This section should be used in conjunction with how to use the syllabus.

Assessment in foundation is based on observation of practice in the workplace, evidence of achievements of each of the foundation professional capabilities (the foundation curriculum outcomes), evidence of engagement with the foundation educational process and evidence of proficiency in General Medical Council (GMC) mandated core procedures (F1 only). Assessments include team assessment behaviours (TABs), the clinical supervisor's and the educational supervisor's respective end of placement reports and the educational supervisor's end of year report. This will be reviewed in the annual review of competence progression (ARCP).

 

What will be assessed

Foundation doctors will only be signed off for progression to the next stage of training when they have demonstrated that their performance meets or exceeds the minimum expected levels of performance required for sign off for each of the 20 foundation professional capabilities. The assessment process is not designed to rank foundation doctors.

Foundation doctors must use their e-portfolio to supply a spread of evidence with appropriate reflection on how their performance meets or exceeds the minimum expected levels of performance required for sign off for each of the 20 foundation professional capabilities. Suitable documentation might include evidence of achievement of some of the 'descriptors' associated with the foundation professional capability. Satisfactory performance will also be judged by engagement with supervised learning events (SLEs) and the resulting personal development. The assessment process is not designed to rank foundation doctors.

At the end of each placement the named clinical supervisor and educational supervisor will report whether the foundation doctor's performance is on course to meet or exceed the minimum expected levels of performance required for sign off for each of the 20 foundation professional capabilities at the end of the year of training. These reports will feed into the educational supervisor's end of year report, which will then inform the ARCP review. The annual review of competence progression panel will be able to make reasonable adjustments to reflect individual circumstances.

 

Clinical supervisor's end of placement report*

Towards the end of each placement*, the foundation doctor and named clinical supervisor will meet to complete a review of the foundation doctor's overall performance and progress in the placement.

The clinical supervisor's report is a review of whether achievement in each of the four sections of the curriculum suggest that the foundation doctor will, by the end of the year of training, meet or exceed the minimum expected level of performance in each of the foundation professional capabilities.

The judgement will be based on review of several sources of evidence including:

  • Direct observation of practice in the workplace by the clinical supervisor (CS)
  • Feedback from the placement supervision group (PSG)

The CS should seek and record evidence from the PSG to corroborate the above. The names of those contributing evidence on the foundation doctor's performance will be recorded in the report

  • Evidence of engagement with the learning process recorded in the e-portfolio
  • Evidence of achievement of curriculum outcomes recorded in the e-portfolio including: reflection on clinical or professional experiences, evidence of formal training (certificates), participation in evidence based medicine (guidelines, posters and presentations) or quality improvement work. The totality of engagement in populating the various domains in the e-portfolio will be used to assess the foundation doctor's success in achieving the outcomes described in the curriculum
  • Evidence of satisfactory performance of core procedures (F1 and only in F2 if not signed off in F1, for example when F1 equivalent happened abroad).

The report will indicate whether the foundation doctor's trajectory is likely to meet or exceed the minimum expected levels of performance required for sign off for each of the 20 foundation professional capabilities. The CS report will use the following comments: no concern, some concern, major concern. Details of the scheme are found in the guidance for clinical supervisor's end of placement report. Explanatory comments to justify the rating are mandatory.

The clinical supervisor's report should comment specifically on:

  • Any noteworthy aspect of this foundation doctor's practice
  • Any targets for future development
  • Any concerns regarding this foundation doctor's practice must be supported by specific examples
  • The foundation doctor's appropriate participation in the agreed educational process
  • Evidence of the foundation doctor's personal and professional development as a result of feedback and reflection.

If there is any concern that a trainee's performance will not meet the expected minimum levels of performance required for sign off for any of the 20 foundation professional capabilities this should be raised with the trainee at the earliest opportunity. The discussion and ensuing action plan should be recorded in the e-portfolio. When minor concerns have been resolved satisfactorily the final report will indicate no concern. If there is an ongoing concern then any professional capabilities which are the source of concern must be specified. The CS may wish to refer to the associated 'descriptors' or other examples to provide further detail.

The outcome of the final discussion will be recorded in the doctor's e-portfolio in the clinical supervisor's end of placement report. In most cases, both the foundation doctor and the clinical supervisor will agree the report. Where there is disagreement the foundation doctor will sign to indicate that they have seen the report. A box will be available for any comments from the foundation doctor.

*note that the CS in the final placement of the year will prepare their report in time for the ARCP

 

Educational supervisor's end of placement report*

The educational supervisor's report will indicate whether the foundation doctor's trajectory is likely to meet or exceed the expected minimum levels of performance required for sign off for each of the 20 foundation professional capabilities at the end of the year of training.

The judgement will be based on review of several sources of evidence including:

1) Clinical supervisor's report

The educational supervisor will sometimes also be the clinical supervisor and then will complete a combined report. If the roles are separate, then the educational supervisor will summarise with 'no concerns', some concerns' or ' major concerns' and add comments to support the judgement.

