Accredited Training in Vascular Surgery: the UK Perspective

1. Accredited Training in Vascular Surgery: the UK Perspective Gareth Griffiths Department of Vascular Surgery, Ninewells Hospital, Dundee, UK Chairman of the Specialty Advisory Committee in General Surgery

2. History of UK Vascular Training • 1960s – 1980’s • Small numbers of general surgeons doing occasional cases • Some vascular surgery in most hospitals • Special interest development within general surgery • 1990s – 2000’s • Increasingly a functional monospecialty • Officially still an interest within general surgery • Issues • Improved specialist outcomes • Increasing difficulty of training in general and vascular

3. Vascular Surgery – A New UK Specialty • 2012 • Officially recognised as a monospecialty • End result of much work by many within the Vascular Society • Training structures established • Within UK specialty training system • Meeting regulator’s requirements • Newly designed within these limits • First UK vascular training programmes start in August 2013

4. UK Accreditation Process • General Medical Council Standards • Stages of training • Trainee selection • Curriculum • Requirements for training units • Trainee assessment • Quality assurance • Life long learning

5. Stages of Training • Foundation Years 1 and 2 • Core Surgical Training • 2 years, 4 specialties (vascular surgery desirable) • Specialty Training • 2 years Intermediate • Breadth of elective and emergency vascular surgery • 1 year general surgery - open abdominal • 4 years Final • Open and endovascular • Generic Professional Behaviour and Leadership Skills

6. Trainee Selection • National, annual, single centre model • 8 component, 2 hour interview • tests all aspects of the person specifications • 11 assessors • Single national ranking • Ranking and applicant preference determine placement • Quality assured by professional and lay assessors

7. National Selection ResultsGeneral Surgery

8. Curriculum • Aim • Independent practice in “everyday” vascular surgery • Manage unselected vascular emergencies • Opportunity to develop a special interest • Referral to colleagues when appropriate • Excludes uncommon complex procedures

9. Curriculum

10. Curriculum

11. CurriculumSelected Clinical and Technical Skills

12. CurriculumGeneral Surgery

13. Requirements for Training Units • Supervised operating lists – 4 half days per week • Supervised out patient clinic – 1 per per week • Supervised ward round – 1 per week • Supervised angiography meeting – 1 per week • Formal teaching – 2 hours per week • Morbidity and Mortality meetings • Regular simulation practice • Time for study and Workplace Based Assessment • Educational facilities, study leave and expenses • Assigned Educational Supervisor (AES) • Initial, interim and final review for each placement

14. Training Programme Approval • Programme applications assessed against: • Requirements for training units • Operative numbers • Case mix • Population covered • Most approved, some required to merge • Rolling assessment and approval of Training Programmes

15. Trainee Assessments Formative • Workplace Based Assessments (WBA – 40 per year) • Clinical Evaluation Exercise • Originally designed by American Board of Internal Medicine • Assessor observation of trainee:patient interaction • Case Based Discussion • Detailed discussion of trainee’s management of a case • Procedure Based Assessment • Derived from OSATS - University of Toronto • Assesses all aspects of an operative procedure • Multi-source feedback • 360o assessment of performance in the work place • 8-12 assessors - different grades and professions • Includes self assessment

16. Trainee Assessments Summative • Assigned Educational Supervisor (AES) report • Achievement of objectives • Knowledge, clinical and technical skills • Annual Review of Competence Progression • Deanery and Specialty Advisory Committee input • Informed by WBA’s and AES report • FRCS (Vascular) Examination • Section one: written • Section two: clinical and oral • Programme Director and Deanery support • Specialty Advisory Committee (SAC) support

17. Quality Assurance • Trainee surveys • General Medical Council (GMC) - generic, high level • Joint Committee for Surgical Training – surgically relevant • Annual reports • Programme Director • Deanery • Specialty Advisory Committee (SAC) • Joint Committee for Surgical Training • Visits • Deanery visits to programmes • GMC visits to Deaneries • Triggered visits • Externality provided by Specialty Advisory Committee (SAC)

18. Quality AssuranceGeneral Surgery 2012 • Very good: • Achievement of 40 WBAs per year • Clinical experience and exposure • Clinical and operative teaching • Feedback • Good: • Number of operating sessions per week • Number of out patient clinics per week • Poor: • Formal teaching • Vascular training can improve on these figures

19. Life Long Learning • Mentoring • Team working • Continued professional development • Annual appraisal • Revalidation • Skill development • Local need • Technological advancement

20. Summary • Newly developing specialty • Well structured accreditation system • Learning from general surgical experience • Accreditation is a life long process