There are four elements to the Quality Improvement Framework:
1. Approval against standards
The standards and outcomes for postgraduate medical education and training are contained in the GMC document ‘The Trainee Doctor’. Deaneries are reviewed against these standards and approval is granted or withdrawn. Approval may be granted with conditions if there are requirements that a deanery needs to meet. Failure to meet those conditions can result in approval being withdrawn.
The GMC assesses whether deaneries are meeting the required standards through routine visits, triggered visits (these are undertaken to investigate possible serious educational failure or risk to patient or trainee safety), responses to concerns, review of deanery reports (based on evidence gained through QM and QC processes), deanery action plans (detailing how a deanery is addressing problems) and national training surveys.
2. Shared evidence
The GMC triangulates the evidence it receives from medical schools, deaneries and medical Royal Colleges to check that it is consistent and comparable. It uses this evidence to make judgements on the quality of delivery of postgraduate medical education and training, to identify trends, patterns and areas of risk that need further investigation.
3. Visits including checks
The GMC carries out routine visits to deaneries which will now be coordinated with visits to medical schools in a region. These visits will looks at foundation, specialty and GP training and will be targeted rather than examining areas that the evidence base shows are already working well. The GMC will also carry out random or targeted checks. Random checks are considered a useful tool to examine the effectiveness of the Quality Improvement Framework. Targeted checks allow the GMC to respond to areas of risk that do not require a triggered visit.
4. Response to Concerns
Concerns may be identified through the GMC’s evidence base or raised by trainees, deaneries, medical Royal Colleges and Faculties or by external bodies. When a concern is identified, the GMC will assess its validity against GMC standards. The GMC may then seek a response form the deanery, examine the evidence base to determine whether an issue has been resolved, monitor the progress of an issue, undertake a GMC-triggered visit or initiate withdrawal of training.
NIMDTA is required to submit Deanery Reports to the GMC twice per year and will be visited by the GMC during routine visits and may also be visited as a triggered visit or as part of a response to concerns.
In order to carry out its role as a Deanery,NIMDTA is required to monitor local education and training providers. Each Local Education and Training Service Provider will be assessed against GMC standards.
The Deanery carries out its functions of QM through:
- The conduct of surveys – Pre-Visit and Post-Visit Surveys, Surveys in response to concerns, End of Year Trainee Survey, Foundation School Survey
- The receipt and review of Reports and Action Plans by Quality Management Group – Specialty Schools Annual Report to Deanery, Local Education Providers Annual Report to Deanery (LEPARD)
- The conduct of visits – Cyclical Monitoring Visits – Interim Progress Visits, Problem-Solving Visits
- The allocation or withdrawal of trainees – Withdrawal of trainees from a post will be notified to the GMC