2) Team assessment of behaviour (TAB)

TAB is the multi-Source feedback tool that is used in the foundation programme. TAB comprises collated views from a range of multi-professional colleagues. It is mapped to the self-assessment tool with identical sections. Guidance for foundation doctors, TAB assessors and educational supervisors is available on the UK Foundation Programme Office (UKFPO) website.

The foundation doctor is responsible for organising TAB and should arrange this in a timely fashion. The educational supervisor cannot sign off the foundation doctor unless a valid and satisfactory TAB has been completed.

The foundation doctor must complete a self-assessment of behaviour before inviting raters to contribute to the TAB process. Self-TAB will include reflection on personal performance.

For each TAB, the foundation doctor should approach 15 raters/assessors. Up to two foundation doctors may be used but attention must be paid to ensure an appropriate mix of raters or the TAB will be invalid.

Following TAB, foundation doctors should reflect on any sections in which there is variance between their self-rating and that of their assessors. They should discuss significant discrepancies with their educational supervisor.

 

Timing and frequency of TAB

  • TAB must take place at least once a year. Deaneries/foundation schools have the option of increasing the frequency.
  • TAB feedback must be gathered during a single placement and by the date specified by the educational supervisor
  • TAB will normally be performed within 1st placement in order to allow time for any required remedial action. However if there are insufficient raters within a placement to allow this the TAB should be completed within the first 6 months of the year of training.
  • If there are any concerns about a foundation doctor which need to be addressed TAB should be repeated. Deaneries have the option of altering the periodicity of TAB to satisfy local needs.

Requirements for a valid TAB

In order to be valid TAB must be completed at the correct time, with feedback from a sufficient number and mix of raters.

Required mix of assessors

To ensure quality, a valid TAB requires a minimum of 10 assessors including at least four senior assessors comprising consultants / trained GPs and senior nurses. The named clinical supervisor will normally be one of the assessors.

The mix of raters/assessors must include at least:

  • 2 consultants or trained GPs. The named clinical supervisor should normally be used as an assessor. However, there may be occasional circumstances where this is not possible, hence, inclusion of the CS is not mandatory.
  • 1 other doctor more senior than F2.
  • 2 Senior nurses (band 5 or above)
  • 2 allied health professionals / other team members including ward clerks, secretaries and auxiliary staff.

Outcomes from TAB

TAB outcomes include

  • Satisfactory
  • Incomplete (within time limit)
  • Invalid (incorrect number or mix of assessors)
  • Unsatisfactory: anything other than trivial minor concern which does not require action will necessitate repeat TAB.

The educational supervisor will meet to review the TAB responses with the foundation doctor and if necessary arrange any additional support required to address concerns.

3) Core procedures

The GMC requires demonstration of competence in a series of procedures in order for a provisionally registered doctor with a licence to practise to be eligible for full registration.

It is a requirement that the foundation doctor provides evidence within the e-portfolio of satisfactory performance of each core procedure at least once during foundation year 1 (F1). By the end of F1, the foundation doctor should be able to competently perform and teach undergraduates these procedures.

The core procedures from F1 do not need to be repeated in foundation year 2 (F2), but evidence of the F1 sign-off is required for successful completion of the foundation programme. It should also be recognised that with practice, the foundation doctor is expected to demonstrate continuing improvement of skills in whichever procedures they perform.

4) E-portfolio

The totality of engagement in populating the various domains in the e-portfolio will be used as a method of assessment of the foundation doctor's success in achieving the expected minimum levels of performance required for sign off for each of the 20 foundation professional capabilities. Although included in the clinical supervisor's report, this will also be reviewed and assessed by the educational supervisor.

5) Engagement in SLEs and attendance at formal educational events

Both of these will help inform the report which will allow the educational supervisor to determine and comment on the learning progression and engagement of the foundation doctor.

Whilst engagement with SLEs and evidence of curriculum coverage will be taken into account, the overall judgement will include a triangulated view of the foundation doctor's day-to-day work performance, which will include their participation in, and attendance at, educational activities, appraisals, the learning process and recording of this in the e-portfolio.

The outcome of the final assessment should be discussed by the foundation doctor and the educational supervisor and recorded in the doctor's e-portfolio in the educational supervisor's end of placement report. The report should detail any outstanding issues that still need to be addressed. Refer to section 10 of the Reference Guide. As in the CS' report, where there is disagreement, the foundation doctor will sign to indicate that they have seen the report. A box will be available for any comments from the foundation doctor.

6) Annual reports - Educational supervisor's end of year report

The annual report is an overall professional assessment and judgement of the foundation doctor. This is a synthesis of all of the placement reports for the year. The educational supervisor's end of year report should comment specifically whether or not the Foundation doctor has met or exceeded the minimum expected levels of performance required for sign off for each of the 20 foundation professional capabilities for the current year (F1/F2) of training. This will inform the Annual Review of Competence Progression (ARCP).

 

Annual Review of Competence Progression

The ARCP is a review of all of the evidence regarding a foundation doctor's performance over a year of practice. The decision about whether or not a foundation doctor's performance in each of the 20 'professional capabilities' (Foundation training outcomes) has met or exceeded the minimum required standard for satisfactory completion of F1, or the foundation programme as a whole, will involve an overall judgement summarised in the end of year report from the educational supervisor and reviewed by the ARCP panel. The ARCP panel judgment will include review of any concerns which have been raised. The ARCP panel is convened by the Foundation Programme Director and their judgement will form the basis of the Foundation Programme Director/Tutor's recommendations regarding satisfactory completion of F1 or and the foundation programme as a whole.

