by the professional spine.
39. The College/Specialty Tutors should ensure that the educational, pastoral & career
planning needs of all trainees in the department are addressed and that those involved in
supervising and assessing trainees understand their role in, and the requirements of, the
specific programme for their trainee – see The Gold Guide.
40. Supporting a trainee in difficulty may necessitate a collaborative approach involving local
expertise e.g. DME, Medical Director, HR etc , deanery expertise e.g. Associate Dean and
College expertise e.g. Regional Education Adviser/Specialty or College Adviser. The
complex nature of these issues necessitates an individual approach but meetings should be
clearly documented and collated.
11

Centre
Academy
of MRCs
Colleges /
Specialist Societies
Region
SHA / HB
COPMED
Postgraduate
Dean
Specialty Schools /
Boards
including College advisers
NACT UK
Local
Trust / Hospital
Director of Medical
Education
Specialty / College
Programme Tutors
Fig. 3: Professional Spine linking local tutors to Colleges.
Specialty Training programmes, as designed by the Colleges and approved by PMETB, are
delivered and quality managed via Deanery and local organisation structures. Strong
relationships exist between the tutors in the local Trusts, the Postgraduate Schools and
Specialty committees regionally and the Colleges/Specialty Societies centrally via a vertical
professional spine. Accountability/performance management is managed horizontally at
Deanery or organisation level. The whole process is under the umbrella of PMETB.
12

Primary Care
41. The inclusion of Primary Care in the Foundation Programme and the expanded new
Vocational Training Scheme (nVTS) requires communication between the GPs responsible
for organising these programmes and the DME and his/her team of tutors. Suitable
representation from the GP Team is required on both the Foundation Committee and the
Medical Education Committee.
42. The model of supervision will be determined locally by the Programme Organiser but is
likely to be one educational supervisor, a GP Trainer, for the 3 year programme. There
should be a named clinical supervisor for each hospital-based placement. The
requirementsforST1andST2inthenVTSaredefinedinthecurriculumandtheGP
Training Programme Organiser should liaise with the Clinical Supervisors to ensure they
understand their role within the programme and the assessment framework.
43. The MEM and administrative staff should support the nVTS programme management and
locally delivered educational activities but may require financial negotiations with the
Deanery for this work.
44. The DME should work closely with the GP Tutor/Team on areas of common interest
regarding permanent medical staff such as Faculty Development, Peer Appraisal and
Mentor Schemes and generic skills such as leadership & management. The DME and MEM
should encourage and facilitate CPD activities for GPs within the hospital setting.
Mental Health
45. The inclusion of Mental Health in the Foundation Programme requires communication
between the Mental Health DME and the DME responsible for overseeing the Programme.
Suitable representation from the Mental Health Team is required on the Foundation
Committee.
46. Mental Health Training Schemes are often arranged across a wide geographical area,
where trainees may access educational opportunities right across the Deanery. DMEs of
Mental Health Trusts should work collaboratively with Deanery-wide educational structures
to ensure smooth transition of trainees between settings and Trusts, and to assist in overall
manpower planning.
47. PGME administrative structures are likely to be required both within-Trust and between-
Trust structures. In many cases these are in an early stage of implementation, but there
needs to be clarity about individual roles and responsibilities. The model suggested in Fig.
One may not be suitable for Mental Health and an alternative is suggested in Appendix 6.
48. Finance negotiations with Deaneries relating to the development of independent psychiatric
PGME centres are also at an early stage. Mental Health Trusts need to consider the
possibility of PGME Centres and facilities across several adjacent Trusts. They (MHT) also
need to have explicit arrangements with Deaneries and Acute Trusts about access to
Deanery-funded facilities such as libraries and educational facilities.
49. Mental Health and Acute DMEs should work closely on areas of common interest regarding
permanent medical staff such as Faculty Development, Appraisal and Mentor Schemes and
to facilitate CPD activities for Doctors within their respective settings.
50. Mental Health DMEs should explore the possibilities of shared educational opportunities
with other Mental Health Trusts, such Medical Student induction, ST/FTSTA induction,
basic skills training and mandatory training for CNST requirements.
13

Faculty Development
51. Modernising Medical Careers (MMC) requires a curriculum based approach to
postgraduate training with identified learning objectives, personalised job planning,
constructive regular feedback and work-based assessments. This requires departments’
Business Managers and individual Consultants to be aware of the change in culture
required, ensure maximum learning in a shortened training programme and a Working Time
Directive (WTD) compliant 48 hour week. Both MMC and WTD challenge the apprentice
model which can be maintained if all involved utilise every learning opportunity. The DME
and team should take every opportunity to inform Departments, Clinical Teams, and
individual Consultants and Trainees of the changes involved with MMC.
52. An Educational Supervisor is the named practitioner who is overseeing the educational
requirements, achievements and Personal & Professional Development of an individual
Trainee during that post/placement/programme (to be defined locally). They are responsible
for performing all Appraisals - both educational and the annual NHS Appraisal. They
require protected time clearly identified in their job plan, usually as SPA time – see
Appendix 5 for detailed roles and responsibilities.
53. A Clinical Supervisor is the named clinician responsible for overseeing the clinical
performance of an individual Trainee within a clinical placement. They are responsible for
observing practice, performing work-based assessments and providing feedback. They
require time within their clinical workload for these tasks and it is important that the
department’s Business Managers are aware of these requirements – see Appendix 5 for
detailed Roles and Responsibilities.
54. The Deanery and the Trust are responsible for ensuring that all those involved in
Educational and Clinical Supervision, understand their role and receive clear guidance.
This may involve organising Training the Trainer sessions or may just require individual
local support. Many Consultants have been Supervisors for years and are extremely able.
Others have already undertaken a course in Medical Education. The DME should have a
database of those experienced/trained in Education Supervision. This should also include
an understanding of Appraisal and Assessment.
55. The DME should assist the Deanery and the University in supporting all Tutors and
Supervisors as necessary and help them to develop in their educational role.
56. Others in the multi-professional clinical team should be made aware of the requirements of
the training programme so they can be involved in feedback and workplace based
assessment – particularly Senior Nurses, Physiotherapists and Pharmacists. They can also
be asked to contribute to the formal Education Programme, particularly in the Foundation
Programme.
57. Trainees are required to undertake reflective practice, self-directed learning, identify
learning needs and set their own learning objectives. Supervisors may require help
developing their Trainees in these areas.
58. Trainees should be involved in the learning process of others. Training opportunities should
be provided for Specialty Registrars in assessment, appraisal and giving feedback.
59. Trainees should be involved in the management of Training Programmes and
representatives invited to attend the Foundation Programme Committee and Medical
Education Committee.
14

