Quality Assurance Framework for O&G Education Approved by Education Board 12 September 2014 Queries to Kim Scrivener, Director of Education Policy & Quality 1. Introduction This document sets out the features of the new Quality Assurance (QA) Framework for O&G postgraduate medical education (the Framework). The Framework makes explicit the means by which RCOG assures itself of the quality of O&G postgraduate medical education, so that doctors are trained to the highest educational and professional standards. The Framework recognises existing arrangements to assure the quality of O&G education, and includes those areas that currently lack appropriate QA. The QA Framework is implemented through the Education QA Committee and other RCOG committees, and is approved by Education Board. It is intended to be a living document and thus will be reviewed on a regular basis by the Education QA Committee on behalf of the Education Board. The Framework links to Aim 2 of the RCOG Education Strategy - the RCOG believes that the College should be a provider of high quality education to improve the standard of care for women internationally - by “developing in-house expertise (including business planning) to improve delivery of high-quality education and training packages”. The role of the Education QA Committee is to provide Education Board with the assurance that all RCOG education products are appropriately quality assured (Figure 1) and to commission new education products where a need has been identified. Figure 1

The Terms of Reference for the Education QA Committee can be found at Appendix 1. 1

The Framework incorporates the following dimensions as laid out in Figure 2. Each of these will be explored in more detail in this document. Figure 2

2. Overarching principles The overarching principles below are drawn from best practice in other educational organisations as well as RCOG’s own Strategic Plan, and will be reviewed on a regular basis. The Framework is:          

designed to make sure that all O&G doctors are trained to the highest standards throughout their careers and thus improve the care of women integral to the central mission and strategic plan of the RCOG, and relates to other educational policy documents (Education Strategy and Faculty Development Framework) holistic in nature and encompasses all education products and the quality strategy for training informed by women and trainees informed by and depends upon peer review by Fellows and Members recognised by RCOG’s partners and stakeholders reflective, evaluative and based on sound evidence supported by consistent processes and strategies that are transparent, efficient and authoritative based where appropriate on the GMC’s standards for education and training flexible and recognises that O&G education products are subject to different QA processes that have developed over time.

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3. Education products RCOG defines education products as tangible manifestations of the intellectual capital generated by Fellows and Members of the RCOG to educate and train O&G doctors, both pre- and post-CCT. Products are divided into two main types – (a) primary and (b) secondary. Primary products are the fundamental elements of O&G education and are subject to their own QA processes. Secondary products are derived from these fundamental elements and are subject to Education QA Committee processes. Figure 3

An overview of the QA and educational governance pertaining to both types of product is shown in Tables 1 and 2 below. Table 1. Primary education products (indirect oversight by EQAC). Category QA process Interested committees Curricula – primary, subspecialty, ATSM, academic

Approval of new/revised module Review GMC CAG process

Assessment systems

Approval of new/revised system GMC CAG process

Curriculum Committee Subspecialty Committee ATSM Committee Academic Board Heads of School Trainees Committee Assessment Sub-committee Curriculum Committee Subspecialty Committee Heads of School SEAC Trainees Committee

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RCOG departments EPQ

Lead committee SEAC

Examinations Examination & EPQ Assessment Committee

MRCOG Exam

DRCOG Exam StratOG primary tutorials

Global Health standards

Standard-setting Question setting Analysis of question performance Standard-setting Analysis of question performance Review – rolling and required Approval of new/revised module Editorial process Approval of new/revised educational activity template

Part 1 MRCOG Sub-committee Part 2 MRCOG Sub-committee

Examinations Examination & Assessment Committee

DRCOG Committee

Obstetrics Sub-committee Gynaecology Sub-committee

Examinations Examination & Assessment Committee EPQ StratOG Editorial Board

Global Health committees

GHU

Table 2. Secondary education products (direct oversight by EQAC). Category QA process Interested committees eLearning packages curriculum, assessment and exam eLearning packages professional development Apps

Courses and meetings curriculum, assessment and exam Courses and meetings professional development Accreditation of non-RCOG courses

Approval of new/revised eLearning package Evaluation Review Approval of new/revised eLearning package Evaluation Review Approval of new/revised App Evaluation Review Approval of new/revised course/meeting Evaluation Review Approval of new/revised course/meeting Evaluation Review Approval of new/revised nonRCOG course Review

Global Health Board

RCOG Departments EPQ Marketing Examinations

Lead committee Education QA Committee

Professional development committees as appropriate PMMG

EPQ Marketing Clinical Quality Membership

Education QA Committee

PMMG

eJournals Marketing

Education QA Committee

Education committees as appropriate PMMG

EPQ Meetings Marketing Examinations

Education QA Committee

Professional development committees as appropriate PMMG

Meetings Marketing Clinical Quality Membership

Education QA Committee

PMMG

Marketing EPQ

Education QA Committee

Education committees as appropriate PMMG

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Faculty Development Framework Global Health standards

