Collins Review- Foundation for Excellence: An Evaluation of the Foundation Programme

Collins Review (published Oct 2010)

Foundation for Excellence: An Evaluation of the Foundation Programme

The report was commissioned by Medical Education England (MEE) to formally evaluate the Foundation programme. The Terms of Reference for the Evaluation were to assess how successfully the Foundation Programme is delivering against its original objectives, as well as against the future needs of the National Health Service and of trainees. The Evaluation was to recommend changes to the Foundation Programme to ensure that the first two postgraduate years deliver against future needs.


Issue 1: Lack of a clearly articulated purpose for the Programme

By the end of 2011, the GMC should define, in a revised edition of The New Doctor, the outcomes required to complete the second year (F2) of the Foundation Programme.

Issue 2: Misgivings about the selection of trainees into the programme

A standardised and uniform process should be developed for the recruitment, selection and appointment of Foundation doctors by 2012, taking into account the guidance provided by the GMC in Tomorrow’s Doctors and The New Doctor.

Issue 3: Confusion over the role of the trainee

MEE should work with its members and partners to develop a consensus statement on the role of the trainee by 2012. NHS Trusts and the HR departments which draw up service rotas must have a detailed understanding of the role of Foundation doctors.

Issue 4: Questions about GMC registration of trainees and medical student

The GMC should review the timing of full registration. It should also review the merits of marking on the Medical Register the successful completion of the Foundation Programme.

Issue 5: Dissension over the length of the Programme and its rotations

The length of the Programme should remain at two years for the present, and be reviewed in 2015.  In the meantime F2 must demonstrate that it is a step-up in experience from F1 and be able to prove its overall value beyond doubt.

Issue 6: Perceived deficiencies in careers information and advice

Define good practice for the provision of careers information and advice.

Issue 7: Lack of flexibility in the Programme

Greater flexibility should be available within a single programme, allowing F1 trainees to have greater input into the allocation of their F2 specialty placements and rotations.

Issue 8: Gaps in the curriculum

The Foundation Programme curriculum should be revised to give greater emphasis to the total patient, long-term conditions and the increasing role of community care. It should also reflect the changing ways of working, in particular the need for team-working skills within a multi-professional environment.

Issue 9: Maldistribution of placements by specialty

The successful completion of the Foundation Programme should normally require trainees to complete a rotation in a community placement, e.g. community paediatrics, general practice or psychiatry.  The distribution of specialty posts in the Foundation Programme is predominantly in two specialties and this must be reviewed by 2013 to ensure broader based beginnings, to share the supervision of trainees among a wider number of supervisors and to ensure closer matching with current and future workforce requirements.

Issue 10: Shortcomings in technology-enhanced learning

The importance of learning resources including skills labs and simulated patient environments is reaffirmed. Concerted efforts need to be made across the different organisations involved to co-invest in facilitating innovations in the delivery of education and training.

Issue 11: Equipping and approval of trainers is necessary

A framework for the approval of trainers involved in teaching and assessing trainees is a high priority and the professional standards developed and published by the Academy of Medical Educators provides a useful resource for this.

Issue 12: Assessment is excessive, onerous and not valued

The range of assessment tools and the number of times assessment must be repeated in the Foundation Programme should be reviewed, with a view to reducing these to the minimum required by 2013. The opportunity to avoid repetitive assessments, by improved transfer of information between undergraduate and postgraduate schools, should be actively explored.

Feedback from patients who have been in contact with the Foundation doctor should be part of assessment by 2013 and the GMC should be invited to oversee research to identify best practice in this regard.

All Foundation Programme assessments should be conducted and signed off by resourced and trained assessors by 2013. Assessors should undergo regular review of their performance for this role.

Issue 13: Variability in the deployment and supervision of trainees

Methods must be developed to ensure that all health professionals and employers understand the objectives of the Foundation Programme, become quickly conversant with the prior clinical experience and level of competence of individual F1 and F2 trainees, and support the standard that no Foundation doctor will be required to practise beyond their level of competence or without appropriate supervision.

Issue 14: Variability in the quality of education and learning

The Postgraduate Deans, the GMC and NHS Trusts must clarify the appropriate balance between service and education during F1 and F2 and ensure that the effective monitoring of this balance is being achieved by 2012. Clear pathways must be available for trainees to obtain satisfactory resolution if the appropriate balance is being eroded.

Issue 15: Lack of pastoral support for trainees

Good practice with regard to pastoral care needs to be defined

Issue 16: Inadequate transfer of information about trainees

In the interests of patient safety and in order to help trainees to address issues which have been identified, the transfer of relevant information about medical students and trainees across the continuum of education and training must take place (within carefully defined limits) by 2012.


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