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A JOURNEY OF EXCELLENCEPOSTGRADUATE MEDICAL EDUCATION ANNUAL REPORT 2013

© NHS Education for Scotland 2013. You can copy or reproduce the information in this document for use within NHSScotland and for non-commercial educational purposes. Use of this document for commercial purposes is permitted only with the written permission of NES

ISBN: 978-0-85791-032-5

We are grateful to all the people who havecontributed to the production of this report.

A JOURNEY OF EXCELLENCE: INTRODUCTIONS 6

Foreword: Malcolm Wright 7

The Year in Focus: Stewart Irvine 8

MEDICAL TRAINEES IN SCOTLAND: THE ROUTE TO A CAREER OF EXCELLENCE 9

The Strategy for Attracting and Retaining Trainees 10

An Opportunity to Prepare and Shadow 11

Scotlands Culture of Academic Activity and Research 12

The Annual Competition for Quality Improvement 13

Investing in the Additional Costs for Teaching 18

A ROUTE MAP OF SUPPORT: SUPPORTING THE DEVELOPMENT OF OUR DOCTORS 19

The Clinical Skills Managed Educational Network 20

The Leadership and Management Training Programme 22

The Scottish Clinical Research and Excellence Scheme 22

Scotlands Support and Advice for Choices in Medical Careers 24

Less Than Full Time Training 25

The Health and Wellbeing of our Doctors in training 26

Supporting our Doctors with Difficulties 26

The Scottish Foundation School 28

General Practice, Public Health Medicine and Occupational Medicine Training Board 29

Anaesthetics, Intensive Care and Emergency Medicine Training Board 31

Diagnostic Specialties Training Board 34

Medical Specialties Training Board 36

Mental Health Specialties Training Board 38

Obstetrics, Gynaecology and Paediatrics Training Board 40

Surgical Specialties Training Board 42

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2

3

CONTENTS

NHS Education for Scotland | The Scottish Medical Directorate 2013 Scottish Postgraduate Medical TrainingA Journey of Excellence2

FIRST CLASS TRAVEL: ENSURING QUALITY WITH PEOPLE AND TECHNOLOGY 44

Managing the Quality of Postgraduate Medical Training 45

The Medical Appraisal Team 48

Staff, Associate Specialist and Specialty Grade Doctors and Dentist 50 Professional Development Project

SHARING THE JOURNEY: ROLES AND RESPONSIBILITIES OF TRAINERS 52

A Summary of Trainee Selection and Recruitment 53

Developing a Faculty to train Medical Educators 55

Training Medical Educators in Scotland 56

Supporting Trainees with Learning Online 59

THE TECHNOLOGICAL CONNECTION: SYSTEMS WHICH CONNECT OUR ORGANISATION 60

The NES Medical Website 61

A Database for Managing Doctors in training in Programmes 62

Scottish Online Appraisal Resource 63

CENTRAL STATION: THE MEDICAL DIRECTORATE FOR NES 64

Governance and the Medical Directorate 65

The Four Scottish Postgraduate Deaneries 65

The Organisation of Postgraduate Medical Training 68

Key Contacts - NHS Education for Scotland Medical Directorate 69

Table of Acronyms 70

References and Additional Reading 72

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5

6

7

Section 2: Medical Trainees in ScotlandThe route to a career of excellence 3

Strategy for Attracting and Retaining Trainees

An Opportunity to Prepare and

Shadow

Scotlands Culture of Academic Activity and Research

The Annual Competition for Quality Improvement

Investing in the Additional Costs

for Teaching

MEDICAL TRAINEES IN SCOTLANDTHE VEHICLES FOR A CAREER OF EXCELLENCE

Less Than Full Time Training

The Scottish Clinical Research and Excellence Scheme

Scotland’s Support and Advice for Choices in

Medical Careers

The Health and Wellbeing of our Doctors in training

Supporting our Doctors with Di�culties

The Scottish Foundation School Diagnostic Specialties

Training Board

General Practice, Public Health Medicine and Occupational Medicine Training Board

Anaesthetics, Intensive Care and Emergency Medicine

Training Board

The Clinical Skills Managed Educational

Network

The Leadership and Management Training

Programme

Obstetrics, Gynaecology and Paediatrics Training Board

Medical Specialties Training Board

Mental Health Specialties Training Board

Surgical Specialties Training Board

A ROUTE MAP OF SUPPORTSUPPORTING THE DEVELOPMENT

OF OUR DOCTORS

The Medical Appraisal Team

Sta�, Associate Specialist and Specialty Grade Doctors and Dentist Professional Development

Project

Managing the Quality of Postgraduate Medical Training

FIRST CLASS TRAVELENSURING QUALITY WITH PEOPLE

AND TECHNOLOGY

A Summary of Trainee Selection and Recruitment

Developing a Faculty to train Medical Educators

Supporting Trainees with Learning Online Training Medical Educators in Scotland

SHARING THE JOURNEYROLES AND RESPONSIBILITIES OF TRAINERS

The NES Medical Website

A Database for Managing Doctors in training in Programmes

Scottish Online Appraisal Resource

The Knowledge Services Group

Scottish Medical Training Website

THE TECHNOLOGICAL CONNECTIONSYSTEMS WHICH CONNECT OUR ORGANISATION

Governance and the Medical Directorate

The Four Scottish Postgraduate Deaneries

An Organisational Map

NES Executive Contacts List Table of Acronyms

Acknowledgements

References and Additional Reading

CENTRAL STATIONTHE MEDICAL DIRECTORATE A JOURNEY OF EXCELLENCE

YOUR ROUTE MAP TO A JOURNEY OF EXCELLENCE


Strategy for Attracting and Retaining Trainees

An Opportunity to Prepare and

Shadow

Scotlands Culture of Academic Activity and Research


Investing in the Additional Costs

for Teaching

MEDICAL TRAINEES IN SCOTLANDTHE VEHICLES FOR A CAREER OF EXCELLENCE

Less Than Full Time Training

The Scottish Clinical Research and Excellence Scheme

Scotland’s Support and Advice for Choices in

Medical Careers

The Health and Wellbeing of our Doctors in training

Supporting our Doctors with Di�culties

The Scottish Foundation School Diagnostic Specialties

Training Board


Anaesthetics, Intensive Care and Emergency Medicine

Training Board

The Clinical Skills Managed Educational

Network

The Leadership and Management Training

Programme





A ROUTE MAP OF SUPPORTSUPPORTING THE DEVELOPMENT

OF OUR DOCTORS


Sta�, Associate Specialist and Specialty Grade Doctors and Dentist Professional Development

Project


FIRST CLASS TRAVELENSURING QUALITY WITH PEOPLE

AND TECHNOLOGY



Supporting Trainees with Learning Online Training Medical Educators in Scotland


The NES Medical Website

A Database for Managing Doctors in training in Programmes


The Knowledge Services Group

Scottish Medical Training Website



The Four Scottish Postgraduate Deaneries

An Organisational Map

NES Executive Contacts List Table of Acronyms

Acknowledgements


CENTRAL STATIONTHE MEDICAL DIRECTORATE A JOURNEY OF EXCELLENCE

5

A JOURNEY OF EXCELLENCEINTRODUCTIONS

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ForewordBy Mr. Malcolm Wright

When NES was established in 2002, it was responsible for the Education of dentists, doctors, nurses, midwives, pharmacists and psychologists. Today, we provide support to all staff groups from administrative and support services staff and healthcare chaplains to clerical workers and chief executives. NES ensures that people get the best healthcare possible from well trained and educated staff

In 2012 we celebrated our tenth anniversary and this gives us the opportunity to reflect on our development as an organisation from education and training for a small number of professional groups, to supporting the whole health workforce and increasing our work across health and social care.

In 2011 the Christie Commission1 set the scene for reform in Scotland, calling for ‘a systematic and coordinated approach to workforce development’ across our public sector. NES is responding to the reform agenda and is supporting the ‘NHS Scotland Quality Strategy’2 and the ‘2020’ vision of one integrated health and social care service by putting in place education and training activities which support care provided to the highest standards of quality and safety, with the person at the centre of all decisions.

2012 also represented the second year of delivering ‘Quality Education for a Healthier Scotland’3, our strategic framework for 2011-14. Last year we focused on changes to make our organisation and our services more efficient, streamlined and consistent in response to the economic downturn and the challenges we face across public services.

The challenges facing the NHS are constantly evolving. In medicine, recent years have seen substantial changes in Postgraduate Medical Education and Training, and substantial changes to the regulation of training, with the advent of a single regulator, covering the whole continuum of medical education.

NHS staff need to be equipped with the skills to respond to the current and projected demands on the service. This report is a celebration of the many ways that NES performs its role as the education, training and workforce development organisation of the NHS in partnership with our Health Boards, and Education providers.

A JOURNEY OF EXCELLENCEINTRODUCTIONS

Malcolm Wright OBE Chief Executive

1

Section 1: A Journey of ExcellenceIntroductions 7

The Year In FocusBy Dr Stewart Irvine

This is the fourth annual Report on Postgraduate Medical Education that NHS Education for Scotland has produced. Its purpose, as before, is to inform a wide range of interested people, both within Scotland and beyond, of what we do. NES is a Special Health Board, responsible for the development and delivery of education and training for all those who work in NHSScotland. Through this, we support the work of NHSScotland in delivering services to patients that are person-centred, safe, effective and evidence-based. The Medical Directorate is responsible for the training of approximately 6,000 doctors - who deliver care every day while working and learning in general practices and hospitals in the territorial health boards across NHSScotland. Our role is to oversee this training, manage the trainee's progress through the programme and ensure that training is delivered to the GMC standards. We also support the five Scottish medical schools through the distribution and performance management of resources for the clinical teaching of medical students - known as Additional Costs of Teaching (ACT).

As ever, the NHS continues to respond to many changes and challenges. 2012 saw the launch by the GMC of an important new framework for the recognition and approval of trainers, and the start of the process of revalidation for all doctors – including those in training. Also in 2012, the national training survey put learning from concerns about patient safety at the top of our agenda. 2013 has already seen the publication of a completely revised version of the GMC’s core guidance to doctors – Good Medical Practice, and, in a seminal moment for the profession, the publication of the Francis Report into the failings at Mid-Staffordshire NHS Foundation Trust. Elsewhere in the UK there have been major changes in the organisation of the NHS, and the establishment of a significant new education and training organisation in the shape of Health Education England (HEE) – with whom we look forward to working closely. And later this year, we look forward to receiving the final report of the major review currently underway into the Shape of Postgraduate Medical Training being led by Professor David Greenaway.

Our approach to medical education and training builds on the well established tradition in Scotland of working closely with many partners with diverse interests who together contribute to and support our work. Without them we could not succeed and to them we are indebted.

Dr Stewart IrvineDirector of Medicine


MEDICAL TRAINEES IN SCOTLANDTHE ROUTE TO A CAREER OF EXCELLENCE

2

The Strategy for Attracting and Retaining Trainees

At the heart of a strong belief in the National Health Service Scotland (NHSScotland), there is a collective sense of pride in this Scottish NHS. There is an appreciation in communities that its services and contribution to society in Scotland are immensely valuable. It is described as a ‘national asset’ with an ‘excellent reputation’. There is a broadly held view that ambitions for high quality services in Scotland are being realised.

NHSScotland champions quality and leads the world in healthcare with its emphasis on patient-centred care, patient safety and a focus on human factors.

NHS Education for Scotland (NES) has a reputation for producing well trained doctors through its high quality training. Unfortunately the lack of familiarity with the range of excellent training opportunities that Scotland offers and the desire among trainees to experience training elsewhere in UK and abroad, can leave gaps in our Scottish training programmes. These gaps compromise the training of others in programmes and impacts service delivery.

The Strategy for Attracting and Retaining Trainees (START) is Scotland’s coordinated response to these challenges.

The aim of this new strategy (START) is to improve recruitment and retention of trainees. It will use a suite of relevant resources and opportunities developed from new understanding around what factors influence choice of location of training and also how trainees access information to inform these choices.

This collaboration is led by NES and includes stakeholder groups such as:

� Scottish Government

� Territorial Health Boards

� Specialty Training Boards

� Royal Colleges

� Scottish Medical Schools

� British Medical Association.

START aims to promote, as never before, the range of high quality medical training opportunities that Scotland has to offer.

The expectation is that gaps in programmes will gradually become a thing of the past as the campaign begins to impact and more trainees choose Scotland as a place to live, train and work.

MEDICAL TRAINEES IN SCOTLAND THE ROUTE TO A CAREER OF EXCELLENCE

2


An Opportunity to Prepare and Shadow

After undergraduate training, Trainees choosing Scotland as their base from which to become doctors in training means they have selected Foundation Training that immediately recognises that a journey towards excellence needs high quality and efficient signposting and support.

The Scottish Foundation School covers the whole of Scotland and is the biggest foundation school in the UK. Encompassing all four Deaneries, the Foundation Programmes are designed to cover different specialties, populations and geographical diversity, including remote and rural practice.

The Foundation school also recognises that the first few weeks of a Trainee’s journey can feel a little daunting. The early days of Foundation Training brings them to the new and sometimes confusing world of employment. Providing Trainees with an opportunity to shadow a colleague who has recently travelled this path provides a welcoming and supportive introduction to the world of work. This opportunity not only benefits our doctors in training, but provides a professional experience for patients, keeping them safe and treating them well. This human factors approach symbiotically improves the health experience for both our doctors in training and our patients.

To ensure that doctors in training orientate quickly into the department to which they are first placed, The Scottish Foundation School welcomes them to a Shadow Week. This part paid Shadow Week demystifies what it means to work in a busy NHSScotland department, inducting them to policies, departmental procedures and regulations. This essential induction not only informs our new employees with the expectations of their employer, but it also gives an authentic introduction to what the First Year of Foundation Training might be like.

The Shadow week starts with a welcome to the Deanery. It also provides a snapshot of what it is like to be a Foundation Doctor. Trainees hear experiences of a Foundation Year One doctor currently in post, who describes to the trainees

Dr Jing Wang

My colleagues agree that the Shadow Week was an invaluable opportunity to prepare them for the first few weeks of work


Scotland’s Culture of Academic Activity and Research

The Shadowing Week shows how doctors in training (trainees) choosing to work and train in Scotland benefit from opportunities that support an ambition for a career of excellence from their first day of employment. This support continues throughout their career no matter which location in Scotland our Trainees find themselves. The Scottish Clinical Research Excellence Development Scheme (SCREDS) provides an integrated training and career development pathway enabling clinicians to pursue concurrently or sequentially academic and clinical training within NHSScotland. It facilitates both the attainment of a senior clinical academic appointment and the award of a Certificate of Completion of Training (CCT). Its current remit is for doctors only.