Review

SEAC

EPQ

Approval of new/revised educational activity template

Global Health committees

GHU

Education QA Committee Education QA Committee

4. Quality strategy for training The Specialty Education and Advisory Committee (SEAC) of the RCOG approved a quality strategy for pre-CCT training in 2010 and reviewed it in 2013 (Appendix 2). The strategy is focussed exclusively on those means by which RCOG helps to improve the quality of pre-CCT training in the O&G workplace, and through which it accounts to the GMC as regulator. Elements of this strategy include: benchmarking of quality standards, externality process, educational roles, training and development of trainers (including the Faculty Development Framework), trainee feedback, Annual Specialty Report (ASR) to the GMC and overseas training.

5. Educational governance RCOG has an established committee structure for governance of all its pre-CCT educational activities and products. Education Board, which is chaired by the Vice President (Education), reports to RCOG Council on education matters and oversees all education-based committees. The work of the Education Board is supported by various committees, the chairmen of which are members of the Board. Heads of School, trainees and representatives from the Women’s Network are all included in the membership of these committees and of the Board. The exception to this arrangement is in Global Health - the Global Health Board is the Lead Committee for the global health standards and will report to the Education QA Committee in a similar way to the other lead committees, i.e. on its own QA activities (Appendix 3).

6. QA responsibilities Approval - All new education products, whether primary or secondary, must be formally approved by the Lead Committee for the category of that product. For new secondary education products, a standard Product Proposal Form should be completed and submitted to the Education QA Committee Secretary. The Education QA Committee will grant outline approval for a product to be developed and ask the Product Management and Marketing Group to investigate the full business case and make a recommendation, upon which final approval will be based. All new education products will draw upon expert opinion given by RCOG committees or provided on a case by case basis. Outcomes of QA processes by lead committees for primary education products will be reported to EQAC. See Appendix 4 for a flow chart of the process. Evaluation - The performance of all education products must be evaluated after delivery against standard criteria for each category of product. The criteria will vary according to the category of education product. This means that user feedback must be sought and acted upon if deemed appropriate. The means by which evaluation is to be carried out must be specified in the approval process. 5

Review - All existing education products, whether primary or secondary, must be formally reviewed to a rolling cycle by the Lead Committee. The method of review will be approved by Education QA Committee or the Lead Committees depending on the nature of the product. Review cycles will be set by lead committees and reported to the Education QA Committee. Figure 4

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Appendix 1

Terms of Reference for the Education Quality Assurance Committee 1.

The Committee will develop an overall strategy for educational QA for approval by the Education Board. The strategy will encompass all College educational activity and will adhere to the GMC’s Quality Improvement Framework.

2.

The Committee will provide advice on QA to all College Committees and Directorates concerned with Education.

3.

The Committee will oversee the two-stage process for education product approval according to criteria that are patient-centred, educationally sound and that meet the defined educational needs of specified target audiences. The Committee will approve an education product in outline before remitting detailed consideration to the PMMG. The Committee will then approve a final product document from PMMG.

4.

The Committee will champion the principles of the GMC’s Quality Improvement Framework and will ensure QA best practice in the College. The Committee will report on QA matters to the GMC, as required, by means of annual specialty reports, responses to concerns, and other GMC matters.

5.

The Committee will ensure that the College has the appropriate evidence base and datasets to inform QA judgements in education.

6.

The Committee will ensure that appropriate benchmarking of education standards and resources takes place, and that information is shared with the appropriate partners. The Committee will identify areas of good practice, concerns and trends for dissemination to those concerned with the delivery of education and training.

7.

The Committee will develop and oversee systems for the regular systematic reviews of all College educational resources. The Committee will determine the structure and content of these reviews and surveys. This will be part of a continuous feedback mechanism from trainers, trainees, patients and others.

8.

The Committee will advise the Education Board to ensure that the totality of the College’s educational and training resources is integrated and coherent.

9.

The Committee will ensure that the College’s print and eLearning resources are complementary, and it will provide a forum for editorial dialogue between the Honorary Director of eLearning, the StratOG Editorial Board, the Publishing Directorate and CUP.

10.

The Committee will have the right to co-opt appropriate advisers for specific pieces of work.

