GMC position statement - November 2012
This document sets out the General Medical Council’s (GMC) requirements for trainees who are working towards a Certificate of Completion of Training (CCT) to transfer to the most recent GMC approved curriculum.
( Where CCT is referred to this also includes Certificate of Eligibility for Specialist or GP Registration through the combined programme route CESR(CP)/CEGPR(CP) )
Following calls for a review of the position, the GMC concluded that the current arrangements (under which trainees in some specialties remain on the same version of the curriculum throughout their training even where it has been superseded) are unsatisfactory; in the interests of patient safety and educational quality, trainees in all specialties should transfer to the most recent curriculum and assessment system.
In effect this will mean that at any one time there will only be a maximum of two approved curriculum per specialty, the “old” one in which only those trainees in their final year of training will remain and the “current” curriculum. This will mean that trainees will be trained and assessed against the most recent standards for the specialty.
Who is covered by the revised requirements?
The revised requirements are relevant to those involved in the organisation, delivery and receipt of postgraduate medical education and training in the UK and those trainees who are in GMC approved postgraduate training programmes leading towards a CCT whose CCT date falls within the implementation plan.
Background
Prior to the formation of the Postgraduate Medical and Education Training Board (PMETB) in September 2005 there was no single set of standards against which curricula were developed. PMETB introduced a set of standards and an approval process and approved curricula for all the specialties in 2007. At that time therefore there were two groups of trainees, those on pre 2007 curricula and those on the 2007 curricula. Many of the curricula were in the early stages of development and it was acknowledged that the assessment systems, in particular,required development in order to fulfil the published standards. PMETB undertook a review of all curricula in 2010 and approved amendments.
The GMC adopted the standards for curriculum and assessment systems defined by PMETB and continues to consider changes submitted by Colleges and Faculties against these standards. This has meant that for virtually all of the 65 approved specialties (the exceptions being those specialties which have only recently been established) there are currently three or four approved curricula and assessments systems that trainees are following
- pre 2007
- 2007
- 2010 and
- post 2010
The current legal position
The Medical Act stipulates the standards which the GMC are required to set and maintain in relation to specialty training and the award of a CCT. To illustrate, the following provisions are relevant:
Section 34H says…
(1) The General Council shall-
(a) establish standards of, and requirements relating to, postgraduate medical education and training, including those necessary for the award of a CCT in general practice and in each recognised specialty;
(b) secure the maintenance of the standards and requirements established under paragraph (a);
And
(2)(b) to ensure that the needs of employers and those engaging the services of general practitioners and specialists within the UK health services are met by the standards the General Council establish under subsection (1)(a).
(4) The standards and requirements established under subsection (1)(a) shall include -
(b) the training curricula to be followed in general practice and in each recognised specialty;
(c) the assessment arrangements for persons undertaking education and training in general practice and specialist medical practice;practice or specialist medical practice;
Section 34L(1) says… the Registrar shall award a certificate of completion of training (CCT) to any person who applies to the General Council for that purpose if -
(b) the Registrar is satisfied that that person has been appointed to, and has satisfactorily completed, a course of training leading to the award of a CCT;
In setting and securing the standards and ensuring the needs of employers are met (34H(1)), and the Registrar’s responsibility to award a CCT to those who have completed an entire course of training leading to the award of a CCT, it would seem entirely reasonable to require that a trainee is up-to-date with the expectations of the relevant specialty current at the time the application is made for a CCT. Patients, and the NHS, would rightly expect nothing less.
Issues
There is general agreement, including amongst organisations representing the interests of trainees, that the current position is unsatisfactory for several reasons:
- Where updated curricula reflect patient safety issues, the needs of service, changing technologies and national legislative changes it would be unacceptable for the GMC to award a CCT to a trainee that had not fulfilled these requirements.
- It is important that all trainees awarded a CCT in the relevant specialty are equally up to speed, knowledgeable and competent – and assessed as such.