On the invitation of the Board for Academic Medicine in Scotland, the Scheme is operated by the Universities in partnership with NHS Education for Scotland (NES).

An explanation of how the scheme operates is set out in ‘The Scottish Clinical Research Excellence Development Scheme - A Guide to the Scheme’ published jointly by The Board for Academic Medicine in Scotland and NHS Education for Scotland in January 2009.

Doctors are eligible for appointment to a SCREDS post if they:

� are on the GMC’s Specialist or General Practitioner Registers

� hold a National Training Number

� do not hold a National Training Number but have been appointed to a decoupled Core Training Programme recognised by GMC and hold an equivalent Core Training Number.

their own experiences of the first year in Postgraduate Training. This presentation allows Foundation Doctors who already have experienced the transition from Undergraduate to Postgraduate to tell a story of; “What I Wish I had Known”.

The rest of the shadow week prepares the trainee for their employment by not only understanding the Deanery, their employers, and the relevant policies but also ensuring that they can put theory into practice. This opportunity not only gets our doctors in training up and running in their department as efficiently as possible, it also allows them to experience different shifts, be present at handovers and to become familiar with their rotas and shifts.

An evaluation of the Shadow week from 2012 has shown that this honest and frank approach offers not only reassurance and insight for the doctors in training in training (trainees) but also provides an informative quality measure for improving this opportunity for future years.

To maintain and continue to improve the quality of the Shadow Week, all doctors in training who have this opportunity complete a questionnaire to provide feedback about the best and worst parts of the Shadow Week. The information gathered from these questionnaires provides invaluable information for continually improving this opportunity year on year.

The Scottish Foundation School regularly reviews the current teaching and experiences available to Foundation Doctors including induction and shadowing.

The Key Learning Outcome for the Shadow Week is for doctors in training entering training to: Identify their responsibilities as an employee in training with the NHS delivering safe patient care by seeking appropriate supervision and is the foundation for our doctors in training as they start their journey of excellence.


More detailed information such as data about the scheme, the number of participants within the scheme, levels of study, specialty, vacancies within the scheme and other relevant information about SCREDS can be found at: www.nes.scot.nhs.uk/media/13713/SCREDS%20Annual%20Report%202012_FINAL.pdf

With initiatives such as SCREDS, Scotland punches well above its weight in academic activity. Each of the five Medical University cities are closely linked to the four NES Deaneries. Other initiatives such as the Scottish Transitional Medicine Training Initiative (STMTI) and the Psychiatric Specialty Training in Academic Research (Psy-STAR) are both Scottish national initiatives which enhance the experience of working and training in Scotland. STMTI implements new medicines into hospital and general practice and Psy-STAR attracts increased research activity in the specialty of Psychiatry.

South East

West

North

East

Base: All posts (120)

TotalNo.

36

36

30

18

18

18

15

9

18

18

15

9

FY1 FY2Figure 1: Academic Foundation posts by Deanery

The Scottish Medical Education Research Consortium (SMERC) is a consortium involving NHS Education for Scotland (NES), the University of Dundee (The Health Informatics Centre and the Centre for Medical Education), the University of Aberdeen and the University of Glasgow. SMERC aims to bring together researchers and educators from all five medical schools in Scotland as well as other groups and individuals that are involved with medical education locally, nationally and internationally.

The close collaboration of Universities and Deaneries facilitates a uniquely Scottish opportunity to negotiate funding from the Board for Academic Medicine which creates a culture of academic activity from Foundation onwards.


The Psychiatry Scottish Training in Academic Research (PsySTAR) programme is a unique combined clinical and academic training opportunity in which participants spend three years out of programme to complete a PhD. The PsySTAR programme was awarded by the Medical Research Foundation to Scottish academic centres, in competition with those all over the UK.

Scotland won the funding due to its internationally recognised research centres, with the additional attraction of effectively working in collaboration to provide a programme over four of the five different centres:

�University of Aberdeen

�University of Dundee

�The University of Edinburgh

�University of Glasgow

As a result of the PsySTAR initiative nine Scottish based psychiatrists will have the opportunity to complete PhDs supervised by and researching with internationally recognised cutting-edge scientists. The opportunity of bringing together four universities expands the limits of what is possible. The programme will address mental health research priorities identified by the Medical Research Centre (MRC). The PsySTAR programme is a terrific opportunity to train as an academic psychiatrist, in a rich and well supported research environment.

Interviewing Dr Ally Rooney, a participant on the programme, he said:

We are all really grateful to the Postgraduate Deans, Specialty Training Board and Training Programme Directors for such help in smoothing the way. I plan to study adult hippocampal neurogenesis with Professor Charles French-Constant in the Medical Research Centre for regenerative neurology in Edinburgh.


Dr Adele Warrilow studied at St Andrews University which ran a traditional course with pre and post clinical years, spent some time in Manchester, and did her Foundation Years in the West of Scotland. She returned to Scotland as she thought the programmes offered were really well structured with many opportunities to work in a variety of settings. After her core training in Psychiatry she has specialised in child and adolescent psychiatry. Dr Warrilow completed a Masters degree in Public Health when she was at Manchester, graduating with merit, and this stimulated an interest in research. When she was thinking about applying for specialty training she found out about PsySTAR. The opportunity to spend three years out of programme to conduct research was very attractive to her ambitions and interests.

When interviewed Dr Warrilow said:

Everyone has been very supportive about the programme, the Deaneries especially. Scotland is uniquely placed to offer such collaboration between different areas. Its size and geographical spread makes this achievable. Places in the programme are funded by the Medical Research Foundation. Although essentially a three year PhD programme, we have been allowed to spend this year formulating our research proposal, using our study leave to travel around Scotland meeting with world class researchers in world class facilities. Being able to connect leading research in psychiatry with that in basic science is just one of the reasons that PsySTAR is a truly unique and very valuable opportunity.


Dr Lindsay Mizen, a psychiatrist in training in Learning Disabilities and also a PsySTAR participant, observed that:

Psychiatry is recognised as an increasingly important specialty because of the impact of psychiatric disorders on the health on the nation. The potential outcomes of PsySTAR are much wider reaching than core psychiatry, potentially developing novel interventions and treatments. The MRC Strategic Review of Mental Health Research promotes understanding the psychosocial causes as well as the biological basis of psychiatry as an important way of improving the nations’ mental health.

It is unique to Scotland that by the time we had our induction week we had already gone round all four universities and in some ways we had a unique perspective on the research that is going on in Scotland. Although a lot of it is complimentary and people do collaborate because we have been everywhere we really had a good overall view of what is happening and that gives a good opportunity to see where collaborations can be made and to have a better idea of what’s going on in terms of choosing our own projects and what me might be interested in.

These academic opportunities present a direction of travel for healthcare in Scotland not only towards Quality of service but of continual improvement and innovation.



With these strong initiatives to progress and support academic and research activities in Scotland, it is no surprise that we reap the benefits in our quality improvement projects. Establishing and strengthening the pathways for quality and innovation, the Annual Competition for Quality Improvement is joint initiative led by our South East Deanery in collaboration with Edinburgh University, and NHS Lothian. It was offered for the first time in 2012, and a prize was presented for the best quality improvement project for healthcare in the South East Region of Scotland. There was an Undergraduate and a Foundation prize.

This Competition was well received and it is hoped that it will be offered across Scotland for future years.


To ensure that this budget is used effectively and that continuous improvement of training from undergraduate through postgraduate can be evidenced, the ACT team have continued to develop the undergraduate student evaluation system. This evidence-based evaluation system, developed over the past four years, is a Scotland-wide system put in place in concert with the medical schools and results are published alongside the Postgraduate National Trainees Survey. The evaluation reports are published by the University of Dundee via the Scottish Medical education Research Consortium (SMERC), mentioned in the earlier article. These reports are reviewed at both a local and regional level and the results of the review along with agreed follow-up action is reported to NES each year.

ACT funding is also used to develop and maintain the infrastructure required for excellent medical education. The costs of developing clinical skills facilities, which is a feature of the next article, is an example of an area of financial support that ACT provides within the Health Boards.

Investing in the Additional Costs for Teaching

NES recognises that ensuring the high quality medical education that produces high quality healthcare starts at University. Our Medical Directorate therefore works closely with the Medical Schools in Scotland to ensure an integrated approach between those responsible for undergraduate and postgraduate medical education. NES is represented on the Scottish Deans Medical education Group (SDMEG) that has been restructured to focus more on joint working. NES has also provided funding for a joint project with SDMEG to review the continuum between undergraduate and postgraduate medical education that should help inform future work programmes.

The Additional Costs for Teaching team (ACT) working with the Medical Schools in Scotland ensure that the quality of teaching at undergraduate level within the NHS is of the highest possible standards. The ACT team aim to provide a quality product within the NHS throughout the undergraduate years.

The ACT team holds a substantial budget of around £80 million. This is fully distributed each year to the Health Boards in Scotland to allow them to meet the additional costs of teaching within NHSScotland. The role of the ACT team is to distribute and performance manage the money to make sure it is used to greatest effect. The recent focus has been on developing detailed teaching activity data that can be agreed between the Schools and the Boards. This includes the time doctors take out of service delivery to teach students, and the time devoted to students during service delivery, for example during ward rounds. This approach allows dedicated teaching time to be identified in consultants’ (and other staff ) job plans and also provide a direct link between ACT funding and directorate budgets. Revised guidance has recently been issued to Boards to assist in the development of this initiative. This project should also help Boards and Medical Schools provide evidence to the General Medical Council (GMC) that trainers have dedicated time in job plans.


A ROUTE MAP OF SUPPORTSUPPORTING THE DEVELOPMENT OF OUR DOCTORS

3

The Mobile Skills Unit has delivered clinical skills training in the past four years to over 3000 healthcare and other public sector staff as well as basic resuscitation skills to the public in 36 different locations. There have been challenges over the last year with the cancellation of two visits and difficulties in releasing staff due to service pressures. There is, however, a Mobile Skills Unit Steering Group, chaired by Richard Carey, the Chief Executive of NHSGrampian, which has put forward a number of innovative suggestions to improve support for local educators and staff which will be piloted by CS MEN in the coming year.

Over the next year, the CS MEN Team will further develop collaboration with other blue light services including the Scottish Ambulance Service (SAS) and the Police Service of Scotland (PSoS) known as Police Scotland, along with Royal National Lifeboat Institution (RNLI), the Ministry of Defence (MoD), and, importantly the general public to maximise the benefit of the MSU and skills training for the Scottish public.

The CS MEN continues to produce a range of education resource packs which can be accessed through the CS MEN Website: www.csmen.scot.nhs.uk

There were a wide range of presentations of completed projects and ongoing developmental work. In the last year new education resource packs covering Suturing, Intravenous Medicine, and Safe Communication have been launched.

The Clinical Skills Managed Educational Network

From a patient’s perspective, the clinical skills of the staff they meet have a profound impact on their experience of healthcare as well as the safety and effectiveness of their care. Clinical skills, in the broadest sense, includes both technical skills such as performing invasive procedures on patients and non-technical skills, such as situational awareness, prioritisation, decision making, team working and communication. The importance of non-technical skills is often under-estimated in healthcare but most instances of unintended and avoidable harm to patients are due to a failure of non-technical skills.

NES has invested in multi-professional, generic skills education through the development and substantive funding for the Clinical Skills Managed Educational Network (CS MEN) which includes a team of four NES staff led by Philip Cachia from Medicine and Mike Sabin from Nursing, Midwifery and Allied Health Professionals (NMAHP). A national clinical lead has been appointed and three regional champions seconded to NES on a sessional basis. CS MEN has a key role in developing networks of educators in Higher Education and the Service, managing the Mobile Skills Unit, developing educational resources, promoting quality standards and educational research and development in the field of clinical skills training.

The NES Clinical Skills Group identifies and supports educational priorities for generic skills education and work with Scotland’s key educational experts. The Scottish Multi Professional Maternity Development Programme, the Scottish Clinical Simulation Centre in Larbert and the Cuschieri Clinical Skills Centres in Dundee are examples of groups that are supported by CS MEN. This support helps to promote effective collaboration and avoid duplication.

A ROUTE MAP OF SUPPORTSUPPORTING THE DEVELOPMENT OF OUR DOCTORS

3


The second Annual Research and Development Symposium was held in November 2012.

The CS MEN continues to provide strategic leadership in educational infrastructure, resources and standards and faculty development. Our aim is to provide patient-focussed, generic clinical skills training and education on a consistent basis across different professional groups and geographies in Scotland.

The Clinical Skills Managed Educational Network is an essential element of the Human Factors approach to healthcare in Scotland. NHS Education for Scotland is committed to integrating information of Human Factors into resources that promote safe, effective and person-centred care. Human Factors science is the study of how humans relate to the world around us. Our behaviour and decision-making is often determined by inbuilt or hard-wired ways the human mind works plus external factors such as stress, fatigue, pressure of time, interaction with colleagues etc. The root cause of many instances of unintended harm in healthcare can often be traced back to Human Factors. Or to put it another way, most adverse incidents are not due to inadequate knowledge or technical skills or lack of commitment or compassion by staff, but arise because of human limitations in a pressured and chaotic clinical environment. A Human Factors approach to reducing unintended harm and improving clinical outcomes is based on understanding the factors identified above and designing systems and specific interventions (physical or psychological) that avoid the predicted error – i.e. ‘making it easy to do the right thing’.

Section 3: A Route Map of supportSupporting the development of our doctors 21

The Scottish Clinical Research Excellence Scheme (SCREDS)

The Scottish Clinical Research Excellence Development Scheme (SCREDS) briefly mentioned in our Academic Activity article earlier further supports our philosophy of working closely with NHS Boards to understand the education and training needs of our doctors in training. This helps NES to provide continuous support for trainees by driving consistent standards, transferability of learning, avoidance of duplication and efficiency delivered through economies of scale.

NES is a frontline Health Board directly delivering the training to and supporting the salaries of approximately 6,000 trainees who deliver care every day across NHSScotland. SCREDS is operated by the Universities in partnership with NES. This partnership allows NES and the Universities not only to develop and benefit the individuals taking part in the Academic Training made available by SCREDS but also to mutually understand and create a mutual vision for the development of healthcare and the medical workforce in Scotland.

