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Current State of Surgical Training

Explore the current profile of surgical training and the shape of training, and discover the opportunity to improve workforce, credentialing, generic professional capabilities, simulation, and more.

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Current State of Surgical Training

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

  2. 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

  3. 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

  4. 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

  5. Issues

  6. 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)

  7. Workshops • General themes and progression to CST • Primary – secondary care interface • Interaction with employers • Issues relating to SAS doctors • Academic pathway • Credentialing

  8. 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)

  9. DH Statement • Implementation in an incremental fashion to minimize service disruption (short and medium term ) • Preserve current fit for purpose structures • Continue the UK Steering Group supported by 4 Nation Implementation Groups • Commission an impact assessment to report by summer 2015 • Implement the recommendation that the careers of SAS doctors should be enhanced. • Pilot credentialing (eg cosmetic surgery) • Seek draft descriptions of training pathways to include CST within 6 years and credentialing for each theme

  10. 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

  11. 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

  12. 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

  13. Improving Early Years Training

  14. Improving Surgical TrainingWhat are the Objectives • To improve quality of surgical care • To improve the quality of surgical training

  15. HEE Perspective

  16. Process

  17. Run Through, Competence Based, MRCS required for progression National selection

  18. Contemporary Challenges to Delivery of Surgical Simulation

  19. Framework for Technology Enhanced Learning

  20. Simulation - Drivers • Clinical Experience • Change in working practices • EWTR • Technological and Scientific advances • Efficacy of Simulation

  21. ChallengesHuman Resources • Trained Faculty • Design curriculum • Provide structured feedback • Role model • Time for Training • Service vs Training • Patient safety demands on trained surgeons

  22. ChallengesEducational Strategy • Structured curriculum • Learning outcomes • Assessment instruments • Formative and summative feedback • Trainee clinic time vs simulation time • SDL • Trainee Awareness

  23. JCST Survey In this post, did you receive simulation and clinical skills training?

  24. Availability of Simulation by Deanery

  25. Availability of Simulation by Specialty

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

  27. ISCP – What’s it for? Curriculum Tells you what you need to know Guide to learning Guides learning Provides structure Improves feedback Improves training Personal study Teaching Informal assessment Feedback Formal Assessment Records outcomes

  28. ISCP v10 • First ever complete re-write • Faster • Better prepared for future developments • Planned for July / August release • Beta version available now

  29. ISCP v10 Easier to use More intuitive Simpler appearance Quicker Improve feedback Reduce tick box culture To improve training and learning To meet objectives of ISCP evaluation • Web design • Navigation • Features • Content • v10 aims to keep ahead of the field

  30. http://v10beta.iscp.ac.uk

  31. Learning Agreement • Central feature • Planning of objectives • Review of progress • Simpler to complete • Logical • No longer needs downloading of topicsBUT • Evidence will still be linked to topics

  32. Improved WBAs • Emphasis on feedback • Structured free text at the top • Strengths • Weaknesses • Actions • Anonymous assessment of trainer quality • Reflective record

  33. 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

  34. GMC Developments • Generic Professional Capabilities • Standards for Training • Equality and Diversity Guidance for Curricula and Assessment • Standards for Curricula and Assessment

  35. Generic Professional Capabilities • Generic Professional Capabilities • Effective communication • Leadership, team working, improving quality and patient safety • Complex and vulnerable groups • Education and training • Research

  36. Generic Professional Capabilities • Generic Professional Skills • Practical skills • Clinical skills • Generic Professional Knowledge • NHS structure

  37. JCST Budget

  38. JCST Finances Funding of JCST 2013-14

  39. JCST Finances Outgoings of JCST (by JCST function) 2013-14

  40. JCST Finances Outgoings of JCST by Type of Spending 2013-14

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