Developing a Framework for Generic Professional Capabilities

Developing a framework for generic professional capabilities Consultation Response from the Royal College of Radiologists

Overall Comments The concept of what the GMC is now referring to as Generic Professional Capabilities is very important. The RCR strongly supports the principle that medical training must develop rounded professionals rather than simply technical experts and finds much to support in the detail of the framework. We believe the content is already well represented (though not completely) in the specialty training curricula for clinical oncology and clinical radiology. We are disappointed that the presentation of this consultation implies that generic competencies such as presented here are not already well embedded in training, which may give a very misleading impression to public and patients. The document includes the statement that: “To inform the Shape of Training review, we gathered a forum of key interest groups in 2012. The forum felt that curricula for postgraduate training may have narrowed in scope over the past decade, listing competences and procedures that must be completed, with very little focus on developing generic professional capabilities.” Whilst that may have been the opinion of a focus group it does not seem to be based on the evidence since, as you go on to note: “Many curricula already feature aspects of the framework, some extensively.” As the GMC knows, the AoMRC produced an extensive Common Competences Framework in 2009 and PMETB at the time required all specialties to incorporate this into curricula. We are not clear how we will be expected to incorporate the framework into future versions of curricula and would appreciate more early guidance on this – whether the expectation is that in future all syllabus content should be presented within the structure of the 10 domains or whether the generic and specialty-specific content is expected to be shown separately. We are also not sure if the level of detail shown for capabilities represents what the GMC would like to see in curricula or if more expansion into detailed competencies (e.g. like the AoMRC Common Competences Framework) is expected. We can see pros and cons to either approach. Domain 1 The wording of this section describes some of the requirements of GMP and sets out some examples of responsibilities. These are critical in professional practice and in maintaining a professional relationship with patients. Whilst these are all important, it is not clear which if any of these are expected to be taught as part of a training programme. Some seem to be more a description of innate values (e.g. acting with honesty and integrity), some a statement of an obligation (e.g. being accountable as an employee to their employer, working within appropriate health and safety legislation). Whether innate or learnt, the points comprise a good framework. However some are very hard to define e.g. developing emotional resilience, and even harder to assess - how can one set a 'standard' for such a behaviour? Domain 2 The listing of “literate, numerate and articulate” is not helpful. It is inconceivable to think that someone could complete (or start) a medical degree without meeting the most stringent dictionary definition of “literate” or “numerate” and if, as is presumably the case, something more than the ability to read and work with numbers is intended it is not clear what. Similarly “articulate” is highly subjective and better described by the specific item “able to give clear, accurate and comprehensible verbal instructions”. The clinical skills section provides a good starting point for refinement and development by specialties. For example, for clinical radiology the formulating of therapeutic management plans or provision of palliative care might not be relevant but the radiation protection aspects of medical devices might need to be expanded. Domain 3 The Professional Requirements section is a statement of fact for all doctors but it is not clear if the rationale for including this section here is in the expectation that training programmes should ensure that trainees understand these requirements for their future careers, or as reminder of current obligations whilst in training. It reads like the latter, but we think the former would be more useful, with some adjustment of the wording to reflect this. For example there is not generally an expectation on trainees to demonstrate ongoing CPD in parallel with training, but the current wording implies that there is. The inclusion of employment law in the National Legislation section is a massive and complex area that it seems unlikely any training programme is equipped to deliver and it is not clear what benefit is intended by this, or what if any specific aspects are felt to be particularly relevant. The item “the law on patient and carer involvement and shared decision making” seems to be in the wrong section (should it not fit under National Legislation?). Domain 4 The points are good, but the following emphases/additions are suggested:  Patients etc - emphasise the need to communicate sensitively and appropriately with vulnerable patients e.g. children, elderly patients.  