What do postgraduate deans do?BMJ 1998; 316 doi: https://doi.org/10.1136/bmj.316.7146.2 (Published 06 June 1998) Cite this as: BMJ 1998;316:S2-7146
- Elizabeth Paice, Dean Director,
- Ilfra Goldberg, Associate Dean
- Flexible Training, North Thames Region, Thames Postgraduate Medical and Dental Education, London WC1N 3EJ
The role of the postgraduate dean seems to be ever expanding, with important consequences for doctors in training. Join Ilfra Goldberg and Elisabeth Paice on a behind the scenes tour
The office of regional postgraduate dean in medical education was established in England and Wales about 25 years ago. Appointments in each region were usually made by the university with a medical faculty, and initially the role included coordination and supervision of postgraduate medical training for hospital medical staff, general practitioners, and other doctors working in the community. Deans also had a liaison role between regional committees and the royal colleges. Most postgraduate deans fulfilled these roles on a part time basis while maintaining some clinical commitments.
The development of the role of the regional postgraduate dean varied considerably from region to region. Appointment procedures varied, job descriptions varied, relations between the university and the regional health authority were different, and each postgraduate dean had his or her own area of expertise or interest that was thought to be appropriate to postgraduate medical training at the time. Postgraduate deans met at a national forum, where they exchanged ideas and views,((1)) but they developed their role according to regional priorities and resources available. The origins of the establishment of postgraduate deans' departments need to be appreciated in order to understand the rather disparate development that occurred.
A developing role
Since the early 1990s the role of postgraduate deans has expanded enormously. They now control a substantial amount of public money and are accountable to the NHS Executive for the way that it is used. They meet together regularly at the Conference of Postgraduate Medical and Dental Deans (COPMeD), and, through this organisation, they ensure consistency of postgraduate training and implementation of policies across the country. The more frequent meetings of postgraduate deans on a national basis, the increased accountability through regional offices, and the devolution of funding streams are likely to result in greater similarities between regions in their roles and responsibilities.
What deans do
Postgraduate deans commission and manage the delivery of postgraduate education for all doctors and dentists in training, whatever their grade, specialty, or pattern of training. They ensure that sufficient training placements are available to meet the future needs of the NHS for trained specialists and generalists and that recruitment to these placements is both rigorous and fair. They also make sure that training placements and programmes meet the quality standards set by the royal colleges and their faculties and by the General Medical (or Dental) Council. They do this through educational contracts with trusts and training practices, and through a network of clinical tutors, postgraduate centre managers, general practice tutors, and course organisers.
Higher specialist training is managed through deanery specialty training committees, where the royal colleges' regional advisors, the consultant trainers, and the postgraduate dean meet to organise training within that specialty. Postgraduate deans have special responsibility for monitoring the quality of preregistration posts in their region on behalf of the university by which they are employed.
The educational contract between the postgraduate dean and hospital trusts covers 50% of the basic salary of most doctors in training (100% in the case of preregistration house officers, public health doctors, and supernumerary flexible trainees). It also includes funding for the postgraduate centre and its staff, the library, and expenses relating to study leave. The sums of money concerned are large, and postgraduate deans are accountable to the NHS Executive for ensuring that they are spent as intended. Postgraduate deans vary in the way they carry out contract monitoring, but most include interviews with trainees or questionnaires to determine the level of satisfaction with the arrangements.
Postgraduate deans are responsible to the NHS Executive for implementing national policies with regard to planning the medical and dental workforce. For the past three years this has included issuing national training numbers and maintaining a database of doctors and dentists in higher specialist training. They are responsible for developing new training placements in specialties with a shortage of trained staff and managing a reduction where the supply of trainees exceeds the expected demand for consultants. The responsibility for managing the education and training of non-medical NHS staff and coordinating the planning for the medical and non-medical workforce lies in the regional offices, where the contribution of postgraduate deans is integral to effective working.
Postgraduate deans, with their responsibilities across all specialties, are well placed to offer career counselling to trainees or students and will often do this by giving lectures at final year careers fairs, or seminars for specific specialties. Most will offer individual counselling on request. They will expect the request to be made in writing, accompanied by a curriculum vitae and a brief outline of the problem, so that it can be directed to the member of the deanery team best placed to help.
