William Allum Chair, Joint Committee of Surgical Training Current State of Surgical Training

William Allum

Chair, Joint Committee of Surgical Training

Current State of Surgical Training

Current Issues

Profile of Surgical Training– Shape of Training– Opportunity to improve– Workforce– Credentialling

Generic Professional Capabilities Simulation v10 - ISCP / e Logbook

– Trainers Surgeon Outcomes Budget

Shape of Training

An agreement between– Medical Education England– Academy of Medical Royal

Colleges– GMC– Council of Postgraduate

Medical Deans– Medical Schools Council– NHS Education Scotland – NHS Education Northern

Ireland– NHS Education Wales

Key broad recommendations

Service requires Doctors with more general skills Requirement for Specialists remains Training – to CST within 6 years Credentialing for specific competencies Training must be more flexible and respond to

patient/service needs Blurring the primary/ secondary care interface

Issues

What has Happened?

UK-wide implementation group, chaired by Professor Ian Finlay (2014)

Division of the report into six workstreams (Autumn 2014)

Workstreams fed back to the implementation group

Report to 4 DH Ministers (Winter 2014/15)

4 DH Ministers Statement (February 2015)

Implementation Group extended (Spring 2015)

Workshops

General themes and progression to CST

Primary – secondary care interface

Interaction with employers

Issues relating to SAS doctors

Academic pathway

Credentialing

What has Happened?

UK-wide implementation group, chaired by Professor Ian Finlay (2014)

Division of the report into six workstreams (Autumn 2014)

Workstreams fed back to the implementation group

Report to 4 DH Ministers (Winter 2014/15)

4 DH Ministers Statement (February 2015)

Implementation Group extended (Spring 2015)

DH Statement

1. Implementation in an incremental fashion to minimize service disruption (short and medium term )

2. Preserve current fit for purpose structures

3. Continue the UK Steering Group supported by 4 Nation Implementation Groups

4. Commission an impact assessment to report by summer 2015

5. Implement the recommendation that the careers of SAS doctors should be enhanced.

6. Pilot credentialing (eg cosmetic surgery)

7. Seek draft descriptions of training pathways to include CST within 6 years and credentialing for each theme

What might the implications be for craft specialties?

Relatively little Broad disciplines will remain Training will be general enough to permit most

doctors to participate in and treat emergency patients

Specialist interest will remain Some sub-specialist activities will be credentialed

What might the implications be for craft specialties?

Training•Fewer trainers but better recognition•More use of simulation techniques•Immersion training•Competency based rather than time based•Training to enter team structures•? Formal mentoring after CST

Strategy for Change in Surgical Training

Opportunity for Surgery

Improve quality of teaching and training– commitment from LEPs

Time for training and supervision

Rota review for emergency service provision

Role of Allied Healthcare Professional workforce

Improving Early Years Training

Improving Surgical TrainingWhat are the Objectives

To improve quality of surgical care

To improve the quality of surgical training

HEE Perspective

Process

Run Through, Competence Based, MRCS required for progression

National selection

Contemporary Challenges to Delivery of Surgical Simulation

Framework for Technology Enhanced Learning

Simulation - Drivers

Clinical Experience

Change in working practices EWTR

Technological and Scientific advances

Efficacy of Simulation

ChallengesHuman Resources

Trained Faculty– Design curriculum– Provide structured feedback– Role model

Time for Training– Service vs Training– Patient safety demands on trained surgeons

ChallengesEducational Strategy

Structured curriculum– Learning outcomes– Assessment instruments– Formative and summative feedback

Trainee clinic time vs simulation time– SDL

Trainee Awareness

JCST Survey

In this post, did you receive simulation and clinical skills training?

Yes No N/A

East Midlands 42.1% 36.3% 21.5%

East of England 44.4% 38.5% 17.1%

KSS 65.4% 27.5% 7.1%

London 51.1% 32.6% 16.3%

North West Mersey 35.9% 45.9% 18.2%

North West 40.3% 40.3% 19.4%

Northern East 65.4% 19.8% 14.8%

N Ireland 27.4% 48.0% 24.6%

Scotland 41.0% 39.8% 19.2%

South West 32.9% 47.8% 19.3%

Thames Valley 48.6% 37.0% 14.4%

Wales 38.9% 44.3% 16.8%

Wessex 36.0% 42.5% 21.5%

West Midlands 39.1% 38.3% 22.6%

Yorkshire / Humber 58.3% 29.8% 11.9%

TOTAL 46.0% 36.5% 17.5%

Availability of Simulation by

Deanery

Availability of Simulation by SpecialtyYes No N/A

Cardiothoracic Surgery 60.3% 23.3% 16.4%

Core 49.8% 36.7% 13.5%

General Surgery 40.7% 43.8% 15.5%

Neurosurgery 33.6% 43.4% 23.0%Oral and Maxillofacial Surgery 27.5% 30.8% 41.7%

Otolaryngology 57.6% 23.5% 18.9%

Paediatric Surgery 57.6% 34.9% 7.5%

Plastic Surgery 41.9% 36.9% 21.2%Trauma and Orthopaedic 44.7% 34.0% 21.3%

Urology 53.4% 30.1% 16.5%

Vascular Surgery 58.3% 41.7% 0.00%

ChallengesLogistics

Task and Procedural Simulators Space for hardware Space for learners Funds to support and maintain Centralised resources Sharing resources

ISCP – What’s it for?

Personal studyTeaching

Informal assessmentFeedback

Formal Assessment

Curriculum Tells you what you need to know

Guides learningProvides structureImproves feedbackImproves training

Records outcomes

Guide to learning

ISCP v10

First ever complete re-write

Faster Better prepared for future developments

Planned for July / August release Beta version available now

ISCP v10

Web design Navigation Features

Content

v10 aims to keep ahead of the field

Easier to useMore intuitiveSimpler appearanceQuicker

Improve feedbackReduce tick box cultureTo improve training and learningTo meet objectives of ISCP evaluation

http://v10beta.iscp.ac.uk

Learning Agreement

Central feature Planning of objectives Review of progress Simpler to complete

– Logical– No longer needs downloading of topics

BUT– Evidence will still be linked to topics

Improved WBAs

Emphasis on feedback Structured free text at the top

– Strengths– Weaknesses– Actions

Anonymous assessment of trainer quality Reflective record

Supervisor Reports

Clinical supervisor

Educational supervisor

Structured feedback

– 9 domains: knowledge, clinical skills......

– Performance descriptors for each

– Free text and performance

grade for each domain

GMC Developments

Generic Professional Capabilities

Standards for Training

Equality and Diversity Guidance for Curricula and Assessment

Standards for Curricula

and Assessment

Generic Professional Capabilities

Generic Professional Capabilities– Effective communication– Leadership, team working, improving quality and

patient safety– Complex and vulnerable groups– Education and training– Research

Generic Professional Capabilities

Generic Professional Skills– Practical skills– Clinical skills

Generic Professional Knowledge– NHS structure

JCST Budget

JCST Finances

Source Amount (£)

Trainee fee 1,203,048

GMC – for CESR work* 129,737

Total external income 1,332,785

Funding of JCST 2013-14

JCST Finances

Function Expenditure (£)

Trainee enrolment and certification ISCP QA

1,421,893

CESR – equivalence work 109,082

Outgoings of JCST (by JCST function) 2013-14

JCST Finances

Area of Spending Amount (£)

Staff 821,000

Honoraria 70,000

Travel 23,000

Catering and AV 30,000

Office Costs 14,000

Accommodation, service and other charges

573,000

Overall total 1,531,000

Outgoings of JCST by Type of Spending 2013-14