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The curriculum has changed for a number of reasons: 1) GMC requirements changed – the new ‘Excellence by design’ standards require all
postgraduate medical curricula to be rewritten, based on high level outcomes and linked to the GMC’s generic professional capabilities framework. It also requires all curricula to demonstrate how they meet the recommnedations of the Shape of Training report.
2) A core aspect of the Shape of Training report was that with an aging population, holistic management of the individual rather than super-specialised management of each specific medical condition is required, and that this requires a re-setting of the balance between specialism and generalism. The Shape of Training report also recognised that there is a huge and increasing acute unscheduled care burden which is not being well supported by the current systems. For trainees, flexibility of training was recognised to be lacking as was the ability of the workforce to adapt to changing service needs over a career.
3) The GMC approvals process now begins with an initial review of the curriculum by the Curriculum Oversight Group (COG), which mostly consists of members of the UK Shape of Training Steering Group, so solutions to these challenges must be an integrated part of all curricula.
4) Separate to these issues, the current curriculum is a long, repetitive and not very user friendly document. It is based on outdated educational practice and trainers and trainees report that it is rarely used.
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The CO Curriculum Committee has worked closely with the MO Specialist Advisory Committee (SAC) to align the two curricula. We were challenged by the curriculum oversight group to improve flexibility for trainees by recognising common areas of training, and to provide greater support for the acute unselected take equipping trainees to manage and develop acute oncology services. The new curriculum reflects these requirements.
We will look at each of the changes in more detail on the following slides.
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Entry requirement will not change - Full MRCP is required for entry into both specialties, as it is now, and trainees must have completed the 2 year internal medicine stage 1 curriculum (which replaces CMT) or equivalent
Note that trainees who have completed the 3 year internal medicine stage 1 and 2 curricula (the 3rd year being the Med Reg equivalent year) can also apply.
Recruitment is unchanged due to this process (although the pandemic may bring changes to recruitment).
The exam structures for both CO and MO remain unchanged (although again, the pandemic may result in changes). Separate to this work, the exam syllabus is being reviewed with the aim of making the content (particularly for the statistics module) more clinically relevant.
There are no changes to tumour type requirements for each specialty
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The generic CiPs are those that describe the outcomes expected of all doctors (e.g. good communication and team working skills). There are 6 of these and they are identical in the CO and MO curricula, and across all of the physician specialties.
The shared oncology CiPs describe the outcomes that apply to both CO and MO trainees. There are 7 of these.
The CO and MO curricula then each have their own specialty specific CiPs. For CO there are 6 of these.
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In the curriculum, each CiP is accompanied by a list of descriptors which break that CiP down into underlying skills and provide guidance to trainees and trainers about the range of clinical contexts which may support achievement of the CiPs. The descriptors are not intended to be prescriptive and do not provide an exhaustive list.
Each CiP is also accompanied by suggested evidence – a guide to the types of assessment that might allow trainees to demonstrate the level of practice achieved for this CiP. This is also not intended to be prescriptive or an exhaustive list. Trainees may demonstrate their progress against the CiPs in a variety of different ways, reflecting their strengths, areas of interest and the resources available to them. They may also complete activities that provide evidence for more than one CiP.
Each CiP is also mapped to the domains of the GMC’s generic professional capabilities framework.
This example shows this structure for one of the common oncology CiPs
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The following video explains this diagram and the principle of using entrustment to assess CiPs: https://www.youtube.com/watch?v=5Ase3ETcsu0 1:44 - 4:10
By assessing a trainee’s progress against one CiP, we are automatically assessing the underlying skills and competencies that allow them to perform that task. If they can be trusted to perform the task independently, then they must also be competent in the underlying skills. This allows us to streamline assessment by looking at a number of competencies in one go.
If the trainee is not yet capable of performing the task described by the CiP independently we can look at the descriptors to drill down into which underlying competencies are still missing. We can then focus feedback and support on these aspects of the task to support further learning. In this way this model also helps trainers to set targets and support trainees to progress.
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Assessment of the CiPs will be based on the concept of entrustment and the CiPs can be considered to describe entrustable professional activities – tasks that a trainee can be trusted to perform independently once sufficient competency has been demonstrated.
We will be using a simple and intuitive 4 point scale that builds on the decisions that supervisors take every day. The key question for supervisors to ask is what level of supervision in this area of practice, for each of the CiPs. As they progress through training, we would expect a lower level of supervision to be required. Progression grids set out the required level at each stage of training.
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The progression grids set out the minimum level of entrustment expected by the end of each stage of training. Trainees may be progressing at a faster rate and achieve higher levels and they may progress faster in some CiPs than in others.
The CO curriculum does not require trainees to be at level 4 for all CiPs in order to CCT – for example CiP 18 relates to delivery of brachytherapy and trainees are not expected to be fully independent in this and would not act independently in this area of practice even as day 1 consultants, so the level expected by the end of ST7 is only level 3.
