Dr Christopher McAloon provides a practical guide to supervising and supporting foundation doctors through the foundation programme curriculum in 12 top tips
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Many consultants, speciality doctors, and GPs are involved in the supervision of foundation doctors. The demand for educational and clinical supervision of these junior doctors will increase across the UK as the expected expansion in foundation training posts in almost all acute and community NHS trusts comes into force.1
Senior clinicians practising within the NHS are expected to take on a supervisory role for these foundation doctors. There are two types of foundation doctor supervisor, and clinicians normally fulfil both roles simultaneously. Every foundation doctor is assigned an educational supervisor for each year of their rotation to support and monitor progress, guide them towards their educational objectives for that year, and ensure they are ready for the annual review of competence progress (ARCP). During each rotation, a foundation doctor will also be assigned a clinical supervisor who is a specialist in that field. The clinical supervisor should be familiar with the foundation doctor’s working environment, and support their work and progress within that specialism. A clinical supervisor can expect to supervise three different trainee doctors per year (one every 4 months).
There is a false perception that there are fewer junior doctors in the NHS now than there were in the past, which is incorrect at the foundation level. The number of foundation doctors is actually increasing, with more each year on the reserve list.1 From 2023, the foundation programme will expand to accommodate the rising number of medical school placements,2 which in turn will require an increase in the number of rotations. To accommodate this, more supervisors will be needed—either pre-existing or new supervisors.
1. Understand the Structure of the Foundation Programme
The foundation programme was initiated in 2005,3 and is the first step in continued medical training following graduation from medical school. It is uniquely placed in postgraduate medical training as the last period of general training before entering speciality training (assuming that a ‘traditional’ training route is taken). The programme involves 2 years of training: foundation year 1 (F1) and foundation year 2 (F2). Each year has an alternative speciality rotation. F1 is the pre-registration year and focuses on a doctor achieving full registration with the General Medical Council (GMC). F2 rotations must now involve a community rotation.
2. Keep Up with Curriculum Changes
The UK foundation programme 2021 curriculum4 differs from that introduced in 2016, with several important changes related to the supervision of foundation doctors and their progression. Educational and clinical supervisors should have a working knowledge of this more holistic curriculum, and the specifications for the completion of the ARCP for each year. This is important for both existing and new supervisors of foundation doctors. Box 1 provides useful links to further information about the curriculum.
|Box 1: Foundation Programme Curriculum Online Resources|
3. Know the Foundation Professional CapabilitiesThe foundation professional capabilities (FPCs) is a new 13-point curriculum within the UK foundation programme 2021 curriculum (see Table 1).4 It is designed to reflect the GMC Generic professional capabilities framework,5 and is a more holistic programme than the 2016 curriculum, with less emphasis on requirements of minimum assessments. One of the keys aims of the new curriculum is to simplify the process for foundation doctors to meet the requirements to progress to completion of F2, and from there potentially into speciality training.
The 13 FPCs are subdivided into three higher level outcomes (HLOs) to mirror the GMC’s professional capabilities framework. Within the HLOs, the capabilities form a common theme relevant to a foundation doctor and their practice.
Table 1: Foundation Professional Capabilities—Higher Level Outcomes 4
Higher Level Outcomes (HLO) 1: An accountable, capable, and compassionate doctor
1. Clinical assessment
2. Clinical prioritisation
3. Holistic planning
4. Communication and care
|HLO 2: A valuable member of the healthcare workforce|
6. Sharing the vision
7. Fitness to practice
8. Upholding values
9. Quality improvement
10. Teaching the teacher
|HLO 3: A professional, responsible for their own practice and portfolio development|
11. Ethics and law
12. Continuing professional development
13. Understanding medicine
|©UK Foundation Programme. UK Foundation Programme Curriculum 2021. UKFP, 2021. Available at: www.foundationprogramme.nhs.uk/curriculum|
4. Be Familiar with the Evidence Requirements
One of the main requirements for a foundation doctor is to collect evidence and then ‘map’ it to the most appropriate capability. When reviewing a foundation doctor’s portfolio, an educational supervisor must decide if enough evidence has been submitted to demonstrate that a specific capability has been achieved (see Table 1) by applying the pyramid of evidence (certain pieces of evidence carry more 'weight'). This may be a bigger challenge than in the past, as the curriculum is now more holistic (Box 1 provides links to further information).
