william allum chair, joint committee of surgical training current state of surgical training
TRANSCRIPT
William Allum
Chair, Joint Committee of Surgical Training
Current State of Surgical Training
Current Issues
Profile of Surgical Training– Shape of Training– Opportunity to improve– Workforce– Credentialling
Generic Professional Capabilities Simulation v10 - ISCP / e Logbook
– Trainers Surgeon Outcomes Budget
Shape of Training
An agreement between– Medical Education England– Academy of Medical Royal
Colleges– GMC– Council of Postgraduate
Medical Deans– Medical Schools Council– NHS Education Scotland – NHS Education Northern
Ireland– NHS Education Wales
Key broad recommendations
Service requires Doctors with more general skills Requirement for Specialists remains Training – to CST within 6 years Credentialing for specific competencies Training must be more flexible and respond to
patient/service needs Blurring the primary/ secondary care interface
Issues
What has Happened?
UK-wide implementation group, chaired by Professor Ian Finlay (2014)
Division of the report into six workstreams (Autumn 2014)
Workstreams fed back to the implementation group
Report to 4 DH Ministers (Winter 2014/15)
4 DH Ministers Statement (February 2015)
Implementation Group extended (Spring 2015)
Workshops
General themes and progression to CST
Primary – secondary care interface
Interaction with employers
Issues relating to SAS doctors
Academic pathway
Credentialing
What has Happened?
UK-wide implementation group, chaired by Professor Ian Finlay (2014)
Division of the report into six workstreams (Autumn 2014)
Workstreams fed back to the implementation group
Report to 4 DH Ministers (Winter 2014/15)
4 DH Ministers Statement (February 2015)
Implementation Group extended (Spring 2015)
DH Statement
1. Implementation in an incremental fashion to minimize service disruption (short and medium term )
2. Preserve current fit for purpose structures
3. Continue the UK Steering Group supported by 4 Nation Implementation Groups
4. Commission an impact assessment to report by summer 2015
5. Implement the recommendation that the careers of SAS doctors should be enhanced.
6. Pilot credentialing (eg cosmetic surgery)
7. Seek draft descriptions of training pathways to include CST within 6 years and credentialing for each theme
What might the implications be for craft specialties?
Relatively little Broad disciplines will remain Training will be general enough to permit most
doctors to participate in and treat emergency patients
Specialist interest will remain Some sub-specialist activities will be credentialed
What might the implications be for craft specialties?
Training•Fewer trainers but better recognition•More use of simulation techniques•Immersion training•Competency based rather than time based•Training to enter team structures•? Formal mentoring after CST
Strategy for Change in Surgical Training
Opportunity for Surgery
Improve quality of teaching and training– commitment from LEPs
Time for training and supervision
Rota review for emergency service provision
Role of Allied Healthcare Professional workforce
Improving Early Years Training
Improving Surgical TrainingWhat are the Objectives
To improve quality of surgical care
To improve the quality of surgical training
HEE Perspective
Process
Run Through, Competence Based, MRCS required for progression
National selection
Contemporary Challenges to Delivery of Surgical Simulation
Framework for Technology Enhanced Learning
Simulation - Drivers
Clinical Experience
Change in working practices EWTR
Technological and Scientific advances
Efficacy of Simulation
ChallengesHuman Resources
Trained Faculty– Design curriculum– Provide structured feedback– Role model
Time for Training– Service vs Training– Patient safety demands on trained surgeons
ChallengesEducational Strategy
Structured curriculum– Learning outcomes– Assessment instruments– Formative and summative feedback
Trainee clinic time vs simulation time– SDL
Trainee Awareness
JCST Survey
In this post, did you receive simulation and clinical skills training?
Yes No N/A
East Midlands 42.1% 36.3% 21.5%
East of England 44.4% 38.5% 17.1%
KSS 65.4% 27.5% 7.1%
London 51.1% 32.6% 16.3%
North West Mersey 35.9% 45.9% 18.2%
North West 40.3% 40.3% 19.4%
Northern East 65.4% 19.8% 14.8%
N Ireland 27.4% 48.0% 24.6%
Scotland 41.0% 39.8% 19.2%
South West 32.9% 47.8% 19.3%
Thames Valley 48.6% 37.0% 14.4%
Wales 38.9% 44.3% 16.8%
Wessex 36.0% 42.5% 21.5%
West Midlands 39.1% 38.3% 22.6%
Yorkshire / Humber 58.3% 29.8% 11.9%
TOTAL 46.0% 36.5% 17.5%
Availability of Simulation by
Deanery
Availability of Simulation by SpecialtyYes No N/A
Cardiothoracic Surgery 60.3% 23.3% 16.4%
Core 49.8% 36.7% 13.5%
General Surgery 40.7% 43.8% 15.5%
Neurosurgery 33.6% 43.4% 23.0%Oral and Maxillofacial Surgery 27.5% 30.8% 41.7%
Otolaryngology 57.6% 23.5% 18.9%
Paediatric Surgery 57.6% 34.9% 7.5%
Plastic Surgery 41.9% 36.9% 21.2%Trauma and Orthopaedic 44.7% 34.0% 21.3%
Urology 53.4% 30.1% 16.5%
Vascular Surgery 58.3% 41.7% 0.00%
ChallengesLogistics
Task and Procedural Simulators Space for hardware Space for learners Funds to support and maintain Centralised resources Sharing resources
ISCP – What’s it for?
Personal studyTeaching
Informal assessmentFeedback
Formal Assessment
Curriculum Tells you what you need to know
Guides learningProvides structureImproves feedbackImproves training
Records outcomes
Guide to learning
ISCP v10
First ever complete re-write
Faster Better prepared for future developments
Planned for July / August release Beta version available now
ISCP v10
Web design Navigation Features
Content
v10 aims to keep ahead of the field
Easier to useMore intuitiveSimpler appearanceQuicker
Improve feedbackReduce tick box cultureTo improve training and learningTo meet objectives of ISCP evaluation
http://v10beta.iscp.ac.uk
Learning Agreement
Central feature Planning of objectives Review of progress Simpler to complete
– Logical– No longer needs downloading of topics
BUT– Evidence will still be linked to topics
Improved WBAs
Emphasis on feedback Structured free text at the top
– Strengths– Weaknesses– Actions
Anonymous assessment of trainer quality Reflective record
Supervisor Reports
Clinical supervisor
Educational supervisor
Structured feedback
– 9 domains: knowledge, clinical skills......
– Performance descriptors for each
– Free text and performance
grade for each domain
GMC Developments
Generic Professional Capabilities
Standards for Training
Equality and Diversity Guidance for Curricula and Assessment
Standards for Curricula
and Assessment
Generic Professional Capabilities
Generic Professional Capabilities– Effective communication– Leadership, team working, improving quality and
patient safety– Complex and vulnerable groups– Education and training– Research
Generic Professional Capabilities
Generic Professional Skills– Practical skills– Clinical skills
Generic Professional Knowledge– NHS structure
JCST Budget
JCST Finances
Source Amount (£)
Trainee fee 1,203,048
GMC – for CESR work* 129,737
Total external income 1,332,785
Funding of JCST 2013-14
JCST Finances
Function Expenditure (£)
Trainee enrolment and certification ISCP QA
1,421,893
CESR – equivalence work 109,082
Outgoings of JCST (by JCST function) 2013-14
JCST Finances
Area of Spending Amount (£)
Staff 821,000
Honoraria 70,000
Travel 23,000
Catering and AV 30,000
Office Costs 14,000
Accommodation, service and other charges
573,000
Overall total 1,531,000
Outgoings of JCST by Type of Spending 2013-14