There is an appeals mechanism for foundation doctors who have not satisfied the requirements and/or are disputing judgements of performance.

If an F1 doctor fails after a 12 month extension, the appeal would normally be held by the graduating UK medical school. If they did not graduate from a UK medical school, the appeal would be held by the deanery.

If an F2 doctor fails, the deanery/foundation school will consider the appeal. The deanery will also normally initiate career management discussions and may refer the foundation doctor to the National Clinical Assessment Service (NCAS) or to the GMC Further information can be found in the relevant section of the reference guide and in the Standards for Training in the Foundation Programme (in The Trainee Doctor, 2011).

Foundation doctors in Scotland have a different system and should refer to the NHS Education for Scotland website for further information.

 

Assessment differences between F1 and F2

Foundation year 1 (F1)

A satisfactory ARCP will indicate that the F1 doctor has met or exceeded the minimum expected level of performance required for sign off for each of the 20 foundation professional capabilities. This will lead to the award of Foundation Year 1 Certificate of Completion (F1CC), this will inform the medical school as to whether they should complete and issue the GMC Certificate of Experience. Once the certificate is issued, the foundation doctor is eligible to apply for full registration with the GMC. The GMC expects satisfactory achievements in all domains set out in Promoting Excellence: Standards for medical education and training and reproduced in the Foundation Programme Curriculum syllabus outcomes.

Foundation year 2 (F2)

The overall judgement of satisfactory completion of F2 will indicate that the F2 doctor has met or exceeded the minimum levels of performance required for sign off for each of the 20 foundation professional capabilities. This will lead to the award of a Foundation Programme Certificate of Completion (FPCC), this will allow the foundation doctor to be eligible to apply to enter core, specialty or general practice training.

 

Lack of progress

Most foundation doctors' will have met or exceeded the minimum levels of performance required for sign off for each of the 20 foundation professional capabilities for F1 by the end of their first year, and the F2 standard of performance by the end of their second year (or whole time equivalent). The actual duration of foundation training will depend on whether the foundation doctor is working full time or less than full time.

Deaneries/foundation schools have systems in place to help foundation doctors who may need additional or targeted support. Such doctors may be identified as a result of:

  • Information transferred from undergraduate medical schools (refer to Conference of Postgraduate Medical Deans COPMeD, MSC and GMC guidance)
  • Concerns raised by foundation doctors themselves, which might include problems relating to their training or assessments
  • Periods of prolonged or repeated absence (refer to the reference guide for further detail)
  • Reluctance/failure to take part in educational processes
  • Reluctance/failure to engage in the appraisal process
  • Concerns about day-to-day clinical work raised by educational and/or clinical supervisors (directly or on the basis of report by other health care professionals)
  • Serious incidents/events/complaints from patients, colleagues or carers.

Whenever concerns regarding progress towards meeting the minimum expected levels of performance required for sign off for each of the 20 foundation professional capabilities are identified the issues must be discussed with the foundation doctor at the earliest opportunity. The educational supervisor should follow the reference guide and any additional local processes and seek early advice when necessary.

Doctors who do not make adequate progress may require additional and targeted education. This will be set out in an agreed learning plan which will include time limited milestones with a schedule of review and assessment. The plan should clearly set out how the trainee will be able to demonstrate that they have met or exceeded minimum expected level of performance and the anticipated time scale for the additional training. Training may be extended for up to a maximum of one year at F1 or one year at F2 (or equivalent for foundation doctors working less than full time) at the discretion of the local deanery.

If there is still inadequate progress following additional and targeted support, then the doctor will be deemed to have failed that element of their foundation training. This means that they will have failed to meet the minimum expected levels of performance required for satisfactory completion of F1 or satisfactory completion of F2. The deanery/foundation school in partnership with the graduating medical school must inform the GMC about any doctor whose performance of the foundation professional capabilities fails to meet the requirements for satisfactory completion of F1 will not be "signed off". Doctors failing to meet the requirements for satisfactory completion will not be eligible for full registration with the GMC; they will not be able to progress into F2 and will only be able to work in a rotation approved for training at F1 level. Doctors who do not satisfactorily complete F2 will not be issued with a Foundation Programme Certificate of Completion (FPCC) and will not be eligible to progress into core, specialty or GP training.

Inadequate progression is most prominently identified by an unsatisfactory ARCP.

The appeals mechanism is described above after the paragraph on ARCP.

The employer is also responsible for assessing and determining the employability of a foundation doctor. A foundation doctor may not be deemed employable in a foundation placement or rotation where particular concerns or problems have been identified.

In such instances, the employer must inform the deanery/foundation school, and in normal circumstances an agreement would need to be reached over referral of the foundation doctor concerned to the GMC, so that the GMC can determine whether or not the foundation doctor can remain on the professional register. In most circumstances this would require referral to the GMC's Fitness to Practise Procedures Committee.