Resources: foundation doctors
The foundation doctor should be proactive in managing their continuing education and career development and must take responsibility for detailing all achievements and progress within their e-portfolio.
To achieve this, the foundation doctor needs to understand:
- the key principles of foundation training: these are explained in the Introduction and Purpose of the foundation sections.
- the role of induction during the foundation programme:
- the local education provider (LEP) will ensure an introduction to the foundation programme and set out how it will be delivered and assessed.
- the local education provider (LEP) will also ensure local induction to the workplace at the start of each placement
- educational and clinical support and supervision during the foundation programme:
The educational supervisor (ES), clinical supervisor (CS) and placement supervision group (PSG) are/comprise senior professionals who are there to provide guidance and support for foundation doctors. The CS and ES will meet regularly with the foundation doctor to discuss and agree objectives and review progress. More details of the ES, CS and PSG are provided below.
Initial appraisal and educational agreements
When foundation doctors start in a new placement, they must arrange an early meeting with both their educational and clinical supervisors, ideally, before the placement commences. This is the responsibility of the foundation doctor. If the foundation doctor is having difficulty in arranging this meeting, the
Foundation Training Programme Director (FTPD) will provide a back-up mechanism to ensure that this meeting takes place.
The meeting is an essential starting point for negotiating the educational goals and discussing learning opportunities, the assessment process and use of the e-portfolio. The goals should take into account individual learning needs and personal circumstances.
The educational agreement and related learning plan must be recorded in the e-portfolio.
Meetings with the educational supervisor
In the first session with the educational supervisor, the foundation doctor may wish to discuss aspects of the curriculum. This might include:
- how to build on strengths from undergraduate training
- particular areas of interest to explore
- any potential targets for development which may need to be addressed
- the minimum levels of performance expected from foundation doctors
- how to record achievements in the e-portfolio
- career objectives.
The foundation doctor and the educational supervisor should also agree a timeline for the undertaking and recording of achievements, and should agree the times and dates for subsequent meetings.
Meetings with the clinical supervisor (CS)
In addition to departmental induction, the named CS will meet the trainee at the start of each placement to agree educational objectives for the placement and to identify the members of the PSG to the trainee.
The clinical supervisor will normally meet with the foundation doctor at the mid-point of the placement to review progress and again at the end of the placement as part of the assessment process. The supervisor or trainee may arrange additional meetings as required.
- Workplace based learning during the foundation programme:
Foundation doctors will cover many of the foundation professional capabilities whilst providing service in the workplace. They should take opportunities to receive feedback during service and more formally, using supervised learning events. The curriculum sections 'learning and teaching' and 'supervised learning events', identify and explain the system of workplace-based learning and other educational opportunities, which should be made available to foundation doctors. Workplace-based learning is supplemented by reflection, self-directed learning and formal educational sessions provided by the LEP.
- Supervised learning events (SLEs):
SLEs are opportunities to receive feedback from consultants and other senior colleagues. They should prompt foundation doctors to reflect on what they have learnt and help them to recognise their strengths and also to target areas for further development. To be most effective, SLEs should cover a range of situations and challenges of varying complexity. The section, SLEs, sets out in detail the tools and how they should be used.
- What foundation doctors are expected to achieve during the foundation programme:
Satisfactory sign off at the end of F1 and F2 requires demonstration that the foundation doctor's performance has met or exceeded the required standard in each of the 20 foundation professional capabilities (foundation programme training outcomes). The 20 'foundation professional capabilities' reflect key generic aspects of professional and clinical medical practice. The syllabus also includes 'descriptors' these are general expectations and indicative examples of clinical and professional accomplishments related to the associated 'foundation professional capability'. A foundation doctor may choose to use some of these 'descriptors' as evidence of achievement, however they should note that these are not a comprehensive list and many more examples exist. The hierarchy of the syllabus is explained in the section,
How to use the Syllabus.
Foundation doctors must provide evidence of engagement with the educational process and that their achievements in each of the twenty foundation professional capabilities have met or exceeded the minimum expected level of performance set out in the curriculum. In doing so, they will demonstrate how their knowledge, behaviour, clinical and professional skills and judgement have developed throughout the course of the programme. supervised learning events (SLEs) are an excellent opportunity to demonstrate engagement with the learning process and to allow senior colleagues to observe the foundation doctor's practice in the workplace.
When engaged in reflection, supervised learning events, formal assessment or self-assessment, foundation doctors may refer to the 'descriptors' for examples of how they might demonstrate that their achievements meet or exceed the minimum expected level of performance in each of the foundation professional capabilities. Educational and clinical supervisors are there to help if foundation doctors experience any difficulties with this.
- Recording progress in the e-portfolio:
It is the foundation doctor's responsibility to populate their e-portfolio with evidence of development. The foundation doctor must make use of the e-portfolio as a record of learning (refer to the reference guide) and should do this from the very start of their foundation training.
Evidence from the trainee will usually take the form of
reflection on clinical or professional experiences including, patient contact, professional interaction, clinical incidents, quality improvement work and formal teaching. It can also include evidence of formal training (certificates), participation in evidence-based medicine (guidelines, posters, presentations) or quality improvement work.
