Selection, transition
and progression
– the role of the GMC
Dr John Jenkins CBE
Chair, Postgraduate Board
Selection, transition and progression are key
elements of the education and training of
doctors, for which the GMC has overall
regulatory responsibility
Provisional
registration
Medical School
(4-6 years)
Certificate of
completion of
training (CCT)
Full
registration
F1 year
(1 year)
F2 year
(1 year)
Specialty/GP
training
(3-8 years)
Specialist/GP
register (to
retirement)
SASG (specialty doctors)
Wider Context for the debate

GMC assuming responsibility for regulating all stages of
medical education and training including undergraduate, foundation, specialty
(including GP), continuing professional development

Increasing recognition of importance of selection,
transition and progression throughout medical
education and training

Implementation of Quality Improvement Framework
GMC Quality Improvement Framework
Quality Improvement Framework:
Four elements
Approva
l
against
Standar
ds
Education strategy 2011-2013
Setting and assuring standards,
and valuing education and training:
Ensure that the standards we set
provide a framework for excellence and
that we are proactive in maintaining
compliance
Defining outcomes for education and
training:
Define clear outcomes which must be
met by students and trainees on
completion of different stages of training
Setting and assuring standards
and valuing training

Alignment and review of standards –
The Trainee Doctor

Valuing training (approval of trainers)

Developing a smarter evidence base

Consolidating quality visits and oversight
Defining outcomes for education and training
 Tomorrows Doctors (2009)

Foundation Programme

Generic outcomes for specialty curricula

Routes to the Specialist and GP Registers
Education strategy 2011-2013
Working with partners and promoting
feedback and learning:
We will work with all those
organisations, groups and individuals
who have a stake in medical education
and training. We will develop
mechanisms to feedback what we have
learned to encourage learning and
improvement
Promoting effective selection,
transition and progression:
Ensure there are clearer progressions
between the stages of medical
education and that risks associated
with transitions are better managed
Promoting effective selection,
transition and progression
 Selection into medical school
 Supporting disabled students and trainees
 Transitions
 Selection into specialty including GP training
 Review of CPD
Roles in selection
Medical
school
Postgraduate deans,
UKFPO
medical Royal Colleges
national
and Faculties – UK
eligibility
wide/ national and/or
and
local depending on
recruitment
Appointment
to career post
specialty
Medical School
Foundation
Program
me
Specialty / GP training
GMC sets standards and requirements
Student Selection – What we say now
Tomorrow’s Doctors 2009 states that:

Processes for student selection will be open, objective and
fair (Paragraph 71)

Selection criteria will take account of the personal and
academic qualities needed in a doctor as set out in Good
Medical Practice and capacity to achieve the outcomes set
out in Tomorrow’s Doctors (Paragraph 73)
Future role of GMC in selection?
 Stronger assurance role
 How effective are current methods of selection to medical
school at assessing non-academic attributes of a good
doctor?
 Diversity in selection processes – is this justified and what
is the impact?
 How robust is the evidence to support current methods of
selection to medical school?
Conclusion of seminar (June 2011)
The GMC has a significant role to play in:
(i) Promoting research
(ii) Evaluating current processes
(iii) Ensuring fairness and transparency
Issues for further debate :
(i) Better alignment of “inputs and outputs”
(ii) Minimising “waste”
(iii) Widening participation
GMC Education Strategy (2011-2013)
Key aim – Promoting effective selection, transition and
progression:
‘In 2011 we will work with the Medical Schools Council
and others to identify examples of good practice in
relation to the selection of medical students, based on
the best available evidence.’
PMETB report on selection into specialty training

There should be effective assurance of the assessment
instruments and processes used in selection into specialty
including GP training

The regulator should examine further the optimum way of
assuring the assessment instruments and processes involved
in selection into specialty, including GP training

In the examination to determine how best to achieve that
assurance, statutory regulation should be considered
Education strategy 2011-2013
Setting and assuring standards,
and valuing education and training:
Ensure that the standards we set
provide a framework for excellence and
that we are proactive in maintaining
compliance
The Trainee Doctor
Foundation and specialty, including GP training
Domain 4 – Recruitment, selection and appointment
Purpose - to ensure that the processes for entry into
postgraduate training programmes are fair and
transparent
Responsibility - postgraduate deans, medical Royal
Colleges and Faculties, specialty associations,
UK Foundation Programme Office, local faculty and,
through these, employers
Evidence - Deanery data, trainee surveys, national and
local recruitment processes
Standard - Processes for recruitment, selection and
appointment must be open, fair, and effective
Mandatory requirements
Candidates will be eligible for consideration for entry into specialty
training if they:
(a) are a fully registered medical practitioner with the GMC or are
eligible for any such registration
(b) hold a licence to practise or are eligible to do so
(c) are fit to practise
(d) are able to demonstrate the competences required to complete
foundation training. This covers candidates who have completed
foundation training, candidates who apply before completion and
those who have not undertaken foundation training but can
demonstrate the competences in another way
The selection process must:
(a) ensure that information about places on training programmes,
eligibility and selection criteria and the application process is
published and made widely available in sufficient time to doctors who
may be eligible to apply
(b) use criteria and processes which treat eligible candidates fairly
(c) select candidates through open competition
(d) have an appeals system against non-selection on the grounds that
the criteria were not applied correctly, or were discriminatory
(e) seek from candidates only such information (apart from information
sought for equalities monitoring purposes) as is relevant to the
published criteria and which potential candidates have been told will
be required
The selection process
4.3 Selection panels must consist of persons who have been trained in
selection principles and processes
4.4 Selection panels must include a lay person
4.5 There must be comprehensive information provided for those within
postgraduate programmes about choices in the programme and how
they are allocated
Foundation training mandatory requirement
4.6 The appointment process should demonstrate that foundation doctors
are fit for purpose and able, subject to an appropriate induction and
ongoing training, to undertake the duties expected of them in a
supportive environment. The process should build on experiences
gained at medical schools to support fitness for purpose in the working
environment.
New elements of selection