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It is important to note that the expected level of entrustment applies to the whole CiP, not each of its constituent descriptors.
At first sight, some of these levels may appear to be set with relatively low expectations, however if you look at the full detail of the CiP this may not be the case.
Taking acute the acute oncology CiP as an example - most trainees should be managing oncological emergencies independently very early in ST3 (they could be managing the acute medical take at Med Reg level if they had continued into year 3 of their IMT training), however this CiP also involves managing an AOS team and service which is a more complex level of practice with elements of clinical pathways, complex multi-disciplinary communication and working etc.
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Meets Shape of Training requirements: Supports development of generalist skills Promotes cross-specialty working Provides greater flexibility for trainees
The progression grid for the clinical oncology specific CiPs does not give levels for ST3. Trainees may be picking up skills that relate to these CiPs, but the focus in the OCS year should be on generic and shared CiPs.
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Trainees already can transfer between specialties at any stage of training by applying through the national recruitment system. This does not change that and does not side step that system.
The only change is that the full year of training can be recognised for both specialties, minimising the need for additional training time. For example, an MO ST3 trainee who wanted to transfer to CO would be able to start CO training at ST4 as they would have achieved the same level in the same outcomes as a CO ST3 trainee. If an ST4 trainee wanted to transfer, there may be a need for some additional training time as they will not have been working towards the CO specific CiPs, however their progress against the generic and common oncology CiPs and their experience from the OCS year could all be recognised.
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Progression grids in both the CO and MO curricula are identical for ST3
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Training in acute oncology is a mandatory part of the curriculum for all trainees from ST3 to ST6 and trainees should develop capabilities in acute oncology longitudinally throughout training. It is not expected that trainees will develop the ability to practise independently in all aspects of this CiP in the OCS year alone.
This CiP is not just focused on trainee’s ability to manage oncological emergencies, it is also prepares them for managing ad shaping the future of acute oncology services
Acute oncology service models vary significantly and are delivered by multi-professional teams in a wide variety of settings – the curriculum offers flexibility for acute oncology training to be delivered in this full range of settings.
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Acute oncology services are delivered by multi-professional teams and trainees may be supervised and assessed by any appropriately qualified member of the acute oncology team. This is not limited to clinical oncology or medical oncology consultants.
Ring-fenced time for acute oncology training should be included in trainees’ timetables. On call provision alone is not sufficient to constitute acute oncology training, however it can contribute to training provided that there are clear educational objectives linked to this CiP, effective feedback to trainees and opportunity for development in this area of practice.
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The ACAT is familiar to trainees from CMT/IMT, and to many trainers who supervise at that level. Acute Oncology training scenarios are directly analogous to the acute medical setting this was developed for.
The MCR has been in use for medical specialties for several years and is a good way of capturing the views of several consultant trainers. In the OCS year this report should include at least one CO and one MO consultant. It may also include consultants from other specialties and professions, including consultant radiographers.
DOSTs and DORPS will be new to MO Required numbers of each assessment have been adjusted so that there is no
overall increase in the number of assessments required
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The decision aid for the OCS year was shown on a previous slide, this slide shows the decision aid for ST4-7
The MSF and MCR are similar assessments – these are not both required in the same year. The MCR is required in the OCS to reflect CO and MO input and at the end of ST6 as greater consultant input was felt to be helpful at this transition point
The oncology registrar’s forum had input into this grid to ensure that trainee views on assessment were represented
Although it may take time to get used to the two new assessments, once these are embedded there should not be an increase in the time that supervisors need to dedicate to WPBA.
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Trainees due to CCT before September 2022 do not have to transfer. All other trainees will need to transfer by this date, including LTFT and out of programme trainees.
Trainees returning from OOP will transfer on their return to training.
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This slide lists the activities and support planned for implementation – if you think we are missing something that you would find useful, or think that there is something on this list that is unnecessary, please let us know
As mentioned, there will be a new look curriculum web page on the RCR website We will also be producing short videos introducing the new elements of the
curriculum and including tutorials on how to complete some commonly queried tasks in Kaizen
We will have a curriculum champion in each region, who will help to ensure that information about the new curricula and implementation is communicated effectively and act as a point of contact for queries, feedback and support. They may provide information at regional meetings or advise the RCR of any regional meetings so that a member of RCR staff can attend
There will be a training slide set, similar to this one available on the curriculum web page, as well as an implementation checklist, calendar, FAQ , terminology guide, guidance for ARCP panels and on using the entrustment scales
The guidance for exams will include the syllabus for part 1 modules We are working on a rough guide to the curriculum with MO There will also be a document that maps the lists of knowledge, skills and
behaviour from the current curriculum to the new CiPs There will be a series of webinars and meetings between now and the
implementation date – the first of these was a joint CO and MO heads of training meeting in October 2020
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