- Colleges/Faculties are submitting change requests on an almost annual basis. With training programmes ranging from three to eight years in duration and the fact that there is an increasing number of trainees working less than full time, if the move to current curricula is not implemented there could be in excess of 10 approved curricula in use at one time.
- Frequent changes to curricula are unsettling for trainees and difficult for trainers to manage.
- Deaneries have been required to manage and deliver as many as three or four different curricula with their matching assessment systems at the same time. We have had reported to us that this has caused confusion for trainees and trainers.
- Colleges/Faculties have also submitted changes to their assessment systems both in respect of work place based assessments and examinations. There is potential for confusion amongst those undertaking the assessments having to use different systems for different trainees under their supervision. In addition if trainees leave the programme without an understanding of the current assessment tools this may cause difficulties for future post CCT roles where the individuals become the assessors.
- A number of Colleges/Faculties use eportfolios, and having different curricula and assessment systems being followed at the same time, has the potential for confusion and technical difficulties.
The implementation of the position statement needs to ensure that the general principle of transfer to the current curriculum is observed, with those in their last year of training not being affected. Therefore transition plans are to follow the following key points
- The plan must be implemented for all trainees as appropriate for the timescales within the implementation plan.
- For “steady state” the plan should demonstrate completion of transition within two years of the approval of the new curriculum, but may be earlier.
- Implementation is expected to begin from approval – i.e. it does not need to await the next recruitment round.
- The administrative burden for trainees and deaneries should be kept to a minimum.
Consultation with key interests
We have consulted widely across the sector, including the UK health departments, NHS Employers, trainee bodies, the Academy of Medical Royal Colleges and individual colleges/Faculties and postgraduate deaneries. There has been general support from all stakeholders.
Implementation
This document together with the attached FAQs provides guidance to:
- Colleges/Faculties and Postgraduate Deans on what is required from them to transfer existing trainees to the most up to date curriculum
- Colleges/Faculties on what they need to do when they propose curriculum and/or assessment system changes.
A number of Colleges have previously approved implementation plans that were submitted as part of their curriculum changes. These have been widely published and are clear to trainees. It has been reported to the GMC that these transition arrangements will be complete by the end of December 2015. Subject to all trainees being transferred to the current curriculum by 1 January 2016 these existing plans remain approved.
The implementation plan is outlined below
by 31 March 2013
- Any College/Faculty submissions for curriculum or assessment system changes to include
- mapping from existing curriculum
- implementation plan for the transition to the proposed new curriculum
- consultation with trainees and deaneries on the implementation plan
by 31 December 2013
- Colleges/Faculties to produce (in liaison with their Lead Dean and trainees) for each of their curricula, a map showing the transfer of competencies from each of the “old” curriculum to their current curriculum. Including details of any impact, for example number of trainees, additional training resources required.
Between 1 January 2014 and By 31 December 2015
- Postgraduate Deaneries move trainees to the current curriculum at the point that they move from one year to another within the programme (usually at the trainees ARCP).
- The deadline of 31 December 2015 is the latest point at which all trainees will be required to have moved. Where Colleges in consultation with Deaneries are able to move trainees earlier this is encouraged by the GMC.
1 January 2016 (or earlier if trainees moved earlier)
- GMC decommission “old” curriculum and assessment systems for each specialty and sub specialty and also decommission “old” programme approvals.
Frequently asked questions
Q: How will Colleges/Faculties map “old” to “current” curricula?
A: Colleges will need to consider
- what areas of the curriculum have changed (been added/ removed/increased/ decreased/ altered)
- what assessments have changed
- when looking at the above, what additional resources or adaptations to existing programmes will be required to enable trainees to fulfil these changes?
Step 1: Colleges map changes from old to current curriculum – broken down into each year of training and outlining if in a later year what needs to be gone back upon in the earlier years.