Medical school – collaborative content (MSC);
Prescribing skills assessment (MSC, BPS)

Improving Selection to the Foundation Programme
project (ISFP) – educational performance measures;
situational judgement tests

Specialty training – increasing move to national/UK
wide recruitment

Award of CCT – exit assessments
GMC Education Strategy 2011 -2013
‘In 2011 we are considering whether research
should be commissioned in relation to the
discharge of our existing responsibilities to set
standards for selection processes into specialty
including GP training.’
The state of medical education and practice in the UK
“In the 2010 national survey of trainees, nearly 90% of
those approaching the end of their training were confident
about taking up a new role as a consultant or GP.”
However, there is also increasing recognition of the
importance of transitions as “pressure points” for both
patient safety and quality of training –
(i) graduation
(ii) entry to specialist training
(iii) CCT and appointment to substantive post
Medical schools need to ensure that graduates
are well prepared for clinical practice
“In our quality assurance visits (inspections) of medical
schools (2005-10), we found inconsistencies and variation
in the assessment policies and practices. This raises the
question of whether all graduates have the same
minimum standards of clinical competence.
There is evidence that, in the past, some medical
graduates reported being unprepared for some of the
practical skills required of them when they entered
Foundation training.”
The state of medical education and practice in the UK, 2011
Transitions research - findings





Graduates looked forward to ‘being a doctor’
While communication is a strong area at graduation, F1s
were under-prepared for some complex communication
tasks
Other clinical skills are well practised, but not in contexts
which sufficiently mimic the clinical environment
Knowledge of non-clinical areas such as legal and ethical
issues, and the operation of the NHS, was lacking at the
start of F1
Prescribing a significant area of under-preparedness
Dr Jan Illing et al: How prepared are medical
graduates to begin practice? (2008)
Transitions research - recommendations
Undergraduates’ preparedness will be improved by more
experiential learning in clinical practice:
 Ensure that placements have more structure and
consistency
 Ensure that students are given a greater role in medical
teams
 Establish fuller and more prescriptive guidelines on
shadowing
 Specify the limits of the F1 role
 Address particular weaknesses in prescribing
Dr Jan Illing et al: How prepared are medical
graduates to begin practice? (2008)
GMC Education Strategy 2011 -2013
We expect that the implementation of TD 2009 will do much to
address past concerns about the preparedness of some
graduates to enter the workplace. Nevertheless, we will continue
to work closely with others to support the critical transition in
responsibility from medical student to new doctor
In 2011 we will continue to contribute to groups established by
MSC and MEE looking at, respectively, transitions and
shadowing
Transfer of Information
Tomorrow’s Doctors 2009
‘While it is essential that the outcomes are achieved by all
graduates, medical schools should also make
arrangements so that their graduates’ areas of relative
weakness are fed into their Foundation Programme
portfolios so they can be reviewed by the educational
supervisor.’
Medical Schools Council Transition Group
– implementing TD (09) recommendations
GMC Education Strategy 2011 -2013
“We will prioritise the development and
implementation of arrangements that ensure,
for the protection of patients and in the
educational interests of trainees, that
appropriate information about graduates is
shared between medical schools and their
Foundation Programme educational
supervisor.”
Future of GMC role in transition
 Defining clear outcomes for each stage of training
(medical school to F1; outcomes for F2; generic
outcomes for specialty training)
 Assuring local processes for sharing information
 Assessing transition outcomes – shared evidence
(including trainee survey)
Progression
 Annual review of competence and progression for every
trainee (ARCP)
 Depends on requirements of curriculum and assessment
system – usually includes specialty exams, workplace
based assessment and feedback from supervisors and
others
Progression issues
 Clear trajectory of learning (level descriptors)
 Robust and fair ARCP with triangulated evidence
 Educational and clinical supervision and reports
 “Workplace based assessments” - ? change in
terminology and use (undergraduate and postgraduate)
 Early identification of unsatisfactory progress, causes and
remediation
Future GMC role in progression
 Approval of Trainers project
 Project to provide overview of current assessment
systems
 Review interaction between specialty exam pass rates
and progression
 Joint project with Deaneries to analyse progression trends
in ARCP outcomes
 Investigation of delivery of ARCP processes
Principles of better regulation
Development of the QIF was guided by the five principles for
assessing and improving the quality of regulation:
• Proportionality - Regulators should only intervene when
necessary. Remedies should be appropriate to the risk posed, and
costs identified and minimised
• Accountability - Regulators must be able to justify decisions and
be subject to public scrutiny
• Consistency - Government rules and standards must be joined up
and implemented fairly
• Transparency - Regulators should be open, and keep regulations
simple and user-friendly
• Targeting - Regulation should be focused on the problem and
minimise side effects
Principles of better regulation
Working together
• Clear understanding of complementary roles and
responsibilities
• Effective communication (including participation in each
other’s structures and workstreams)
What is the GMC doing to improve training?
 Clarifying the standards of training (for today’s healthcare) and
education (for the challenges of tomorrow, including complexities,
uncertainty and risk)
 Securing an identified individual responsible and accountable for the
quality of training delivered locally
 Maximising the value of training time, including the experiential and
environmental components
 Aiming for excellence (building on competence and including
confidence) in personal responsibility for the quality and safety of care,
delivered in the context of team-based approach to management