Careers in Medical Education
60. There has been no clear structure of career progression for those wishing to develop
themselves in the area of medical education. Clarity of Roles and the creation of Job
Descriptions and Person Specifications provide, for the first time, an opportunity to provide
this guidance. Fig. 4 details a suggested pathway.
61. Career Management is increasingly being discussed at all levels. Modernising Medical
Careers should result in doctors acquiring specialty status and consultant appointment at a
younger age than previously. This type of pathway enables career planning through the
Consultant years.
Director of Medical Education
Trust/division
Postgraduate Dean
Deanery
DeputyDirector of Medical
Education
Trust/division
Associate
Dean/Foundation
School Director
Deanery
Training Programme Director
Deanery
Programme Tutor (CMT/FP etc.)
Trust/division
SpecialtyTutor
Trust/division
Education Supervisor
Trust/division
Fig. 4: Demonstrating a pathway for career progression in Postgraduate
Medical Education
15

Quality Control
62. All Postgraduate Medical Training Programmes require information/evidence to be
collected in order to demonstrate compliance of the Programme and reach the standards
detailed in the Quality Assurance of the Foundation Programme (QAFP) and the PMETB’s
Generic Standards for Training. PMETB has given the responsibility for quality assurance
of PGME to Postgraduate Deans, who need to ensure that local quality control is robust,
aligned with the multi-professional agenda and uses PMETB & QAFP standards. These
should be presented by the organisation for external inspection by the Deanery.
63. Deanery inspections are likely to concentrate on 3 main areas:- the learning environment,
the programme of training and the outcome of training e.g. assessments, progression etc.
Feedback to organisations and departments will lead to an action plan which should be
monitored.
64. A high level of commitment to the quality of training should occur where training takes place
and is the responsibility of both the Clinical Team, including Managers, and those leading
the Programme locally. Trusts and Departments should be encouraged to monitor their own
performance, aim to increase the quality of training as well as ensure that it meets National
Standards.
65. Local quality control should be transparent and accountable. There should be a forum for
Trusts/NHS Boards to feedback their experiences to the Dean and have an appeal process.
This requires a co-ordinated approach across both Specialties and Programmes, and
Tutors may need support with these tasks.
66. PMETB uses the word “trainer” in their Generic Standards for Training. We suggest a
Trainer is an experienced practitioner who is involved in training and supervision in the
workplace. This would include Education Supervisors, Clinical Supervisors and other
doctors and professionals providing clinical supervision of doctors in training. A database of
Trainers may be held centrally, recording attendance at meetings, developmental
programmes and mandatory training essential for the role e.g. equality & diversity.
67. There must be a well-defined governance structure within the Trust/Board to ensure that
Trainees are incorporated into and adhere to the National and local policies and
procedures which govern all aspects of their employment.
68. Educational Supervisors should complete the work-base (NHS) appraisal documentation
for Trainees as part of an integrated appraisal discussion. Although most of the appraisal
documentation is stored within the Trainee’s learning portfolio. Form 4 will be required by
the Clinical Director or equivalent employer lead to document the satisfactory performance
of postgraduate doctors – for more information see The Gold Guide.
69. Trainees must be encouraged to engage with the educational process (manage their own
training) and comply with both Employers’ and Deanery quality management processes
(attend induction & mandatory training, complete PMETB questionnaire & training
evaluations, attend deanery inspection interviews etc).
70. Robust processes should be in place for the support and management of Trainees whose
conduct, health, progress or performance is giving rise for concern. Individual educational
supervisors may require guidance by Tutors/DME. Local guidelines should be available
(NACT UK currently preparing this document) and support from the Deanery, Occupational
Health, Human Resources and NCAS as necessary. The DME should be available to
advise on individual cases.
16

Communication & Governance within the Organisation
71. PMETB have stated that in all organisations with postgraduate trainees (Acute & Mental
Health Trusts and independent treatment centres) there should be a named Executive Director
representing Medical Education on the Board. Several Trusts have now included medical
and Dental Training under their HR/Training & Development Directorates, thus taking
forward their Multi-professional educational agenda which is dependent on local
personalities and working relationships. Other Trusts have a Department of Medical
Education under the Medical Director. The exact model/structure is not important, however
a knowledgeable informed Director at Board level, representing medical education, is
essential to ensure that the required standards and outcomes of PGME are achieved and
the delivery of high quality Postgraduate Medical Education and Training in the work place,
is supported by the Trust.
72. The organisation should value the delivery of high quality education and training and
integrate it within Clinical departments so that training becomes part of the Trust’s Core
Business. It needs to be considered within directorates and service delivery planned
accordingly to ensure Clinical Supervisors have time to train and assess doctors in training
whilst managing patients in the clinical area. The role of the Specialty & Programme Tutors
should be valued and respected within the department and education should be on the
agenda for all Directorate/Division meetings. Regulation should be seen as a means to
improve practice and not a “tick-box”.
73. The DME should support the organisation when complying with the Standards laid down by
External Regulators regarding the education and training of medical staff. The DME should
be a member of the Clinical Risk/Governance Committee and co-ordinate information
required by the Deanery and for other purposes e.g. NHSLA. External Regulations and
Quality standards require a co-ordinated approach to clinical, education and finance
governance – Integrated Governance.
74. Medical education is delivered in Acute, Mental Health, Community and Primary Care
Trusts. PGME staff in each area should work closely with each other to ensure that the
expertise of Trainers and the experiences of Trainees are shared across these areas. In
particular a number of competencies and learning opportunities are shared by Acute and
Mental Health Trusts and the PGME staff need to ensure that there is regular
communication throughout.
75. Close working relationships should exist both centrally and within departments; between
the PGME staff and those involved in the management and administration of Training in
other disciplines e.g. Training Department, Clinical Skills, Nurse & AHP education etc,.
76. PGME staff should work closely with Medical Staffing and the HR department, assisting
with recruitment and induction. There should be a shared database across the sites within
the organisation and into the Deanery.
77. The DME should be involved within the organisation in looking at different models of
working e.g. Hospital at Night. Although the “firm” structure is difficult to sustain with shift
working, the development of multi-professional clinical teams and the creation of a
supportive learning climate can assist the trainee in maximising all learning opportunities.
Appropriate supervision, handover and the opportunity for post-night debrief can help to
make the most of learning opportunities at night. Recently, there have been useful
recommendations from the Royal College of Physicians on shifts etc. Whereas Medical
Staffing should ensure the rotas are WTD complaint, the DME should ensure that they are
educationally acceptable. It is recommended that no less than 70% of total hours worked
should be daytime hours to enable the post to be suitable for training.
78. Suggesting new ways of working creates training needs for the individuals who take on
these expanded roles. This may be nurses expanding their role or it may be doctors
requiring specific training for their role in the night team e.g. leadership skills. Much of this
training needs to be done locally by doctors.
17

