The foundation programme curriculum 2016 (the curriculum) sets out the framework for educational progression that will support the first two years of professional development, following graduation from medical school.

This edition of the curriculum updates the curriculum published in 2012 and includes minor revisions from the 2014 and 2015 editions.

 

Key messages of the Curriculum

The foundation programme curriculum is based on educationally and clinically supervised, practice-based learning, underpinned at regular intervals by feedback, reflection on practice and assessment. Foundation doctors will be working to establish their professional identity in the workplace and learning to integrate and work effectively within multidisciplinary teams and the healthcare system as a whole. All foundation doctors will need to demonstrate that they are refining their skills and that they are able to take responsibility appropriately whilst recognising and working within the limitations of their competence.

Foundation doctors are expected to be responsible for their education and the development of their critical thinking and professional judgement. During the foundation programme, they should reflect regularly on their performance and feedback that they have received. They should use this process to identify their strengths and to set targets for personal and professional development.

By engaging in the educational and assessment processes, foundation doctors should fulfil their curricular requirements in preparation for entry into specialty or general practice training and will be able to demonstrate:

  • the ability to work adaptively in healthcare teams
  • the ability to manage patients with acute and long-term conditions
  • continuous improvement in their professional and clinical skills/ acumen
  • increasing understanding of the healthcare environment.

At the end of each placement the clinical and educational supervisor will each provide a report to indicate whether the foundation doctor is making satisfactory progress in each of the 20 'foundation professional capabilities' to allow 'sign off' by the end of the year of training.

While most foundation doctors will have no difficulty in achieving the Curriculum outcomes by demonstrating their achievements in each of the foundation professional capabilities, sometimes a doctor in training may need additional support. The clinical and/or educational supervisor/s are responsible for identifying when this is necessary and for ensuring that the required support is put in place as soon as possible. The foundation doctor will always be encouraged to work with their supervisors to resolve any issues with their performance.

 

Good medical practice and the foundation doctor

The curriculum is based on the General Medical Council's (GMC) documents, 'Good Medical Practice (2013)' and 'Promoting excellence: standards for medical education and training' (July 2015). The curriculum builds naturally on the skills, attitudes and behaviours acquired during undergraduate training as set out in 'Outcomes for graduates' (originally published in Tomorrow's Doctors (2009)). All foundation doctors must comply with contemporary GMC guidance on the principles and standards of clinical care, competence and conduct.

The UK Foundation Programme Office's (UKFPO) companion document, the Foundation Programme Reference Guide (2016) (the reference guide) provides guidance to foundation schools about the structures and systems required to support the delivery of the curriculum

 

The curriculum in practice

The curriculum is intended for foundation doctors, their trainers and those responsible for quality assurance (General Medical Council), quality management (foundation school) and quality control (local education provider). It is also intended to inform medical schools of the outcomes of foundation training. Trainees and trainers should use the curriculum in conjunction with the e-portfolio and the reference guide.

It is highly recommended that the section, How to use the curriculum in the workplace is read thoroughly by all. The syllabus is particularly relevant to foundation doctors and their supervisors as this sets out the foundation professional capabilities foundation trainees must demonstrate.

 

The syllabus

The syllabus has undergone evolutionary changes, which have been developed in agreement with the General Medical Council.

The syllabus comprises four sections.

Section 1: Professional behaviour and trust
Section 2: Communication, team working and leadership
Section 3: Clinical care
Section 4: Safety and quality

Foundation professional capabilities: There are 20 foundation programme training 'outcomes' to be achieved within the curriculum; these are termed 'foundation professional capabilities'. Each 'foundation professional capability' describes a key clinical or professional aspect of medical practice. Foundation doctors must provide evidence of how their achievements related to each 'foundation professional capability' meet or exceed the expected minimum standard of performance for their year of foundation training. In order to progress to the next stage of training foundation doctors will be assessed at the end of each year of training. Progression will be dependent on meeting or exceeding the minimum expected standard of performance in each of the 'foundation professional capabilities'.

Descriptors: Each 'foundation professional capability is accompanied by 'descriptors'. These are indicative examples and general expectations of the knowledge, skills and behaviours which foundation doctors and trainers might use to understand whether they are performing at an appropriate level. These 'descriptors' are not intended to be exhaustive lists and many other examples exist. Foundation doctors may choose to use some of the 'descriptors', or alternatives, as supporting evidence of how they are achieving the curriculum outcomes. It is neither expected nor necessary to provide evidence relating to each of the 'descriptors'.

 

Learning opportunities in foundation

The most effective way for professionals to develop their expertise is through repeated clinical experience accompanied by observation of practice with immediate feedback on performance from a senior clinician or healthcare professional. Every clinical experience is a learning opportunity and the interaction between the foundation doctor and trainer during 'supervised learning events' (SLEs) should lead to reflection and suggest further areas for professional development.

