Abstract

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PMETB: Establishment and Merger
The Postgraduate Medical Education and Training Board (PMETB) was established by the General and Specialist Medical Practice (Medical Education, Training and Qualifications) Order 2003. The PMETB was created in order to address concerns about the perceived lack of transparency in medical postgraduate education and the inconsistency in the quality of medical training across the UK.

Introduction

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The PMETB began operations in 2005 and took over the responsibilities of the Specialist Training Authority of the medical Royal Colleges and the Joint Committee on Postgraduate Training for General Practice. Following a recommendation from the Tooke's inquiry into Modernising Medical Careers, the PMETB merged with the GMC in 2010. This move aims to deliver a more seamless and consistent approach to the regulation of medical education and training at all stages of a doctor's career. The GMC has regulated undergraduate medical education and, after its merger with PMETB, it regulates all stages of medical education in the UK. PMETB, (and after the merger, the GMC) is accountable to Parliament and acts independently of government as a UK competent authority.
PMETB roles
The PMETB (and currently the GMC) has the responsibility for defining the standards necessary for entry into specialist medical training. It also defines the standards of the training, and the standards to be met by the end of training. By doing so, it enables the necessary levels of competence and experience required for certification as a registered specialist to be achieved[i] . The PMETB (and subsequently the GMC) also promotes and develops UK postgraduate medical education, aiming to improve both the skills of doctors and the quality of healthcare offered to patients and the public.
PMETB surveys
The PMETB (currently the GMC) conducts the largest and widest reaching quality assurance programme of postgraduate medical training in the UK. PMETB surveys cover all stages of postgraduate medical education in the whole of the UK. In many deaneries and most specialties, the PMETB survey is the only method used to assure quality and evaluate postgraduate training.
Survey background:
The idea for a national survey of trainees was suggested to PMETB in a paper by Janet Grant et al and contains items first developed from the existing Point of View survey used by several postgraduate deaneries in the UK (London, Kent, Surrey and Sussex and East of England). The survey has the support of employers and junior doctor representatives from the British Medical Association's Junior Doctors' Committee and the Academy of Medical Royal Colleges Trainee Doctors Group. All parties are committed to developing the survey and building on its success to date and beyond PMETB's merger with the GMC in 2010.

Benefits and Limitations

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Benefits of the surveys:
The surveys provide invaluable and direct information that might help to improve the quality of medical education throughout the UK.
The PMETB's surveys form an important part of the evidence that underpins the assurance of the quality of postgraduate medical education and training. The findings of the surveys require action by deaneries. These actions will be monitored by the GMC. Findings will also contribute to the GMC's visits to deaneries and responses to concerns.
The surveys also provide a picture of what the UK's trainees think about their training.
The surveys provide the trainees' perceptions of training subdivided into deanery, specialty and specialty training levels.
Four surveys have been completed so far. The results of three of them are available on line with the last one's results being due in the second half of 2010.
Despite the richness of PMETB survey data, research into PMETB and use of PMETB surveys in medical education research is, surprisingly, so scarce. A Medline and Embase review of articles where PMETB was mentioned either in titles or abstracts led only to 16 citations!
Limitations to the surveys:
Because the survey is annual, it provides a snapshot rather than a continuous picture. Data relate to the previous six months and can be up to a year out of date at the time of the annual PMETB reports.
There are also problems in small departments. To provide anonymity, the survey data can only report if there are at least three trainees per department. Although the PMETB data could be aggregated over a period of three years, the trends over time are lost within this process.[ii]
There is a significant difficulty in getting all sets of available data. For example, to get all the data about surgical training in the North West, I needed to review an initial report that provided a simple comparison between the North West and surgical trainees in the UK in general. I then had to click on each of the 22 Forrest plots (related to the 22 indicators) separately to get a comparison between the North West and the rest of the deaneries. I then had to click on the comparative graphs (each on a separate screen) to access detailed results for the questions in each area.
2009 Survey:
The 2008/09 survey included all trainees in a PMETB approved posts on 2 January 2009, whose data were supplied to PMETB by the deaneries. Trainees who were not on the deanery lists were able to request a Survey Access Code directly from PMETB.
In 2009, 42,714 doctors in training out of 50,145 for whom PMETB had a valid record in the surveys database, took time to answer the survey giving a response rate of 85 per cent. The survey has a median completion time of 24 minutes. The survey was mandatory for specialty trainees and, from 2010, it will also be mandatory for foundation doctors.

