NHS Education for Scotland (NES) strives to achieve excellence in medical education and training and is responsible for upholding the educational standards outlined by the General Medical Council (GMC), and is committed to improving the quality of postgraduate medical education provided to all trainees across the Scottish Deanery.
Quality management visits are a key element of the work undertaken by the NES Quality Management Team. Such visits enable NES to make an assessment regarding the quality of a training environment provided by local education providers (LEPs) or within a particular training programme, and specifically whether training satisfactorily meets the GMC's Standards for Medical Education and Training.
Quality management visits are NOT an assessment of individual trainees or their competencies. The visit panel wants to hear and acknowledge YOUR experiences of training, both good and bad to identify and promote areas of good practice as well as support the introduction of measures to develop and improve training. All trainee views are taken into account by the panel, irrespective of training programme or stage of training. As a trainee your role in the visit process is crucial and we encourage you to make every effort to attend. Your department or local postgraduate education centre should make arrangements to free you from clinical duties and enable you to attend for the visit.
The dropdown list below is written from a trainee’s perspective to provide greater insight into the Quality Management process and the procedures involved when a Visit occurs. We hope that the information contained here will answer any questions you may have. If you have questions not addressed here please contact Jill Murray, Senior Quality Improvement Manager at: Jill.Murray@nes.scot.nhs.uk.
Trainee Information video
Quality management visits take place in both primary and secondary care. The majority of visits are focused on individual LEPs. The LEPs encompass any department or site within a Health Board that delivers medical education and training on behalf of the Scottish Deanery, for example; a single speciality department within a certain hospital or general practice surgery. Occasionally visits examining an entire specialty training programme across a geographical area occur. These visits can be regional or national depending on the size of the specialty.
Each LEP and training programme will be visited by the quality management team at least once every five years, as part of a regular quality assurance cycle (scheduled visits). A visit outside this cycle may be triggered, or a revisit arranged, should there be any concerns raised during the annual quality review panel (QRP)
Every specialty training programme within the Scotland Deanery, including the Foundation Programme, is overseen by one of eight specialty quality management groups (sQMGs).
Each sQMG is required to hold an annual QRP. At the QRP information relating to the quality of every training post across Scotland, within the specialities for which they are responsible, is scrutinised. This information includes data from the GMC national trainee and trainers surveys (NTS), NES Scottish trainee survey (STS), annual review of competence (ARCP) outcomes, written reports from the relevant training programme directors (TPDs) and directors of medical education (DMEs), as well as local knowledge provided by QRP members. All this intelligence is reviewed and discussed to enable the QRP to decide on whether a quality management visit to a LEP is indicated, and if required, within what timescale.
Information and intelligence considered at annual quality review panel to decide if a quality management visit is required.
Potential outcomes following discussion at annual quality review panel.
Individuals participating on a quality management visit on behalf of NES are referred to as panel members. The number of individuals on a panel can vary from 6 to 11 depending on the type of visit. The role of the various panel members is listed below:
Often but not always from the specialty being visited. Chairs each session of the quality management visit, facilitates discussion, and helps focus panel members on areas of interest.
Responsible for collating and presenting visit findings during the feedback session.
Confirms the content of the published visit report.
Associate Postgraduate Dean or
Specialty Training Programme Director
Active panel member, often but not always from the specialty being visited.
Provides additional insight into the structure and curriculum of the specialty visited to help inform fellow panel members.
Foundation Lead or Foundation Programme Director
Active panel member, may attend where there are Foundation trainees are based in the specialty being visited.
Provides additional insight into the structure and curriculum of the Foundation curriculum requirements to help inform fellow panel members.
General Practice Assistant Director or GP Training Programme Director
Active panel member, may attend where there are General Practice trainees are based in the specialty being visited.
Provides additional insight into the structure and curriculum of the General Practice curriculum requirements to help inform fellow panel members.
Quality Improvement Administrator
Administrative role on the quality management panel. Responsible for documenting the points discussed during each session, thereby allowing reference and technical accuracy when writing the visit report.
Quality Improvement Manager
Active panel member with an in depth understanding of the NES Quality Management framework and processes.
Responsible for writing the visit report based upon the visit findings and panel members’ individual feedback.
Active panel member providing a trainees’ perspective to the quality management panel.
Trainee Associates are competitively appointed by NES and will have displayed an interest and commitment to the quality of medical education and training.
Trainee Associates will be based in an unrelated specialty from another health board to that visited.
Quality management trainee associates were introduced to the panel to provide a trainees’ perspective on any issues which may arise during a visit. If you are interested in the role or becoming a NES quality management trainee associate you can find more information here.
Active panel member providing a valuable external perspective to the quality management panel.
Lay representatives often have a non-medical background and offer a wealth of knowledge from their experience across various other working environments.
Royal College Representative
Active panel member, not always present.
Royal colleges are invited to nominate a representative to participate on the panel during quality management visits to their respective specialty.
Active panel member, not always present.
Attendance dependent on the nature of the quality management visit.
In advance of a quality management visit the assigned panel members conduct a pre-visit teleconference to discuss the material contained within the pre-visit information pack. The pack includes any data or intelligence relating to the upcoming visit, for example; previous NTS and STS results, the feedback from the Pre-Visit Questionnaire (PVQ), relevant TPD or DME reports, as well as additional supporting information such as departmental rotas and local teaching programmes. Close attention is payed to any free text comments left by trainees in the NTS, STS and PVQ.
The material contained in the pre-visit information pack helps to orientate panel members to the site being visited and assists in identifying areas they may wish to explore in greater detail during the visit. This may be driven by concerns emerging during review of the data, or evidence of good practice that the visit team are keen to learn more about and share with others.