During the foundation programme, the foundation doctor will have the opportunity to experience working in a range of placements and will manage patients with both acute and long-term conditions in a variety of clinical settings. Learning opportunities and educational objectives for every placement will be discussed and agreed between the doctor in training and their educational and clinical supervisors.

 

The foundation learning e-portfolio (e-portfolio)

The e-portfolio is a record of a trainee doctor's progress and development through the foundation years. Successful completion of the curriculum requires doctors in training to record evidence of progressive attainment across all 20 'foundation professional capabilities' (foundation programme training outcomes) in their e-portfolio. The e-portfolio is also the means by which trainers and supervisors record feedback and assessments on their trainees.

The completed e-portfolio will contribute to the educational supervisor's end of year report, which informs the annual review or competence programme (ARCP) panel. The foundation doctor may use evidence in their e-portfolio during interviews for core, specialty or GP training programmes to demonstrate their ability and highlight achievements.

 

Assessment during foundation training

Assessment during foundation training is intended to ensure that the trainee is progressing appropriately and that their performance is on course to meet or exceed the minimum expected level for each of the foundation professional capabilities (foundation programme training outcomes). This is in contrast to experiences such as SLEs, which provide feedback designed to help the doctor to improve their skills.

The assessment process comprises:

  • End of placement reports by the named clinical supervisor (CS) to ensure the trainee has made appropriate progress during that post
  • End of placement reports by the educational supervisor (ES) to ensure that the trainee is progressing satisfactorily as they move through different posts
  • Team assessment behaviour (TAB)
  • Demonstration of competent performance of core procedural skills (F1 only)
  • An end of year report by the educational supervisor to ensure that the trainee has reached the required standard by the end of either the F1 or F2 year.

The annual review of competence progression (ARCP) process will judge whether the foundation doctor is ready to proceed to the next stage of training.

 

End of placement reports

The 'named clinical supervisor's end of placement report' and 'educational supervisor's end of placement report' are records of the foundation doctor's professional development during each placement and whether their knowledge, skills and behaviours suggest that their practice is on course to allow sign off as having met or exceeded the minimum expected level of performance for each of the 20 foundation professional capabilities at the end of the year of training.

The named clinical supervisor (CS) and educational supervisor (ES) will make their judgements regarding satisfactory progression after considering multiple sources of evidence including:

  • Direct observation by the supervisor of the doctor's practice in the workplace
  • Feedback from members of the 'placement supervision group' (PSG) who have also observed practice in the workplace.
  • Evidence recorded in the foundation doctor's 'e-portfolio' demonstrating:
    • Achievements in each of the 20 'foundation professional capabilities' (foundation programme training outcomes) towards the level set out in the curriculum.
    • Completion of satisfactory 'Team assessment behaviour' (TAB).
    • Engagement with SLE.
    • Reflection on practice during the placement.
    • Demonstration of competent performance of the core procedural skills required by the General Medical Council GMC (F1 only).
  • Attendance.
  • Participation in formal teaching sessions.
 

End of year assessments

The educational supervisor will complete an end of year report that synthesises their personal knowledge of the foundation doctor, together with the portfolio of evidence, including Team assessment behaviour (TAB), end of placement reports, evidence in the e-portfolio and engagement with formal teaching and other achievements, in order to recommend an outcome to the annual review of competence progression (ARCP) Panel.

 

Annual review of competence progression ARCP

The ARCP is a review of evidence of achievement over the course of a year of training. The ARCP Panel will review and validate the educational supervisor's recommended outcome against the foundation doctor's portfolio of evidence. Although the ARCP is not in itself an assessment, it is a summative judgement of a foundation doctor's performance and development throughout the year. The ARCP Panel will make recommendations to the postgraduate dean, meaning the ARCP process decides whether an individual doctor can progress to the next stage of training. Progression is dependent on evidence that the foundation doctor has met or exceeded the minimum expected level of performance in each of the 20 foundation professional capabilities (foundation programme training outcomes).

 

Progression through foundation training

A satisfactory annual review of competence progression (ARCP) at the end of F1 will lead to award of Foundation Year 1 Certificate of Completion (F1CC), this indicates that the foundation doctor is working effectively in the clinical team and applying the professional duties, principles and responsibilities set out in good medical practice. Sign off requires that the foundation doctor is established in clinical practice and is performing safely in their role as a doctor in training and is competent to perform the core procedures defined by the General Medical Council. Satisfactory F1 ARCP will lead to a recommendation to the GMC that the foundation doctor satisfies the requirements for full registration and is eligible for progression into F2.

At the end of F2, a successful ARCP indicates that the foundation doctor has demonstrated progression in their practice such that they are increasingly able to assume a leadership role in the clinical team by virtue of their experience and decision making skills. Evidence of working towards increasing maturity of practice will be reviewed and (if satisfactory) lead to award of the Foundation Programme Certificate of Completion (FPCC) which will indicate that the foundation doctor is ready to enter a core, specialty or general practice training programme.

Dr David Kessel. Chair of the Academy Foundation Programme Committee