Educational Governance in the Severn Deanery

Introduction

This paper sets out the educational governance structure for the Severn Deanery for postgraduate medical education to ensure that the Severn Deanery meets its responsibilities to deliver postgraduate education on behalf of the Strategic Health Authority to the standard required by the General Medical Council. The standards were formerly set by the Postgraduate Medical Education and Training Board. The General Medical Council has identified nine domains for quality training:

Patient Safety
Quality assurance, review and evaluation
Equality, diversity, and opportunity
Recruitment, selection and appointment
Delivery of curriculum including assessment
Support and development of trainees, trainers and local faculty
Management of education and training
Educational resources and capacity
Outcomes

This paper should be read in conjunction with

The Severn Deanery Quality Framework
The Severn Deanery Quality Panels Guidance
The South West Strategic Health Authority Severn and Peninsula Deaneries Educational Roles and Responsibilities Document

This paper will summarise:

Roles and responsibilities of those working in Postgraduate Medical Education
Key committee and meeting structures to support the delivery of these roles
Appointment, accountability and reporting framework

Roles and Responsibilities of those Working in Postgraduate Medical Education

It is essential that there is a clear understanding of respective roles, responsibilities and accountabilities of all those working in postgraduate medical education. These are described in the Educational Roles and Responsibilities for Clinical Supervisors, Educational Supervisors, Training Programme Directors, Director of Medical Education, Heads of Postgraduate Schools and others involved in postgraduate medical education.

Overarching Governance Structure with Seven Deanery

The overarching governance structure within the Severn Deanery consists of the following formal and business meetings. Terms of reference and membership for each group are shown in Appendices 1-7 respectively.

Formal Advisory Meetings

Foundation School Board
School Boards
Speciality Training Committees
Trainees Forum

Business Meetings

Severn Deanery Executive Team Meeting
Severn Deanery Staff Meeting
Strategic Health Authority Workforce Directorate Business Meeting
Heads of School Meeting
Training Programme Directors Meeting
Director of Medical Education Meeting

Accountability and Reporting Framework

A summary of the accountability and reporting framework for key individuals involved in Post Graduate Medical Education is shown below.

Interaction of Roles within Severn

This diagram relates principally to the hospital setting. The relationships in General Practice differ.

Trainee

The role of the trainee is defined in the Gold Guide 8.10 to 8.18.

In particular it should be noted that trainees must maintain a learning portfolio that must be shared with their educational supervisors.

Clinical Supervisor

The role of the clinical supervisor was defined by Postgraduate Medical Education Training Board (March 2009).

Educational Supervisor

The role of educational supervisors was defined by Postgraduate Medical Education Training Board (March 2009).

It is set out in the Gold Guide (4.22 to 4.26) and summarised below:

Educational supervisors are responsible for overseeing training to ensure that trainees are making the necessary clinical and educational progress.

Educational supervisors should:

be adequately prepared for the role and have an understanding of educational theory and practical educational techniques e.g. have undertaken formal facilitated training or an on-line training programme or participate in relevant Training the Trainers programmes
be trained to offer educational supervision and undertake appraisal and feedback
undertake training in competence assessment for specialty training
be trained in equality and diversity
provide regular appraisal opportunities which should take place at the beginning, middle and end of a placement
develop a learning agreement and educational objectives with the trainee which is mutually agreed and is the point of reference for future appraisal
be responsible for ensuring that trainees whom they supervise maintain and develop their specialty learning portfolio and participate in the specialty assessment process
provide regular feedback to the trainee on their progress
ensure that the structured report which is a detailed review and synopsis of the trainee’s learning portfolio is returned within the necessary timescales
contact the employer (usually the Medical Director), the Training Programme Director and the Postgraduate Dean should the level of performance of a trainee gives rise for concern
be able to advise the trainee about access to career management
be responsible for their educational role to the Training Programme Director and locally to the employer’s lead for postgraduate medical education, usually the Director of Medical Education
have responsibilities through their supervision of trainees to support the delivery of the educational contract which exists between employers which provide postgraduate training and Postgraduate Deaneries.
are responsible both for the educational appraisal of trainees, and also for review of their performance based on Good Medical Practice.

These important educational and review roles make it essential that there are unambiguous lines of accountability for educational supervisors into both educational programme arrangements through the Training Programme Director and also into the management structure of the trainee’s employer (e.g. through clinical directors or the designated lead for medical education such as the Director of Medical Education or Specialty Tutor) so that there is clarity about:

who is providing educational supervision
the clear link between the appraisal, assessment and planning of a trainee’s educational programme and their performance as a doctor
the transparency of the process ensuring that the trainee is aware of the information being shared with the employer
the arrangements for raising matters of clinical concern and professional performance about a trainee within the employing authority and with the Postgraduate Deanery in line with wider regulatory requirements

Employers of educational supervisors must have this role recognised within job planning arrangements.

