Statement on short and medium-term absence(s) from training: Requirements for notification and potential impact on training progression for dentists and doctors
Definition Time out of training in this statement is defined as absence, other than for study or annual leave, including illness of any duration maternity leave parental leave paternity leave adoption leave compassionate leave and unpaid leave This statement does not describe formal Out of Programme (OOP) absence, which is covered elsewhere. Female trainees who are pregnant should consult the new PGMDE Guidance on Working during Pregnancy. Absence may occur at short notice, and without planning, but sometimes is planned, particularly around paternity leave or elective treatments. Absence may impact upon a trainee s ability to acquire all the necessary competencies within any twelve month period to satisfy requirements for career progression towards the CCT. A day is defined for doctors and dentists working within the PGMDE of HE Thames Valley as any shift, whether daytime, night-time or at a weekend when the doctor or dentist was rostered to be on duty, and therefore would have been supervised (directly or indirectly) and therefore, trained. This matches the GMC definition. Notification of short notice absence All trainees are required, on the first day of absence, to follow the local notification processes outlined by their employer / trainer. In addition All trainees are required to notify their Programme Manager in the Deanery by email if they have time out for any of the indications listed above. The number of days of absence must be stated in the email. All trainees should log absence in the relevant section of their record of training (typically in the eportfolio). Probity Trainees are reminded that failure to be honest and declare such absences is considered a breach of probity and could result in disciplinary action, including referral to their regulator (GDC or GMC). Probity issues also impact on medical revalidation.
Notification of planned absence Readers are directed to the Return to Practice Guidance published by the Academy of Medical Royal Colleges in April 2012 for a comprehensive exposition of best practice. This document is lodged on the Deanery website by clicking on the About the Oxford Deanery tab on the left and then Medical and Dental Policies. This guidance relates to all doctors and dentists returning to the same area of practice as that they had previously worked in, regardless of the reason for absence from clinical practice. The list below shows the most common reasons why doctors and dentists may be absent from their normal practice for three months or longer, but is not exhaustive: Maternity leave Prolonged illness of any sort Out of programme training (research) Out of programme training in a different, or highly specialised, field Out of programme (career break) Doctors or dentists undergoing formal capability or conduct proceedings Doctors and dentists who have surrendered their licence to practise whether voluntarily, or not. All trainees who are absent from training programmes for three or more months will have their CCT date adjusted. It should be noted that absence in excess of fourteen days per annum may result in an adjustment of projected CCT date. Evaluation, before absence, of likely needs on return Planning before absence is highly desirable, as it may be possible and / or appropriate, in some circumstances, for the trainee to Keep in Touch (KIP) with current developments relevant to the practice. The AoMRC paper has a ten point checklist, appended to this paper, to complete before prolonged absence wherever practicable. Evaluation of needs before return to work Doctors and dentists are professionally required to ensure that they are safe to return to practice. This demands a mature approach to planning the return to work, including identifying issues which may require additional training / support before or soon after they return to work. The 15 point checklist is appended to this document. Trainees in Hospital Practice All trainees in hospital practice have an Educational Supervisor. The trainee and their supervisor should undertake the initial Return to Practice needs assessment. It may be necessary, or even desirable, for the Training Programme Director (TPD), or
Director of Medical Education (DME) at the host Trust to be included in the assurance processes. Trainees in Primary Care All trainees in Primary Care have a designated trainer, who should meet with the trainee to undertake the Initial Return to Practice assessment. Training Programme Directors may be involved in some cases. In a few cases, there may be complex issues which will require input from the relevant Post-Graduate Dean, or their nominated deputy. Impact on career progression The national rules are different for provisionally registered and fully registered doctors with respect to career progression, and for dental trainees, there is a Deanery position in anticipation of the deliberations by COPDEND: The UK Foundation Programme is both time and outcome based; any F1 trainee who has more than a month off in addition to the allowed annual leave may not be eligible to apply for full registration 1. The trainee is advised to contact the Foundation School Director promptly if this situation seems likely. The GMC Position Statement of November 2012 applies to all fully registered doctors who take more than fourteen days out in any year. These doctors should expect that their provisional CCT date may be adjusted at the next ARCP 2, depending on competencies gained. Dentists training within the Oxford Deanery who take more than fourteen days out should also expect a review of their progression towards gaining the necessary competencies as described in dental post-graduate curriculae. References 1. 1.UK Foundation Programme Guide, 2012 revision, page 42, section 10, paragraph 10.1 and table 1 2. GMC Position Statement 2012, Time Out of Training. 3. AoMRC Return to Practice Guidance, 2012 Consultation This statement is based on GMC requirements and also best practice, as outlined by the AoMRC. Consultation has been with the wider PGMDE Executive, but in particular, has been checked by Anne Edwards, Foundation School Director, Glynis Buckle, GP Dean and Judy Curson, Ass Dean for Revalidation.