Evidence from the trainer will usually involve the trainer reviewing an aspect of the foundation doctor's practice, providing feedback and documenting it directly in the doctor's e-portfolio. The foundation doctor should reflect on the feedback with focus on how to improve practice in future.
Many types of evidence can be used by the trainee to show appropriate professional and clinical practice and therefore, how their achievements meet or exceed the minimum expected level of performance in each of the foundation professional capabilities.
- Reflective practice: foundation doctors should make reflection a part of their routine practice. When a doctor writes about their reflections, and discusses this writing with a senior colleague, it provokes enriched deeper learning and critical thinking that leads to improvement in practice.
Foundation doctors should reflect on and learn from both their positive and negative experiences in order to demonstrate professional development. When things have gone well the foundation doctor should consider what led to a positive outcome and how to ensure that they incorporate this into their practice. Equally important, when an outcome has been suboptimal, the foundation doctor should reflect on why and consider what lessons if any, can be learned to improve future practice. Support and advice from their clinical or educational supervisor should also be sought, as needed.
- Ensuring professional development:
One of the best ways the foundation doctor and their supervisor can see that their development is in line with achievement of the foundation professional capabilities, is through regular supervised learning events (SLEs). Feedback should be given straight after each SLE. This feedback should indicate both what the doctor is doing well and also suggested actions which will help develop skills in the workplace.
SLEs should start early in each placement to give foundation doctors time to gain the most from feedback. Foundation doctors should read and reflect on how they will change practice as a result of the feedback.
The end of placement reports by the clinical supervisor (CS) and educational supervisor (ES) are also used to indicate whether the foundation doctor is on course to achieve the required outcomes by the end of the year of training.
Assessment
Foundation doctors should familiarise themselves with the assessment section in the curriculum.
Assessment of performance is based on observation of the foundation doctor in the workplace. Formal assessments include the team assessment of behaviour (TAB) and
end of placement reports by the clinical supervisor (CS) and educational supervisor (ES), and the educational supervisor's end of year report. F1 doctors will also need to provide evidence of their ability to perform core procedures as mandated by the General Medical Council (GMC).
The clinical supervisor's assessment will be based on multiple observations of the foundation doctor's practice and progress in the workplace. In addition to their own observations the CS will draw on feedback from doctors and senior healthcare professionals in the placement supervision group (PSG).
There is an expectation of professional development during each placement. The foundation doctor's performance will be judged according to whether it is appropriate for the stage of training and will reflect whether their achievements in the foundation professional capabilities suggest that they are on course to meet or exceed the minimum expected level of performance in each of the foundation professional capabilities in order to be signed off at the end of the year of training.
The foundation doctor should recruit an appropriate number and mix of appraisers for the TAB. A satisfactory TAB is dependent not only on the comments received but also on receiving sufficient responses from an appropriate spread of assessors. Trainees should request their TAB feedback in a timely manner to ensure sufficient responses.
Comments from the TAB should be discussed with the educational supervisor who will help the trainee reflect on and provide guidance on resolving any areas of concern.
- Annual Review of Competence Progression: at the end of F1 and F2 the annual review of competence progression (ARCP) provides a formal review of progress. This process is used in all specialty training programmes in the UK. The ARCP includes review of CS and ES reports and evidence provided in the e-portfolio. A satisfactory ARCP will be based on achievement in each of the 20 foundation professional capabilities will lead to the award of Foundation Year 1 Certificate of Completion (F1CC) which is required to be eligible for full registration at the end of F1 and to obtain the Foundation Programme Certificate of Completion (FPCC) at the end of F2.
Minimum expected level of performance during the F1 and F2 years
By the end of each year of foundation training the foundation doctor's achievements in each of the 20 foundation professional capabilities (foundation programme training outcomes) must meet or exceed the minimum expected levels. By demonstrating this, the foundation doctor will have demonstrated achievement in the key aspects of clinical and professional medical practice. When considering the provision of evidence, foundation doctors may find it helpful to refer to the general expectations descriptors' indicative examples of clinical and professional accomplishments set out in the 'descriptors'.
Remember that performance is reviewed according to the stage of training, for example less will be expected of a doctor in their very first placement than a doctor in the same placement at the end of F1. A satisfactory clinical supervisor (CS) and educational supervisor (ES) end of placement report will indicate that, by the end of the year, they expect the foundation doctor's practice in each of the 20 foundation professional capabilities (foundation programme training outcomes) to meet or exceed the minimum expected levels of performance.
At the start of the foundation programme, foundation doctors should concentrate on achieving the F1 sign off by ensuring that they are able to provide evidence that their professional and clinical practice meets or exceeds the high level performance indicators for each of the 20 foundation professional capabilities. This evidence might be based on the indicative examples and general expectations set out in the accompanying 'descriptors'. Alternatively the foundation doctor and their trainers may provide examples of their own. It is essential to recognise that it is neither expected nor necessary for a trainee to provide evidence of every 'descriptor'. F2 doctors are expected to perform at a higher and increasingly independent level. All foundation doctors should consider further professional and clinical development and work towards achievement of F2 outcomes from the outset.
The foundation doctor who demonstrates excellence may well achieve and exceed the minimum expected levels of performance across all 20 foundation professional capabilities, and beyond, well within the two-year time frame. However, the foundation doctor cannot pass an ARCP before finishing a full year in F2 placements.