Update on PH training in the UK

Premila WebsterAssistant Academic Registrar

Faculty of Public Health

• The role of the Faculty in training

• PH training in the UK

• The new curriculum

The session

Role of the Faculty

The Faculty of Public Health oversees the quality of training and maintains the professional standards in the discipline.

Assessing competence

Responsibility for this lies with the Faculty of Public Health and is achieved by:

• assessing specific knowledge (through the Part A exam)

• assessing the ability successfully to apply knowledge to carry out the functions of public health - 'shows how' competence (through the Part B exam and in work assessment by public health accredited trainers).

PH training in the UK

Who can specialise? The higher specialist training programme in public health

is open to both qualified medical doctors and those from other public health disciplines.

How long does training take? Training usually lasts five years, full-time. Part-time

training is proportionately longer. The five years usually includes one year (full or part time) on an academic course, and 48 months in higher specialist training posts.

Specialist registration

On completion of the five-year training programme:• medical doctors will be recommended to the

Postgraduate Medical Education and Training Board (PMETB) for inclusion on the Specialist Register

• those from other disciplines will be recommended for registration with the UK PH Register for Public Health Specialists.

This qualifies them to work at consultant-level in the NHS.

Routes to the register

• Training

• Experience (‘Article 14’)

The 2007 curriculum

Why did we need a new curriculum?

• Modernising Medical Careers

• PMETB

• RITA consistency

Modernising Medical Careers

• Foundation programmes

• Run-through

• National standardised recruitment

Run-through training

Continuing Professional Development

Medical school – 4-6 years

Undergraduate medical training in medical schools

Career posts

F1

F2 competences achieved

UK MMC Career Framework

Postgraduate Medical Training

Senior AppointmentsSenior Appointments

Continuing Professional Development

CCT route

Foundation training in foundation schools

Article 14/11 route

Fixed Term Specialist Training Appointments

Arrows indicate competitive entry

Specialty training inSpecialty schools

REGISTRATION GMC Specialist Register/UKVRPHS

PMETB

• PMETB is an independent statutory body.

• It is responsible for promoting the development of postgraduate medical education and training for all specialties, including general practice, across the UK.

• PMETB aims to improve UK medical education.

• PMETB assumed its statutory powers on 30 September 2005.

PMETBIt took over the responsibilities of the Specialist Training Authority

of the Medical Royal Colleges and the Joint Committee on Postgraduate Training for General Practice.

Responsibilities include:

• Establishing standards and requirements for postgraduate medical education and training.

• Making sure these standards and requirements are met.

• Developing and promoting postgraduate medical education and training across the country.

PMETB prescribed elements for Curricula

• Purpose• How developed• Learning models and educational strategies• Delivery, content and outcomes• Appropriateness• Links to training stages, supervision• Feedback, remediation, review and evaluation• Compliance with anti discriminatory

requirements

Curriculum principles

• What does a consultant need to know?

• Clarity about what needs to be learned and when

• Clarity about assessment method and triangulation

Curriculum development

• Since 2005, work on the curriculum

• In 2006, workshops, key leads, iterative development

• Parallel work

All trainees in specialty training, from 1 August 2007 follow the new PMETB-approved 2007 curriculum. Trainees appointed prior to this can transfer to the 2007 curriculum as well.

Curriculum consists of three broad sections

• How you learn • What you learn • How you are assessed

The curriculum for specialist training in public health describes all the required components of training that to lead to a certificate of completion of training (CCT) in public health.

PH training

Training in PH covers nine key areas of public health practice across the three domains of public health (health protection, health improvement and service quality), as well as ethical and professional practice.

What does the curriculum do?

The curriculum provides a framework within which trainees and trainers can determine and understand the knowledge, skills, attitudes and behaviours which will allow a trainee to achieve the level of competence required of a specialist in the field.

Curriculum 2007

It defines and describes the processes (recruitment, induction, assessment and remediation), phases of training , settings , learning methods and learning outcomes.

Recruitment

• Single annual recruitment• Electronic portal• Backgrounds other than medicine• National person specification• National application form• Longlisting• Assessment centres• Shortlisting• Selection centres

Learning areas

Learning outcomes

Learning areas

• Surveillance• Effectiveness• Strategy• Leadership

• Health improvement

• Health protection• Health services• Health intelligence• Academic

Learning Outcomes Framework

• Details the learning outcomes expected in each key area including ethical management of self and professionalism.