SCREDS supports and creates Academic Training Opportunities such as:

� Academic Foundation Training

� Clinical Lectureships

� Appointments to undertake out of programme research

� Appointments for Advanced Academic career development

The Scottish Clinical Research Excellence Development Scheme produce a report annually which details the distribution of Academic training posts, how to apply for posts, and areas of Academic Training which currently have posts available for application. The current annual report can be found at: http://www.nes.scot.nhs.uk/media/13713/SCREDS%20Annual%20Report%202012_FINAL.pdf

The Leadership and Management Training Programme

Our workforce includes doctors in training trained in Scotland who have an awareness of, and engagement with, leadership and management theory and practice that best prepares them for a career of inevitable change and challenge. The Leadership and Management Training Programme (LaMP) is a NES resource designed and developed by the Medical Directorate to deliver The NHS Leadership Framework (2011) competencies in a way that best serves the needs of future practitioners in the NHSScotland. The LaMP continues to focus on developing and delivering an extensive and relevant leadership programme to all Scottish trainees and is driven forward by a collaborative steering group drawn from all four Scottish Deaneries, The Knowledge Services Group, the ePortfolio team, a NHS Board Director of Medical education, and our Educational Development Directorate (National Leadership Unit).

The LaMP is a good example of the strength in collaboration across NES to provide modern training opportunities that offer the best development for our future doctors. This programme exemplifies the way ahead for NES in partnership learning. It uses a blended learning design, incorporating bespoke e-learning materials relevant to the Scottish context, focussing learners on the opportunities in the work place. With a unique array of face to face work shops, the LaMP’s blended approach to the development of participants, with most learning occurring on the job and in the clinical workplace is effective and efficient. Although currently dependent on eLearning for Healthcare (eLfH) LeAD modules, the programme aims to be self-sufficient for e-learning hosted by the Knowledge Network from August 2013.

To find more information and to book face to face module access the NES booking portal found on the NHS Education Internet Site: https://www.portal.scot.nhs.uk/


The Scottish Clinical Research Excellence Development Scheme continues to support the development of our doctors in training by managing the availability and recruitment to Academic Training Posts.

Specialty TraineesN= 4,158

SCREDS 2011-2012University Grand Fellow Lecturer Advanced Other Total Total Total Appointments

Aberdeen 40 13 15 3 9

Dundee 48 22 22 2 2

Edinburgh 129 53 54 21 1

Glasgow 92 48 37 7 0

Scotland 309 136 128 33 12

Foundation DoctorsN=1,608

Academic Foundation PostsEast 18

North 30

SE 36

West 36

Total 120

Certificate of Completion of Training (CCT)

Figure 2: Overview of SCREDS Posts


The deaneries focused on complementing and not duplicating this National Website by writing a short information Flyer for Scottish National Careers. NES provides training to Educational Supervisors, and other trainers within the Health Boards so that local trainers can support and inform trainees regarding their career choices. The Supporting Training and Revalidation (STAR) online system featured later in this document also provides online training in careers coaching. Regular consultation with the universities ensures that information sessions can target significant points in doctors in training’ career progression, points such as:

� the start of clinical studies

� application for Foundation and Specialty posts

Each of the four Scottish deaneries has an Associate Postgraduate Dean for Careers who can advise on career information and can provide one-to one advice for trainees when required.

Scotland’s Support and Advice for Choices in Medical Careers

Apart from the opportunities to further academic research today’s medical careers are complex, dynamic and competitive. The new doctor of today needs support and guidance to make correct and informed careers choices. Most undergraduates start to consider their choices in Medical School, formulating a possible vision of their future career. A career in Medicine is currently impacted by many different factors making this a rapidly changing environment: this includes increased competition in some posts, and greater availability of posts in other specialties. The new generation of doctors view their career choices through the paradigm of achieving the essential work-life balance, as well as opportunities for specialisms that the undergraduate may not previously have considered, makes a medical career choice, complex.

To support our doctors in training in making the best choices, our four deaneries have worked together to provide a range of resources that helps trainees formulate a flexible and clear vision of their future. The NES resources support those available UK nationally on the NHS Medical Careers Website: https://www.medicalcareers.nhs.uk/


Less than Full Time Training

NES understands that supporting our doctors in training in training also demands the assimilation and accommodation of doctors in training with diverse personal and professional needs. A career in medicine is a career that is entered with passion, for fulfilment and with a lifetime of commitment. As a result, the lives of our doctors in training and the lives of the patients that need the Health Service continually feed and demand from each other and not with equal weight. It is also a profession that is physically challenging in complex social and professional environments and emotional situations. As a result a career in Medicine historically has not been a career which readily offered flexibility and fluidity across working arrangements.

NHSScotland recognise the strengths and benefits of maintaining excellent Doctors as they travel through both their career and life. The benefits of balancing this supremely demanding career with lifestyle choices offer NHSScotland and the doctors in training who choose to live and work here an opportunity to deliver excellent healthcare. The challenge of balancing an excellent health service with enhancing the experiences of our patients creates choices and restrictions for both our doctors in training and the delivery of this excellent service.

NHSScotland strives to negotiate a balance between service and the quality of life of our doctors in training. With a view to offering the widest choice of location in which to train, and a flexibility of training opportunities that are mutually conducive to the service and the new doctor NHSScotland offers medical trainees the option to undertake Less Than Full Time Training (LTFT) when possible.

Trainees apply for LTFT based on a stringent, fixed process. Initial LTFT application is made via direct discussion with the trainee’s postgraduate dean.

The Training Programme Director (TPD) is alerted and will be asked to confirm that the LTFT application will not affect the trainee’s educational progression, as the trainee will still need to complete their competencies within a defined training period.

Any LTFT application is then ultimately subject to Service approval, as Service will need to identify and accept any reduction to Service delivery. If Service delivery cannot be guaranteed, or there is a wider impact upon fellow workers, trainees or the overall training programme, then the LTFT request can be justifiably declined. This is consistent with the requirements of the 2002 Employment Act.

Finally, practical approval of the LTFT is made via the standard Human Resources, payroll and funding processes. Our Medical Directorate in NES continues to support the development of our doctors in training, by negotiating a mutually beneficial training pattern, ensuring a balance that maintains the health and wellbeing of our doctors and Service delivery.


Supporting our Doctors with Difficulties

The four deaneries recognise that medical training in Scotland is large enough to be complex, and as such have developed support mechanisms that reflect the often unique trainee needs which are dependant on location, but as a Nation the four deaneries are small enough to offer that important individual support.

NHS Education for Scotland has a well organised Doctor in Difficulty (DiD) support structure with a National Trainee Performance Advisory Group (TPAG) overseeing the process. There is representation on TPAG from all four Deaneries, the Occupational Health service, NHS hospital service, and a Lay Representative. Although all four Deaneries have in place the same protocols and structures they have developed slightly different approaches to Doctors in Difficulty in order to respond to local need.

The focus in 2013 for TPAG and the Deaneries will be to move towards consolidation of the national DiD strategy ensuring fair, consistent and transparent processes for managing trainees across Scotland.

One area of development will be to advertise to trainees and trainers the supportive nature of systems currently in place and thereby reduce the stigma of being a doctor in difficulty. Trainees are not always in difficulty through any fault of their own. There may be issues relating to their health, post, external situation, trainer support or their programme which need to be considered and addressed. Working with trainees in difficulty is about accurate identification of problems to ensure that all factors affecting performance are taken into consideration and appropriate remediation and support put into place. The Deaneries work together through TPAG to ensure equitable access to remediation resources such as the Ward Simulation Exercise in Dundee, the Acute Care Scenarios in Larbert and Communications courses offered by NHS Lothian.

The health and wellbeing of our doctors in training

Health and Wellbeing of the workforce is a clear and important priority throughout NHSScotland. The health and wellbeing of our doctors in training is particular priority for the four Deaneries that make up the Medical Directorate for NES.

There is increasing awareness of the help that doctors in training need to maintain their personal health and wellbeing. The Medical Directorate are building strategies to support and raise awareness of this. The Deanery in the West are currently developing training options to provide support and information around Health and Wellbeing for all doctors in training, starting with a video educational resource for launch in August 2013.

NES works closely with NHS Boards to understand their education and training needs, so driving consistent standards, transferability of learning, avoidance of duplication and efficiency delivered through economies of scale.

The health and wellbeing of our doctors in training has always been a clear priority for our four Deaneries. Over the next twelve months NES will work towards raising the awareness generally of the importance of acknowledging the health and wellbeing of all of our doctors in training working with NHSScotland.

Medical training in Scotland maximises the opportunities that a country of its size and commitment to support provides. Along with a strong and dedicated support structure in the Doctors in Difficulty (DiD) national initiative, the deaneries work hard to provide support to doctors in training who experience difficulties helping them to manage their personal and professional challenges.


A further aim for 2013 will be to try and ensure an allocated budget for ongoing support for DiDs in order to fund remedial training, supernumerary placements and other specialised input. TPAG currently collates figures on numbers of DiDs and direct costs associated with trainee support. However, a challenge for the group is to find a way to calculate indirect costs, for example time spent with trainees by clinical and educational supervisors in giving this support.

One way to ensure that doctors in difficulty are being identified, helped and followed up is by having access to good IT systems and TPAG is currently working with those developing the new Pinnacle database to create a designated highly secure area that records details of individual DiD situations without compromise to a doctor’s confidentiality. TPAG recognises that the Ward Simulation Exercise is primarily focused on Foundation Year competences and that with further development it could be used to assess skills in higher trainees. TPAG is supportive of such a development as more accurate assessments of difficulties at the appropriate level of training will in turn lead to better targeted support.

In summary, there is a robust national support structure in place to manage doctors in difficulty. The challenge for TPAG and the Deaneries is to continue progressing this work to ensure equitable access, appropriate assessments, and costed remediation to trainees who need extra support.


The Scottish Foundation School

The four Scottish postgraduate deaneries have operational responsibility for ensuring that all aspects of postgraduate medical education, from Foundation to Core and Specialty Training, are delivered to the highest standards. The Scottish Foundation Programme is committed to ongoing improvement and development to meet the needs of current and future trainees.

In 2013 the Scottish Foundation Team undertook an extensive revamp of the existing NES Scottish Foundation web pages. A more modern design ensures that users will no longer need to click through multiple pages to locate specific Foundation programme information. This new NES Foundation website will ensure the Scottish Foundation Programme is both attractive and inspiring to graduating medical students, whilst promoting Scotland as a great place to pursue a medical career.

Each year, the Scottish Foundation Programme hosts a conference in central Scotland. This is a successful event where representatives from all Deaneries, including Foundation Programme Directors (FPDs), administrative leads and Educational Supervisors can be updated on current Foundation recruitment trends and review Foundation developments. The annual event also provides scope to share what has gone well in the year and identify any challenges which may lie ahead. The curriculum for the UK Foundation Programme has been updated five times since 2005 and whilst annual e-Portfolio and UK Foundation school updates will capture primary developments, it is the Scottish Foundation Programme day which provides a practical opportunity to directly share information and discuss implementation of important changes. The Scottish Foundation Day encourages active involvement and engagement with the people who deliver Foundation training and is scheduled for 30 May 2013.

The Foundation Day was augmented this year by a highly successful meeting in March which discussed the Foundation Taught Education Programme across Scotland. A number of areas of best practice, such as Simulation and Handover training, were discussed and will be disseminated across the 4 Deaneries.

The Collins and Cook4 report (2010) had a series of recommendations to further improve the Foundation Programme. The Collins report had recommended that an increase Community facing posts in Foundation training would be necessary, especially as it is widely recognised that 50% of all medical graduates will pursue roles in General Practice (GP). Scotland had previously been disadvantaged as it did not have suitable funding allocated to set up additional GP posts, however, current developments allow scope to explore an expansion in opportunities for Psychiatry and Community posts. 2012/13 saw the continuation of the work undertaken by The UK Foundation Programme Office (UKFPO), including the Scottish Foundation School, with the Medical Schools Council around the implementation of the Situational Judgement Test (SJT). This was unfortunately not trouble free. A full report on the issues will be produced by Health Education England (HEE).

The Speciality Training Boards in Scotland strive to attract and maintain the best doctors in training.



Through 2012/ 13, general practice has been working increasingly closely with others to develop and deliver a NES Primary Care Strategy. This led David Bruce and Professor Rosemarie Parr, Director of Pharmacy Training to focus on:

� alignment of NES Continuing Professional Development (CPD) activities for the four primary care contractor professions

� integration and multi-disciplinary working in primary care practice round the NHS quality agenda

� integration of health and social care and developing community hospitals

� leadership

� national NES primary care education network

� the integration human factors principles and learning from patient safety incidents in primary care.

The STB continues to support a range of post-CCT GP fellowships that provide a year-long higher professional experience that address a range of service, public health and occupational medicine needs. These include ‘standard’ rural fellowships, ‘acute care’ rural fellowships, health inequality fellowships, occupational medicine fellowships, medical education fellowships and, in collaboration with the academic primary care departments of our sister medical schools, academic fellowships.

Throughout 2012 the Royal College of General Practice (RCGP) have been seeking support for their case to enhance GP training. General Practice has the shortest period of training and the college’s case to enhance training proposes a move from the current three year programme with 18 months in GP to four years with two years in GP. These enhanced training arrangements would address a perceived need for enhanced clinical skills, generalist skills and leadership skills.

The General Practice (GP), Public Health Medicine (PHM) and Occupational Medicine (OM) Board is a diverse Specialty Training Board (STB). The STB prides itself on balancing the interests of all three sub specialties with an equitable distribution of representatives and discussion on issues of relevance to the individual specialties and on areas of common interest or collaboration.

In 2012, the GMC piloted a virtual Quality Assurance visit process to review smaller specialties. They undertook a review of the Scottish National OM Training Programme which is hosted in our West of Scotland Deanery. The virtual visit not only reviewed OM Specialty Training arrangements in Scotland but also provided an opportunity to showcase the benefits of the Scottish STB structure and process. The visit report highlighted as good practice joint working between GP and OM facilitated by the STB structure including revision of the General Practice Specialty Training (GPST) curriculum to better reflect occupational factors. The GMC virtual visit demonstrated some merits of the STB structure, where a smaller specialty such as OM, is able to find a voice and forum to contribute more widely and to celebrate achievements.


The educational case has been accepted by Westminster’s Department for Health and the Scottish Government has acknowledged the strength of the case. The RCGP in Scotland has described how these changes will support the Scottish Government’s 20:20 Vision for integrated health and social care. Implementation will depend on an economic case being accepted and the GMC have stated that their support will only be forthcoming if there is four nation approval. On behalf of the STB, a short-life working group has looked at the implications for Scotland if this case was accepted, in particular with reference to the four year programmes that are currently offered to trainees in Scotland but are quite different to those envisaged by the RCGP.