Pastoral Support
79. A system of pastoral support for trainees should be available within the programme,
directorate or Trust and trainees informed at induction how they can access it. A mentor
scheme may be in place and accessed either as a routine or when required. The
Postgraduate/Clinical Tutor Role of providing trainee support outside the individual’s
department has been a successful model and should not be lost due to the creation of the
DME and the more robust structures of PGME.
80. All tutors may require support at some stage when faced with challenges from individual
trainees, pressure from management/service delivery, dealing with difficult educational
supervisors etc. There should be a culture created to encourage assistance and help from
the DME and Deanery when needed. This is increasingly necessary as we move into a
culture of appeal, criticism and even legal action.
81. Support networks for both trainees and trainers could extend outside the Acute Trust with
links to Mental Health and Primary Care Trusts.
Career Management
82. All medical students, trainees and permanent medical staff require assistance with their
career management and planning. For the majority this can be managed at appraisal,
although Education Supervisors and peer appraisers may need guidance and assistance
with regard to what additional resources are available and how to access them.
83. All organisations should have a named individual co-ordinating Careers Advice who should
have received training for the role. He/she should be supported by Careers Advice
processes at the Deanery, and should be consulted as necessary, particularly by
Foundation Trainees who are having difficulty selecting a Specialty.
84. Career Management sessions should be part of both Undergraduate and Foundation
Programme teaching sessions. The Training Departments within the Trust should have
resources which can be accessed to assist with this.
Undergraduate Medical Education
85. Most District Hospitals have seen a recent increase in medical students and require a
structure for managing undergraduate education with links to the local Medical School. It is
suggested that this structure is managed under the umbrella of the Director of Medical
Education to ensure close collaboration and joint working.
86. The Lead for Undergraduate Medical Education within the Organisation should work closely
with the Director of Medical Education on medical issues, be involved with the Foundation
Programme and the Medical Education Committees. He/she should liaise with those
leading on pre-registration courses in other Health Professions, identify opportunities for
inter-professional learning and attend the Multi-professional Education Committee.
87. Resources for undergraduate education should be considered with those available for
postgraduate medical education to merge the faculty responsibilities for the delivery of both
undergraduate and postgraduate training at departmental level.
88. The DME and Foundation Programme Tutors, where appropriate, should work with the
Undergraduate Leads, be involved with the medical students regarding career guidance,
preparation for the Foundation Programme and their individual career management.
18

SASG and Trust Doctors
89. The DME, or named individual working collaboratively with the DME, should be involved in
overseeing the education and continuing professional development of Associate
Specialists, Staff Grades and Career/Trust post doctors.
90. A system of annual appraisal and revalidation should be in place with development
opportunities identified and supported. All doctors should be given an individual mentor or
Education Supervisor.
91. Doctors wishing to be considered for entry to the Specialty Register via Article 14 should be
supported, if appropriate, with a named Educational Supervisor, regular review and
assistance given to collect the relevant evidence required for their application. A Study
Leave Budget should be available to support this.
Consultants
92. With the increased expectations by managers and the public from consultants, there is a
need to support and develop these senior doctors. In large merged organisations, where
finance and targets are the priority, the Medical Director is distracted from the role of
overseeing the expanding body of consultants. In the new ways of MMC leadership etc,
young consultants require mentoring, established consultants require training, with all
requiring rigorous suitable robust appraisal using the Department of Health’s White Paper
“Trust, Assurance and Safety – The Regulation of Health Professionals in the 21 st Century”.
93. The DME should be involved in overseeing the education and continuing professional
development of Consultants and Senior Medical Appointments.
a. A system of NHS appraisal should be developed and reviewed with trained
appraisers.
b. Study Leave and resources should be available to ensure that consultants are
able to satisfy their specialty requirements for re-certification and for achieving
professional development in line with Trust and department requirements.
c. New consultants should be offered a mentor and taught leadership skills.
19

Multi-professional Education and Training
94. Postgraduate Medical Education is now the remit of the SHAs in England, NES in Scotland,
WAG in Wales and NIMTDA in Northern Ireland. In England there is a Multi-professional
Learning and Development Agreement between the SHAs and the Education providers.
Those involved in medical education will need to work closely with Training Leads in other
professions e.g. Nursing and AHP Education as well as within the organisation i.e. Lead for
Training, Lead for Leadership and Organisational Development etc. There should be a
Multi-professional Education Committee chaired by a Board member. Membership and
Terms of Reference of such a committee are suggested in Appendix 7.
95. The opening in many areas of Multi-professional Education Centres has led to the loss of
control by PGME over room access and reduced opportunities for income generation. This,
together with the recent reduction in MADEL, has caused many PGME departments to
suffer financial difficulties. A co-ordinated multi-professional approach to the SHA for funds
is likely to be more successful than individual bids. (not applicable in Scotland)
96. The current provision of educational opportunities should be mapped across specialties and
disciplines. Collaborative programmes and opportunities for development should be
identified both within the Acute Trust and with partner organisations such as Mental Health
and Primary Care. The more explicit curriculum in professional and generic skills, in both
foundation and specialty curriculum, creates these opportunities.
97. The new specialty programmes emphasize work-place learning opportunities and the
Clinical Team should be engaged in facilitating this to the benefit of all within the team
regardless of discipline. The recent emphasis on Multi-disciplinary Team meetings (MDT)
are an example of case based learning opportunities. This supports the culture of a learning
environment in Organisations involved in Training and Education.
20

Finance
98. Most Clinical Tutors receive One PA of pay (most as Additional Responsibility Allowance) in
their salary direct from the Trust to ensure the satisfactory delivery of the Deanery
Education Contract. In 1992 NACT, supported by COPMeD, proposed that Clinical Tutors
should receive a session of time for the role from the Trust and a session of pay from the
Deanery. In England this is included in the MADEL levy. A survey by NACT in 2004
demonstrated that most Clinical Tutors received one session of money from the Deanery
but no time or funds from the Trust.
99. Clinical Tutors do duties outside their prime responsibilities of delivering the Deanery
Education Contract and are, for a variety of reasons, used as an educational expert by the
Trust. It is suggested therefore that the Trust should match the finances currently paid by
the Deanery. This will vary depending on the requirement of the specific roles.
a. For Trainees support etc - One PA per 30 trainees - funded jointly by Deanery
and Trust.
b. The funds should be placed in the Postgraduate Budget to be used by Director
of Medical Education to create a local “fit for purpose” structure.
100. If the DME is expected to oversee the Professional Development, Study Leave, Appraisal
and Mentor process for SASG & Trust doctors, additional funds of one PA per 60 doctors,
should be made available from the Trust.
101. If the DME is expected to oversee the Professional Development, Study Leave, Appraisal
and Mentor process for Consultants additional funds of One PA per 100 consultants,
should be made available from the Trust.
102. Arrangements for undergraduate support should already be available from the SIFT
budget.
Medical Education Budget (not applicable in Scotland).
103. The money for the management of doctors in training, which includes clinical tutor time
and administrative staff, comes into the Trust as part of the MADEL levy and should be
clearly accounted for in the following three sections:
a. The doctors salaries – managed by the Trust
b. The administration of PGME to include Tutor time and administration – to be
given to PGME for administration and accountability
c. The study leave for doctors in training – requires clear local arrangements for
administration and accountability. Mental Health may opt to centralise this
function within one or two host Trusts for the Deanery.
104. The new Learning and Development Agreement between SHA and Trust carry significant
contractual management obligations on the Trust and it is not currently clear how this
contract will be managed by the SHA or what the consequences are of any monitoring
failures. The standards to be met and the reporting requirements seem to indicate that a
level of resource needs to be allocated for the contract management task.
105. The Study Leave budget for Trust doctors and SASG should be identified and given to
PGME for administration and accountability.
106. The Study Leave budget for consultants should be identified with consideration given to
allocating some or all to PGME for administration and accountability.
107. The SIFT/ACT budget should to be managed by the Undergraduate Lead
21