• Lists a total of 184 learning outcomes (16 ethical management of self; 121 core; 47 trainee selected) each linked to: – The target phase of training– suitable assessment methods – knowledge base– other key areas

Learning outcomes framework

Overall descriptor provides learning aims

Knowledge base and know how

Details the knowledge needed to achieve the learning outcomes

Links to KSF

Knowledge and Skills Framework mapped for trainees from disciplines other than medicine

Learning experiences

Describes level of learning at each phase of training

Describes in which situations trainees may achieve learning outcomes

Supports trainers and trainees in planning learning activities

Learning outcomes

Learning outcomes fall within nine broad key competency areas relate to the three domains of public health practice. These learning outcomes are outlined in the Learning Outcomes Framework and are available on the faculty website.

The knowledge base which underpins them is based on the MFPH Part A syllabus.

Learning Outcomes

• 184 learning outcomes

– 121 core– 16 ethical management of self– 47 optional (special interest)

LOF – the learning outcomesSplit by phase to enable progression of learning, appropriate assessment and remediation

Standard vocabulary to aid understanding

Some are required at increasing levels throughout training

Many can be gained together or in short periods of time

Later phase outcomes are likely to be gained on projects crossing many Key Areas

Delivering the framework

.

Model of learningEducational strategies

• Three phases of learning

• Competence based

Training phases

The curriculum consists of three phases of learning. These phases reflect:

• an early induction and basic grounding in public health;

• acquisition of the knowledge base; • basic skills training; • consolidation of core advanced skills • an option for trainee selected components

which will allow development of defined interest or practice within a specified setting.

The phases of training

• Phase 1– Induction; knowledge; basic ‘show’ in simple

settings

• Phase 2– Increasing complexity, lead for simple areas;

communication skills, HPU; on call;

• Phase 3– Complex work; significant lead; consolidation;

special interests (depth/breadth/settings);

Underpinning theory - Miller’s Triangle

Knows

Does

Phases 2 & 3 Learning through increasingly complex service work and assessed through Part B MFPH and WBA

Phase 3Demonstration of integrated practice of complex competencies and assessed through the workplace

Knows how

Phase 1 & 2 Learning through service experience and assessed through WBA and paper 2 Part A MFPH

Shows how

Phase 1 Learning through formal study and assessed through WBA and paper 1 Part A MFPH

F2 ST1 ST3 ST5ST4ST2

CONSOLIDATIONACADEMIC

On-call

CCT

Phase 1 Phase 2 Phase 3

Knows/knows how Advanced shows/shows how

Foundation Higher Specialist Training

Health protection unit attachment by the end of phase 2

F1

Basic shows

Pt B MFPH

The move between the three phases is dependant both on exam success and achievement of learning outcomes. The timing is not exact

Selectionthrough MTAS*

Pt A MFPH

Time out of training for research leading to a PhD under the Walport initiative, or equivalent for other graduate entrants, is taken after completion of phase 2 with re-entry after three years to complete phase 3

Other graduates are also selected through this portal

* Medical Training Application Service

The training pathway

As well as the required core, trainees may select special interest options during phase 3

Products

• Application form• Document guide• Curriculum statement• Entering public health• Training pathway• Programme Delivery• 3D model of learning• KSF levels guide

• Part A syllabus mapped to LOs

• Map to Good Public Health Practice

• Learning outcomes framework

• LOF cut by phases• Glossary• Portfolio templates• Consultation comments

KnowledgeThe knowledge base has been mapped to the nine

key areas of public health practice and every learning outcome has a clearly identified knowledge base (other than those which define attitudes and behaviours).

• Knowledge platform• Delivery of knowledge• Part A syllabus• Advanced knowledge

Recommended learning experiences

• First placement in PCT or equivalent

• Specialist options

• National treasures

• Time abroad

• At least two placements plus HPU

• LOF includes examples of vehicles and settings

Learning experiences

• Learning from practice

• Learning with peers

• Formal learning

• Personal study

• Teacher input

Learning from practice

• From early stages of training, trainees undertake guided and supported service work with regular feedback on specific learning outcomes . Trainees, with their trainer, develop an educational plan through which they identify specific outcomes to achieve and develop and then negotiate and agree work in support of this. Trainees are given exam preparation practice in groups and individually.

Continued……

• Trainees spend the majority of their time in experiential work based learning through delivery of service work closely supervised by their trainer. Initially this work is focussed around the needs of the population served by a PCT/Health Board.

Learning with peers

• Trainees are encouraged to learn with their peers. Trainees, particularly in the first two phases of training, will generally be placed alongside other trainees. Regional postgraduate teaching opportunities will allow trainees at different phases of training to come together for group learning.

• Examination preparation for both parts of MFPH will encourage the formation of self-help groups and learning sets. Self directed trainee groups are also encouraged to meet and work together as a peer group to develop and practice specific skills such as critical appraisal, presentation, on call debrief etc. Learning sets may be facilitated by public health specialists and senior trainees.

