Current challenges facing Postgraduate Medical Education in ...

Current challenges facing
Postgraduate Medical Education
in England and the UK
Peninsula and Severn
Deaneries JT Annual
Education Conference
7 th October 2011

Covering:
• Strategic considerations
• “operational issues”
• Research and development

1. Strategic considerations

1
Key Knowns
• Arrangements for health services and pgme are
increasingly influenced by country specific
factors (England and DAs)
• Fiscal constraints will worsen not ease
• SHAs will remain until April 2013 but as 4
clusters
: London
: South and South West
: Midlands and East
: North

2
• PG Deaneries (including PG Deans!) and their
staff are to be secured; linked to LETBs
• As are SHA workforce and educational
commissioning staff
• HEE will be established (SpHA) and operational
asap, and will oversee the creation of local NHS
Education and Training Board (LETB) via a
“rigorous authorisation process”

3
• Employers will have greater accountability and
responsibility to plan and develop their
workforce (within LETB framework)
• A greater focus on multi-professional workforce
planning and education [sic]
note: do they mean IPE?
• Development of a national education and
training outcomes framework (EOF)

4
• Phased transition to provider led LETBs
• Education and training funding “to be protected”
• Funding allocation with increased fairness and
transparency (DN: does this mean “improved
equity”?)
• Specific arrangements for small professions and
specialties via HEE

5
Timeline for transition/change
Oct 11
Dec 11
Draft framework agreement for HEE NHS CB established in
shadow form as SpHA
HEE top team appointed
April 12
(earliest)
Oct 12 (latest)
By Oct 12
HEE established as SpHA in shadow form (not taking full
functions but can support development of provider-led
networks and in particular manage authorisation process)
NHS CB established as independent statutory body
Oct 12 (earliest)
April 13 (latest)
April 13
HEE framework agreement signed-off
SHAs and PCTs are abolished
HEE takes on full operational functions for education and
training
PHE established

6
Budgetary framework
(MPET)
HEE
Commission
LETB
tba
contract
contract
provider
provider

2. “Operational” issues
7

8
a) Revalidation of trainees
• Creating and implementing a system that
works/isn’t overly bureaucratic
• Finance/resource implications
• Consequences/impact

9
b) Monitoring, assessing, confirming competence
acquisition AND performance progress
♦WPBA (formative and summative assessment)
♦Professional examinations
♦The role of the “peer” faculty of educators (Cees van
der Vleuten)
c) Calibrating outcomes for pgme (vfm issues)

10
Note:
Knowing that, knowing how
• Task conscious, acquisition learning.
Sometimes referred to as unconscious or implicit
learning. Whilst the learner may not be
conscious of learning, they are usually aware of
the task in hand
• Learning conscious, formalised learning
Arises from facilitated learning; learning itself is
the task
After Alan Rogers 2003
(after Lewin, Argyrus, Schön,
Polanyi)

11
d) Approving and re-approving “trainers”
♦ Initial approval
♦ Educational activity, appraisal, reflection, and time
♦ Loss of approval (individual/organisation
implications)

12
e) Technology enhanced learning
• E learning/blended learning
• Simulation
• Utilising social networking (?) or other new
developments

13
f) What are we training for?
♦ Future service
♦ Safe, high quality practise
♦ Generalism V specialism
♦ ??

3. Research and development
14

15
• £5 billion spent on healthcare professional
education and training (England)
• Is it value for money?
• What makes a genuine difference?
(better outcomes, accelerated progress, added
value)
• Uni-professional, inter professional
WB. We collect an increasing amount of data, what are we/will we do
with it?

16
• Are the outcomes of pgme more determined by
the individual than the processes to which the
individual is subject?
• Should pgme (indeed U/G education) be used
as an instrument for intra-professional and social
change?

17
• Is the present norm of medical school selection
at 18 years irredeemably flawed and are the
processes themselves robust (E.g. predictive
validity)?
• Are certain disabilities, personal characteristics,
psychometric profiles inimitably opposed to the
future safe and reliable practice of
medicine/healthcare?