Improving Surgical Training: Enhanced Curriculum, Simulation, and Trainer Development

1. William AllumRCS Council Lead STATE OF THE NATION

2. Project Principles • Enhanced training • Increased time for training • Professionalised, better-trained trainers • Simulation • Technical and Non-Technical Skills • Extended Surgical Team • Surgical Care Practitioner curriculum – related to ISCP • Re-structuring of rotas • Minimum of 10 in a full shift ‘cell’, including non-medical workforce in Core-level on-call rota • Curriculum modification • “Excellence by Design” • Embedded, enhanced induction (‘boot camps’) • Centrally managed and funded post-CCT fellowships • True competence-based progression • Run-Through progression (with min and max duration and enhanced ARCP)

3. IST Governance • Project Board • Joint membership between RCS and HEE • Chaired by Ian Eardley • Operational Group • Joint membership between JCST, HEE, COPSS and RCS • Chaired by Gareth Griffiths

4. Operational Group Data collection and Sharing Stake-holder updating – social media Pilot site selection form Monitoring

5. HEE PLANS • Schools started • What works • What doesn’t • Plans for expansion • Schools not started • Plans to start • If not why not • No support • Not possible

6. LETBs Not Taking part Peninsula – visited this week North East – plan complete rollout in 2020 cf Scotland West Midlands – visit in May; plan to base at least 4 (?) GS posts in first tranche Oxford – no plans – visit in May N Ireland – visit in June; initial response is not to be involved

7. Current IST status • IST Trainees started • England, Wales and Scotland August 2018 • London October 2018 • 2019 Recruitment – advertised November 2018 • General surgery • Urology • Vascular surgery • 2020 Recruitment • Trauma & Orthopaedics

8. Pilot Sites Scotland: 18 posts: run through General Surgery 30 posts:core surgical training IST posts

9. INDICATIVE POSTS 2019 by LETB/Region

10. Trainee FeedbackReasons for Applying 32 responses 19 selected for Run Through 15 train in same region Simulation Focussed training Improved training opportunities

11. Feedback from Pilot Trainees (1)

12. Feedback from Pilot Trainees (2)

13. Feedback from Pilot Trainees (3)

14. Trainee Feedback – Text Comments • Access to operating – elective and emergency • Competition with ST3 • Service pressures • Trainer engagement and understanding of IST • F2 work • Simulation • Access • Local vs regional Teaching • Vascular / Urology / GSCH • Working with EST • Business as usual

15. Heads of School Feedback Rotas / Training time - 1:10 difficult EST – variable support Trainer time – limited support; job plans; lack of understanding of IST Simulation – limited access; lack of clarity Training sites – variable Trust engagement; NE full roll out planned Expansion – limited ST3 posts within Run Through

16. Practical Initiatives of IST 60% working week dedicated to training Simulation – technical and non-technical skills Dedicated time with trainers Run through training Working with the extended surgical team Ensure the product at the end of training meets current and future patient needs.

17. 60% working week dedicated to training • Discontinued 1:10 or more from criteria for posts • Develop guidance on what constitutes training to achieve 60% • cf CMT / IMT • Emergency / Elective challenge • Rotas

18. Rotas • 52 week Rota • On-call Block 5 weeks 4 times per year • 1 week SAU; 1 week Emergency theatre;1 week nights; 2 weeks emergency • Elective – 8 weeks 4 times per year – 1 x 8 week split Paeds and DCU • IST Colorectal and Upper GI • Staffing • 3 x IST; 2 x GC CT; 2 x Urology CT; 3 x F2 [Vascular, Breast, Urology]; 1 x GP VTS; 2 x ACP

19. Simulation – technical and non-technical skills • Definition of Simulation • Technical • Non-technical • Availability of simulation in training • Boot camps • Simulation Lead

20. Dedicated time with trainers • Job planning • Recognition of Trainers • Trainer training • Rollout Trainer Bootcamps locally • Define how to spend time • Trainer / IST Champion

21. Run through training • Preferred trainee option • 12 months in same place • Need to ensure regular assessment to ensure trajectory • Feed into ARCP • Interim ARCP • ST3 planning • How to continue IST themes • Criteria for pilot sites • Whole systems approach (cf Scotland)

22. Working with the Extended Surgical Team • NHS England Long Term Plan • Training of EST • Establishing how EST fits within “new firm” • Employers view • Business case

23. Initiatives Skills Clubs Mentors Rota Coordinators Centralised Regional Teaching Audit of current CST posts for compliance with IST Regional Presentation day

24. HEE Plans • Local HEE Offices • Deans – Regional trainer boot camps • Employers • Trainer job plans • Promote EST • Local Champions (£5k)

25. Project Developments • Benchmarking • ST2 – ST3 • ST3 and onwards – from 2020 • How to continue IST themes • Criteria for pilot sites • Evaluation of Project • HEE sponsored independent evaluation

26. Progression to higher specialty training will be dependent upon achieving the appointable score required of non-IST trainees applying for uncoupled ST3 posts in those specialties. Scores by pilot trainees will form part of the evidence considered in support of profression to ST3

27. Project Developments • Benchmarking • ST2 – ST3 • ST3 and onwards – from 2020 • How to continue IST themes • Criteria for pilot sites • Evaluation of Project • HEE sponsored independent evaluation

29. Conclusions Improve Core experience More confident and competent trainees More able to progress through specialty training