Learning in formal situations

• Formal learning in phase 1 is generally delivered through university based academic courses.

• In subsequent phases of training there are regional and national opportunities to attend courses and conferences which meet educational needs.

Personal study

• Study leave allocation is managed in accordance to deanery principles. During all stages of training, trainees have opportunity for study leave which may be taken as self directed learning to support educational objectives/exam preparation or to attend formal courses in support of their stage in training, special interests and career aims.

Specific teacher inputs • Trainers work in settings where, normally, there are

other trainers. While every trainee is allocated a specific trainer, there will be support and input from other trainers and more senior trainees in that location.

• Some trainers have particular expertise and trainees may either request placements with these individuals or undertake work that links across to them.

• Named academic supervisors provide an academic focus to all elements of the trainees' educational progress including support in examination preparation, maintaining an academic rigour for service work and in encouragement to publish and disseminate their work.

Continued……….

• Usually each programme has a representative amongst the body of national examiners for the OSPHE who are able to bring expertise in process and performance to their trainees.

• The pool of examiners for Part A MFPH is too small to allow this but programmes will have an individual identified to take the lead in supporting a group through this element of training.

Trainer accreditation

All trainers are accredited for their training role and should be fully conversant with the requirements of the curriculum and assessment methods.

Supervision & feedback

• Educational supervisor

• Project supervisor

• Academic supervisor

• Concept of three way handover

• Reflective practice

• ARCP

• Exam feedback

What does all this mean?

• Significant change• New cohort trainers need ‘skilling’ up• Structured training pathway• Double running

Assessment

Assessment of training There are two aspects:1.Assessing competence to do the jobResponsibility for this lies with the Faculty of Public Health and is

achieved by:• assessing specific knowledge (through the Part A exam) • assessing the ability successfully to apply knowledge to carry out

the functions of public health - 'shows how' competence (through the Part B exam and in work assessment by public health accredited trainers).

2.The assessment of satisfactory progress in the training programme

Responsibility for this lies with employing deaneries and is achieved through

• An annual review of the progress trainees are making in training - the RITA / ARCP process.

•

Assessment elements

• Methods– Examinations– Direct observation of practice– Case based discussion– Simulation exercises– Multi source feedback

• Checkpoints– RITA/ARCP– Exams/summative assessment

• Evidence– Logbook & portfolio– External validation

Assessment methods

• Part A

• Part B (OSPHE)

• Multi-source

• Workplace

Assessment in the workplace

• 121 core learning outcomes

• assessed locally

Workplace assessment

• Know the standard

• Know the trainee

• Don’t be an impressionist: look at the evidence

Assessor training

• Training sessions

• Guidance manual

Guidance manual (1)

• 2.3 ‘Make use of others in finding and retrieving evidence (e.g. librarians, information specialists)’

Guidance manual (2)

• 8.3 ‘Appraise the validity and relevance of data and data systems in order to assess their quality and fitness for purpose’

Glossary (1)

• Weight

• Complexity

• ‘Use’

• ‘Interpret’

Glossary (2) - weight

• Phase 1: ‘…work aimed at/done for a single manager’

• Phase 2: ‘…at a committee’

• Phase 3: ‘…at Board level’

Evidence

• Log books

• Reports/CD, etc.

Multi-source feedback

• ‘Keep colleagues well informed when working in partnership…’

• ‘Respect skills and contributions of colleagues…’

Multi-source feedback

• Timing – originally thought about 18 months into training

• But need for 20 assessors– Consultant x5– Peer x5– Support staff x5– Other organisation x5

• So may need to be later to gather required number of assessors

On call assessment

• Assessment of fitness to start on call– Health protection induction/basic skills– Knowledge/Part A pass– On call induction– Have started HPU– Safe on call assessment

• On call logbook

Remediation

Remediation is tailored to the individual and to the particular milestone or learning outcome causing difficulty.

Principles are: • early identification of difficulty and particular need; • focussed support to address identified need; • regular monitoring and feedback to avoid surprises; • appropriate evidence of progress supports all decision taken.

Remediation is particular to the trainee and will be under the overall direction of the Programme Director. The educational supervisor will be pivotal in targeting remediation.

What’s to do?

• We have until 2010 to develop and refine the assessment system

• Assessors/educational supervisors need to be trained

• E-portfolio

Some implications

• Re design of training programmes• Training in assessment• Double running

Useful website – Faculty of Public Health – fph.org.uk

Information about training, curriculum, competencies, appraisal, revalidation and

framework

Look under professional standards and training

With thanks to

Steve George &

Ed Jessop