Collins Report summary and Progress

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.

The Collins Review of Foundation Training has been published. The main recommendations are that the length of the Foundation Programme should remain unchanged at two years, but this should be reviewed in 2015 when the impact of the General Medical Council (GMC) recommendations in Tomorrow’s Doctors will be clearer, and that action should be taken to strengthen supervision for Trainees, many of whom have had to act beyond their level of competency. The review also recommended that trainers should be supported in providing the supervision for the trainees.

Other recommendations included:

  1. Standardised recruitment system for selection into training
  2. Need to define the balance between service and educational needs. It is essential that, in addition to delivering patient care, Trainees receive protected time with which to complete their Training. Failure to do so could lead to a generation of inadequately trained doctors and, in turn, compromise patient safety.
  3. 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.
  4. 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.
  5. 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.
  6. 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.
  7. 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.


Progress on the Collins Review:

The Academy of Medical Royal Colleges has revised the foundation programme curriculum for trainees who start in 2012 to deal with some of the concerns raised by John Collins’s review of the programme in 2010.

The updated curriculum aims to meet the purpose of the foundation programme and includes high level descriptors, differentiating between F1 and F2 outcomes, after the review by Professor Collins and Medical Education England said that the programme “lacks a clearly articulated and generally accepted purpose.”

Greater emphasis is given to long term conditions, in response to comments that the syllabus was too biased toward the acutely ill patient; and the “total patient” and the increasing role of community care are also given more precedence.

Formal assessment during foundation training will take place in supervised learning events evenly spread throughout each placement, instead of workplace based assessment. The Collins report described the current arrangements for assessment of foundation trainees as “excessive, onerous and not valued” and recommended that the number of times that foundation doctors are assessed should be cut.

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