Within the Severn Deanery, the Postgraduate Medical Dean will expect Directors of Medical Education to ensure that suitable arrangements are in place within the Trust to ensure clarity as above. This will include Foundation Doctors, Fixed Term Specialty Training Appointments, Specialist Registrars and General Practice Vocational Training Scheme doctors who are within the Trusts. The Director of GP Education will undertake this role for General Practice Educators, and the Head of the School of Public Health will ensure that Directors of Public Health undertake this function for educational supervisors in diverse locations such as the government office and Primary Care Trusts.

Training Programme Director

The role of the Training Programme Directors is set out in the Gold Guide 4.12 to 4.14 and summarised below.

Training Programme Directors have responsibility for managing specialty training programmes including Fixed Term Specialty Training Appointments (FTSTAs). They should:

participate in the local arrangements developed by the Postgraduate Dean to support the management of the specialty training programme(s) within the Deanery or across Deanery boundaries
Work with delegated College/Faculty representatives (e.g. college tutors, regional advisors) and national College/Faculty training or Specialty Advisory Committees (SACs) to ensure that programmes deliver the specialty curriculum and enable trainees to gain the relevant competences, knowledge, skills, attitudes and experience.
In General Practice a GP Director or Associate Patch Dean would take on these roles.
take into account the collective needs of the trainees in the programme when planning individual programmes
provide support for clinical and educational supervisors within the programme
contribute to the annual assessment outcome process in the specialty
help the Postgraduate Dean manage trainees who are running into difficulties by supporting educational supervisors in their assessments and in identifying remedial placements where required
ensure, with the help of Deanery administrative support, that employers are normally notified at least three months in advance of the name and relevant details of the trainees who will be placed with them. From time to time, however, it might be necessary for Training Programme Directors to recommend that trainees be moved at shorter notice.
be responsible for organising and chairing the Speciality Training Committee. (This can be delegated if so wished to another member of the Specialty Advisory Committees, example, regional adviser, senior experienced member).

Training Programme Directors also have a career management role. They will need to:

ensure that there is a policy for careers management which covers the needs of all trainees in their specialty programmes and posts
have career management skills (or be able to provide access to them)
play a part in marketing the specialty, where there is a need to do so, to attract appropriate candidates e.g. coordinating taster sessions during Foundation training, career fair representation, maintaining the Programme web site, and liaison with Specialty Tutors and with Royal Colleges/Faculties.

Training Programme Directors are appointed by the Severn Deanery on behalf of the Strategic Health Authorities. They will be accountable for their work to the Postgraduate Dean. Where Training Programme Directors are part of a School lead by an Associate Dean such as Medicine, Surgery and Psychiatry, responsibility for appraisal will be delegated to the Head of School.

A modest budget is allocated to Training Programme Directors to support their work on a capitation fee per trainee; this is allocated to the employing Trust. The Training Programme Director will be expected to monitor and provide reports to the Strategic Health Authority on the use of this budget.

Director of Medical Education

The role and responsibilities of the Director of Medical education are set out in the Learning Development Agreement (LDA) between the Strategic Health Authority and the Trust.

The Director of Medical Education is responsible for maintaining and developing the profile of medical education in the Trust, and for ensuring the delivery of the Learning Development Agreement (Educational Contract) with Strategic Health Authority with respect to medical education.

Funding for 1-2 sessions depending on the size of the Trust is included within the Learning Development Agreement.

In addition the Director of Medical Education is accountable to the Trust for the delivery of medical education (this role may vary according to Trust Policy). Directors of Medical Education will therefore be jointly appointed by the Dean and the Trust (normally via the Medical Director), and will have a joint appraisal between the Postgraduate Dean and the Trust.

The Director of Medical Education will normally line manage the Foundation Programme Directors and the Medical Education Manager(s).

The Director of Medical Education is responsible to the Chief Executive for the business of Medical Education and Training within the organization and for ensuring the delivery of the medical aspects of the Learning Development Agreement. They will have a close professional relationship with the Dean/Deanery to ensure quality control of Programmes, develop and deliver the wider educational agenda and for supporting and developing supervisors and tutors as educators.

General Responsibilities

Take responsibility for the organization achieving defined standards of postgraduate (and in some places undergraduate) medical education.

Provide professional leadership and vision for the organization on medical education issues
Produce, implement and monitor a strategy for the provision of medical education and training
Align medical training and education with the service objectives as defined by the Trust Board or equivalent
Represent the organization on medical education issues, both externally and internally.

In order to deliver these, the Director of Medical Education 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 and develop all involved in medical education and be involved in their appointment
Manage resources and budgets devolved by the organization to medical education and 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 General Medical Council Quality Assurance processes, and other external bodies as required
Ensure that trainers and trainees are fit for purpose within the organization
Report to Trust Board, or equivalent, as appropriate to ensure awareness of the impact of changes in medical education on the organization
Implement, monitor and improve medical training programmes
Provide an annual financial report and business plan

Appendix 1 - Severn Deanery Executive Team

Appendix 2 - Foundation School Committee

Appendix 3 - Primary Care School Board - Constitution

Appendix 4 - Postgraduate Schools

Appendix 5 - Specialty Training Committee

Appendix 6 - Business Meetings - Director of Medical Education Meeting

Appendix 7 - Business Meetings - Heads of School Meeting

Appendix 8 - Training Programme Directors Meeting