Recruitment to GP Specialty Training in Scotland remains challenging with particular difficulties in filling four year programmes in areas peripheral to the major conurbations. The institution of a rural-track GPST programme in Scotland in 2012 has shown some early promise and the STB look forward to playing a full part in the START (Strategy for Attracting and Recruiting Trainees in Scotland) Alliance initiative in the coming years.

There are some uncertainties and challenges around the future training arrangements for Public Health Medicine in Scotland. Some Health Boards are reluctant to take on potentially expensive trainees and not all retirements at consultant level are being replaced. In addition, there is uncertainty around what the ideal training establishment should be. Finding the way through this will involve close working between the Scottish Government, the specialty of PHM, the STB and Health Boards.

Practice Based Small Group Learning (PBSGL)

The Practice Based Small Group Learning (PBSGL) NES-supported project continued to expand in 2012. PBSGL originated at McMaster University in Canada in the late 1980s and was implemented in Scotland from 2006.

PBSGL provides a forum for GPs and other healthcare professionals to meet in peer-facilitated small groups to address topic-specific educational modules based around participants’ own patient cases and shared experiences. The aim of PBSGL is to drive evidence into day-to-day practice. There are now over 1300 GPs involved in PBSGL (approaching 30% of the Scottish GP workforce) and it continues to grow with significant cross-border interest. There has been increasingly successful engagement with other primary healthcare professionals including pharmacists and nurses. The NES Pharmacy Directorate are involved in joint working and see PBSGL as both a useful method for pharmacists uni-professional learning and for multi-professional learning involving professionals from other primary care disciplines.

PBSGL is a successful example of international collaboration (with McMaster University’s Foundation for Medical Practice Education) and the implementation and adaptation of external innovation.

http://www.gpcpd.nes.scot.nhs.uk/pbsgl.aspx


Anaesthetics, Intensive Care and Emergency Medicine Training Board

Anaesthesia provides a wide diversity of clinical training opportunity based around elective and unscheduled care as well as a variety of subspecialty opportunities in for example Critical Care Units, Maternity services, Acute and Chronic Pain as well as pre-assessment and pre-optimisation of patients prior to theatre. Anaesthesia trainees have led projects in Enhanced Recovery, Patient Safety, as well as the development of initiatives around Healthcare Associated Infection. There is a great depth to the specialty, beyond the acute care aspect, with further options in academia and quality improvement

The wider Shape of Training review has directed focus towards a more generalist training approach to ensure delivery of the workforce required by the NHSScotland. Generalist training is already embedded in the Anaesthesia curriculum, thereby allowing trainees scope to pursue appropriate subspecialty interests within a generalist training programme. The flexibility of this generalist training makes it more attractive to trainees interested in exploring different options as they progress through their professional career via a variety of medical environments Diversity and exposure has been key to the success of Anaesthesia, Intensive Care and Emergency Medicine and the specialties are leads in seeking new innovations and approaches to medical practice. This dynamism ensures trainees in the specialties can develop as professional leaders who will enjoy a constantly evolving medical career progression.

2013 will also see additional promotion of the Anaesthesia, Intensive Care and Emergency Medicine academic opportunities. Anaesthesia has a SCREDS post and the STB is committed to expanding Academic opportunities at all stages in training.

Anaesthetics, Intensive Care and Emergency Medicine are dynamic specialties based in high profile, fast paced medical environments that offer far reaching opportunities

The nature of Anaesthesia, Intensive Care and Emergency Medicine has meant they have always been leaders in new specialty developments. Quality Improvement (QI) methodologies have applied to the specialties from their outset. In 2013, the specialties will aim to further strengthen their existing quality approach further and will continue to look at ways to confirm delivery of quality in training and CCT outputs. The specialties recognise their training programmes are fit for purpose and career opportunities are strong. The Board will seek to explore ways to assess and document what defines their quality of training.

Anaesthesia, Intensive Care and Emergency Medicine trainees have always been expected and actively encouraged to embrace QI developments. The Anaesthesia, Intensive Care and Emergency Medicine specialties have historically embedded QI, Patient Care and Safety into their approach and actively pursue new innovations to ensure they remain at the forefront of contemporary initiatives. In 2013, the specialties will continue to develop and promote QI programmes building on previous foundations in this area.


Dr Fiona King is an ST6 in anaesthesia working at Ninewells Hospital in Dundee. When asked about academic opportunities she said:

Recruitment to the Anaesthetics and Emergency Medicine board for 2012/13 and beyond will be directed and focussed, as there are recurrent issues relating to gaps in appointments.

For the 2013 intake, full recruitment has been completed at CT1 level in Core Training. The past and present challenges occur at recruitment in higher Specialty training, where both Anaesthetics and Emergency Medicine have been unable to fully recruit.

The standard of trainee in the two specialties is very high, but frustratingly, there are still issues relating to appointing to full capacity. There are multiple reasons which need to be reviewed and addressed, including attrition and low numbers in core training. There is also some uncertainty amongst doctors applying for training programmes about the diversity of opportunity offered by the specialties. Trainees often hear only of the arduous nature of acute specialty practice, rather than the professional rewards and wider career opportunities.

In 2012, Anaesthesia undertook a significant review of attrition levels in both Core and Higher specialty training. It was identified that 16 of the 52 CCT holders, 30% of the annual trainee CCT total, had moved to posts outwith Scotland. The loss of trainees from Scotland is a serious issue for concern and in 2013, the STB will be actively engaging with the NES START project to seek recommendations for a way forward. START has been welcomed as an important long term initiative and a positive development to establish a way forward for Scottish Medicine, improve recruitment, ensure quality of training, guarantee good safe patient care and plan a future health service.

I have been appointed to the Wellcome Trust Clinical PhD programme. I commenced this in September 2012 and will be out of programme for the 3 years that it will take to complete. The project is entitled 'Targeting opioid receptor signal transduction to produce sustained analgesia' and I am being supervised by Professor Hales at the Institute of Academic Anaesthesia (University of Dundee/ NHS Tayside). This appointment allows me to gain experience in basic science research in world class facilities.


Like most specialties across Scotland, Anaesthetics and Emergency Medicine moved to UK Recruitment in 2013. Both specialties had previously delivered high quality recruitment via the SMT process. Thus far the move to UK recruitment has been largely successful.

In late 2012, the STB was expanded to include Intensive Care Medicine (ICM), which has been welcomed as a fully fledged primary CCT specialty. In each of the four Deaneries, a significant amount of work was undertaken to draft, coordinate and implement the ICM training programmes and also to deliver the ICM recruitment for the first 2013 intake. Coordination of a completely new training programme has been a challenge for ICM regional advisors and TPDs, but the successful outcome clearly demonstrates ICM’s dedicated efforts and cohesive approach across Scotland.

ICM is a primary CCT specialty and it is important to acknowledge there will be challenges as the new specialty moves forward. For 2013 ICM recruitment is via the Scottish Medical Training system. The strong links and cross-specialty cooperation between Anaesthesia and ICM have ensured opportunity to recruit to 10 Anaesthesia/ICM dual posts; two further posts are available to ensure access to dual ICM training for the wider partner specialty group. The ICM training community is keen to develop and further expand opportunities by way increased engagement with other dual CCT partner specialties. There has been as yet no specific funding for this increasing ICM training requirement. This is a significant concern and a potential barrier to the engagement of all appropriate specialty groups.

The current focus is for ICM to continue working towards an expansion of ICM recruitment for 2014 and beyond, with further engagement across all partner specialties. The new ICM specialty will commence a directed strategy to ensure promotion across the different areas of practice and encourage engagement. This will be good for training, service delivery and crucially workforce planning, given the increasing evidence for a required future increase in critical care services. Appropriate funding is key to this strategy.


Diagnostic Specialties Training Board

Diagnostics is at the forefront of technological innovation in healthcare. Laboratory and Imaging services are fundamental to the provision of high quality diagnostic, prognostic and monitoring information. This guides the care each patient, as an individual, in the Scottish NHS. The use of specific therapies in the treatment of malignant diseases, tailored to the susceptibility of tumours to these interventions can be predicted by laboratory investigation whilst, at the same time, radiological innovation underpins the increasing demand for procedures that prevent the need for open surgery. New diagnostic techniques are being employed in detecting and classifying pathological microbes, determining the nature of inherited conditions and in diagnosing and managing metabolic disorders. Diagnostics are at the centre of the Scottish Breast, Cervical and Colon Screening Programmes, providing the tests that can detect early disease and, in doing so, lead to swift intervention and improved outcome for the people involved. The Scottish Government’s Detect Cancer Early initiative is another example where the detection is based on diagnostic services. Diagnostics is in the vanguard of service redesign, embracing new working practices, extended roles and increasing clinical involvement over many years to best employ the precious human resource of the NHS in Scotland.

The Diagnostics Specialty Training Board supports service innovation by advising NES nationally, and locally championing the education of a medical workforce prepared and enabled to deliver diagnostic services across Scotland whilst recognising that the medical contribution can only be maximised as part of a greater constellation of other staff groups with connected and mutually respectful roles. This ethos extends beyond departments to involve teams and primary, secondary and tertiary care within which diagnostics specialties are core members.

Specific Diagnostics themes at present include developments in several areas

� Interventional Radiology is a sub-specialty of Clinical Radiology which concentrates on carrying out therapeutic procedures utilising imaging techniques and technology. These procedures include embolisation of tumours and bleeding peptic ulcers and the insertion of stents and vascular prostheses that prevent the need for major open surgery. Finding the establishment to populate training in this sub-specialty is the topic of on-going exploration with the Board, the specialty, NES and Scottish Government.

� Innovative approaches have proved successful in recruitment to Chemical Pathology. For 2013 appointments have been made at ST1. Post will also be advertised, as has become conventional, at ST3, to the Metabolic Medicine sub-specialty, aiming to attract applicants who have completed Core Medical Training.

� Virology is recruiting to a joint programme at ST3 with Infectious Disease for 2013. A new Infection Training programme is under development at the Physicians’ and Pathologists’ Royal Colleges, awaiting the outcome of the Shape of Training Review.

� Radiology and Histopathology have taken part in UK wide selection and recruitment processes for 2013 ST1 posts. Whilst Radiology has filled all posts, the same is not true for Histopathology. Challenges exist in attracting high calibre applicants to the latter specialty with Scottish data showing a falling trend of popularity from a level of high competition four years ago to reach the current unsatisfactory situation with more than a third of ST1 posts in the UK unfilled as yet for 2013. The Board will be looking to finding innovative ways of marketing this and other specialties for 2014.


� New specialties have evolved from Histopathology. These are Neuropathology, Forensic Pathology and Paediatric Pathology. These disciplines have been a feature for many years but as of 2013 have assumed unique specialty status as opposed to being sub-specialties of the parent Histopathology. The Board has considered how these new specialties might be configured in Scotland and the governance structures that will surround them educationally.

� Increasing workload in Diagnostics is a consistent feature, driven by pressure of numbers of requests for tests and by the complexity of interpretation of these tests. This complexity is a function of enhanced technology, the provision of more detailed, evidence based, information and standards of care. Negotiation has led to the formation of a Short Life Working Group under the auspices of the Scottish Government Diagnostics Steering Group. This will address the balance of workforce to meet the increasing expectations of Diagnostic’s demand-led workload. A draft report will be submitted in April 2013.

For future, the Board has its sights set on enhancing the quality of medical education and training in its specialties. In his report (“Time for Training: A Review of the impact of the European Working Time Directive on the quality of training”, 2010) Professor Sir John Temple headlined that “training is patient safety for the next 30 years”. In Diagnostics, the recognition of this is allied to increased understanding of disease, its detection and accurate classification. These factors, in turn, translate to improved quality of care across the breadth of patient interactions with health services. And so, the STB will pursue engagement in education and training across Scottish Government, territorial Health Boards, NES, the Colleges, Medical Schools, hospitals and communities, medical, scientific and allied professions. The cake is worth the eating.



Medical Specialties are acknowledged as the most complex area of specialty training to manage. Most Training Boards deal with a small number of individual specialities whilst Medicine has 26. This means the Scottish Board for Training in Medical Specialties (the Board for short) must speak globally for a number of different practice areas and cannot include representatives from all Medical specialties. The Board prides itself on both meeting the needs of trainees across 26 area of medical specialty, whilst allowing scope for all specialties to present their individual interests and concerns.

The role of the Board in Scotland is an advisory one, with the Chair, Dr Donald Farquhar, holding a role similar to a Head of School elsewhere in the UK. The UK Royal Colleges of Medicine determine the curricula and most decisions relating to Scottish trainee numbers are made by Scottish Government. It is the Board’s role to make sure the curricula are being delivered to trainees in Scotland, that trainees are adequately trained and to ensure all four Deaneries take the same approach to training and maintain consistency. The Board is responsible for ensuring trainees are well positioned for consultant jobs at the end of their training programme.

The Board has a lead role in annual recruitment in Core Training (first two years post completion of Foundation Programme) and Higher Specialty Training (the five years thereafter). The Board has an increasing role and responsibility in the Quality Management of training programmes in Scotland. There are differing arrangements across the 26 specialties, with a mix of national programmes for the small specialties (2-25 trainees managed nationally) and larger programmes run individually in each of the four Deaneries. The Board needs to ensure each Deanery programme meets training requirements and maintains a high standard of quality for training. Trainees are encouraged to provide feedback, via the Specialty leads and Board representatives, on differences between

programmes, recruitment and exposure across the Deaneries. This process guarantees a fluid communication and ensures appropriate action can be taken to maintain the quality of the training experience. In 2012, the Board identified the specific training needs of Clinical Oncology trainees in the North Deanery required a temporary secondment to Glasgow or Edinburgh. The Board is dedicated to ensuring that no matter where a trainee goes in Scotland they will receive the same training opportunities.

Negotiating trainee numbers and quality of programmes is a complex and detailed process, especially as it can be difficult to predict the resilience of a specialty. The Board has strong support from its representatives and has a credible reputation that it meets the needs of all 26 medical specialties. This was demonstrated during 2012 when the Board received a direct request from the Scottish Government for consultant numbers, acknowledging that the Board’s information on consultant figures was more up to date than those presented by the Information Services Division (ISD).

Key to the past and continuing success of Scottish Medical training has been that Scotland is small enough to make things work easily, whilst still offering training programmes across a variety of environments. Trainees may enjoy the cultural festivities of Edinburgh, the hurly burly of Glasgow, or the stunning vistas of remote and rural practice. Across this range of differing medical situations, the cohesive influence of the Board, which is in direct communication with specialty leads, ensures all trainees in Scotland receive a high standard of medical training and preparation for their medical career.

