Training and training establishments as a source of safety information

Accepted.
The General Medical Council has made it clear that it places a high priority on feedback from students and tutors in ensuring both quality education and patient safety, and will look to reinforce this through its Review of Quality Assurance in Education. The General Medical Council will share its proposals in the first half of 2014.

The GMC sets out requirements for the management and delivery of undergraduate and postgraduate medical education and training in its standards (Promoting excellence). The standards sit alongside its Outcomes for graduates and Outcomes for provisionally registered doctors, which set out what the GMC expects doctors to learn and to be able to demonstrate. Its last review of Promoting excellence highlighted a theme of ‘learning environment and culture’ and focuses on ensuring that educational environments are safe for patients and leaners. The theme, now built into the standards, encourages the notion that an effective learning environment should ensure that learning is part of the culture, and that safe and effective care can be provided to patients.

The standards outline the responsibilities of education providers in creating a learning environment and culture and the requirements the GMC set. The standards say that ‘[Local education providers] are responsible for taking action when concerns are raised that impact on patient safety’ [and] ‘Postgraduate deaneries, LETBs and medical schools make sure that medical education and training takes place in an environment and culture that meets these standards, within their own organisation and through effective quality management of contracts, agreements and local quality control mechanisms. They work together to respond when patient safety and training concerns are associated.’ (Promoting excellence pages 8-10).

The GMC engaged with its stakeholders as part of the review to help shape the standards and there has been wide support for defining what a learning environment would look like. The standards were published in 2016 and the GMC is beginning work to consider its Education Framework which will include a review of its standards and how it can build on lessons from previous reviews to ensure its approach remains fit for the future.

Students and clinicians in training are the eyes and ears of the service today and the safety leaders of the future. As they move around during their training, they can spot where safety doesn’t seem to be a priority, there is poor communication, and the concerns of patients and staff are not being listened to. As the future stars of a stronger safety culture, they need to be trained not only in safe care of the patient in front of them – already central to training – but in all the elements crucial to creating safer clinical systems: understanding human factors, measurement and audit, effective multidisciplinary team working, safe handovers of care, learning from error and near misses, and the tools of improvement science.

The General Medical Council is reviewing its standards of medical education and training, as set out in Tomorrow’s Doctors and The Trainee Doctor. The review will consider the importance of student, Trainee and trainer feedback on their training experience, including supervision, support and learning opportunities. A new standards framework will be consulted on in early 2015.

Currently two Local Education Training Boards have a live non-medical feedback system, with all other Local Education Training Boards gathering information by other means, including formal evaluations of placements, informal feedback to the Local Education Training Board and Higher Education Institutions as well as placement providers, questionnaires, focus groups, specific interviews as part of a quality assurance process, etc. This happens across all Local Education Training Boards, developed in partnership with relevant parties involved in the process of quality improvement. All Local Education Training Boards collect trainee intelligence through the National General Medical Council survey.

Through the Health Education England Commission on Education and Training for Patient Safety comprehensive proposals for enhancing safety training for all health and care professionals are being brought forward, including producing a film to help staff and learners in the NHS to raise concerns if they experience or witness practice which puts patients at risk.

The General Medical Council is working with the Medical Schools Council and key partners to ensure that medical students and doctors in training are supported to become the leading lights of excellence in safety, with students starting this autumn seen as patient safety champions from day one. The General Medical Council will showcase current best practice at its conference in March and publish a report. The 5000 new Health Foundation NHS improvement ‘fellows’ will work with medical educators to bring the most up-to-date knowledge on improving safety to the heart of training. The General Medical Council has focused on safety throughout its revised standards for education and training, published for consultation in January 2015, and expanded the questions on safety in its annual survey of all trainees. Through its visits to check the quality of medical education and training, it will work with providers to improve standards and tackle safety concerns, and its regional liaison service will expand its work with students and doctors in training on raising concerns and improving safety.

This recommendation was accepted by the Government.

The General Medical Council published new standards in July 2015, which came into effect in January 2016. These included a requirement that “Organisations must demonstrate a culture that both seeks and responds to feedback from learners and educators on compliance with standards of patient safety and care…”