NACT UK
The National Association of Clinical Tutors (NACT) was founded in 1969 to represent the
interests of Clinical Tutors nationally and to support them in their work. All Clinical Tutors in
both Acute and Mental Health Organisations are expected by their Postgraduate Deans to be
members.
PMETB and MMC have led to the appointment of others with education roles such as
Foundation Programme Directors/Tutors and Directors of Medical Education. The reorganization
of Mental Health and Primary Care Trusts together with the increasing emphasis
on Faculty Development, Continuing Professional Development and cross-organisation
rotations, have brought all those with an interest and commitment to Postgraduate Medical
Education closer together across the healthcare community.
The Association’s emphasis remains on Postgraduate Medical Education although, with the
required blurring of the Undergraduate/Postgraduate transition, we have some members who
are Undergraduate Deans or Leads for Year 5. In essence anyone with an interest in
Medical Education is welcome to join.
InMay2007theAssociationvotedtochangeitsnametoNACTUKwhichreflectsthemore
diverse membership and to emphasize that the Association represents members in all four
countries of the United Kingdom.
Much of what the Association is involved in, consists of liaising with the many National Bodies
involved in Medical Education; with representation at the Conference of Postgraduate Medical
Deans (COPMeD), Medical Workforce Forum of NHS Employers, Academy of Medical Royal
College Committees, MMC Committees, PMETB Working Parties and some of the Royal
College Training Committees. NACT UK is increasingly being asked for advice by The
Department of Health, PMETB and others involved in setting or implementing strategy. We
provide a conduit of information between the places where Medical Education is actually being
delivered and the central London Offices.
We promote the Study of Medical Education amongst members and have close working
relationships with the Association for the Study of Medical Education (ASME), Association of
Medical Education in Europe (AMEE) and the new Academy of Medical Educators (AME).
A member of NACT UK is entitled to:
• receive regular updates and information via the email cascade
• attend meetings and training courses run both by NACT UK or by ASME at reduced
membership rates
• be considered for election for NACT UK Council
• receive the quarterly newsletter
• purchase ASME booklets/resources at membership dates
• apply for the annual NACT UK/Wyeth Travelling Fellowship to North Carolina
• receive the annual Directory of Postgraduate Medical Centres & A Gazetteer of
Useful Addresses
Registered Charity no. 295172
Supporting Excellence in Medical Education
22

References
1. The Guide to Postgraduate Specialty Training: The Gold Guide, June 2007.
http://www.mmc.nhs.uk/pages/home
2. The Roles and Responsibilities of College Tutors. Report of a Working Party of
the Academy of Medical Royal Colleges. October 2004.
http://www.aomrc.org.uk/pdfs/collegetutors.pdf Accessed December 13th 2006.
3. COPMeD and Academy of Medical Royal Colleges. Developing Local
Postgraduate Schools, a discussion document. London: COPMeD and AoMRC,
February 2005
4. PMETB documents on Generic Standards for Training, Assessment and
Curricula http://www.pmetb.org.uk/index.php?id=quality
5. MMC policy documents http://www.mmc.nhs.uk/pages/resources/keydocuments
6. Foundation Programmes documents
http://www.mmc.nhs.uk/pages/resources/keydocuments
7. NHS Employers/MMC Joint Briefing 2: Specialty and GP Training Programmes:
June 2006 http://www.mmc.nhs.uk/download_files/NHSE-briefing-19-FINAL.pdf
8. Designing safer rotas for junior doctors in the 48-hour week. September 2006
http://www.rcplondon.ac.uk/pubs/contents/09446ffc-7f46-4f18-a1d0-
fb5b8607b0c4.pdf
9. A Guide to the Management and Quality Assurance of Postgraduate Medical
and Dental Education: The Green Guide. August 2000.
http://www.copmed.org.uk/document_store/1141901674CFvw_the_green_guide.
pdf
23

JOB DESCRIPTION
Director of Medical Education (DME)
Appendix 1.
The Director of Medical Education is responsible for maintaining and developing the profile of
education within the organisation and promoting high quality education. They should develop a
local strategy for medical and dental education, be responsible for the Business of Medical
Education and Training and for ensuring the delivery of the Deanery Educational Contract.
They will have a close professional relationship with the Dean/Deanery to ensure quality control
of programmes, develop and deliver the wider multi-professional educational agenda and for
supporting and developing tutors as educators.
The DME should be a Senior Officer in the Health Organisation, with a seat on or access to the
senior decision making structures within the organisation ensuring that medical education is
fully integrated with the delivery and future requirements of the service both operationally and
strategically. Recent changes to the way junior doctors are trained, as part of Modernising
Medical Careers (MMC), and restrictions imposed by the Working Time Directive pose
challenges to both the educational and service environments. The explicit specialty curricula
and assessments of competence detailed in MMC have changed the type of educational
provision required within Trusts. Increasingly knowledge and skills training are being dealt with
in the work-place. This requires a co-ordinated, cross-specialty approach with educational
support readily available for those charged with implementing the curricula and carrying out
assessments. “Transition” from the current postgraduate medical training arrangements to
those envisaged under MMC will take a minimum of 5 years and will require careful
management to ensure that neither education and training nor service suffers.
Education as a core NHS responsibility, is on a par with clinical activity, and as such requires
robust governance policies and procedures. PMETB has the responsibility in the UK for quality
assuring specialty training at a national level. At a local level it is essential that quality
assurance takes place outside scheduled PMETB inspections and this requires local
leadership. Education is increasingly seen as an integrated, inter-professional activity and
appropriate linkages need to be developed at the local level.
Quality assured, competency based, time limited and seamless medical training is key to
Government’s commitment to a high quality, consultant based service. Central to this is quality
assured postgraduate medical education and training. Trusts will need to create and develop a
first class “educational environment” if they are to attract and retain approved training posts.
There will be a need to develop and enhance the teaching and training skills of existing medical
staff.
The need for educational governance is recognised by all key education stakeholders –
PMETB, Deaneries, NACT UK and Royal Colleges – as is the need for a dedicated medical
educational lead at Trust level. Following failures of educational supervision (e.g. Southampton
University Hospitals Trust) the NHS Litigation Authority in England now views educational
governance as a key component of overall corporate governance.
The structure for medical education created within the organisation should encompass medical
students, doctors in training, Career/Trust posts, SASG and consultants with clear roles and
responsibilities of all involved. The Director of Medical Education should be involved in the
processes of NHS Appraisal, pastoral support and Continuing Professional Development of all
doctors within the organisation.
24