Step 2: Colleges send to deaneries to consider the implementation plan for each of their trainees
Step 3: Deaneries at the next ARCP agree the changes and any targeted training to cover new/missed competencies and whether training needs to be extended
Step 4: Colleges report on progress in their annual specialty reports, Deaneries report on progress in their annual deanery reports.
Q: Will the College need to look at every trainee to ascertain where they slot into the current curriculum?
A: No. In order to ensure the administrative burden on Colleges, Deaneries and trainees is as low as possible, the mapping will outline at each year (so one map per year of the curriculum) of the curriculum where competencies will be transferred and this will be confirmed at the trainee’s next ARCP meeting, with a trainee’s programme being adapted as appropriate.
Q: Will there be guidance for Deaneries on the implementation?
A: As part of the mapping Colleges will be asked to provide guidance for programme directors and heads of school, but they would not be looking at individual trainees situations.
Examinations and assessments
Q: If I am in a training programme and the examination has changed will I need to retake it when I have already passed it?
A: No. However if the examination amendments have included examination in “new” areas of the curriculum then the College will define within its mapping whether additional evidence is required such as targeted workplace based assessments.
Q: I have passed part of the old exam – will this count towards the new exam?
A: Part of the College submission for any amendments to their curriculum and assessment systems will include discussion with trainees on the implementation and timings of changes and will outline whether parts of the exams will contribute towards the new exam. For existing curricula and assessment systems the mapping provided by the College will show how the “old” examination maps to the “current” one.
Q: I am in uncoupled training and have passed the old membership/fellowship examination but have not yet entered ST3 training. Will I need to take the new exam as well?
A: The examination is one part of the curriculum and assessment system for your specialty. The mapping produced by the College will outline what elements of the “current” curriculum you have already achieved and will indicate what assessments you need to complete. The Colleges will take into consideration the agreed position in relation to currency of examinations.
Q: If a new examination is introduced will I need to take it?
A: As part of the submission for the change of the assessment system the College will submit outlines of how existing trainees will move onto the new curriculum, this will include consultations with trainees to ensure that the timeframes are suitable and appropriate (falling within the maximum of a two year transition). For example if an examination is introduced in a trainee’s final year of training then it would not be reasonable to require a trainee to pass this new examination. However trainees may wish to take the examination for future employment opportunities.
Q: There is a new WPBA being introduced, will I need to go back and have all my old assessments completed against this new WPBA?
A: No – there will be an introduction date and it will be from that date that trainees will need to be assessed using the new WPBA. A number of trainees may also have been part of pilots prior to the formal introduction. It is important that the transition does not place an overly burdensome administrative process on all those involved or that trainees are required to demonstrate competencies they have already demonstrated.
Q: In my specialty the current curriculum requires trainees to record their progress/assessment using an e-portfolio – will I need to use it?
A: Where Colleges require trainees to use specific assessment or progress recording systems such as eportfolios then, yes you will need to use these, however you will not be required to retrospectively gather data. Colleges will provide guidance on the transfer of existing information.
Exemptions from transfer
Q: I am in my grace period after my expected CCT date – will I have to transfer?
A: No, however you must apply for your CCT within six months of your CCT date.
Q: I am in my last year of training – will I have to transfer?
A: the implementation plan will outline the timing of transfers to the current curriculum. These will be individual for each specialty. For clarity No trainee (including any less than full time or those out of programme) may remain in an “old” curriculum from 1 January 2016, subject to those trainees that fall into the category outlined in 24Q.
Q: Will I have an option to transfer even if I fall outside the requirement to transfer?
A: All trainees will be encouraged to transfer to the current curriculum so as to ensure that they will be fully up to date with current requirements for their specialty to ensure patient safety. Trainees should also be aware that not completing the current curriculum may have a detrimental affect on their employment opportunities.
Q: I am looking at becoming a less than full time trainee and this would extend my CCT date beyond January 2016 – will I have to transfer?
A: Yes.
Out of Programme
Q: I am currently in research – what will happen to me?