Appendix These Q&As have been taken from the GMC position statement, which is also available in full on the PGMDE website, adjacent to this paper. Q: If I am absent for more than 14 days (when I would normally be at work) will my CCT date automatically be amended? A: The deanery will review each case of absence of 14 days or more in a single year and look at various factors:- timing of the absence - is it early in training or in the final months of the programme, is it immediately after a period of annual leave history of absence has the trainee had periods of absence repeatedly nature of the absence has the trainee been able to continue to participate in some elements of the training such as reading, online study etc. nature of the training that has been missed performance and assessments The deanery will then consider whether the trainee has been able to demonstrate the curriculum competencies for the ARCP level, whether any deficiencies could be addressed through a period of targeted training or whether training needs to be extended. The deanery may wish to postpone this decision dependent on the following year s performance, that is, to give the trainee the opportunity to achieve the competency through targeted training. Q: How will the deanery know about my absence? A: it is each individual trainees responsibility under Good Medical Practice to be honest and open and act with integrity and as such, to ensure that the deanery are aware of their absences through the deanery reporting requirements. Q: What do the GMC mean by normally at work? A: A doctor s pattern of work will vary, with absences being blocks or weekends. Where a trainee is absent during their scheduled time away from work (work includes study leave) then this does not get counted within the period of absence. For less than full time workers where they are absent during their scheduled non working time this does not count towards the period of absence. Scheduled time away from work for full time or less than full time trainees cannot be amended to avoid counting absent time. Q: Will short term absence impact upon my recommendation for revalidation? A: If you are absent or take a break from the training programme which is approved by the deanery, then your submission date and prescribed connection will remain the same, and you do not need to do anything else. This might include taking up an out of programme training or research post, or going on maternity or long term sick leave.
If your revalidation submission date happens to fall while you are out of training, your Responsible Officer will have the option to defer the submission of your revalidation recommendation. Deferral of the revalidation recommendation is a routine, administrative decision which does not have any impact on your licence to practise. Q: If I do not get an outcome 1 in my ARCP does that mean I will not receive a positive revalidation recommendation or decision? A: The decision about your revalidation is separate to the decision made about your progression through training: revalidation is about your fitness to practise rather than your training progression. For example, receiving an outcome 3 or 4 at your ARCP would have no effect on your revalidation unless there is a concern about your conduct, performance or health that could raise a question about your fitness to practise. Jane Siddall, Associate Dean for Educator and Faculty Development PGMDE HE Thames Valley
Appendix 1 Form 1: Planning Absence from Practice Checklist (adapted from AoMRC) 1 How long is the trainee likely to be absent from the training programme? 2 Are there expected to be any significant changes to training arrangements during this period? (e.g. curriculum, eportfolio updates, equipment). Will this trainee need updating on return? 3 How long has this trainee been in postgraduate training in this field? Does this have a bearing on their needs upon return? (e.g. moving from core training to higher specialist training, or to a more senior position within the training programme). 4 Could this trainee Keep in Touch through occasional supervised days in the workplace, or by attending relevant educational events? (These are voluntary: no trainee can be made to attend whilst absent. Trainees whose licence has been suspended cannot enter the workplace during their suspension) 5 Does this doctor have any additional educational goals / targets to achieve during their absence? (This may particularly apply to those who have been suspended locally through Conduct or Capability issues) 6 What sort of training support, CPD etc will need to be in place to support the doctor on their return? 7 Are there any cost issues related to the question above? (e.g. locum cover if return is to be phased?) 8 Will the doctor be able to retain their licence to practise during their absence? Will they also be able to fulfill requirements for revalidation? 9 Are there any issues which could relate to the doctor s next annual assessment (ARCP)? If so the Head of School and Post-Graduate Dean should be informed by the Education Supervisor or Trainer.
10 How is the trainee going to plan their return to a learning environment whilst away? Signature trainee Date Signature of ES or Trainer Date One copy should be retained by the trainee, a second copy should be filed in the PGMDE file for the trainee, so should be sent to the relevant Programme Manager.
Appendix 2 Form 2: Planning Return to Practice (adapted from AoMRC) The trainee should bring their copy of Form 1 to the meeting 1 How long has the trainee been absent? 2 Has the absence been longer than had been expected? (This may be especially relevant if the original absence had been unplanned) 3 How long had this trainee been practising before the absence? 4 What responsibilities does the trainee have in the role to which they are returning? Are these different to those before absence? Are any new or more onerous? 5 How does the trainee feel about their confidence? How do they feel about their skill set (not just technical abilities) 6 What support has the trainee identified as likely to be helpful on their return? 7 Has the trainee had any Keeping in Touch (KIT) opportunities during their absence? 8 Have there been any major changes since the trainee to leave of absence? (e.g. New equipment, new responsibilities, new treatments, new clinical guidance/ pathways etc.) 9 Has the absence had an impact on the trainee s ability to gather evidence to support revalidation? 10 Are there any new issues (personal or professional) which have arisen whilst the trainee has been away which may impact (positively or negatively) on confidence or ability? 11 Has the trainee undertaken any relevant learning or development whilst absent (Can apply to any trainee, but particularly those with Conduct or Capability issues contributing to, or causing, absence)
12 Has Occupational Health recommended that this trainee needs a phased return to work? 13 Are there any issues which need to be raised with the Head of School or Post- Graduate Dean around the trainee s next ARCP? 14 Will this trainee require a period of observation of others practice before they return to work? 15 Will this trainee require direct supervision / additional support on return. Does this have an additional staffing or cost implication? Signature trainee Date Signature of ES or Trainer Date One copy should be retained by the trainee, a second copy should be filed in the PGMDE file for the trainee, so should be sent to the relevant Programme Manager.