General Responsibilities
Take responsibility for the organisation achieving defined standards of postgraduate (and
in some places undergraduate) medical education.
Provide professional leadership and vision for the organisation on medical education
issues
Produce, implement and monitor a strategy for the provision of medical and dental
education and training
Liaise with the Undergraduate Lead and the local Medical School to ensure a smooth
transition from undergraduate to postgraduate training.
Align medical training and education with the service objectives as defined by the Trust
Board or equivalent
Represent the organisation on medical education issues, both externally and internally.
In order to deliver these, the DME will
Identify a structure for the local delivery of medical education, ensuring that all those
involved have clear roles and responsibilities and are accountable for these educational
roles
Lead, direct & develop all involved in medical education and be involved in their
appointment
Represent the Provider Organisation on University and Deanery committees to ensure a
joined up approach between different phases in training.
Manage resources and budgets devolved by the organisation to medical education &
training
Manage data collection and reporting processes necessary both for internal quality control
and training service development
Liaise with other educational leaders towards the development of multi-professional
learning as appropriate
Key Result Areas
Provide evidence of robust systems for educational governance required by statute for the
GMC & PMETB QA processes, and other external bodies as required
Ensure that trainers and trainees are fit for purpose within the organisation
Report to Trust Board, or equivalent, as appropriate to ensure awareness of the impact of
changes in medical education on the organisation
Implement, monitor and improve medical training programmes
Provide an annual financial report and business plan
The wider role of Directors of PGME involves participating in Deanery meetings, Dean’s
monitoring visits and representing the Deanery at appointments committees.
Procedure for appointment & accountability
Post should be widely advertised within the Trust. Applicants should be formally interviewed by
a panel which should include the Postgraduate Dean (on behalf of the University and the NHS),
the Chief Executive, Medical Director and the NACT UK Deanery representative.
The exact models require local negotiations between the Postgraduate Deans, the SHA, Trusts
and DMEs but in most Deaneries the DME will be managerially accountable to the Trust and
professionally accountable to the Postgraduate Dean. Different models may exist within and
between Deaneries.
Annual review of the role will take place through the appraisal and job planning processes.
To ensure professional development within this role DMEs should join NACT UK and attend
regional and national meetings of an educational nature.
Requirements
The duties will normally require 3-5 PAs of protected time.
Goods & Services – mileage, laptop & mobile internet access
Administrative support (1 Grade 5 WTE) & office space
25

PERSONNEL SPECIFICATION
JOB TITLE:
LOCATION:
Director of Medical Education
FACTOR CRITERIA HOW INFORMATION
WILL BE OBTAINED
ESSENTIAL
DESIRABLE
1. ATTAINMENTS
(General and
Higher Education,
Professional/Mana
gement Training,
Relevant
Experience etc.)
2. KNOWLEDGE
AND INTERESTS
1. SPECIAL
APTITUDES
(Dexterity,
numeracy,
computer literacy,
ability to drive,
communication,
etc.)
4. PHYSICAL
REQUIREMENTS
(General Health,
Eyesight, Build and
Cleanliness, etc.)
5. SPECIAL
CIRCUMSTANCES
1. GMC Full Registration
2. Name on Specialty Register of GMC
London
3. Minimum of 5 years experience as a
Consultant
4. Minimum of 5 years experience in a
senior medical education role, e.g.
Postgraduate Clinical Tutor, Royal
College Advisor, Specialty/College Tutor
5. Consultant with a minimum of 5 PA
clinical contract with the organisation.
Knowledge of management structures in
medical education and awareness of recent
changes in the delivery of medical education,
nationally and locally.
Interest & enthusiasm for improving delivery
of medical training and Continuing
Professional Development
Knowledge of assessment methods
Evidence of ability to work in a team and to
organise and manage the work of the
Department.
Effective leadership & communication skills.
Motivating and developing others.
Approachability. Good interpersonal skills
Evidence of delivering well evaluated teaching
sessions/tutorials.
Ability to manage change
Ability to meet the travel requirements of the
post, including access to a car on
appointment.
Evidence of personal development in medical
education
Health Standards applicable:-
(a) Doctor
Acceptable attendance record.
N/A
Postgraduate
qualification in
Education (could be
essential in the
future)
Evidence of relevant
research and/or
publications.
Evidence of
experience at
strategic level of
national and/or
international
education
organisations
Evidence of
supporting trainees
and trainers
Understand use of IT
in education
Evidence of
successful delivery of
training
strategy/programmes
Evidence of working
with other specialties
& professions
Evidence of
audit/research in
medical education
Application Form
Interview/
Presentation
Interview
Interview
Interview/
Presentation
Interview
Interview
Interview/Portfolio
Occupational
Health
Assessment
APPLICANTSPLEASE NOTE: Short-listing will be carried out on a basis of the Short-listing criteria set out above, using the
information given on the application form. You should therefore address the requirements of the specification when completing the
application form, as failure to do so may result in you not being short listed. Applicants may be required to make a presentation to
the panel as part of the selection process.
Appointments are subject to verification of appropriate qualifications
Application Form/
Interview/Referee
/Report
26