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Meetings:

Three per year

Reporting to:

Education Board

Membership: Chair

Vice President Education

Chair of Examination and Assessment Committee

ex officio

Chair of SEAC

ex officio

Honorary Director of eLearning

ex officio

Editor-in-Chief of StratOG

ex officio

Editor of TOG

ex officio

Honorary Director of Conferences

ex officio

Chair of Curriculum Committee

ex officio

Faculty Development Lead

ex officio

Plus 3 clinicians to be selected by competitive interview Senior lay representative Chair of Trainees’ Committee or nominee Deputy Chief Executive Director, Education Policy and Quality Director, Journals and ePublishing Administrative support:

EPQ Directorate

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Appendix 2

Quality Strategy for Training 1. Introduction The RCOG maintains quality in postgraduate medical education by supporting the delivery and development of quality measures and by using external experts to monitor and improve the quality of training across the UK. Royal colleges have a clear role in supporting quality management in postgraduate medical education as mandated by the GMC. The RCOG strongly believes that educating and training junior doctors to a high standard is vital to ensure women receive safe care of the highest quality. The RCOG aims to promote high-quality education and training in the workplace through a variety of processes and functions, and to positively influence the training of future O&G specialists. With the exception of those dedicated to trainers, these processes and functions have been developed by consensus with Heads of Schools and trainees through the Trainees' Committee and are approved by the RCOG Specialty Education Advisory Committee (SEAC).

2. Benchmarking of quality standards Deaneries coordinate the delivery of training by managing specialty training programmes and reviewing trainees' professional and clinical competency progress through the Annual Review of Competence Progression (ARCP) process. To ensure consistency of training, the RCOG has created the Training Matrix outlining the annual expectation of educational progression, guidelines for its use in the ARCP process and the new curriculum mapping tool.

3. Externality process Deaneries are responsible for the management of trainees and have a quality management role, as prescribed by the GMC. The GMC requires deaneries to include externality within their processes (ARCPs and quality visits) to ensure objectivity. The RCOG has therefore developed a Specialty Assessor Scheme so that appropriately experienced Fellows and Members can be supplied to deaneries. Through this process the RCOG can identify issues within deaneries and help develop solutions and share good practice. If a significant concern is identified, the Specialty Assessor is advised to raise this directly with the Postgraduate Dean, or alternatively with the GMC through the Response to Concerns process. The RCOG may also raise issues with the GMC through the information it receives.

4. Educational roles All UK deaneries/LETBs have specialty schools of O&G. They have different internal structural arrangements for managing quality and have the fundamental responsibility for directly managing the quality of education in Local Education Providers (LEPs). Heads of School are jointly appointed by the deanery/LETB and RCOG, and are significantly represented on SEAC. All hospitals/units have an RCOG College Tutor whose responsibility is to ensure that the O&G curriculum is delivered and that O&G standards of training are maintained. 9

5. Training and education of trainers In line with the introduction of the GMC's recognition of trainers scheme, the RCOG now provides the Faculty Development Framework for all Fellows and Members to use to calibrate and plan their career in education and training. The Framework specifies the courses needed to progress and attributes of different categories of trainers. All Trainees, Fellows and Members will be members of the Faculty and will have access to training courses, eLearning materials and other guidance. The Faculty Development Framework is overseen by the Education QA Committee.

6. Trainee feedback The RCOG takes the analysis of the outcomes of the GMC's annual trainee survey very seriously and uses it to effect changes in training and education. The RCOG believes additional targeted data are needed to identify trends around the practical delivery of the curriculum and to this end is reviewing the Trainee Evaluation Form to ensure that it is fit for purpose. The RCOG receives a significant amount of feedback from the Trainees' Committee.

7. Annual Specialty Report (ASR) to GMC The RCOG takes data from a variety of sources, including deanery annual reports, and uses it as evidence for the ASR from O&G to the GMC. The RCOG shares the reports with all deaneries. The RCOG aims to triangulate the evidence from the GMC Trainee Survey with that obtained from Specialty Assessor and deanery reports. This process of triangulation ensures that key themes are identified that are reflected in the ASR and helps direct the development of strategies for the future. The action plan in the ASR is actively monitored by SEAC and is part of the RCOG Education Strategy.

8. Overseas training The RCOG has a global role in promoting high-quality care for women and is actively involved in promoting education and training for all specialists through the Global Health Unit. The Global Health Strategy 2013–17 outlines how this will be implemented. The RCOG has a process for accreditation of overseas centres for Advanced Training Skills Modules (ATSMs) to promote the development of specialist skills that are equivalent to the training offered in UK centres. For more information please read the guidance on registering for ATSMs while overseas. Overseas specialists can sit the MRCOG exam and this is increasingly being undertaken in centres outside the UK.

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Appendix 3

RCOG Educational Governance Structure 2014

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Appendix 4

Product Approval Process

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