The Foundation Charter

The Foundation Charter has been created to encourage and mandate Foundation Year 1 doctors to participate in direct patient care in order to prepare them for the F2 year.

This is a new initiative for 2013. It reflects a response by the Northern Ireland Foundation Programme directors to concerns

  1. Raised by F1 doctors in Deanery visits and the Annual GMC survey that some rotations offer limited opportunities to practice traditional doctoring skills.
  2. Raised by consultants that there is often no incentive for F1 doctors to become involved in direct patient care activities. In some rotations the F1 is often perceived as “invisible”.

The Foundation School identified the importance of three key activities in helping the F1 doctor learn the skills of clinical assessment, team working and communication.

  1. Clerking in patients
  2. Attending ward-rounds
  3. Presenting patients

It is also important for F1 doctors to learn patient management by being included in complex case discussions.

Finally, teaching is an important component of being a doctor and F1’s should be encouraged to see teaching as part of the doctor’s role.

The Charter is designed to encourage both the F1 doctors and their supervising departments to facilitate these activities.

What are the required activities?
The working year is defined as 46 weeks to take into account annual leave.

Clerking in patients

The F1 is expected to undertake an average of 1 clerking per week. These can include both elective and acute admissions. A “clerking” can also include a patient whom a Foundation doctor was called to see/review where a full history, examination, management plan and decision making is undertaken.

Ward Rounds.

The F1 is expected to attend an average of 1 ward round per week over the working year.

Ward rounds can be either consultant or trainee led.

Presentations

The F1 is expected to present an average of one case per week at an appropriate forum. This can be a ward round, MDT, X-Ray meeting, a referral to another team, handovers and other equivalent meetings. The presentation should be short and clinically relevant. It is not a formal Power-Point presentation.

Direct Observation of Senior Discussions

The F1 doctor is expected to attend one of these discussions per month. Examples of such discussions include; complex case management, consent, care of the dying discussions, escalation of care, breaking bad news.

This gives the opportunity for the F1 to “learn from the expert” and to begin to understand and develop the skills that will be required later in their medical career. It also will help consolidate their role within the team and emphasise the importance of continuity of care.

Direct Teaching

The F1 doctor is expected to undertake six sessions of teaching per year. This should include presentations at Postgraduate meetings and ward based teaching to medical students.

How are the activities to be recorded?
Each F1 doctor has been issued with a logbook in which they record their “tally” of activities.

A senior doctor (Consultant, Associate Specialist, Staff Grade, SpR) should sign off their weekly activity. The reason for requiring a doctor more senior than a CT grade is to ensure that the F1 trainee gets a chance to engage once per week with a senior doctor in their department.

It is the responsibility of the Foundation doctor to honestly record their activity.

The F1 doctor is encouraged to regularly scan their Logbook into their eportfolio in case of loss.

The activities in the logbook should be reviewed as part of the Clinical and Educational Supervisor meetings to ensure that both the Foundation doctor and their department are engaged in this process.

Will the Charter be part of the F1 signoff (ARCP)?
Yes.

The logbook activity will be taken into account at the F1 ARCP as part of the general activities of the F1 doctor during their first year as a doctor.

It is designed to complement the Supervised Learning Events. For example a presentation at a ward round can be used as a MiniCex.

It is recognised that in some rotations, it may not be currently possible for a Foundation doctor to achieve easily the required weekly activities. This will be taken into consideration  but where possible the activities should be spread over the whole of the F1 year rather than during a particular rotation.

It is however intended that following the launch of the Northern Ireland Foundation Charter, each department withF1 doctors will critically look at their training environment and work to ensure that they are able to undertake these basic medical duties.

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