Appendix 2.
GENERIC JOB DESCRIPTION
Medical Education Manager (MEM)
Band 7/8
The Medical Education Manager (MEM) is professionally responsible to the Director of Medical
Education (DME). The MEM provides strategic direction, specialist medical training knowledge,
planning and leadership to the Medical Education Team. This includes providing guidance and
senior management support to the DME, and other Tutors, particularly focusing on the
interpretation and implementation of national policies and current legislation relating to medical
training and service level agreements.
The roles and responsibilities outlined in this job description demands in-depth managerial
knowledge and therefore should be undertaken by a Senior Manager.
This job description is not definitive; roles and responsibilities of MEM’s vary throughout the
Country where additional responsibilities may include Undergraduate Management, GP
Education/ST, Continuing Medical Education, Dental and library services etc.
Job Purpose
The post encompasses management responsibility for the delivery and evaluation of
professional teaching activity, training programmes, Continuing Professional Development
activity, induction and skills training for junior doctors and specialty trainees.
The post also involves financial management responsibilities associated with educational
contracts, business planning and departmental policy and service development.
General Responsibilities
• Responsibility for the support of medical education services across the organisation; this
includes the provision of a comprehensive service, responsible for the planning, delivery
and evaluation of professional teaching activities, training programmes, continuing
professional development, induction and skills training for junior doctors and specialty
trainees.
• Provide specialist knowledge and advice and guidance on PGME related matters for all
medical staff and managers in the Trust.
• Work with the Director of Medical Education, Clinical Tutors, Specialty Leads,
Foundation and College Tutors to monitor, evaluate and develop medical education.
Ensuring this is done within the framework of the Educational Contract.
• To implement and monitor all current legislations and relevant policies and/or
procedures as identified by the organisation.
• Responsible for the implementation of the Foundation Training Programme in line with
Modernising Medical Careers and supporting the local implementation of the Specialty
Training Programmes in the Trust.
• Supporting a broad range of training programmes and complex educational activities,
including identification of training opportunities, training the trainers and co-ordination of
projects to assess and/or improve medical education.
• Supporting the Director in ensuring the postgraduate service provided is quality
assured, competency based and meets the requirements of the Educational Contract
and relevant regulatory bodies.
• Ensure data collection and reporting processes are in place, which are necessary for
quality control and training service development.
27

• Ensure evidence and systems are in place for robust reporting for educational
governance and PMETB quality assurance and other external bodies as required.
• Liaise with other educational leads within the Trust to identify develop and promote
multi-professional learning.
• In association with the DME and other associations develop Business Plans and
produce Annual Reports.
• Develop networks with other Medical Education Managers to improve/share best
practice.
Finance
• Delegated budget holder of PGME budgets.
• Manage the resources and budgets devolved by the organisation for medical education
and training.
• Write and submit finance reports as required.
• Work closely with Management Accounts so that systems are in place to record and
monitor expenditure
• Responsibility for study leave budgets for junior medical staff and consultants where
appropriate.
• To identify opportunities to meet income generation targets (as set by the Trust), and to
monitor and audit the appropriate use of funds.
Management
• Provide specialist knowledge in the area of Postgraduate Medical Education.
• Provide senior management/business support to the DME/Tutors.
• Business planning to ensure continued development of service and staff in order to
meet the requirements of MMC and other changes in medical education.
• Manage medical education team including recruitment, appraisal, CPD, performance
management and disciplinary issues.
• Develop and implement policies, protocols and procedures for medical education and
Centre.
Education Centres (where managed by MEMs)
• Responsibility for day to day management and promotion of all aspects of the Education
Centre’s functions, including security, maintenance and compliance with statutory
requirements and policies.
• Develop the commercial use of the Education Centre ensuring maximum use through
positive promotion.
• Responsible for a range of policy implementation and development for the Education
Centre.
• Advise on and be responsible for the development of the centre to meet the long term
needs of education in the organisation.
Strategy and Policy
• Assist in the formulation of long-term strategic service plans to develop Postgraduate
Education in the Trust, including developing policy and services which may impact on
clinical services and financial/physical resources.
• Assist in developing project implementation including monitoring, evaluation and
adjustment of strategies as part of implementing MMC and other changes as directed
nationally.
• Interpret information being presented locally, regionally and nationally on developments
in Medical Education and make judgements on the impact to the organisation.
28

Responsibilities for Financial and Physical Resources.
• Manage, monitor and audit the appropriate us of the medical education budget provided
against the education contract.
• Manage, monitor and audit the appropriate use of income generation funds.
• Produce budgetary reports as required.
• Act in accordance with the organisation’s standing financial instructions.
Personal Development
• Ensure continuing professional and personal development, keeping abreast of
professional issues, changing technologies and involvement in PD.
• Membership of appropriate professional organisation (e.g. NAMEM or NAMPS)
PERSON SPECIFICATION
ATTRIBUTES ESSENTIAL DESIRABLE
Qualifications
Experience
Knowledge
Skills
Educated to degree level or equivalent professional qualification
or experience
2 years experience as a manager in an education or training
role, or 2 years as a senior manager in the NHS
Experience of line managing teams and managers in a senior
position.
Experience of strategic and operational thinking, policy/service
development, business planning and decision making
Managing budgets in the public sector
Specialist, expert level knowledge of medical education training
Demonstrable understanding of the operational management of
the NHS, and the delivery of services in a secondary or tertiary
care environment
Good working knowledge of performance management of
services and staff
Confidence with Information Technology and Experience of
using Microsoft Office especially Word, Excel, Access,
PowerPoint and email
Ability to operate and analyse with a high degree of independent
judgement and initiative
Strong team leadership and communication skills, with
experience of managing people, conflict and negotiating change
Highly advanced organisational skills and ability to co-ordinate
and prioritise complex projects
Enthusiastic, resolute and flexible approach to work, including
ability to motivate team members
Postgraduate
Certificate in
Education or relevant
Postgraduate
qualification
Experience of QA,
audit and
management of
regulatory body
inspection visits
Clinical education
methodology
Knowledge of GMC
framework and
statutory regulations
Counselling and
career adviser skills
29

Foundation Programme Committee
Membership
1. Chair – Director (non-executive or executive) of one of the local Trusts
2. Foundation Programme Directors
3. Foundation Programme manager
4. Designated Departmental Leads including psychiatry and primary care
5. Undergraduate Medical Lead/5 th year lead tutor
6. F1 and F2 trainees
7. Medical Staffing Representative of Host Trust
8. Director of Medical Education of Host Trust
9. Representation from the local Foundation School.
Appendix 3
Terms of Reference
• To enable a county wide approach to the delivery of the Foundation Programme
• To provide a network of trainers to work collaboratively to improve the Foundation
Programme and to consider creative new ways of delivering education involving other
members of the multi-professional team. Thus creating a local learning environment
which will facilitate the learning needs of all staff in order to improve patient care
• To ensure
o that the programme is delivering the curriculum
o the quality of the work-based assessments
o a unified approach to documentation
o careers advice and management is offered and audited
• To ensure that educational and clinical supervisors understand their role, attend
appropriate developmental programmes and that their job plan reflects their educational
involvement
• To identify and oversee the collection of data to ensure fit for purpose quality control of
the Foundation Programme. To improve the quality of training as well as assuring it
meets national standards.
• To provide a forum for feedback from trainees to be received and acted upon
• To encourage communication with the local Medical Schools to enable a smooth
transition from 5 th year to the Foundation Programme.
• To discuss & share individual department’s strengths and weaknesses and provide
suggestions for improvement
• To identify and resolve any identified weak areas for action prior to inspection by
Deanery and/or Foundation School
• To enable greater communication and collaboration with local Foundation School to
ensure that practices from elsewhere are shared to enable the development of all the
Foundation School Programmes
Accountable to the Medical Education Committee of Host Trust
Meets every 3-4 months. Alternating venues
30