A piece of evidence that appears high up in the hierarchy of evidence provides greater confidence that an ARCP panel will agree an FPC has been achieved than those that are low down in the pyramid. Supervised learning events (SLEs) rank highest and, although officially there is no minimum requirement, it is recommended that evidence of five clinical encounters is presented for capabilities 1–5. An example could involve a trainee doctor asking a senior clinician for a work-based assessment to be completed, based on an observed interaction with a patient. FPC 2 requires evidence of specific life-support capabilities, for example, completion of an advanced life-support course or equivalent (which may be a specific SLE). Understanding quality improvement (for F1 doctors) or completing a quality improvement project (for F2 doctors) is necessary for FPC 9, and evidence of ‘teaching the teacher’ must be presented in FPC 10. It is recommended that a DIRECT or Leader form6 is completed for this.
5. Reinforce the Importance of Curriculum Mapping
Mapping evidence is a critical final step once a piece of evidence has been obtained, and an educational supervisor should encourage the foundation doctor to map their portfolio to the curriculum at every opportunity. It is not part of a supervisor’s role to identify where evidence to specific FPCs within the portfolio should be linked or mapped, and the ARCP panel will not search for it in a portfolio if this hasn’t been done.
6. Remember the Summary Narrative
The summary narrative is a reflective piece of work (300 words) written by an foundation doctor to explain their evidence selection, and to demonstrate that they have reached the standard for a specific HLO. Each HLO (there are three in total) requires a summary narrative. The foundation doctor should have started each one in the first rotation, and it must be referenced in the end-of-rotation educational supervisor report. There are no specific writing criteria, and it is not formally assessed, but it is a requirement for ARCP completion.
7. Put Together a Placement Supervision Group
The Placement Supervision Group (PSG) is an anonymised formative assessment of a foundation doctor that focuses on clinical performance rather than the professional behaviours assessed in the Team Assessment of Behaviour (TAB). This is a major new addition to the foundation programme. The PSG is mandated at least once per year, although it is recommended for each rotation. It is initiated by the clinical supervisor, who requests assessments from the foundation doctor’s peers. A PSG must have at least three members (two in general practice), including a consultant or GP and other allied healthcare professionals (for example, pharmacists, senior nurses, or doctors that are more senior than F2), and the PSG must be referenced in a clinical supervisor’s report.
8. Retain Professional Development Plans
A professional development plan (PDP) is no longer specifically required to pass the ARCP. It is, however, strongly recommended that a PDP is completed by the foundation doctor for each rotation—firstly, to develop writing skills for future training and, secondly, to allow a foundation doctor to focus on what they need to do to develop themselves in the relevant training year.
9. Regularly Add to Form R
Form R is a data capture form specific to each foundation doctor. Educational and clinical supervisors should encourage the foundation doctor to complete this as they go along, as filling it in retrospectively is often more challenging. Any sick leave should be noted, as well as details of any locums completed that are not part of normal shifts. In addition, information on any significant events that a foundation doctor is involved in should be added.
10. Encourage Reflection
Reflective practice is essential for a postgraduate doctor. The ability to learn from specific events in their career is essential, and reflection is one of the tiers in the hierarchy of evidence. There are no specific requirements on the number of reflections, but regular reflection must be performed and recorded in the portfolio.
11. Complete Clinical/Educational Supervisor Reports
Each rotation in a year requires an end-of-rotation report that summarises a foundation doctor’s progress within that rotation. Both an educational and clinical supervisor must report on each rotation for the ARCP, except for the third (final) rotation each year. In the third end-of-rotation report, an educational supervisor completes an end-of-year report in advance of the ARCP.
12. Explore the ePortfolio
This top tip is not strictly related to the new curriculum, but is important for reviewing a foundation doctor’s progress and evidence presentation. ePortfolio navigation can be quite daunting. Taking time outside of end-of-rotation reports and the ARCP to navigate the portfolio system is important. Box 1 has links to helpful support material.
There are many aspects involved in the foundation programme curriculum and the requirements of the educational and clinical supervisors to support and supervise foundation doctors. The programme is now more holistic, with less of an assessment burden on foundation doctors, and all supervisors should be aware of elements in the curriculum introduced in 2021. The top tips provided here are not exhaustive, but extensive information is available, and it is always worth having a discussion with your local foundation programme co-ordinator to obtain advice and further details on the specifics.