The 2012 GMC survey results confirmed that Medical specialty trainees across all four Deaneries have high overall satisfaction. This is an outstanding achievement for the Deaneries, medical training and Scotland.


Scotland is recognised as an academic achiever in science and medicine. NHS funding per person is more in Scotland, which has allowed additional scope and flexibility for trainees to pursue research and academic opportunities. All five Scottish Medical Universities have a strong academic bent for Medicine, with 42 of 150 Medical specialty trainees in Edinburgh pursuing an MD or PhD. This is a third of trainees pursuing academia. Aside from Oxford and London, options for academic medical trainees are limited in the UK. The largest proportion of Academic MRC funding goes to Medicine and it is significant that Scotland is recognised as a UK leader.

Medicine is now seeing a growth in popularity in less acute specialties that are more suited to a different work/life balance and are more family friendly. There will always be smaller specialties which will be difficult to fill and there are also specialties which are traditionally high profile with competitive entry numbers. For the past 10 years Cardiology, Gastroenterology and Respiratory had been the most popular for trainees; these three are all extremely challenging specialties in acute medical practice. In 2012, this changed with Dermatology emerging as the most popular specialty. Dermatology has very limited out of hours, standard sets of clinics per week and numerous academic or research opportunities. The change in popularity of specialities such as Dermatology indicates medicine is attracting people in different ways and is a reflection of how Medicine will need to develop in the future.

The diversity of the 26 Medical Specialties provides a unique window to wider social trends and an evolution in the outlook of the medical profession. In Scotland, Medical Specialties has already recognised that the broad variety of specialties provides a cross section of different medical approaches, which determine the course of individual future medical career pathways. The Board is already considering the best way to align its specialties with a changing dynamic. There are posts in Acute Medicine, Geriatric Medicine and

Endocrinology/Diabetes which are becoming harder to fill. These are specialties with a high percentage of acute, out of hours work, and a reputation for being physically and mentally challenging. Set against this change has been the growth in popularity for less acute medicine or more empathetic specialties like Dermatology, Palliative Care and Genito-Urinary Medicine.

People no longer work to the detriment of family life and are making different lifestyle and professional choices. Scottish Medical Specialties has taken the lead in identifying change and seeking new ways to address a transforming workforce. Hard to fill specialties have been invited to engage in the Core Medicine taster programme and create one day taster sessions. Tasters are offered to Core Medicine and Foundation doctors. This is extremely useful for a junior trainee who is particularly interested in a hard to fill specialty or if they need direction to determine their area of specialty. The Board is very encouraging of the taster programmes and will fully support release of trainees to attend specific training.

The geography of Scotland means it is small enough to ensure flexibility, communication and sharing of ideas across training programmes. There is a strong academic element, rich and diverse cultural stimulation, idyllic outdoor locations and a standard of living that rivals anywhere else in the UK. The Scottish Board for Training in Medical Specialties (the Board) is confident its Scottish training programmes offer all trainees first class training opportunities. This has been confirmed by the excellent results in the 2012 GMC survey for overall satisfaction. Training programmes work hard to be flexible and accommodate changing trainee needs without compromise to ongoing professional development.

Scotland is small enough to make change happen, but large enough to guarantee an excellent training and lifestyle experience.



Mental Health has been working hard to explore and expand trainee opportunities. 2012 saw a number of specialty projects and reviews come to fruition which will greatly benefit current and future Mental Health trainees. Earlier in this document the Psy-STAR initiative featured opportunities for further academic research.

In 2012, Mental Health moved from a single to twice yearly recruitment at ST4. The first recruitment round, in Spring 2012, was undertaken using the Scottish system. Psychiatry then joined the national Royal College of Psychiatrists recruitment system, recruiting to ST4 in October 2012 and have now joined the UK system for Core Recruitment in November/December 2013.

Mental Health also undertook a significant Recruitment Review in 2012. The review examined predicators of entering Psychiatry and career progression thereafter. The initial review was of trainees who entered the Psychiatry programme in 2008 and completed CT in 2011. Of this cohort, only 36% had received a satisfactory ARCP and completed their exams at end of the three years. The specialty identified this would cause subsequent issues for the Higher Training (HT) posts. A further review was requested of the 2009 to 2012 cohort. The provisional results of the second review show improvement. Changes in the Royal College of Psychiatry exams system, allowing trainees to sit exams earlier in training, should improve completion rates within three years.

Mental Health also engaged in a more specific evaluation of Scotland’s 2012 ARCP results. Outcomes were reviewed nationally and it was identified that a large number of trainees had Outcome 5 results (insufficient evidence). Most Outcome 5s were subsequently overturned to successful Outcome 1s. It was identified that the College had a very rigid routine for completion of the MiniPat (360 degree feedback). In 2012, the third round of the MiniPat had been

held in June, but many trainees had ARCP in May, so had insufficient time to complete the MiniPat. The College has now changed the MiniPat scheduling and trainees may now sign up for Minipat at any time in year. It is anticipated this will decrease Outcome 5s. Again, this is a constructive development for Mental Health which will benefit trainees.

Quality will be a priority for 2013, and a QIM lead will be appointed to the STB to take forward.

Mental Health is actively promoting additional Psychiatry posts via the Foundation Programme. Exposure to Psychiatry is important for all doctors. There is documented evidence that if trainees experience Psychiatry early in their training programme; they are more likely to apply for the specialty as a career. The UKFPO, in consultation with the UK Psychiatry Board, has directed that 7.5% of all FY1 posts and 7.5% of all FY2 should be assigned to Psychiatry posts. Scottish FY2 numbers are consistent with (or better than) these percentages, but FY1 numbers are currently very low. Mental Health hopes that practical experience in Psychiatry at FY1 will greatly improve recruitment numbers and is engaged in ongoing discussions with the Scottish Foundation School. There are some encouraging developments.

The Royal College of Psychiatrists has introduced a defined Recruitment and Retention strategy to promote the specialty and increase trainees in Psychiatry. Dr Tom Brown, previously a consultant in Glasgow, is now the College lead and Associate Registrar for Recruitment & Retention in Psychiatry. Dr Brown is also a member of the STB and his appointment creates another link between the STB, NES and the College, thus ensuring contemporary specialty and trainee interests are well represented.


Mental Health commenced an enhanced Taster week programme for 2012/13, which will be promoted in conjunction with the College. A Taster week is where interested FY doctors can spend a week in a specialty of their choice. Mental Health has prepared job descriptions specific to individual Psychiatric specialties. These are posted on line to capture the interest of FY trainees.

Scottish Psychiatry is also engaged in two very successful collaborative programmes; STARG and PsySTAR. The Scottish Teaching and Recruitment Group (STARG) is an initiative between the Scottish Training and Research Committee (part of the Royal College of Psychiatrists in Scotland) and the STB, which aims to improve teaching in Psychiatry and encourage applications to the specialty. It has set up student associateships in Psychiatry at all the Scottish Universities, with good uptake. PsySTAR is an excellent Scottish project which is conducted in partnership between the universities and the Deaneries. Academic training posts for Higher Trainees in Psychiatry are offered at ST4; participants complete a clinical year, followed by three years out of programme to do research, then a return to clinical training for the final two years. The first three recruits, in three different Psychiatric specialties, started in August 2012 and interviews are underway for 2013 recruits. The PsySTAR programme is proceeding very well and the Mental Health STB is excited by progress to date.

Further expansion to Academic training in Core Psychiatry is also underway via the GATE Academic mentoring programme. The Glasgow Academic Training Environment (GATE) is a collaboration between the West Deanery and Glasgow University across several medical specialties, which aims to address an identified gap between Academic Foundation trainees and SCREDS lecturer status at ST4. One of the identified posts is in Core Psychiatry. The North Deanery is currently looking to develop two Academic training posts at Core Training in Psychiatry. This demonstrates the growing academic network and structure within Scottish Psychiatry.

The West Deanery took the lead in 2012 to improve and develop options for the specialty, engaging in a full review and audit of the Psychotherapy programme, which confirmed Core trainees attained the Psychotherapy competencies as set by training requirements. This audit had a very positive outcome. Scotland is one of the leading UK providers of Medical Psychotherapy training at advanced level and contributed to the GMC small specialties review of medical Psychotherapy. A second audit cycle is underway.

Mental Health continues to explore and encourage opportunities which will enhance the specialty through contemporary developments. The specialty looks forward to the rewards of further expansion in 2013.



Obstetrics & Gynaecology and Paediatrics are both 24 / 7 acute specialties. They are also those programmes where trainees are most likely to seek flexible working arrangements, whether this is Out of Programme, LTFT or parental leave. This combination makes the two specialties amongst the most difficult to maintain training programme requirements against Service need.

In 2012 / 2013 the Obstetrics & Gynaecology and Paediatrics specialties will both focus on how best to ensure quality of education. The first step has been the triangulation of the GMC Survey results directly with feedback from regional training programme committees. If one particular region identifies a problem with a specific part of programme, then other Training Programme Directors (TPDs) are encouraged to advise how they addressed the issue or what approach they took in their regions. This has been a positive development as it has provided the specialties with an option to remove unsuitable programmes, without compromise to the curriculum.

Obstetrics & Gynaecology and Paediatrics both moved to national UK recruitment in 2013. This will ultimately give a more accurate representation of the popularity of Scotland as only trainees who have Scotland as their first choice of placement will be interviewed.

Both specialties had good recruitment at ST1. On a UK wide basis, Paediatrics generally has issues relating to recruitment numbers, but Scotland still receives good levels of recruitment. Paediatrics is exceptionally well showcased at an undergraduate level and has a good number of Foundation posts in Paediatrics.

All posts in Scotland were filled. There was a fall in trainees but an increase in consultants. Obstetrics & Gynaecology have reached the target set by the Scottish Government, as set by the Reshaping the Medical Workforce Consultation.

Obstetrics & Gynaecology has commenced a review of subspecialty training against what is needed on a Scotland wide basis.

The reduction in Paediatrics trainee number has been paused. There has been governmental and organisational recognition that specialty training in Paediatrics takes longer to complete than the eight years of set curriculum. This acknowledgement will allow Paediatrics to more readily focus on Quality of Education.

Trainees in Paediatrics have the opportunity to pursue national (NTN) Grid Subspecialty training via the Royal College of Paediatrics and Child Health. Scottish Paediatrics is currently reviewing Grid subspecialty training posts across Scotland to explore ways to expand these Grid opportunities. Currently, the West is the only Deanery that has sufficient trainee numbers to host Grid trainees with ease and it will be important to ensure further Grid posts can be equitably offered across Scotland. This is an exciting development which demonstrates how the four Deaneries work together to best meet the needs of Scottish trainees and actively seek higher level subspecialty career options within Scotland.


The provision of Community Child Health (CCH) training will be a significant issue for Paediatrics in the near future. A number of Scotland’s CCH medical professionals are due to retire in the next five to ten years and this has been affirmed by a report commissioned by the Scottish Government - “Developing a CCH Service for the 21st Century” (Dr Zoë Dunhill). There will need to be an increase in CCH training posts and qualified CCH professionals. It will be a challenge for Paediatrics to adapt its existing training programme to meet the pending CCH shortage; however, there will also be greater opportunities for trainees interested in a dedicated CCH career pathway.

In Scotland, Paediatrics has taken the lead in altering their training programmes to better meet trainee needs. It was identified that rotational arrangements were causing dissatisfaction amongst trainees who had put down roots and were reluctant to move, i.e. trainees were required to spend three years in the West Deanery then rotated to the North for the rest of their Paediatrics programme. The four Deaneries reviewed their rotational training programmes in Paediatrics and introduced new arrangements for 2013. Trainees now retain their training within one Deanery and undertake a secondment for training that their host Deanery cannot provide, such as the Paediatrics Intensive Care Unit (PICU). This an extremely positive development which demonstrates the unity and cohesion across the Scottish specialty training programmes.

The Scottish Co-ordinated Paediatrics Education (SCOPE) programme is now in its third successful year.

A new subspecialty training programme in Community Sexual and Reproductive Health was launched for recruitment in 2013.



A significant contribution of the Surgical Board throughout 2012 was the further development of the two Core Surgical Training Programmes. The first cohort of core surgical trainees commenced in August 2011 but with the phased development of this programme, further posts were identified from CCT graduates in the contributing specialties and this led to a further cohort being appointed at CT1 level in August 2012. Seven surgical specialities contribute to Core Surgical Training in Scotland (General Surgery, Urology, ENT Surgery, Cardiothoracic Surgery, Plastic Surgery, Paediatric Surgery and Oral and Maxillofacial Surgery) and as these specialties have decoupled, core surgical training now remains the route to entry to these specialties at ST3 level. However, it was also decided to put two Trauma & Orthopaedic posts into Core Surgical Training this year, as although this specialty predominantly remains a “run through” specialty in Scotland, it is decoupled in the other devolved nations and therefore including some Trauma and Orthopaedic posts within Core Surgery was felt to provide additional opportunities for trainees in Scotland.

The two Core Surgical Training programme directors (Alison Howd and Andrew Rennick) continue to put significant effort into the educational programme and are making significant efforts with initiatives, such as simulation training. Ms Howd also acted as the Scottish Lead for facilitating the Scottish component of the National Recruitment process for Core Surgical Training and this ran very smoothly. There was a 96% fill rate to Core Surgical Training in Scotland and the quality of those trainees appointed through this nationally co-ordinated recruitment process was felt to be of a very high standard.

In 2012, General Surgery and Ophthalmology joined the National Recruitment process. There was excellent engagement with this and feedback from those involved reported that the processes were extremely well run, fair and transparent. Many consultants from Scotland were involved in the selection process and all ST vacancies were filled in Scotland.

Cardiothoracic Surgery, Urology, Paediatric Surgery, Plastic Surgery and Oral and Maxillofacial Surgery (OMFS) continued to recruit at ST3 level using National UK Recruitment processes hosted by a variety of Deaneries in England. Recruitment was hosted by SMT and facilitated by Lothian HR for ENT (at ST3 level) and T&O (at ST1 level). Scotland continues to be the one region in the UK offering “run-through training” in T&O, but the quality of those selected continues to be of an exceptionally high calibre.

Overall, recruitment to the surgical specialties in 2012 went extremely smoothly with an excellent fill of ST posts, although there was some difficulty in filling a number of Locum Appointment for Training (LAT) posts in some of the surgical specialties.