Appendix 4
Medical Education Committee
This Committee should be accountable directly to a subcommittee of the Trust
Board or directly to the Trust Board.
Membership
1. Chair – executive director with responsibility for PGME
2. Director of Medical Education and deputies/Clinical Tutors
3. Medical Education Manager
4. Foundation Programme Directors/Tutors
5. Programme Tutors/Leads for CMT, CST, ACCS, GP VTS
6. Medical & Surgical Tutor and key College/Specialty Tutors e.g. Anaesthesia, Paediatrics etc
7. Director/Lead for Medical Education from Mental Health Trust
8. GP Tutor with CPD responsibility
9. Undergraduate Medical Lead
10. Trust Head/Associate Director of Training & Organisation Development
11. Senior Librarian
12. Medical Staffing Officer
Terms of Reference
• To provide a network of trainers to develop a co-ordinated approach to medical
education and to create a learning environment across the healthcare community;
improving the standard of teaching and facilitating the learning needs of all staff to
improve patient care
• To implement, monitor and improve all Specialty Training Programmes.
• To oversee the development of the Foundation Programme and receive reports from
the Foundation Programme Committee
• To develop the appraisal process for permanent medical staff and a mechanism for
addressing generic learning needs identified
• To provide a forum for the discussion of Audit/Quality Assurance/value for money for
educational events both internal and external
• To identify and resolve any identified weak areas for action prior to external inspection
and to share results of inspection and provide support to address any
recommendations.
• To create a unified approach to data collection, inline with the Trust training records, to
ensure processes of programme delivery and quality control of training are standardized
and reported in a similar way enabling cross-referencing between specialties
• To share and solve common issues around Clinical Governance and Healthcare
Commission standards regarding Training & Education
31

JOB DESCRIPTION
College/Specialty Tutor
Appendix 5
The College/Specialty Tutor is responsible, within their defined area, for overseeing the delivery
of the education programme to all postgraduate medical trainees. They should ensure a
learning environment at departmental level which is challenging, supportive and, where
appropriate, multi-professional. They should be appointed jointly by the Trust, Deanery and
Royal College, managerially accountable to the DME, with professional responsibility to
Specialty Training Programme Director and College/Specialty body.
General Responsibilities
To ensure that the educational, pastoral & career planning needs of all trainees in your
specialty department are being addressed
To implement, monitor and improve the specialty training programmes in the department
in conjunction with the DME& the Deanery
Where appropriate to work with the relevant Foundation & Core Programme tutors to
ensure the specialty placement fulfils the programme requirements
To represent their specialty area at training committees, both internally and externally, as
required
To ensure, along with the DME, that all those involved in training and assessing trainees
have received appropriate training
To manage trainee performance issues in line with Trust policy and in conjunction with the
DME
To ensure, in conjunction with the Clinical Director, that trainees receive appropriate
departmental induction and are competent to practice prior to starting clinical practice
Where appropriate to represent the College/Specialty body in the workplace and vice versa
Key Result Areas
Educational plans and timetables appropriate to individual’s learning needs
All trainees will have a named educational supervisor who understands his/her role
Provision of educational programme of both formal and work-based learning opportunities
covering both specialty and generic curricula in collaboration with colleagues and
programme directors
Clear evidence of the delivery, uptake and effectiveness of learning for trainees in all
aspects of the curriculum
Contribution to the specialty teaching on the Foundation, Core as well as Specialty
programmes
Departmental induction occurring in the specialty which is evaluated and attendance
recorded
Attendance at local and deanery education meetings as appropriate
Active involvement in recruitment, assessment and annual review processes
Recording of information required by local, regional and national quality control processes
and the provision of a report as necessary
Counselling and Careers Advice available for all trainees
Personal Development
Develop an appropriate education PDP to be discussed and approved at annual appraisal.
Annual review of the role will take place through the appraisal and job planning processes.
32

JOB DESCRIPTION
Programme Tutor/Lead
The Programme Tutor is responsible for the overall management and quality control of the
programme within the Trust. They should be appointed jointly by the DMEand deanery
representative and be accountable to the DME.
General Responsibilities
To implement, monitor and improve the core training programmes in the Trust in
conjunction with the DME& the Deanery ensuring that the programme meets the
requirements of the curriculum and the Trust in compliance with the PMETB Standards for
Training.
To inform and support other specialty tutors to ensure the specialty placement fulfils the
specific programme requirements
To oversee the progression of the trainee through the programme and devise a
mechanism of delivering co-ordinated educational supervision, pastoral support and career
guidance
To manage trainee performance issues in line with Trust policy and in conjunction with the
DME
Key Result Areas
Provision of a clinical work-based programme offering a varied experience, appropriate to
the curriculum
To ensure those involved in supervision and assessment are familiar with programme
requirements
Clear evidence of the delivery, uptake and effectiveness of learning for trainees in all
aspects of the curriculum
To organise and ensure delivery of a teaching programme based on the curriculum
covering clinical, specialty and generic topics. To provide tutorials as necessary for
examination preparation and practice.
Attendance at local and deanery education meetings as appropriate
Active involvement in recruitment and annual review processes
Recording of information required by local, regional and national quality control processes
and the provision of a report as necessary
Support tutors and educational supervisors in dealing with the trainee in difficulty
Personal Development
Develop an appropriate education PDP to be discussed and approved at annual appraisal.
Annual review of the role will take place through the appraisal and job planning processes.
33