Reports

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Reports:
The PMETB published summaries and key findings of its surveys. More detailed reports can be obtained online. It is possible to obtain reports for a variety of different groupings. Responses from a given trainee may be included in multiple reports, for instance a report about training in their hospital and a report about training in their deanery.
The reports analyse patches of questions categorised into 22 indicators. The key findings report categorises the survey indicators into six chapters (three chapters related only to the trainees survey, two chapters are related to trainees and trainers surveys and one related to the trainers survey). The six chapters are:
1. Trainees satisfaction with training
2. Service versus education
3. Workplace Based Assessment
4. Medical error
5. European Working Time Directive (EWTD)
6. Stress
The online reports are displayed visually using a Forest plot, allowing comparison between hospitals, trusts and deaneries.
What does the 2009 survey say about surgical training in the North West of England?
For most items, the median score for the North West is between 25th and 75th percentile when compared with all surgical trainees in the UK. When the North West deanery is compared with other deaneries, it is at the bottom third of the deaneries league in regards to 10 training indicators, it is at the middle third in another six areas and at the top third only in six areas. Surgical training in the North West deanery is characterised by mediocrity and patchy excellence. Tables 1 and 2 summarise the 22 indicators and how the North West deanery score in each indicator.
What does the 2009 survey say about surgical education in the North West of England?
We identified seven areas in the survey that are directly and primarily related to education.
Table 3 represents a summary of the PMETB's evaluation of these indicators of surgical training in the North West deanery. In summary, while North West trainees seem to have higher number of weekly educational hours when compared with other deaneries, the educational opportunities on local level (local teaching and access to educational resources) are suboptimal. The educational supervision of surgical trainees in the North West deanery is the worst in the country. This might be partially compensated for by better access to study leave and by the best regional teaching in the country. The seven indicators are summarised below and then presented in more details in appendix 1.
Hour education:
This indicator looks at the hours of weekly education. Trainees are unlikely to take into account monthly or less frequent regional training days, etc. 42% of surgical trainees in the North West Deanery had 1 hour or less of weekly education that is suboptimal in a training post. Only 4% had more than three hours of weekly education.
Educational Supervision:
This indicator is about the educational framework underpinning the post. Every element of the framework is associated with good training. Low scores suggest attention should be paid to programme management. While most trainees have an educational supervisor, around 46% of trainees do not have learning agreements with their trainers and 43% of trainees do not use learning portfolios.
Access Educational Resources
This indicator looks at the easiness of access to relevant resources and the quality of available resources. Seventy per cent of trainees found it very or moderately easy to access library services, while only 52% found good coverage of curriculum topics in available resources.
Local Teaching Score Description:
This indicator looks at the ease with which trainees can attend teaching sessions and their perceived quality of these sessions. While most trainees (78%) did not have any specialty specific teaching locally, teaching lasted less than an hour in almost half of the cases and it was not protected in any instance. However, around 64% of trainees evaluated the quality of teaching as good or excellent.
Other Learning Opportunities:
This indicator combines a range of unrelated additional opportunities: audits, research and multi-professional learning. 82% and 48% of trainees were involved in audit and research projects respectively. Seventy-eight per cent of trainees never or rarely have opportunities to learn with other healthcare professionals.
Study leave:
Trainees must be made aware how to apply for study leave and be guided as to appropriate courses and funding and trainees must be able to take study leave up to the maximum permitted in their terms and conditions of service. Only 44% of trainees had excellent or good encouragement to take study leave. However, 76% reported no difficulty in obtaining study leave.
Regional teaching:
This indicator looks at the ease with which trainees can attend departmental teaching sessions and their perceived quality of these sessions. 85.14% of trainees evaluated the regional teaching programme as either excellent or good. Despite that, only 45.82% of trainees were able to attend teaching all or most of the time with service commitments being the most common barrier to attending.

Summary

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The PMETB conducted several surveys of postgraduate training in the UK. Its survey of general surgical training in the North West of England showed a trend of the scores of its survey indicators towards median scores with only few better scores. The indicators of general surgical education in the North West deanery show similar trends. In contrast, the regional teaching programme is the most pronounced exception and it stands as the best in the country.

Source(s) of Funding

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Neither sought nor received.

Competing Interests

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None

Disclaimer

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