The learning agreement is a written statement of the mutually agreed learning goals and strategies negotiated between a trainee (learner) and the trainee’s Assigned Educational Supervisor (AES). It is agreed at the initial objective setting meeting and covers the period of the placement. The agreement is based on the learning needs of the individual trainee undertaking the learning as well as the formal requirements of the curriculum. The electronic Learning Agreement form is accessed through the secure area of the web site and is completed on-line. The AES and trainee complete the learning agreement together and are guided by the Training Programme Director’s (PD) global objective.
Training Programme Director’s global objective
The placement objectives will be based on the global objectives which the PD sets for the trainee’s training year. These broad global objectives, derived from the syllabuses, are included in the Learning Agreement and highlight what the trainee should achieve during a period that may encompass several placements. They normally cover the period between the annual reviews.
The global objective for early years training would normally cover the following components:
- Run-through programmes: the common surgical syllabus, speciality-specific competences in the chosen speciality and professional behaviour and leadership skills for the stage.
- Themed programmes: the common surgical syllabus, speciality-specific in a number of complementary specialties and professional behaviour and leadership skills for the stage.
- Unthemed, broad-based programmes: common surgical component of surgical training: the common surgical syllabus, sampling a number of specialties (topping up in specific specialties later in the stage) and generic professional behaviour and leadership skills for the stage.
For those wishing to pursue an academic surgical career, a proportion of competences might emphasise additional academic pursuits including research and teaching.
Together, the global and placement objectives are the means used by the TPD, AES and trainee to ensure curriculum coverage.
The content of the learning agreement will be influenced by the:
- requirements set by the surgical specialty in its syllabus for the stage of training
- learner’s previous experience
- learner’s knowledge and skills
- local circumstances of the placement.
Although the learning agreement is a statement of expected outcomes, there is equal emphasis on learning opportunities and how the outcomes can be met. Trainees use it to keep track of which objectives have been completed and which have not; AESs use it to set down the educational strategies that are suited to the experiential learning appropriate to the placement, to monitor progress and ensure the correct training is delivered. TPDs use it to oversee the process and to ensure the duration of the training programme is appropriate to the achievement of learning outcomes.
Each stage in the process allows the trainee and the AES to make individual comments on the training and appraisal process and to sign it off. The trainee also has the right of appeal to the TPD through the process.
The trainee will meet the AES at the start of each placement to agree the learning and development plan and at mid-point and end of placement to review and report on progress. The frequency of meetings can be increased if required. The Learning Agreement provides a mechanism for the trainee and AES to meet and discuss feedback and guidance.
Learning Agreement stages
There are three stages to the learning agreement that should be completed in sequence: objective setting; mid-point review; and final review.
Objective setting is where the trainee and the AES conduct the following actions:
- Refine the Global Objective made by the TPD according to the learning that can be delivered in the placement by focussing on particular learning objectives. The resultant list represents the target learning objectives for the placement.
- Agree on the Workplace Based Assessments that have been agreed for the placement to obtain feedback and demonstrate progress matched to syllabus objectives, e.g. DOPS for central venous line insertion.
- Identify the resources required so that the trainee can achieve his/her learning objectives for example time slots, events, equipment.
- Identify learning opportunities, activities or events in the educational programme that the trainee should attend, e.g. seminars, presentations, peer reviews.
- Consider the examinations the trainee is required to take whilst in the placement and courses the trainee plans to attend.
- Consider the audit/research/projects opportunities.
- Once these aspects of the placement have been finalised and agreed, the trainee and the AES sign off the Learning Agreement.
Although the objective setting stage of the learning agreement is the agreed plan for the placement, it can be modified during training if circumstances change and this can be recorded during the interim or final review. Additionally the trainee can update information about resources, learning opportunities, examinations and courses attended and the self-directed learning undertaken.
The electronic Learning Agreement is automatically uploaded into the portfolio and links to the syllabus content and the Workplace Based Assessments. A word version is available to download below. Workplace Based Assessments are recorded on electronic forms which are automatically uploaded into the portfolio.
Mid-point review occurs at the mid-point of the placement. This stage is encouraged even for four-month placements to check that progress is in line with the placement objectives. In the event that difficulties are being experienced, focussed training and repeat assessments should be initiated. The objectives for progress and further action plans agreed at the meeting are recorded on the mid-point review form and are signed off by the trainee and AES.
Final review occurs towards the end of the placement. The trainee and AES review what the trainee has learned in the placement against the placement objectives set down in the Learning Agreement. Evidence would typically include:
- Workplace Based Assessments and feedback (trainees are encouraged to accumulate more than the minimum number and use a range of assessors).
- surgical log book
- audit and projects
- outcomes of courses
- reflective practice (includes self-MSF and other self-assessments, written accounts of CBDs and personal development plans)
- case presentation/teaching
- timetable and rota attendance.
Each tool captures elements of judgment in action and maps to standards of Good Medical Practice. Over the training period they reveal the trainee’s particular strengths, needs and areas for development.
The AES is responsible for synthesising the evidence at the end of the placement, although the process of judging the evidence would involve the team of clinical supervisors. The PD takes a holistic view of progress over the whole training period. The AES’s evidence-based report is written in terms of the trainee’s progress and specific learning outcomes which is facilitated by the learning portfolio.
Blank Learning Agreement
The portfolio has been designed to store evidence of the trainee’s competence and fitness to practise. The trainee is solely responsible for the contents of the portfolio both in terms of quality and veracity. Submission of information known to be false, if discovered, will have very serious consequences. The trainee's portfolio includes his or her health and probity statement (PDF), educational contract(PDF), Learning Agreements and a record of the assessments completed. The portfolio is supplemented by the logbook. The portfolio is available throughout the trainee's career and is accessible to the trainee, the AES and the PD.
All entries to the portfolio must respect the confidentiality of colleagues and patients and should not contain names or numbers to identify patients or staff. Portfolio evidence must be collected and documented systematically by the trainee as they progress through each placement. Trainees must record all assessments that are part of the training period. Workplace Based Assessments are considered to be formative and those that are less than satisfactory standard, if reflected upon appropriately, need not necessarily be seen as negative because they provide developmental feedback to drive learning and so improve practice. Where assessments have been unsatisfactory they should be repeated after focussed training until successful. The portfolio should enable the AES at the end of placement to assess the trainee in the round.
The portfolio is the vehicle used by the annual review to decide on the trainee’s continuing training or award of the Certificate of Completion of Training (CCT). The AES's reports are key to the annual review of training.