The most important addition to the 2015 Public Health Specialty Training Curriculum was the introduction of Key Area 10: Integration and Application of Competences for Consultant Practice (CCP). CCP describes the overarching learning outcomes registrars demonstrate when they are ready for independent practice as consultants. Readiness for independent consultant practice requires an ability to consistently judge how to select and use a range of specialist public health expertise and skills and work at senior organisational levels to deliver improved population health in complex and unpredictable environments.
The terms ‘formative’ and ‘summative’ can be used to describe the intended use of an assessment. In formative assessment the findings of the assessment are used to influence the learning process. In summative assessment the focus is on producing results for external reasons, for example to determine if a registrar has achieved a required learning outcome. Assessment is defined as formative or summative in reference to its primary purpose, not the process or method used.
Summative assessment to demonstrate that a registrar has achieved these Key Area 10 learning outcomes will be undertaken in the final year of training utilising: the activity summary sheets, a range of workplace-based assessments with multiple assessors and the results of the multisource feedback. Guidance for assessment of competency and Guidance for method of assessment for Key Area 10 learning outcomes are provided in the 2015 curriculum.
The 2015 curriculum requires all supervisors and registrars to understand and comply with the principle that regular and high-quality assessment and feedback is essential for development of consultant level competence. Regular and timely feedback is an essential component of educational progress and development. The curriculum allows rich opportunity for the registrar to develop the ability to seek and act on feedback from a variety of sources. Registrars are also encouraged to self-assess. This sets the foundation for compliance with Good Medical Practice, the UKPHR Code of Conduct, and subsequent revalidation.
Formative assessment and feedback takes place during the required regular service progress meetings between registrar and supervisor which measures progress against agreed educational objectives and identifies further educational need and opportunity. Regular informal feedback is given by the supervisor(s) as tasks are delivered and formally at dedicated training feedback sessions. Registrars are encouraged to seek formative feedback on their public health practice from other colleagues both over specific pieces of work and more formally through multi-source feedback.
In line with the 2015 curriculum the Faculty of Public Health therefore strongly encourages registrars to take part in the development and evaluation of a formative assessment of Key Area 10. This specific formative assessment tool is not part of the curriculum and assessment system, and registrars are not required to participate in this specific formative assessment. Formative assessment and feedback are a curriculum requirement but using the specific formative assessment tool that is being developed and evaluated for Key Area 10 is not.
Development and process evaluation a formative assessment tool for Key Area 10
The implementation plan submitted to the General Medical Council (GMC) as part of the 2015 curriculum change submission indicated that the Faculty would continue to explore the development a new formative assessment tool linked to Competence for Consultant Practice (CCP). The decision letter from the GMC approving the 2015 curriculum stated that with regards to the pilot of the consultant readiness assessment, the Faculty is to be applauded at the attempt to introduce an external assessment of the progress of a doctor in training and the GMC understand that the current plan is for a larger pilot before a possible resubmission.
The Curriculum and Assessment Committee has discussed Key Area 10 extensively throughout the curriculum review and implementation, particularly how the Registrars and their Educational Supervisors can be best supported in developing and demonstrating these learning outcomes.
Development, testing and evaluation of the formative assessment for Key Area 10 is being undertaken by all public health specialty training programmes in the UK using a standardised approach developed by the Curriculum and Assessment Committee.
The assessment is to help registrars in their progress towards consultant level working and should assist with preparation for an Advisory Appointments Committee (or equivalent).
It is based on the Registrar’s work to date and it does not require the identification of new projects. It is a matter of reflecting on work to date and the synthesis of actions.
It is a formative assessment leading to an appropriate Personal Development Plan for the final year of training (ST5), leading the registrar toward consultant practice. In this, the panel, registrar and supervisor explore progress towards the learning outcomes in Key Area 10 and identify learning skill acquisition and experience areas which would benefit from development and plan to meet these within the final year of training.
This model will be developed and refined for future years as experience is gained and development will be informed by an evaluation.
The Key Area 10 assessment that is being developed is not designed as a summative assessment, no learning outcomes are signed off and there is no pass/fail outcome. Templates have been derived for suggested paperwork for the Key Area 10 panel designed by registrars to make the process easy, practical and consistent. The formative assessment provided by this supportive panel is designed to support the implementation of the new Key Area 10 in the approved curriculum.
Guidance and templates on the formative assessment of key area 10 are attached in the KA10 assessment Guidance document.
Individual training programmes will communicate directly with registrars at an appropriate stage in training to provide details of the practical arrangements for accessing this formative assessment in their locality.
Long term plans for formative assessment of Key Area 10
Development, testing and evaluation of the formative assessment for Key Area 10 will be an iterative process. Registrars are central to the process and are encouraged to conceptualise the formative assessment as a professional activity rather than something which is done to them. It provides an opportunity to reflect on their practice and their approach to public health to identify areas of practice where they could make improvements or undertake further development, as well as providing a method for seeking formative feedback on their public health practice from other colleagues.
The long-term plans for the formative assessment depend on the outcome of the evaluation. If it is not felt to be helpful, productive or useful for registrars or supervisors then the Faculty is committed to identifying any alternative methods of supporting the delivery of this part of the curriculum. If, however, it has clear benefits it may form part of a future curriculum change submission to the GMC and UKPHR.