Six weeks prior to a quality management visit, the Deanery invites all trainees currently working at the site or programme due to be visited to complete a pre-visit questionnaire (PVQ). The PVQ covers various aspects of the training environment including; induction, handover, rota and workload, availability of study leave, provision of feedback, local and regional teaching arrangements, educational and clinical supervision, issues relating to culture and undermining, and raising patient safety concerns. The results of the PVQ are collated anonymously, ensuring no answer is ever attributable to a single individual. An opportunity to leave free text comments exists, and these are often helpful should someone wish to praise an aspect of their training to the panel or highlight a specific area that they believe could be improved upon.
The PVQ is emailed to trainees directly from the Deanery and remains open for two weeks. Trainees are strongly encouraged to complete the PVQ as it provides invaluable information to the panel in advance of a visit, reflecting the views and experiences of current trainees, offering a ‘real-time’ account of the training environment. During the pre-visit teleconference the results from the PVQ contribute significantly to any discussion and help identify aspects of training that the panel may wish to explore in greater detail.
Quality management visits occur over the course of a day and are structured to allow adequate time to speak with trainees, trainers, nurses and allied health professionals. Occasionally department managers and administration staff will also attend relevant sessions. Trainee and trainer sessions are usually scheduled to last approximately one hour but can occasionally run longer if required. An example of a visit timetable can be found below:
All visits are conducted using the NES quality management question sets. These are standardised and structured question guides that have been purposefully written to reflect the domains outlined in the GMC's Standards for Medical Education and Training. The question sets are specific to each session, with a different focus depending on whether trainees, trainers or allied health professionals are present. The visit lead will generally direct panel members to ask questions relating to particular aspects of medical education and training, which includes; induction, formal teaching, the provision of feedback, study leave, workload, rotas, handover, adequate experience, clinical and educational supervision, education resources including IT, patient safety, adverse incidents, and culture and undermining.
Following each session, the panel will discuss any issues which emerge and use this information to help inform later sessions. At the end of the process the visit lead, in conjunction with the other panel members, will develop a set of recommendations and requirements which they believe should be introduced to develop and improve the educational experience and training environment for trainees. To conclude the visit, a feedback session is scheduled for the visit lead to provide the site with a verbal summary of the panel's findings. This includes areas of good practice and any recommendation and requirements regarding areas which need to be developed further. Depending on the overall findings of the visit a decision may be made to re-visit a site with the timescale for this indicated either during the feedback session, or shortly after the visit. The feedback session is open to anyone who has participated in the visit and trainees are encouraged to attend.
Prior to a quality management visit your department, training programme or postgraduate education centre should notify you in advance to confirm the location, date and time that you will be required to attend. Arrangements should be made locally to cover your regular clinical commitments to ensure you are available to attend the trainee session of the visit. The expectation is that all doctors in training who are on duty on the day a quality management visit occurs will meet with the panel. You will also have had the opportunity to complete the pre-visit questionnaire before the visit.
If you work in a large department which has numerous trainees working across different grades several trainee sessions may be organised. The session you are invited to attend will be relevant to your level of experience, for example; foundation trainees, core trainees, GP trainees and speciality trainees will ideally be seen separately. For smaller departments, or departments in which only speciality trainees are present; such as some diagnostic specialities, the entire trainee cohort may be seen in a single session.
During your session the quality management visit panel will introduce themselves with the visit lead explaining the purpose behind the visit. Panel members will then take turns at asking questions relevant to your training environment. The answers you provide will guide the panel in making an assessment regarding the quality of education and training being provided at the site visited. Questions are always posed to the group of trainees attending and no one will ever be individually targeted. Most trainee sessions will last approximately an hour.
It is always the intention of the quality management visit panel to create a supportive and open environment for trainees to discuss the quality of their training. Occasionally some people can find this experience uncomfortable, especially if they wish to raise a sensitive issue. The quality management visit team recognise that training can at times be a pressurised and stressful process which may result in experiences that trainees may not wish to speak about openly, particularly those concerning bullying and undermining. NES promotes a strict zero tolerance approach to bullying and undermining behaviour, and all quality management visit leads are happy to discuss concerns of any kind with trainees confidentially. If you wish to do this you can contact NES, in confidence, in advance of the visit via the quality improvement manager, or on the day by speaking to the visit lead or quality improvement manager. Alternatively, you may wish to submit a notification of concern.
Immediately after a quality management visit a brief outline providing feedback to the DME about the visit panel's findings is provided to the DME within 3 working days. This document is a formal written summary of the verbal feedback provided by the visit lead at the end of the visit.
Following this, a comprehensive visit report is produced within 6 weeks of the visit, detailing the findings of the visit panel with respect to all of the GMC's Standards for Medical Education and Training. After approval by panel members and the visit lead, the report is circulated to the LEP, relevant TPDs and DME. The report is carefully written so that any information is anonymised and not traceable to a single individual; this includes trainers as well as trainees. Visit reports are now published on the NES website normally within three months of a visit and will include requirements and recommendations:
Issued when a visit identifies that a GMC standard, whilst technically met, could be improved upon.
Issued when a visit identifies that a GMC standard is not currently being met and requires a direct intervention to satisfy the standard.
In response to the report the DME, in collaboration with trainers from the visited LEP, are required to develop an action plan which adequately addresses any training concerns, recommendations or requirements that have been highlighted through the quality management visit process. The action plan is required to be shared with NES within four weeks.
Depending on the outcome of the quality management visit a re-visit may be arranged to follow up any concerns within a specified time scale. Alternatively, NES will liaise with the local DME to check on the implementation and progress of the action plan, with a more detailed review conducted at a future QRP. LEPs delivering successfully on their action plans will be recognised, however, if there is no progress following a re-visit and significant concerns persist then a LEP can be referred to the GMC's enhanced monitoring process.