In the latter part of the year, the surgical STB has continued to work with SGHD regarding 2013 recruitment. It was felt that there still needed to be a modest expansion of the Core Surgical Training programme and it was recommended that a further eight posts should be identified to allow this expansion. These posts were identified from CCT graduates in General Surgery, Plastic Surgery and Paediatric Surgery and have been included in 2013 recruitment.


The Surgery STB has spent a significant amount of time discussing and debating the role of simulation in surgical training. Ken Walker has taken a lead for this and has undertaken a significant amount of work in identifying facilities and courses available in Scotland for simulation training. Currently many of the surgical specialties Specialty Advisory Committees (SACs) are submitting revised curriculae to the GMC with a plan to incorporate simulation within their curriculae. However, the GMC has requested further clarification regarding the deliverability of this altered programme. Following discussion at the STB, it was recognised that although facilities may be available, the most important aspect of delivering simulation training will be in ensuring that trainers are appropriately trained and have the capacity to deliver such training.

The surgery STB continued to be supportive of the development of Advanced Medical Training Fellowships (AMTFs) and several have been given educational approval during 2012. Particular areas that have been shown to be successful have included Paediatric Urology, Remote and Rural Surgery and subspecialty aspects of Ophthalmology with trainees now in post. A number of others has been approved pending availability of funding at some point in the future, including Hand Surgery and Spinal Surgery.

Professor James Garden, in collaboration with external colleagues, continued to facilitate reviews of a significant proportion of all surgical trainees in academic posts across the four Deaneries. Individualised reports provided feedback to Training Programme Directors regarding their academic progress and gave advice regarding personal development plans. These trainees included those who were out of programme undertaking research (OOPR), those in clinical lectureship posts and those with intermediate Clinical Scientist Fellowships.

The surgical STB has also given consideration to how it will contribute to the quality management of surgical training programmes. This involved reviewing the GMC National Training Survey results for various specialties, analysing the Deanery Post Assessment Questionnaire (PAQ) Reports and also considering the proposed Joint Committee on Surgical Training (JCST) Deanery reports on Surgical Training Programmes. It is anticipated that there will be an increasing emphasis on this in the coming year.

Mr Dominic Byrne, Associate Postgraduate Dean in the West of Scotland has now succeeded Professor Rowan Parks as Chair of the Surgical Specialty Training Board and we look forward to his continuing input to the oversight of surgical training in Scotland.


FIRST CLASS TRAVELENSURING QUALITY WITH PEOPLE AND TECHNOLOGY

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The Medical Directorate has a dedicated Quality Improvement team. There are five Quality Improvement Manager (QIM) appointments across Scotland, one in each Deanery plus a Central Office QIM. There is also a team of dedicated Associate Deans, again one in each Deanery, who are responsible for specific Quality portfolios. The QIMs coordinate, implement and support Quality Improvement initiatives, while the Associate Deans for Quality ensure the input and representation of a senior medical professional in Quality Improvement initiatives.

There has been a historical lack of understanding about what Quality Improvement is about and what Quality Improvement Management can offer. Quality Improvement is about connection with key stakeholders and users, analysis and seeking recommendations on ways to improve and enhance processes. Quality Improvement is not something which is simply fed into a process: there must be engagement with the people involved as it is the participant who will know their process and can best explain what is going on and where.

Previously, Quality had a reputation that it was something done to people, not something they were actually engaged in. A key drive for the QIM team in 2012 was to actively seek information from Specialties and ensure wider QIM input. The former approach had been to note identified “flags” in survey results for a specialty or Programme, whereas in 2012 specialties were encouraged to actively examine why red flags occur and look for ways to change i.e. these are the results of the trainee survey, highlight possible areas of dissatisfaction or concern, how will the specialty address and move forward.

As year on year more data is gathered, greater opportunity exists to triangulate the data and make an informed decision on possible issues highlighted by surveys. Flags are not viewed in isolation but are reviewed against existing datasets which helps to determine the validity of a possible concern, from this basis the Deanery Quality Teams can decide on a course of action. There has been improved engagement with specialties, information has been forthcoming and there is an increased awareness that Quality Improvement is a positive collaborative process that provides a suitable forum for discussion and recommendations for improvement. A Quality Improvement review is a mechanism to make things better, lift standards and make lives easier.

2012 saw a change in direction and drive for the Quality Improvement team at NES. Previously, the focus had been on Quality Managing, where a review or report would look at a situation, then identify and assess risks to training and Service. This has shifted towards Quality Improving with more self examination, review and positive recommendations for the future. Quality Improvement allows scope for Deaneries look at what they have done well, how was it done and ways that knowledge can be shared with others. Quality Improving also allows scope to acknowledge what is not being achieved and how this can be improved in the future. Quality Improvement allows the Deaneries to appraise themselves, analyse what lies behind the GMC Surveys and what lessons can be learnt.

FIRST CLASS TRAVELENSURING QUALITY WITH PEOPLE AND TECHNOLOGY

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Section 4: First Class travelEnsuring quality with people and technology 45

The change towards Quality Improving has also provided an opportunity to lift the profile of trainees and allow doctors in training active engagement in the evaluation and improvement processes. In 2013, the QIMs will be seeking ways to expand trainee involvement and be engaged in the Quality Improvement research process. This will ensure trainees have a sense of ownership in their future training development, with benefit to their training and career progression. It is essential trainees are involved, can contribute to the shape and modelling of their training and feel engaged in the training process

As part of Quality’s Improvements expanded involvement with trainees, all Deanery visits to clinical sites involve meeting with trainees to hear their opinions on training and to give the visit team the opportunity to understand what aspects of their training trainees find worthwhile and enjoyable, what is less effective and what may have triggered any flags for that site. This sort of feedback also helps to put in context survey results, which should not be looked at in isolation.

A good example is the case of trainees in a busy emergency unit in Glasgow. While the trainees note in surveys that the work is demanding and the shifts are busy, when trainees are asked about these experiences, they are extremely positive and enthusiastic about their time in the department. They recognise that this is the way of an A&E department and the training opportunities they receive during these busy shifts to develop and hone their skills are opportunities which will serve them well in their future careers. In this case the busy workload is balanced by glowing comments from the trainees that they would recommend this post to a friend. For the QIMs and the Quality Improvement team, survey results are only the beginning. Quality Improvement is about using the data and applying it to progress medical training forward.

The Quality team have also been working collaboratively to improve processes and redesign reports across Scotland. The Training Programme Director (TPD) annual report was previously a slow, labour intensive report with a poor response rate. In 2012, the QIMs reviewed the TPD annual report and identified it was not very user friendly, text heavy and was not actively circulated afterwards, which did not encourage user completion. The QIMs pared back the TPD report to a very short template and streamlined the reporting process. This resulted in a much quicker turnaround and the TPD response rate lifted from 50% to nearly 90%, with most reports lodged on time.

The results from the TPD report results ultimately fed into wider reports such as the Deanery report to GMC. It was important the information was completed; correct and lodged on time to made a direct influence on future work within Deaneries. The report also included scope to positively highlight where TPDs had taken an innovative approach to change their programmes. The improved TPD annual report is practical reflection of how a small change leads to benefits for trainees, trainers and Deaneries across Scotland.

The previous focus for the QIM team had tended to be based on surveys and reports, but in 2013 the QIM will aim to do much more. Currently, the Quality Improvement web presence is limited, with little or no publication of surveys or report information. QIMs have access to very useful information, but as the information has not been published there has not been a suitable forum to demonstrate where successes lie, what innovative programmes have been applied and what Scotland does well. The GMC National Training Survey is available from the GMC website, but the actual Scottish Post Assessment Questionnaire is not publicised. For Scotland to emphasise its strengths and progressive approach, there needs to be demonstrable evidence to show


where the Scottish surveys have highlighted what Scottish Medical Training does well, as well as recognising where a surveys has identified an issue and what Scotland has done about it. In 2013, the Quality team will be seeking practical examples to depict “You said, we did”.

The Medical Directorate and the Quality team’s focus is on Quality Improvement for the future, improving training for current trainees and ensuring training continues to progress for tomorrow’s doctors in training.

http://www.qihub.scot.nhs.uk/default.aspx

The Quality Improvement Hub



The Medical Appraisal Team contributes to the development and maintenance of an Educational Infrastructure within NHSScotland by ensuring all trained doctors working in the NHS have the opportunity to be involved in an Appraisal Process. Doctors support their own continuing professional development by engaging in an annual appraisal with an appropriately trained peer. Approximately, 10% of Secondary Care doctors and 4% of GPs have undertaken training to become an Appraiser.

Creating a workforce that regularly reflects on its own practice and development enhances a culture of continual development. The fact that a significant proportion of the workforce are trained appraisers further enhances and encourages a reflective culture.

The Scottish Appraisal process seeks to support doctors to develop their own performance but also to consider their influence on the performance of NHSScotland and its patient community. Taking account of and reflecting on the patients’ experience is an essential element of appraisal and consideration of impact on patient care is pivotal in this infrastructure of quality and excellence.

The Medical Appraisal Team consider that by embedding a strong infrastructure to support reflection and development, doctors in training can benefit from the support and development provided to them by experienced doctors who have taken ownership of their own continual professional development.

Initially the Medical Appraisal Team were only involved with Primary Care Appraisers, but due to the positive changes to medical regulation made by the GMC, the appraisal team have proactively taken responsibility for training appraisers for both primary and secondary care in the last three years.

The Medical Appraisal Team provides courses to train appraisers in all specialties across Scotland. The courses are delivered by a faculty team who are experienced doctors, trained appraisers and tutors. The strength of this faculty is that they have significant experience of appraisal and delivering appraisal, and as a result hold strong credibility. The team point out that appraisal is important for a number of reasons but not least that appraisal may represent the only structured opportunity that most trained doctors have to reflect on and discuss their work with a peer. The benefits of reflecting on their professional experience and development with another doctor in a supportive but structured fashion are clear. Discussing procedures they have undertaken, and reflecting on training needs with a colleague appraiser allows experienced doctors to objectively consider their Continuous Professional Development, and gives them an insight into planning their own careers which is invaluable when supporting the career development of our doctors in training. In addition annual appraisal is a key component of revalidation and ties in closely with the Quality Improvement Agenda of the NHS.

To train doctors who want to become Peer Appraisers, The Medical Appraisal Team provide face to face training. This currently entails participation in a two day course for new appraisers. This focuses on key communication skills, enabling the appraiser to draw out information that allows experienced doctors to reflect effectively on their performance and their development. As in a Knowledge Skills Framework interview, the experienced doctor (the appraisee) is expected to provide supporting information in advance of the interview. This material provides a background to the Appraisee’s recent experience, and should include; Significant Event Analysis, Case Reviews, Multi Source Feedback and, importantly, any complaints and a Patient Satisfaction Questionnaire.


The GMC have actively designed the revalidation process to encourage doctors to reflect and learn and to meet the requirements of GMP. The training that the Medical Appraisal Team provides is directed towards encouraging and supporting reflective practice. Trained appraisers aim to help appraisees to develop insight into their performance.

The New Appraisers course includes a continuous process of assessment. The course is intensive with required pre-course preparation. A tutor panel considers the performance of the participant across the course of the two days, and on the basis of this performance ‘against established criteria’ a recommendation is made to the Health Board regarding the participant’s suitability for the role of Medical Appraiser. A completion certificate is also awarded.

The work of Appraisers and the benefits to the individual appraisees not only improves our service in NHSScotland overall, it demonstrates a clear commitment to providing a service of excellence to our patients. Appraisal also demonstrates the required standard to our doctors in training, who benefit from professional reflective interviews with experienced doctors who seek to maintain excellence in healthcare for Scotland.

The numbers of appraisers requiring initial and further training presents a challenge for the Medical Appraisal Team. It is however a positive challenge, as Health Boards identify more appraisers who are willing to be trained and the established appraisal workforce seek to develop and enhance their own skills. At times, the training programme can be very difficult to manage, as Health Boards request the provision of courses to meet their need for sufficient appraisers to support revalidation which are additional to the NES planned programme of training events. Issues also exist with ‘churn’ in participants as clinical demands lead to candidates dropping out and reserve call ups.

This creates particular challenges as courses require significant preparation on behalf of NES and the candidates including the pre-course exchange of materials between participants.

The introduction, roll out and engagement in appraisal in Scotland has been recognised as very successful and NES has worked with all stakeholders to support and develop the process. The Medical Appraisal Team are keen that the profile of Appraisal is heightened and maintained, but this creates a need for securing resources to support development of the process including ensuring appropriate staffing of key personnel within the Appraisal Team. Support for appraisers is also an issue that requires consideration both in ensuring local organisational support and the provision of relevant incentives for those volunteers that undertake the essential role of Appraiser.

The Team have also taken a lead role in developing an Information Management System called the Scottish Online Appraisal Resource (SOAR), to support Boards, Appraiser, Appraisees and Administrators with the management and documentation required for all Medical Appraisals in Scotland.

http://www.appraisal.nes.scot.nhs.uk/



Staff, Associate Specialist and Specialty Grade Doctors and Dentist Professional Development Project

Work to date has involved:

1. Establishing a Project Implementation Group with representation from our key stakeholders which include:

� Scottish Association of Medical Directors

� Directors of Medical education Group

� Scottish Academy of Medical Royal Colleges

� Scottish BMA

� NES Medical & Dental Directorates.

This group meets quarterly and has recently re-focussed its objectives from design & development, to delivery of the key project components.

2. Establishing a small Project Team to coordinate operational aspects of this complex distributed project. This team are building UK-wide networks as a learning team.

3. Design and implementation of a Territorial Health Board-based Educational Adviser Network, managed by the Project Team. Work to recruit Educational Advisors (EA) has been undertaken over 2012-13 and the network was officially launched on the 14 March this year. This managed network will have a leadership development programme co-designed with the Project Team.

4. Design and development of a scheme for managing funding applications from eligible doctors and dentists across Scotland.

5. Ensuring that data handling and recording systems are in place to allow evaluation of the project.

In 2010 the British Medical Association (BMA) and the Royal College of Physicians of Edinburgh (RCPE) surveyed Staff, Associate Specialist and Specialty Grade Doctors and Dentists (SAS) working in Scotland and identified that approximately 2/3 of respondents wished to extend expertise within their existing roles and improve service delivery to patients and 1/3 wished to undertake training which would enable them to enter the Specialist Register and progress to a consultant appointment.

