What is happening and why?
The Faculty is currently undertaking a root and branch review of the curriculum – the first since its launch in 2011. We have been keen to undertake such a review as part of the standard process of reviewing a new curriculum for some time, but the significant changes underway within the General Medical Council (GMC) have necessarily delayed that ambition. Those changes, however, are likely to present the specialty with an opportunity to make the curriculum much more akin to that which the Faculty originally envisaged, and more aligned to the outcome-based system used in Cobatrice.
The work has begun in the form of a small pre-project group chaired by Tom Gallacher, as the overall Chair of Training, Assessment and Quality (TAQ), including trainers and the lead trainee representative. This group is tasked with coming up with some initial proposals about how the new curriculum might be structured. The overall process includes multiple points to consult on progress with trainers, doctors in training and other stakeholders in training (such as related specialty Colleges, Deaneries and Employers).
All curricula should be submitted by the closing months of 2020 to go ‘live’ in August 2021. We will continue to keep you up to date with progress.
So what are the changes?
The entire nature of how curricula are designed and approved has changed following the General Medical Council’s Standards for Curriculum and Assessment Review and the publication of Excellence by Design: Standards for Postgraduate Curricula. The changes fall into three main categories:
Outcomes vs competencies
The new curriculum is focussed on high-level outcomes rather than the intensive detail of competencies. This presents both positives and challenges for the specialty. The obvious positive is the ability to move towards a system where doctors in training are assessed more holistically rather than in the micro level of individual procedures. The challenge is preparing and supporting the training system (notably trainers, who will have greater autonomy and an increased personal responsibility for assessment) for this seismic shift. What the Faculty ultimately hopes to see is a more fluid and flexible system that is focussed on overall learning rather than competency acquisition.
The new GMC process is much longer than its predecessors were. There is considerable focus on preparation of materials, pre-approval and back-and-forth review. This would mean that a substantial curriculum change could take a minimum of 12 months (and likely up to 18 months) to introduce from the moment TAQ approve it to the moment it comes into practice. Again, there are positives to this approach in that it protects trainers and doctors in training from sudden changes to their programmes. The negatives are obvious: changes become less adaptive and more reactive. The Faculty has been one of the most vocal Academy members in encouraging the GMC to move towards a system where more independence is given to individual Faculties and Colleges to make smaller proactive updates to their curricula.
Workforce and employers
Whilst NHS Employers and related bodies in all four nations have been part of the process previously, this is now given a much more central place in curriculum approval. The movements of NHS projects like Shape of Training have placed a strong focus on training to clearly produce what the NHS workforce needs. Each curriculum change therefore must come with a considerable amount of evidence to support its future need in Consultant practice.
Should the curriculum change?
An initial survey (to all Fellows and trainees) to focus the discussion of the core group appeared to suggest that most of the actual content of the curriculum is right, but the structure needs review. This was a view shared by TAQ.
Should anything be added to the curriculum?
As with the discussion above about the greater involvement of the views of employers and workforce forecasters, some aspects of critical care practice have long been considered for inclusion in the curriculum but have not yet been added. The simple fact is that unless every region and devolved nation can provide something for trainees, it cannot be a mandatory part of the curriculum.
The importance of echocardiography training
TAQ are very sympathetic to the need to develop the role that echocardiography and point-of-care ultrasound training plays in our specialty, but, at present, the number of regions that cannot reliably provide training remains significant. Our Regional Advisors continue to assess local provision on an ongoing basis, following two national surveys. The curriculum rewrite group will consider how specific techniques and procedures can be incorporated in the new curriculum and echo will remain a part of that discussion.
We would, however, strongly urge each training site to consider how prepared it would be to give some form of exposure to ICM doctors in training to echocardiography and point-of-care ultrasound. We would welcome hearing from sites who feel that echocardiography and point-of-care ultrasound provision in the longer term would not be a viable proposition in order that TAQ can consider options which may allow for alternative provision thus allowing for echocardiography and point-of-care ultrasound training to be incorporated into the curriculum in the future.