Improving Surgical Training: HEE Perspective for Better Patient Care

1. IST – The HEE perspective Paul Sadler Interim PG Dean HEE Wessex

2. Why am I here? • Collaboration HEE and RCS • Lead Dean for IST (& 2 surgical SACs) • My background • Critical Care and Anaesthesia • CCrISP / ATLS Course Director • Director of Education / Deputy Medical Director • Common issues in the past “missed training opportunities” “no time in theatre” “no one else on wards” “supervisors have no time” “service focus” “ok as long as rota is full” “if get to theatre I just hold the retractor” “teaching just doesn’t happen” “I felt isolated” Backed up by JCST / GMC survey

3. IST: History

4. Improving Surgical Training • A new competence-based, run-through training programme in General Surgery. • HEE and RCS working together • The pilot will trial: • improvements in the quality of training, • better balance between service and training, • professionalise the role of the trainers • Develop members of the extended surgical team to work alongside surgical trainees to improve patient care

5. The HEE Perspective

6. HEE Perspective

7. Process

8. Process Surgery: HEE trainee perspective Periods of Acute/Core Skills ITU and peri-operative medicine Generic surgical technical skills Non-clinical skills On-calls Simulation Periods of ‘Intensive surgery’ Specialist surgery Acute/trauma training Longer rotations No on-calls Post-CCT: Fellowships for sub-specialisation Upkeep of acute, general and specialist skills Periods of Specialist Surgery with on-calls Specialist surgery Longer rotations Specialist on-calls

9. Project Principles • Enhanced training • Increased time for training (60%) • 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)

10. Improving Early Years Training

11. HEE ARCP Review The purpose of the ARCP process should be recognized as: • Assessment of competence to progress to the next stage / completion of training • Ensuring trainees fulfil GMC revalidation requirements • Ensuring trainees are regularly appraised receiving formative feedback and careers advice A consistent, robust and fair process

12. HEE ARCP Review • Assessment – meaningful and achievable • Appraisal • ES / CS role • ARCP members role • QA of ARCP

13. HEE Plans • Local HEE Offices • Deans • Employers • Trainer job plans • Promote EST • Local Champions (£5k) • Schools started • What works • What doesn’t • Plans for expansion • Schools not started • Plans to start • If not why not • No support • Not possible

14. Challenges • Moving to business as usual • School / Employers • Rotas • Trainer Time • Simulation access • What is simulation? • ST3 numbers • EST

15. ?

16. Summary • Holistic review of Surgical Training • Protects training time • Emphasis on the value of the trainer • Requires changes in EST to make it work • Values General / Acute work through programme • Good for patients? • I WANT TO BE HERE!