In January 2012, the Scottish Government agreed to fund a professional development programme for SAS clinicians. The purpose was to allow this group to undertake significant training and development opportunities, not normally delivered by employer study leave arrangements, and so evidence benefit to the individual clinician and to patients through related service improvements. The NES Medical Directorate developed an outline business case to support this, titled: “The use of additional support for the professional development needs of Staff, Associate Specialist and Specialty Grade Doctors and Dentists in Scotland”, (Jan 2012). This business case was accepted and the Medical Directorate in NES have been designing, developing and implementing a three year funded pilot project of work (2012-2015).

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As we approach the end of our first year, we have attempted to assess progress.

Strengths: we have the infrastructural support in place to drive the project forward into its second year; we are encouraged that funding applications are increasing in number and improving in quality; the key stakeholders have been mostly well-engaged and supportive.

Weaknesses: obtaining accurate information on eligible doctors and dentists across the system has been difficult and we have been overly reliant to date on centrally reported (ISD) data that will benefit from improved information, through the local Educational Advisers Network.

Opportunities: the majority of EAs are now almost all appointed and their relationship to their Health Boards and to their Directors of Medical education now enables the project to more fully galvanise the interest of SAS clinicians and their service leads in their further development.

Threats: the success of the project is entirely dependent on those who are successful in their funding applications demonstrating service improvement/impact. Service engagement in applications and support of the delivery of their outcome is key to achieving this. Lessons on how to facilitate this have been learned over 2012, with a resultant revision to the applications process and clearer direction to applicants.

We have been pleased at the early growth of applications and the apparent improved understanding of the purpose of the fund and look forward to supporting awareness and use of the fund over 2013-14, for the benefit of patient care, through the newly established network and Project Team.

Standing from left to rightDr Jane Shearer, Dr Anna Maria Ewins, Dr Patricia Townsley, Dr Derek McLaughlan, Dr Ann Cadzow, Dr Jane Wilkinson, Dr Victoria Dobie, Mr Chandrasekharan Badrakumar, Dr Jennifer Devine, Dr Susan Robertson

Sitting down from left to rightDr Lynne Meekison, Dr Leonora Coll, Dr Anna Hanusiak, Dr Sarah Miller

Not in the photo or present at the eventDr Sally Winning, Dr Colin Baines, Dr Morag Gorrie

SAS team



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2012 saw the pilot of a UK wide recruitment process, for 2013, for the majority of specialties. Applications to UK recruited specialties were made to a lead Deanery or Royal College on behalf of the UK. For UK recruited specialties candidates submitted one application per specialty. They were then given the opportunity to preference the Deaneries in which they wished to work. Each specialty had a nationally agreed person specification listing the required competencies for that specialty. The recruitment ran to a nationally agreed timetable to allow the synchronisation of offers and also consistency for candidates. Only a small number of specialties were recruited via the local SMT process.

The UK recruited specialties were recruited via one of four recruitment models:

Single Centre Recruitment

The host recruiting agency undertook the complete recruitment process and local Health Boards had no involvement in the process other than advising the number of vacancies to be advertised in that particular specialty. No Health Boards in NHS Scotland were host recruiting agencies for any specialties as they had already been allocated elsewhere.

Local Recruitment

All the vacancies for a particular specialty were advertised by the host recruiting agency but then everything else from short listing through to interviewing was dealt with locally by Health Boards. The IT system used was not SMT but one of the equivalent systems in England.

Central Recruitment

As much as possible of the process was centralised including long listing, short listing and offers but where it differed from Single Centre Recruitment was that interviews were devolved to local Health Boards and then the results were fed back in nationally.

Cluster Model

This was based on the local recruitment model but where a Board/Organisation had very small numbers to recruit to and they choose to link with other Boards into a cluster to make the process easier.


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Section 5: Sharing the journeyRoles and responsibilities of trainers 53

This UK-wide recruitment process is a pilot for trainees due to start in August 2013. Its aim was to provide candidates across the UK with a consistent and fair recruitment process working to nationally agreed processes and timetables. An evaluation of this pilot will be held in spring 2013, with scope for review and feedback to ensure national UK processes are firmly aligned for the 2014 intake.

The NES UK Offers system, part of the Scottish Medical Training IT system in operation since 2007, was applied across the UK at a four nation level and all offers were made through the UK Offers System to a nationally agreed timetable. This is an important UK acknowledgement of NES’ previous success in recruitment support and asserts the robustness of the NES system.

The following table shows the Round 1 recruitment (Core Training and Run Through training) application numbers for Scotland, received as part of national and SMT recruitment. This was for 746 vacancies; 285 Core Training posts, 426 Specialty Training posts and 35 LAT posts.

Round 2 (ST3+) recruitment closed on 22nd March. There were approximately 293 ST vacancies and 67 LAT vacancies.

ROUND 1 (Core and run through training)

Specialty Level Applicants PostsACCS - Emergency Medicine 1 National 26

Anaesthetics & ACCS Anaesthetics 1 119 35 & 17

Cardiothoracic Surgery 1 National 1

Cardiothoracic Surgery 3 National 1

Chemical Pathology 1 3 3

Clinical Radiology 1 National 21

Community Sexual & Reproductive Health 1 43 3

Core Medical Training & ACCS Acute Medicine 1 223 96 & 9

Core Medical Training 2 13 7

Core Psychiatry Training 1 62 47

Core Surgical Training 1 78 48

GP 1 464 304

Histopathology 1 National 11

Medical Microbiology 1 20 6

Neurosurgery 1 National 3

Obstetrics & Gynaecology 1 31 16

Obstetrics & Gynaecology 3 87 21

Ophthalmology 1 National 12

Ophthalmology 3 National 4

Paediatrics 1 48 27

Paediatrics 2 13 10

Paediatrics 4 3 3

Public Health 1 National 3

Trauma & Orthopaedic Surgery 1 115 12

Totals 1322 746



The General Medical Council (GMC) regulates all stages of doctors’ training and professional development in the UK. Most recently the GMC has set and put in place systems to monitor the standard for all postgraduate medical training. The GMC has agreed a phased process for implementing new arrangements for recognising and approving trainers and has identified an initial deadline of 31 July 2013 for local systems to be in place to work towards recognising four specific training roles across undergraduate and postgraduate medical education. By July 2016 all trainers in the four roles shown below, or entering any of the four roles, will be recognised i.e. have met the medical schools/deaneries’ criteria, without use of interim arrangements. The four specific training roles that are to be recognised under these new arrangements are:

� Educational Supervisors in postgraduate training

� Clinical Supervisors in postgraduate training

� Lead coordinators of undergraduate training at each local education provider

� Doctors responsible for overseeing students educational progress for each medical school

This means that in simple terms that all educators both at under and postgraduate level should be identified and recognised as trainers. The standards that the GMC will use for recognition of trainers are set out in The Trainee Doctors publication for postgraduate trainers and in Tomorrows Doctors for undergraduate education. The GMC are using seven areas which were originally set out by the Academy of Medical Educators which are:

1. Ensure safe and effective patient care through training

2. Establish and maintain an environment for learning

3. Teach and facilitate learning

4. Enhance learning through assessment

5. Support and monitor educational progress

6. Guide personal and professional development

7. Continue professional development as an educator

Local education providers which include Health Boards and General Practices must use the seven areas to show the GMC how they have identified, trained and appraised trainers who fall into the four educator roles shown above. The Postgraduate Deans and the Medical Schools will collate and report that information to the GMC confirming the arrangements in place to meet the GMC standards. NES has created the Faculty Development for Scotland Project to promote a joined up approach across Scotland to meet the GMC requirements. The Faculty Development for Scotland Project was established around three years ago (ahead of the GMC requirements) and aims to develop a Scottish Trainer Framework which will be accessible by all to support the approval of trainers.

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The Project recognise the opportunity for efficiency by working together across Scotland and that by identifying common core competencies trainers can be developed to GMC standard by accessing a range of training products, depending upon local need.

A major piece of work has already been completed as part of the Project. This piece of work included a Core Competencies Survey, developed by Dr Michael Ross of Edinburgh University which identified priority core competencies for Faculty development in Scotland which were then mapped to the seven areas used by the GMC. The Scottish Trainer Framework is being designed to map all the training products currently available in Scotland to support individuals performing the role of trainer. Products from: Royal Colleges, Medical Schools, Health Boards and NES are being identified for the framework. The Project is also considering the role of revalidation and educational appraisal, and the Directors of Medical education (DME’s) Group are working with the project to achieve this.

A key achievement of the Faculty Development Project has been to agree a common submission to the GMC on behalf of the four deaneries and five medical schools reporting a joint action plan for the whole of Scotland, to deliver their approval of trainers requirements. The project are involved in the role out of PINNACLE version three, which will provide a facility for collecting a register of recognised trainers. An external common interface would allow all stakeholders (Health Boards, Medical Schools, etc), to access training information for all trainers in the four roles identified by the GMC. This Project demonstrates NES’s leadership as a special health board within the NHS in Scotland.

Training Medical Educators in Scotland

The training of trainers in NHSScotland has been varied. Under the new regulations to recognise Trainers, NES has established the Faculty Project to develop accessible and appropriate Training of Trainers. As the Faculty Project considers the results of the Core Competencies Survey NES continues to provide support and development of Trainers through the Supporting Clinicians on Training in Scotland programme (SCOTS) and the Staff Training Appraisal and Revalidation eLearning suite (STAR).

In anticipation of the GMC’s requirement that trainers are formally recognised (by NES Deaneries as Educational Organisations EOs) as being suitably prepared and trained for their role, the SCOTS Clinical and Educational Supervision workshops have been developed and their content mapped to the GMC’s Trainee Doctor (2011) and the Academy of Medical Educators Framework for the Professional Development of Postgraduate Medical Supervisors (2010).

During 2012 Regional Faculty Groups have been established across the country to deliver these new SCOTS Clinical and Educational Supervision workshops. There are now 8 active regional groups who have delivered a total of 55 workshops to 607 participants. In some places, Directors of Medical education DMEs have established equivalent arrangements, mostly using SCOTS materials, and building on the success of regionalisation. We would anticipate a continued need to develop the SCOTS approach, whilst supporting increasingly a blended and DME-delivered approach.


Although senior trainees have participated in SCOTS Clinical Supervision training over the years, NES has now piloted the delivery of Clinical Supervision workshops to groups of exclusively Pre-CCT trainees. These workshops have been very popular with trainees and evaluated well. In total 33 trainees have attended the three workshops delivered so far. By completing this workshop before the end of their specialty training, trainees will be prepared to fulfil the role of a named Clinical Supervisor when they take up their Consultant posts.

The Management of Doctors in Difficulty Course continues to provide guidance and support for trainers in the identification and management of this small but sometimes challenging group of trainees. During 2012 six courses were delivered across Scotland to 63 participants.

A modular course for GP trainers was development in 2011. This format was piloted during 2012 and has resulted in a considerable reorganisation of course content and delivery methodology. We now have a one-day course for GP trainers which has been piloted and has the potential to be adapted for hospital-based trainers.

Data from the December 2012 NES trainer survey are currently being analysed. This survey was designed to gain insight into trainers’ levels of confidence in identifying and managing trainee doctors in difficulty. These data will be used to inform the development of further training, access to information and support.

The Training Programme Director (TPD) course was introduced in 2012 with a target audience of current or prospective Training and Foundation Programme Directors. One course was delivered last year with 12 participants. The course is new and demand is increasing. There is one course scheduled for the first half of 2013 and plans to deliver another later in the year.

Sharon Hutton (seated) is the Postgraduate Courses and Events Administrator. Carol Cunningham is Secretary to the Training & Education Development Manager.

SCOTS admin team


With over 2000 active account holders, the web-based STAR system has been continuing to support the development and delivery of training materials for clinical educators, in line with the aims of the NES Faculty Development Project. A new module on Clinical Supervision has been created, in association with the SCOTS development team, to support new training required to implement the GMC Recognition of Trainers Plan. This will be released in summer 2013.

Additional modules to support Scottish Government requirements for training in ‘Do Not Attempt Cardiopulmonary Resuscitation’ and ‘Information Governance’ were released over 2012.

Other development work has included a new messaging system to support Health board-based administrator communication with supervisors and enhanced functionality, to reports on module uptake, for Directors of Medical Education.

Work by the STAR team has also prepared the way for the data exchange needed to support clinicians in evidencing their training during appraisal of their educational roles, e.g. merging information about SCOTS courses in Portal with that of other courses in STAR, and the mapping of steps required to share overall records of training with Pinnacle and SOAR. To support closer integration with other NES systems, STAR is expected to move to a NES-based server in 2013.

The STAR team looks forward to developing additional modules in 2013-14 and also to supporting the Scottish Government training of senior medical staff in relation to the Death Certification legislation that is due for implementation in Spring 2014.

The STAR team would also like to encourage additional Scottish senior medical staff to take up their offer of a STAR account and looks forward to working with Directors of Medical Education to support this. (Senior Medical Staff can request either a reminder of a previously sent account, or new account details, through the ‘request a reminder’ or ‘contact your administrator’ links on the front page of STAR - https://www.mystar.org.uk)


Supporting Trainees with Learning Online

To complement the training and support provided to our trainers and trainees across Scotland, The Scottish Medical Directorate in NES, work hard to provide the best and most efficient access to Educational and Developmental Opportunities online. Last year saw the retirement of the Doctors online Training System (DOTS). DOTS elearning content has been migrated to The Knowledge Network, where it will in future be available alongside other evidence and learning resources. A new connection has been built between The Knowledge Network and e-Portfolio, so that trainees can access these resources and the associated records of their learning from the e-Portfolio LEARN system.

The Knowledge Services Group has worked closely with the NES Medical Directorate to continue to develop the online Leadership Knowledge Portal and eLearning resources to support the LAMP Leadership and Management programme for postgraduate trainees. A key development has been creating a connection between the Knowledge Network where LAMP elearning resources are hosted, and the NES portal for booking face to face training. This supports a blended learning ethos which allows trainees to sign up to the face to face LAMP training and be authorised to access the relevant elearning resources at the right time in the learning process.

The Knowledge Services Group continues to promote the national Knowledge into Action Initiative, which provides knowledge broker support, tools and skills development to help Postgraduate Medical Trainees to continually translate new and existing evidence into practice. To this end the Knowledge Services Network is creating zones within the Network which allows our new doctors enhanced access to learning resources, guidelines, journals and other evidence relevant to their curriculum and core clinical areas of practice. Under the auspices of Knowledge into Action, the Knowledge Services Group has delivered mobile solutions to support frontline decisions in management of sepsis and an evidence sourcing and summarising service for frontline clinical enquiries. Knowledge Services has also scoped and analysed the potential for mobile enablement of a wider range of point of care knowledge resources essential for trainees –including local formularies and guidelines. The Knowledge Network continues to support mutual learning through a wide range of online communities of practice for a broad range of clinical, safety and improvement issues. It also offers regular webinars and face to face training in use of the Knowledge Network and the principles of translating knowledge into action.