Roles & Responsibilities of an Educational Supervisor
More detail available in The Gold Guide
1. All trainees must have a named education supervisor and the trainee should be informed in
writing of this. The exact model, i.e. by placement, year of training etc, will be determined
locally and all parties informed in writing of model and expectations.
2. The Educational Supervisor should provide regular educational appraisal and an annual
workplace based NHS appraisal which is a requirement for all doctors working in the NHS.
3. Support of Trainee
a) Oversee the education of the trainee, act as their mentor and ensure that trainees are
making the necessary clinical and educational progress
b) Meet the trainee in the first week of the programme (or delegate to colleague if absent
on leave), ensure the structure of the programme, the curriculum, portfolio and system
of assessment are understood and establish a supportive relationship. At this first
meeting the educational agreement should be discussed with the trainee and the
necessary paperwork signed and a copy kept by both parties.
c) Ensure that the trainee receives appropriate career guidance and planning
d) Provide the trainee with opportunities to comment on their training and on the support
provided and to discuss any problems they have identified
e) Review meetings should be held regularly. The trainee arranges these meetings. These
occur in protected time, in a private environment and consist of reviewing the learning
objectives to ensure they have been met, giving feedback, monitor the delivery of the
Educational Agreement, reviewing the assessments and portfolio evidence of learning.
Before this session the educational supervisor will usually have obtained information
from colleagues, those involved in clinical supervision and other key professionals with
whom the trainee has worked during the placement.
f) At the end of the year the final appraisal session consists of reviewing all the
assessments, the portfolio of evidence of learning and ensuring that all the learning
objectives of the programme have been satisfied. All the necessary documentation
needs to be completed and returned to the Programme Director to enable satisfactory
completion of the end-of-year paperwork.
4. If the trainee’s performance is not reaching the required standard
a) This should be discussed with the trainee as soon as identified
b) Written record of the meeting kept
c) Remedial measures should be put in place as soon as possible with clearly defined
written objectives
d) Trainees must have an opportunity to correct any deficiencies identified
e) The appropriate Programme Director should be informed of any significant problem
5. All Educational Supervisors
a) Should be approachable, keen to develop the trainee and understand the importance of
the role
b) Must be familiar with the Programme Curriculum, the Learning Portfolio and the
Programme design
c) Are responsible for ensuring that relevant information about progress and performance
is made available to the appropriate Programme Director and informing them should the
performance of any individual trainee give rise for concern.
d) Should contribute in relevant areas to the formal education programme
e) Will act as a resource for trainees seeking specialty information and guidance
f) Liaise with the Specialty/Programme tutor and the rest of the department to ensure that
all are aware of the learning needs of the Trainee
g) must be given adequate time to perform their role and approx. 0.25 PA per trainee
should be identified in their job plan..
34

Roles and Responsibilities of a Clinical Supervisor
More detail available in The Gold Guide
For every placement the trainee must have a named clinical supervisor and the trainee
should be informed in writing of this.
All Clinical Supervisors:
a. Must offer a level of supervision of clinical activity appropriate to the competence and
experience of the individual trainee; no trainee should be required to assume
responsibility for or perform clinical, operative or other techniques in which they have
insufficient experience and expertise; trainees should only perform tasks without direct
supervision when the supervisor is satisfied regarding their competence so to do; both
trainee and supervisor should at all times be aware of their direct
responsibilities for the safety of patients in their care.
b. Should be involved with teaching and training the trainee in the workplace and should
help with both professional and personal development.
c. Support the trainee in various ways:
a. direct supervision, in the operating theatre, the ward or the consulting room
b. close but not direct supervision, e.g. in the theatre suite, in the next door room,
reviewing cases and process during and/or after a session
c. regular discussions, review of cases and feedback
d. He/she may delegate some clinical supervision to other members of clinical team as
long as the team member clearly understands the role and the trainee is informed. The
trainee should know who is providing clinical supervision at all times.
e. Ensure specialty induction occurs & includes:-
a. Introduction to the clinical department - duties of the post, any particular
responsibilities, departmental meetings and senior cover.
b. Role of the multidisciplinary team that covers out of hours to ensure safe and
effective clinical care at night and weekends - cross-specialty induction when
cross-cover required, bleep policies, managed hand-over, clear team
understanding of individual competencies and safe supervision etc.
f. Should meet the trainee before or within a week of starting the placement, establish a
supportive relationship and agree a learning plan, agreeing specific and realistic
specialty learning objectives appropriate to the level of the individual trainee
g. Provide regular review during the placement both formally and informally to ensure that
the trainee is obtaining the necessary experience, including supervised experience in
practical procedures and to give regular constructive feedback on performance.
h. Perform and oversee the work-based assessments
i. Ensure the trainee’s attendance at formal education sessions, completion of audit
project and other requirements of Programme.
All Clinical Supervisors
a. Should have prepared themselves adequately for the role, be familiar with the relevant
Programme Curriculum and the specialty specific learning objectives.
b. Are responsible for ensuring that relevant information about progress and performance
is made available to the educational supervisor, particularly if the performance of any
individual trainee gives rise to concern.
c. Should ensure that the appropriate members of the multi-professional team are aware
of the learning and assessment needs of the Trainee and are familiar with the relevant
paperwork surrounding the workplace assessments
d. Are responsible for creating a learning environment in the workplace to enable positive
and constructive feedback to the trainee from the multi-professional team
e. Should have time within their clinical commitments to undertake the role
35

Organisation Chart for Department of Medical Education (Mental Health)
Postgraduate
Dean
TRUST A
Deanery
Foundation School
Postgraduate Schools
TRUST B
Site
Tutors
Head of School
(Psychiatry)
Scheme
Organisers
TRUST C
TRUST D
Director of
Quality &
Clinical
Governance
Multiprofession
Education Lead
Medical Education
Manager
Appendix 6
Identified
Director/Chief
Executive
Trust Director of
Medical Education
(CPD Lead for
Consultants, Trust
doctors & SASG;
Undergraduate Lead
Postgraduate &
Undergraduate
Administration
36

Appendix 7
Multi-professional Education & Training Committee
Membership
1. Chair – HR Director or nominated Deputy This should be a Board level Director
2. Associate Director of Training, Education and Development
3. Director of Medical Education
4. Assistant Nursing Director, Education
5. Head AHP Education
6. Undergraduate Medical Lead
7. Medical Division Representative
8. Surgical Division Representative
9. Womens & Children Division Representative
10. Specialty and Diagnostic Division Representative
11. Support Services Representative
12. Medical Education Manager
13. Head of Library Services
14. IT projects manager
Terms of Reference
This committee should develop and promote policies and practice relating to education, learning
and organisational development. It should monitor the management of the Trust’s education
resources, be a Sub-Committee of the Trust Board and be responsible to the Board for the
following functions:-
• To develop Education, training and Development Strategies, objectives and action plans
designed to meet national guidelines and requirements and support the achievement of
the Trust’s strategic objectives as well as current and future services.
• o monitor progress and recommend improvements with the implementation and effectiveness
of the Education and Training Strategy, objectives and action plans through the use of
appropriate performance indicators, benchmarks and audits.
• To develop robust appraisal systems and processes that ensure that all staff develop and
maintain the knowledge and skills required to perform their role effectively and efficiently and
to maintain their professional registration
• To recommend and implement Education and Training standards and learning opportunities
that support the development of excellent leaders, teachers, supervisors and role models
within all staff groups and departments.
• To ensure that quality of the clinical learning environment for undergraduate and postgraduate
students and the library services meet the standards required by the relevant accrediting
organisations/ bodies
• To ensure the provision of a wide range of learning and development opportunities and
resources which represent value for money and reflect the requirements of all staff
throughout their career and whatever their work patterns.
• To develop and maintain effective links, working relationships and communication
processes with Local Education Providers and Education Leads within the Health and
Social Care community, the SHA & local Multi-professional Deanery, and nationally where
appropriate
• To ensure optimal access to all external funding streams and resources available for
Education, Learning and Development and these and any internal funds are used as effectively
as possible within the Trust.
37

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