The Chemical Pathology curriculum and assessment proposal were submitted to the Curriculum Advisory Group (CAG) in October 2019. The proposed major changes to this curriculum are outlined below:
Metabolic Medicine as a sub-specialty (of either Chemical Pathology or General Internal Medicine, although the latter route is rarely utilised) was introduced in 2001 with a requirement for recruitment through core medical training and MRCP in recognition of the general physician/acute medical skills required to look after certain groups of patients with complex metabolic disorders. Trainees in Chemical Pathology and those in Chemical Pathology (Metabolic Medicine) currently use the same curriculum assessment framework, including direct assessment of the clinical skills included in the scope of practice of most consultant Chemical Pathologists.
A formal consultation of all RCPath College Fellows and members and relevant specialist organisations was undertaken in 2017. The full findings from this consultation can be viewed in the COG application for Chemical Pathology. There was strong support for a single integrated curriculum from consultants (77%) and the organisations which replied (85%). The consultant and organisation responses were strongly in favour of a revised, integrated curriculum and broad based, post-Foundation recruitment options.
This curricular solution is to develop a single integrated laboratory and clinical Chemical Pathology curriculum that includes and assesses the core clinical elements practised by the majority of consultants working in the specialties. With the integration of the Chemical Pathology and Metabolic Medicine curricula, trainees will be expected to gain competencies in all five of the clinical domains described in the current Metabolic Medicine curriculum (2010). This integrated curriculum will replace the current specialty and sub-specialty training framework.
The College intends to pursue the changing of the specialty name to reflect the integration of Metabolic Medicine. However, this is a separate process which must be completed upon approval of the new training programme.
Broadening the base of recruitment from post-Foundation postgraduate core training programmes in the following specialties will attract a wider range of young doctors into the specialty, whose prior clinical experience will more closely mirror the range of clinical specialties supported by chemical pathologists and chemical pathology services:
- 2 years of Stage 1 Internal Medicine plus MRCP(UK)
- Core paediatric training plus MRCPCH
- Core GP training plus MRCGP
- Broad Based Training plus completion of core training in one of the above specialties and the relevant postgraduate diploma.
- ACCS plus MRCP(UK)
- Core anaesthetic training plus FRCA part 1 or MRCP(UK)
The current suite of workplace-based assessments carry an element of both ‘formative’ and ‘summative’ outcomes; in additional to the assessor providing verbal and written feedback to trainees which is recorded in the ePortfolio (LEPT system), the assessments also require that the assessor ‘score’ the trainee, and provide either a ‘satisfactory’ or ‘unsatisfactory’ outcome. However, an unsatisfactory outcome does not fully or completely determine training progression.
As a major change to the assessment programme, we will be introducing a new type of workplace-based assessment. These are supervised learning events (SLEs), and trainee and assessor usage will be via an updated LEPT system. The SLEs will be strictly formative assessments, providing verbal and written feedback to trainees to aid their learning experience and development.
Several changes have been proposed to the schedule of examinations, with the intention of reducing the exam burden on trainees, but also removing costly examinations which have been shown to be non-discriminatory and therefore not fit for purpose. These changes are provisional subject to further consultation. More information regarding these provisional changes will be made available in due course.
The Chemical Pathology curriculum comprises six generic and five specialty-specific Capabilities in Practice (CiPs), linked to the nine domains of the Generic Professional Capabilities Framework:
- Able to function successfully within NHS organisational and management systems.
- Able to deal with ethical and legal issues related to clinical practice.
- Communicates effectively and is able to share decision making, while maintaining appropriate situational awareness, professional behaviour and professional judgement.
- Is focussed on patient safety and delivers effective quality improvement in patient care.
- Carrying out research and managing data appropriately.
- Acting as a teacher and clinical supervisor
- Able to lead and manage a laboratory
- Able to use the laboratory service effectively in the investigation, diagnosis, and management of disease processes
- Able to manage a multi-disciplinary team effectively
- Able to contribute effectively to the management of problems in patients in other specialties
- Able to lead and manage a clinical service (out-patient clinic, inpatient, ambulatory or community setting, including management of long term conditions)