6

The NES website

Up to date online information and presence is vital to success in the contemporary professional environment. Our Medical Directorate revamped its website in 2011 and has continued to keep pace with ongoing updates and new pages on issues pertinent to contemporary medical professionals, such as Revalidation and the SAS Doctors programme.

Two exciting initiatives underway for 2014 are:

1. Updated Recruitment pages

2. Mobile Enabled Webpage

Updated Recruitment pages

START is the Medical Directorate’s strategy to actively encourage trainees to pursue training in Scotland. Key to the success of START will be the development of a new dedicated recruitment website, which will bolster the Medical Directorate’s On-line presence.

The Medical Directorate is committed to making a much more robust and visible online presence and a coordinated Social Media is underway. A Medical Directorate Twitter profile will deliver relevant tweets and encourage trainee participation via a supporting Twitter feed. Regular newsletter updates will also ensure trainees feel included in current Scottish Medical developments and can contribute ideas to their future training.

Mobile Enabled Webpage

The Medical Directorate has commenced development of a Mobile Enabled website. Review of the Medical Directorate’s website statistics revealed a 53% increase in people using phones and tablets to access information and it was important that the Directorate met the needs of these modern users.

Initial focus was on updating Foundation and Programme Information, as it was identified these areas were most likely to be reviewed on the go. Mobile Enabled information will ensure website users can immediately see information in a way that is relevant to the specific individual, rather than a Deanery or specialty.


1

2

http://intranet.nes.scot.nhs.uk/smt-response-site/index.html

Mobile Enabled Webpage

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Section 6: The Technological ConnectionSystems which connect our organisation 61

A Database for Managing Doctors in training while in Programme

Pinnacle is the database system which manages doctors in training through their programmes.

Pinnacle continues to be developed by NES to ensure it best meets the needs of current medical trainees, with Pinnacle Version 3 on target for launch in October 2013. Pinnacle needs to be ready to meet GMC requirements, which can be subject to change and review as the medical profession itself progresses. The examples of Recognition of Trainers and Revalidation are recent GMC developments which needed to be fully integrated into the Pinnacle system. The Recognition of Trainers list is a single record of recognised trainers across undergraduate and postgraduate medical schools. The list is unique to Scotland and is managed by NES. Revalidation is confirmation of a doctor’s continued licence to practise in the UK. From the outset of release, Pinnacle Version 3 will need to be ready to align trainee, trainer, practice and progression records, whether for Recognition of Trainers or Revalidation purposes, or to meet additional changes as they occur.

It is imperative the robustness of Pinnacle is confirmed and established to best meet the needs of an evolving medical profession. In 2012, the Medical Directorate undertook a significant amount of work to finalise agreed processes across Scotland. Part of this was an expansive review of Deanery job descriptions and functions to ensure wherever a trainee was located across Scotland, that individual trainee would receive the same quality of service and processes to support them.

The expansion of Pinnacle is an ongoing Medical Directorate project which needs to be fluid as the GMC introduces additional requirements. Pinnacle’s continued development via Version 3 demonstrates how NES and the Medical Directorate have been committed to continually developing and enhancing the database system, adapting as changes occur.

The end result will be an equitable service across all four Scottish Deaneries where all trainees will receive consistent access to services and training, whilst remaining confident their supporting training information will be reflected in a single, consistent record.

Pinnacle version 3



The Scottish Online Appraisal Resource (SOAR) is a web based resource which was originally developed to support the appraisal of General Practitioners. As we move to revalidation for all doctors, it is important for NES to support appraisal. To achieve this goal the SOAR system was expanded from GP to include secondary care. This system is secure (password protected) and allows the appraisees, appraisers and medical managers to complete the necessary documentation and processes for appraisal. It also allows the Health Boards to manage and track appraisals, which complements the collaborative approach of the Health Boards and NES not only to report back to the GMC but also to move towards a supportive and developmental community of Healthcare.

This efficient system of recording appraisals is continually being developed to ensure interoperability with other relevant systems including those at the GMC, colleges and academies and eventually to communicate directly with the e-portfolio system. The Scottish Government is very keen to provide this online system and that any similar systems and processes are consolidated into one system. One system avoids duplication and ensures that everyone uses the same information and approaches to appraisal, creating a true common Scottish community of learning and development.

It is hoped that SOAR will soon house video recordings of the face to face Appraisal Training sessions delivered by the Medical Appraisal Team (see earlier article). The Medical Appraisal Team can provide training on SOAR via video conference technology (Webex).

Section 6: The Technological ConnectionSystems which connect our organisation 63

CENTRAL STATIONTHE MEDICAL DIRECTORATE FOR NES

7


NES and its postgraduate deans are accountable for managing the delivery of postgraduate training to standards required by the regulator - the General Medical Council (GMC)

Governance arrangements are underpinned by Service Level Agreements between NES and the territorial NHS Boards. These support educational and financial obligations between NHSScotland Health Boards and NES as an NHS Special Health board. The Health Boards recognise that supervised training is a core responsibility and integral to maintaining the quality of service delivery now and for the future.

The Four Postgraduate Deaneries

The four postgraduate deaneries in Scotland are part of NES. They are responsible for managing the training programmes in their region, across regions in two or three deanery programmes, and across Scotland in the national programmes. They work closely with the wider NHS through the regional workforce planning groups.

The Scottish model means that the four deaneries work together as part of our Medical Directorate, ensuring equity of recruitment and management approach. National policies and working committees such as Specialty Training Boards mean that the four deaneries can deliver a consistently high quality approach across Scotland, and allows NES a stronger voice on a UK basis.

In partnership with the central directorate team, the four Deaneries are responsible for quality managing the training programmes based in or hosted by their region. They work closely with the wider NHS directly and through the regional workforce planning groups.

The Scottish model ensures a consistent approach to quality management wherever our trainees and trainers are in Scotland.

The postgraduate Deans provide strategic leadership and direction for postgraduate medical education and training to meet the requirements of the GMC. The Deaneries benefit from the current and accurate advice from our Specialty Training Boards, the UK and Scottish Royal Colleges and Faculties and other expert groups. This advice ensures consistent regional delivery of national and NES policies.

CENTRAL STATIONTHE MEDICAL DIRECTORATE FOR NES

7

Section 7: Central StationThe Medical Directorate for NES 65

This year (2012), has been dominated by the Medical Directorate Vision implementation and the direction of travel towards a more integrated and collaborative approach to supporting our trainees and trainers. An example of this approach has been the work of the Trainee Performance Advisory Group (TPAG, previously NAG) for Doctors in training with Difficulties. Close collaboration of the NAG with a validated Ward Simulation Exercise developed and delivered by the Simulated Ward at the Dundee University ensures that the trainees are better supported.

The active work of the Medical Quality Management Team, a national distributed team, has supported deaneries in their efforts to continuously and consistently Quality Improve systems for trainees and trainers.

At the heart of how the four Deaneries do business are their solid relationships with key local partners such as the territorial Health Boards.

Our Medical Directorate is beginning to work towards creating support structures for the Human factors of working in NHSScotland. The Strategy for Attracting and Retaining Trainees hopes to pro-actively address gaps in programmes, researching the choices our Doctors in training make and why they make them. This kind of information and research will inform our current initiatives to make Scotland exciting for a medical career and highlight new initiatives for the future.

The Deaneries have shown the richness of opportunity to carry out internationally acclaimed research as part of the Scottish Medical Careers Cohort Study (SMCCS), and the unique size and shape of Scotland means there is a diversity of opportunity for research with Scottish Medical education Research Consortium enabling a manageable system of support to find progress and completion of research initiatives.

The four Deaneries provided training opportunities which receive reports of high satisfaction from the GMC Trainee survey year upon year. The largest hospital in Europe at New South Glasgow is underway and is scheduled to open in 2015. As we anticipate the opening of this new hospital the service is being reconfigured as new services combine with a view to freshly locating to the new hospital.

The four Deaneries present strong teams to support the education and training not only for our Trainees but those who train them. The Faculty Development Plan for Scotland was initiated in 2010 and has reached a crucial phase as we respond to the GMC Recognition of Trainers implementation plan arrangements. Its Working Group 1 reported during 2012 and this foundation has allowed the ongoing development of the Scottish Faculty Development Framework building on the GMC adopted AoME Framework and mapping a range of Scottish trainer products to enable trainers in their quest for recognition by July 2014.

The four Deaneries continually strive improve working relationships. The Deaneries work with key local partners, such as the Health Boards and other University Medical Schools.

The Deaneries have shown the richness of opportunity to carry out internationally acclaimed research as part of your Medical Career in Scotland, and the unique size and shape of Scotland means there is a diversity of opportunity for research with a manageable system of support to find progress and completion of research initiatives.


Across Scotland the Four Deaneries provided training opportunities which receive reports of high satisfaction from the GMC Trainee survey year upon year. The largest hospital in Europe at New South Glasgow is underway and is scheduled to open in 2015. As we anticipate the opening of this new hospital the service is being reconfigured as new services combine with a view to freshly locating to the new hospital.

The four Deaneries present strong teams to support the education and training not only for our Trainees but those who train them.

NHS Education for Scotland: Postgraduate Deaneries and their associated NHSScotland Health Boards

All figures are approximate and subject to change

NES North DeaneryPopulation: 923,860

Foundation Training:Nos. Trainees 270Nos. Programmes 11

Specialty Training:Nos. Trainees 600Nos. Programmes 33

NES East DeaneryPopulation: 396,942



NES South East DeaneryPopulation: 1,291,972



NES West DeaneryPopulation: 2,568,294



Glasgow Edinburgh

Dundee

Aberdeen


The Organisation of Postgraduate Medical Training

The key functions (both managerial and advisory), lines of accountability of educational managers and how these support the delivery of training programmes are set out in overview in the accompanying diagram.

Scottish GovernmentHealth Directorates

NES BoardSpecialty & Foundation Boards

Postgraduate Deans

Training ProgrammeDirectors

Directors of MedicalEducation

Provider NHSScotlandHealth Boards

Educational SupervisorsEducationally accountable to TPDManagerially accountable to DME

Remit: National & advisory

Specialty Training Committees

Remit: Deanery & advisory

National Management orAdvisory Groups

Remit: National & advisory

Deanery Management orAdvisory Groups

Remit: Deanery & advisory

(14 NHS Health Boards)Clinical Supervisors

Medical DirectorNHS Education for Scotland

GP Directors &Associate Deans

Figure 3: The Governance of Postgraduate Medical Education in Scotland -

Overview of Key Managerial and Advisory Functions and their Lines of Accountability.


Key Contacts - NHS Education for Scotland Medical Directorate

Malcolm Wright Chief Executive T 0131 313 8030 E [email protected]

Dr Stewart Irvine Director of Medicine T 0131 313 8129 E [email protected]

Prof Rowan Parks Deputy Director of Medicine T 0131 313 8129 E [email protected]

Mrs Jean Allan Executive Manager T 0141 223 1418 / 0131 313 8039 E [email protected]

Prof. Philip Cachia Dean of Postgraduate Medicine T 01382 632 288 East of Scotland E [email protected]

Prof. Gillian Needham Dean of Postgraduate Medicine T 01224 553970 North of Scotland E [email protected]

Prof Alastair McLellan Dean of Postgraduate Medicine T 0141 223 1505 West of Scotland E [email protected]

Prof. William Reid Dean of Postgraduate Medicine T 0131 650 2613 South East of Scotland E [email protected]


Table of Acronyms

A Additional Costs of Teaching (ACT) Advanced Medical Training Fellowships (AMTFs)

C Clinical Skills Managed Educational Network (CSMEN) Community Child Health (CCH) Continuing Professional Development (CPD)

D Director of Medical education (DME) Doctors in Difficulty (DiD)

E eLearning for Healthcare (eLfH)

F Foundation Programme Directors (FPDs)

G Glasgow Academic Training Environment (GATE) General Medical Council (GMC) General Practice (GP) General Practice Specialty Training (GPST)

H Health Education England (HEE)

J Joint Committee on Surgical Training (JCST)

L The Leadership and Management Training Programme (LaMP) Less Than Full Time Training (LTFT) Locum Appointment for Training (LAT)

M Medical Leadership Competency Framework (MLCF) Medical Research Centre (MRC) Mobile Skills Unit (MSU)

N National Health Service (NHS) National Health Service Scotland (NHSScotland) National Advisory Group (NAG) Nursing, Midwifery and Allied Health Professionals (NMAHP)

O Occupational Medicine (OM) Oral and Maxillofacial Surgery (OMFS)

P Paediatrics Intensive Care Unit (PICU) Police Service of Scotland (PSoS) known as Police Scotland Post Assessment Questionnaire (PAQ) Practice Based Small Group Learning (PBSGL) Psychiatric Specialty Training in Academic Research (Psy-STAR) Public Health (PH) Public Health Medicine (PHM)

R Royal College of General Practice (RCGP)


S Specialty Advisory Committees (SACs) Supporting Clinicians on Training in Scotland (SCOTS) Scottish Clinical Research Excellence Development Scheme (SCREDS) Scottish Co-ordinated Paediatrics Education (SCOPE) Scottish Deans Medical education Group (SDMEG) Situational Judgement Test (SJT) Scottish Medical Education Research Consortium (SMERC). The Strategy for Attracting and Retaining Trainees (START) Scottish Online Appraisal Resource (SOAR) Scottish Transitional Medicine Training Initiative (STMTI) Specialty Training Board (STB) Scottish Teaching and Recruitment Group (STARG)

T Training Programme Director (TPD) Trainee Performance Advisory Group (TPAG)

U The UK Foundation Programme Office (UKFPO)



(Endnotes)

1 http://www.scotland.gov.uk/Resource/Doc/352649/0118638.pdf

2 http://www.scotland.gov.uk/Resource/Doc/311667/0098354.pdf

3 http://www.nes.scot.nhs.uk/media/5280/strategic_framework_2010_2014%20web.pdf

4 http://www.mee.nhs.uk/pdf/401339_MEE_FoundationExcellence_acc.pdf


NHS Education for Scotland Westport 102West PortEdinburgh EH3 9DN Tel: 0131 656 3200 Fax: 0131 656 3201www.nes.scot.nhs.uk

ISBN: 978-0-85791-032-5

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