A: The current curriculum may not have the same recognition for research as the “old” one and so your training requirements will be considered on an individual basis. If you are in a programme and on an Out of Programme for Research (OOPR) then your transfer will not wait until your return to the programme. If you are not in a programme then you will apply in the usual way to the curriculum in place at the point of your application.
Q: I am currently in an Out of Programme Experience approved for training – what will happen to me?
A: You will be transferred to the current curriculum in the same way as other trainees at your ARCP (this will not wait until your return to the programme).
Q: My forthcoming Out of Programme Experience has been approved based on the “old” curriculum, what does this mean for me?
A: You will be transferred to the current curriculum in the same way as other trainees at your ARCP (this will not wait until your return to the programme if the ARCP is earlier). You may be required to undergo targeted WPBAs to ensure that you fulfil the requirements of the “current” curriculum.
Q: I am on maternity leave – what will happen to me?
A: As part of your ARCP you will be transferred to the current curriculum in the same way as other trainees.
Curricula competencies
Q: A change to the curriculum has been made in the early years of the programme that I have already completed (i.e. in ST3 and I am in ST5), will I have to go back and do this training?
A: The Colleges will map the “old” curriculum to the current one. Where the achievement of these earlier competencies can be demonstrated via later WPBAs or examinations then they will not need to be repeated. It should be noted however that some curricula are spiral in nature and earlier competencies are needed to underpin later ones and therefore you may need to have targeted training to support the achievement of the curriculum requirements. Other curriculum changes have been made to answer employer requirements and trainees may want to demonstrate these competencies for their future employment prospects.
Q: I am an advanced or higher trainee. Will I be affected by changes in Core training?
A: No, unless these changes are necessary to underpin later competencies in the curriculum. See question 18 above. Colleges will detail this in their mapping of the “old” to the current curriculum.
Q: The new curriculum stipulates a specific requirement which will be difficult to achieve at my current stage of training. What should I do?
A: Your postgraduate dean and training programme director will work with you to deliver the training that you require to complete the requirements of the current curriculum. Every effort will be made to do this via targeted training rather than an extension to training.
Q: The new curriculum is longer – does this mean that my CCT date will be extended?
A: All curricula are competency based and therefore it will be necessary as part of the Colleges’ submissions for changes to indicate whether there will need to be an extension to training time in order to enable trainees to demonstrate the competency levels. Every effort will be made to do this via targeted training rather than an extension to training.
Performance
Q: I have an outcome 3 or RITA E – where will I transfer?
A: You will transfer into the current curriculum at the point when you were last considered to have satisfactorily completed training. The transfer will not give you additional opportunities for training extensions.
Q: I have already had the maximum extension to training permitted in the gold guide, what will happen to me if the transfer requires an extension to my training?
A: Every effort will be made to enable trainees to achieve additional requirements via targeted training. If however an extension to training is required this will not count within the maximum extension to training period defined in the gold guide.
Q: My expected CCT date has been extended to June 2016 as I have not been able to demonstrate the required competencies. I did not originally have to transfer, will I now have to do so?
A: Where an extension is for six months then you are not required to transfer but if the extension is for more than six months then you will need to transfer. As outlined above - All trainees will be encouraged to transfer to the current curriculum so as to ensure that they will be fully up to date with current requirements for their specialty to ensure patient safety.
Future changes
Q: How will I know if there is a change planned to the curriculum?
A: any changes proposed by Colleges to the GMC are required to include input from trainees/trainee organisations (as well as Deaneries) particularly in relation to the transition plans and implementation timetable. It is important therefore that you maintain contact with your College throughout your training so that you are aware of developments.
Guidance
Q: Where can I find guidance on how to use the “current” curriculum and /or assessments?
A: Guidance on the current curriculum can be found on your College website.
Q: The “current” curriculum has new competencies, where can I find guidance on how to achieve these?
A: In the first instance please discuss any queries you have with your supervisor. Any changes to curricula and assessment systems are cascaded by the Collegesthrough the College and Deanery networks of trainers.