Postgraduate deans have special arrangements for doctors who have difficulty pursuing full time training through domestic commitments, illness, or disability. Most will have identified an associate dean with special responsibilities for organising flexible training. Flexible training can be arranged by reducing sessions in an established post, job sharing, or creating a supernumerary placement, and demand is rising with the increasing proportion of women in medicine. Assessment and remedial training
One of the features of the recent reforms to higher specialist training has been the requirement to carry out an annual review of progress for every specialist registrar. Once training is approaching satisfactory completion, the postgraduate dean advises the relevant college specialty advisory committee, which then issues the certificate of completion of specialist training. This has created a lot of work for trainers who make the assessments and the deanery specialty training committees, which review the documentation and decide whether it is satisfactory. A consequence of this activity has been to show the need for consultants to have training in both appraisal and assessment, and most deaneries now provide this.
Another consequence has been to identify trainees who are not doing well at an early stage. Previously, such trainees were allowed to “fall through the cracks” between jobs, usually failing to move from registrar to senior registrar posts. They were no one's problem but their own. Now postgraduate deans are developing targeted or remedial training opportunities, rigorous systems for ensuring fairness, and exit strategies for those who are clearly not going to complete training in the specialty. In doing this, postgraduate deans are very conscious of the need to ensure that patient care is never compromised by the needs of trainees. An additional responsibility has recently been acquired - that of facilitating the retraining of career grade doctors referred by the GMC under the new “Poorly performing doctors” procedures.
Postgraduate deans work in partnership with a number of other agencies. Health authorities are one of the most important of these. They are the commissioners of service and, as such, might be expected to feel little responsibility for training. However, they recognise that much of the service is in fact delivered by trainees and that quality of training is inextricably linked to quality of patient care. They also recognise the need to secure the supply of trained doctors for the future. Postgraduate deans consult with health authorities about proposed reconfigurations of service and the development or withdrawal of training opportunities. They work especially closely when a service is threatened by the potential withdrawal of training.
Royal colleges are responsible for setting the standards of training for their specialties. They define the entry criteria, curricula, and exit criteria for specialist training programmes. It is the job of the postgraduate deans to ensure that the appropriate systems and resources are in place for these standards to be met. The deanery specialty training committees are designed to facilitate close working with the colleges' regional advisors. Nationally, there is a lead postgraduate dean for each specialty, and postgraduate deans sit on college committees. Increasingly, postgraduate deans are combining their visits to trusts for monitoring contracts with visits by colleges. Other national relations include the General Medical and Dental Councils, the BMA, and the Specialist Training Authority. At the regional level, the university and its medical school or schools, the educational consortia, and local medical workforce advisory groups are all important. With the government's new white paper, it is likely that primary care groups (general practitioners and community nurses) will take responsibility for commissioning services and deploying resources. The central role of general practice is thus strengthened and will need to be recognised in the training needs of all medical trainees. The deaneries' general practice leads are already working with their primary care colleagues in ensuring that postgraduate medical education is not forgotten in the new arrangements.
The dean's team
In order to carry out these and the other tasks that form the work of the deanery, the postgraduate dean is supported by a team, the size of which depends on the size of the patch covered and the number of trainees (which varies from 1,500 to 5,500). The team includes a dental dean, a director or dean of general practice education, one or more associate deans, and a business manager. Many of the medical staff will be on a part time contract and continue to carry out clinical duties. Most will have a background in clinical tutor or college tutor work, or have been a general practice tutor or course organiser. All will have a commitment to improving postgraduate medical and dental training, and through this work, to improving the quality of patient care.
Deans' work and that of their team directly affect all doctors currently training in medicine and, indirectly, their trainers. Opportunities to train, places in which to train, rotational arrangements, and standards in trusts and training practices are influenced considerably by the work and efforts from deaneries. Furthermore, policy decisions and plans implemented now by postgraduate deans will affect the standards and patterns of healthcare delivery in the future.