Successful completion of the foundation programme requires an understanding of the hierarchy of syllabus and how this relates to the assessment process.
The hierarchy of the syllabus
The hierarchy is illustrated in figure 4
The syllabus is organised into four sections reflecting the central themes set out in Good Medical Practice.
Section 1: Professional behaviour and trust
Section 2: Communication, team working and leadership
Section 3: Clinical care
Section 4: Safety and quality
Clearly there is overlap between the sections in day-to-day practice e.g. safety and quality are at the heart of clinical care; the delivery of care requires communication, team working and professional behaviour.
There are 20 foundation professional capabilities describing the key clinical and professional aspects of medical practice. Foundation professional capabilities are the outcomes of foundation training and indicate what the doctor in training is expected to be able to do.
In order to progress from F1 into F2 and from F2 into GP or specialty training the foundation doctor has to be signed off for each foundation professional capability as having met or exceeded the minimum levels of performance required for sign off set out on.
F1 doctors must demonstrate that their professional and clinical practice is at the level required by the General Medical Council (GMC) to obtain full registration.
F2 doctors are expected to demonstrate that their professional and clinical practice has developed such that they are able to work with increasing clinical maturity and are establishing a leadership role within clinical teams.
Each of the foundation professional capabilities is associated with 'descriptors'. These are general expectations and indicative examples of aspects of professional and clinical practice related to the 'foundation professional capability'.
'Descriptors' have been provided to help trainees and trainers recognise how experience in the workplace might provide supporting evidence of achievement. Although each 'descriptor' appears only once in the syllabus, many of the aspects of practice they describe are applicable to several foundation professional capabilities and trainees and trainers are encouraged to be flexible when deciding where the evidence best fits. In addition as these are not exhaustive lists alternative examples should be considered when deciding how to demonstrate that they are meeting or exceeding the minimum expected level of performance in each of the 20 foundation professional capabilities.
Figure 4: Illustration of the hierarchical arrangement of the syllabus: sections: foundation professional capabilities: descriptors.
This section should be used in conjunction with the section on assessment.
In order to progress to the next stage of training the foundation doctor's professional and clinical practice must meet or exceed the minimum levels of performance required for sign off in each of the 20 foundation professional capabilities. Performance will be reviewed on a regular basis throughout the year to ensure that the trainee is on course to be signed off and if necessary to put in place any additional support.
At the end of each placement, the clinical supervisor (CS) and educational supervisor (ES) reports will report on the trainee's performance utilising several sources of evidence including: feedback from the placement supervision group (PSG) and Team assessment behaviour (TAB) (when performed), evidence provided in the e-portfolio of achievement of each foundation professional capability and engagement with the learning process (completion of supervised learning events (SLEs), reflection on practice and attendance). Evidence of satisfactory performance of core procedures is required for F1 doctors only.
The CS and ES reports will indicate for each 'section' of the syllabus whether the trainee is on track meet or exceed the minimum levels of performance required for sign off at the end of the year. The report will include comments to indicate what the doctor in training is doing well and also to identify targets for future development. If there are any concerns comments will be provided detailing specific issues with performance mapped to the relevant foundation professional capability.
Foundation doctors must use their e-portfolio to record a range of evidence in support of achievement of each foundation professional capability to demonstrate that they are performing at or above the minimum level expected of a F1 or F2 doctor. Evidence can take many forms including achievements framed in terms of some of the 'descriptors', reflection on clinical or professional experiences, evidence of formal training (certificates), participation in evidence-based medicine (guidelines, posters, presentations) or quality improvement work.
Evidence from trainers will usually be in the form of feedback from members of the placement supervision group or following SLEs. These involve the trainer viewing or discussing an aspect of the trainee's practice, providing feedback and documenting it directly in the trainee's e-portfolio. The trainee may then choose to reflect on the encounter and consider how their practice might evolve as a result.
The trainee should choose evidence that shows how their performance in each of the foundation professional capabilities meets or exceeds the minimum levels of performance expected from an F1 or an F2 doctor.
Table 2: The relationship between the syllabus and assessment