Colleagues - emphasise the need to communicate appropriately with ALL members of the team, such as AHPs and administrative staff and respect/value all contributions. We wonder if this item “making appropriate arrangements where culture does not permit certain conversations with a male doctor” might need to be broadened to include female doctors for some circumstances. Though there must be a balance between attempting to accommodate reasonable cultural requirements and not accepting these as an excuse for sexism. Domain 5 No comments Domain 6 “take part in revalidation” does not sit well here and is already addressed in Domain 3. We are not sure what is meant by “debrief their own performance” and if this is different to “reflect on their personal behaviour and practice”. Domain 7 Selective application will be needed – for example we do not think radiology trainees should be expected to manage common mental health conditions. Domain 8 This is very important. The term 'safeguarding issues' is rather vague in point 1. In terms of children, one might use terms such as non-accidental injury and neglect, so there is no ambiguity. Bullet 4 - Positive behavioural support is also used for children in distress. The Equality Act 2010 is a substantial piece of legislation much of which refers to employment rights. It is unreasonable and irrelevant to require knowledge of all of this so we suggest rewording this item to refer to relevant aspects of the Act. Domain 9 “take part in induction and orientation” is unclear. Does this mean take part as a new employee (in which case it is hardly an ability to demonstrate) or take part in leading the induction and orientation of new staff? We suggest the addition of a point about respecting patients' wishes in respect of whether or not they wish to participate in the education of trainees. Domain 10 No comments Is it important that generic professional capabilities are assessed? It is important that GPCs in general are assessed in order to: emphasise that these capabilities are as important as specialty-specific clinical knowledge and skills; to drive teaching and learning; to assure regulators and the public of doctors’ preparedness. This does not necessarily mean that all capabilities must be individually assessed for all trainees. Can generic professional capabilities be assessed? The wording of this statement implies the need to document assessment of each separate item in the curriculum: “Any assessment framework or assessment method must assess whether a doctor has developed each of the stated generic professional capabilities or elements.” This seems somewhat at odds with the latter statement that “Longitudinal assessment methods that take a holistic or longer term view of personal and professional behaviour and practice may be better than isolated assessments at specific points during training”. Currently most assessment frameworks take a sampling approach – i.e. not expecting specific recording of assessments against each curriculum competency – which is generally in line with the sentiments expressed about longitudinal assessment. We support the view that assessment of many of the generic professional capabilities will be best undertaken by longer term professional judgements. Certain elements can be assessed within the current framework of formative and summative assessments, which should remain in the training programmes, but certain elements involve more complex, subjective assessments which may be more difficult to ensure consistency / precision. Behaviours are extremely difficult to assess with any level of accuracy. It would be extremely challenging to assess certain behaviours in clinical practice e.g. “developing emotional resilience”. Do you think it is possible to use existing methods and tools for assessment? Some existing tools will have a role to play (e.g. MSF, Audit/QI Assessment, royal college examinations where they include relevant content). Many WpBAs already include aspects of generic capabilities such as communication with patients or colleagues. The development of a multiplicity of new assessment formats is unlikely to be helpful, particularly as the role and value of workplace-based assessments in informing summative decisions is still under question. Do you agree that we have sufficiently addressed patient safety in the framework? Yes, particularly via the important Domain 6, but also in other areas. Do you agree that we have sufficiently addressed equality and diversity in the framework? Yes Are there any other themes you think we should include in the framework? Possibly more is needed on professional relationships with patients (including use of social media etc.) Is there anything you think we should remove from the framework? Only the small number of points made in response to earlier questions. How easy was the framework to read and navigate? The framework itself is easy to read and navigate, though our understanding is that the framework forms the basis for what should be included in individual curricula, rather than being an end product in itself to be read by trainees, trainers and the public. The diagram on P11 does not seem to relate to the 10-domain structure and we are not sure what the relevance of this is or how to interpret it. Did you understand all the terms used? A number of terms are used which are not in common usage and may not be immediately understood, e.g. emotional resilience, followership, fixation error, cognitive biases, human factors, positive behavioural support. Footnotes are provided for some but not all of these. It is reasonable to use appropriate technical terms such as these, but trainees and trainers may need more explanation as part of their education.