Subspecialty Training 2019

1. Subspecialty Training 2019 Alec McEwan Subspecialist MFM Acting Head of School O&G HEEM

2. Redrafting the subspecialty curricula • Short time frame • Subspecialty reps on the subspecialty committee asked to do the work • Previous SST Modules redrafted into Capabilities in Practice • High level learning outcomes, key skills, descriptors, types of evidence, knowledge criteria • Procedures • No new skills/competencies to be added • Generic non-technical skills to be removed • Removing overlap with core • Removing redundant skills/competencies • Explanatory documents and examples/case studies

3. Gynae oncology subspecialty modules pre-2019 • Module 1: General Assessment of a Gynaecological Oncology Patient • Module 2: Pre-, Peri- and Postoperative Care Objectives • Module 3: Generic Surgical Skills in Gynaecological Oncology • Module 4: Ovarian Cancer • Module 5 Cancer of the Uterus • Module 6: Cancer of the Cervix • Module 7: Cancer of the Vulva • Module 7: Cancer of the Vulva • Module 8: Vaginal Cancer • Module 9: Medical Oncology • Module 10: Clinical Oncology • Module 11: Radiology • Module 12: Palliative Care • Module 13: Urology • Module 14: Colorectal Surgery • Module 15: Plastic Surgery and Wound Care • Module 16: Gestational Trophoblastic Disease • Module 17: Genetic Predisposition to Gynaecological Cancer

4. Key: Common competency framework competences Medical leadership framework competences Health inequality framework competencesModule 5 Cancer of the Uterus Learning outcomes:  To understand and demonstrate appropriate skills and attitudes in relation to managing a patient with a diagnosis of uterine cancer: - undertake primary surgical management- understand management options to address co-morbidity- manage recurrent disease Page 25 GMC Good Medical Practice (GMP) Domains: Domain 1: Knowledge, skills and Performance Domain 2: Safety and quality Domain 3: Communication, Partnership and Teamwork. Domain 4: Maintaining Trust

6. Gynae-oncology SST CIPs • CIP 1: The doctor assesses and manages patients with suspected and confirmed gynaecological cancers and those without cancer who are concerned they may develop it. • CIP 2: The doctor plans surgical care and manages problems safely along the entire surgical pathway. • CIP 3: The doctor ensures the patient undergoes a procedure of appropriate radicality for gynaecological malignancy safely, performing it independently or as the leader of a wider surgical effort. • CIP 4: The doctor assesses ovarian cancer and initiates appropriate interventions for all stages and contexts of disease. • CIP 5: The doctor assesses uterine cancer and initiates appropriate interventions for all stages and contexts of disease. • CIP 6: The doctor assesses cervical cancer and initiates appropriate interventions for all stages and contexts of disease. • CIP 7: The doctor recognises, assesses and manages patients with suspected vulval cancer. • CIP 8: The doctor is competent in the assessment of vaginal cancer, performs the practical aspects of its management and assists in the delivery of non-surgical elements of care. • CIP 9:The doctor effectively discusses the role of chemotherapy in the management of gynaecological cancers, both at presentation and in recurrent disease, within the wider multidisciplinary team. • CIP 10: The doctor works within the multidisciplinary team to assess the need for radiotherapy in all gynaecological cancers, initiates appropriate interventions and manages side effects. • CIP 11: The doctor requests and interprets the most appropriate radiological investigations and interventions for gynaecological oncology patients. • CiP 12: The doctor assesses and manages the holistic needs of patients with terminal gynaecological malignant disease alongside specialist palliative care services. • CiP 13: The doctor understands the impact of gynaecological cancers on the urinary tract and is able to identify, investigate and manage urological complications. • CiP 14: The doctor assesses and performs appropriate surgery on the gastrointestinal (GI) tract and manage cases perioperatively. • CiP 15: The doctor understands the principles and practice of plastic surgery techniques and wound care as applied to gynaecological oncology and uses these at an appropriate level. • CiP 16: The doctor is competent in the assessment and initial management of a patient with suspected and confirmed gestational trophoblastic disease. • CiP 17: The doctor diagnoses, investigates and manages patients with a possible genetic predisposition to gynaecological cancer and their families, alongside specialist genetics services.

8. Evidence to inform the decision

9. Subspecialty Reproductive Medicine CIPs

10. Subspecialty Urogynaecology CIPs

11. Maternal and Fetal Medicine SST (pre-2019) • Module 1 – Maternal medicine • Module 2 – Genetics • Module 3 – Fetal Anomalies • Module 4 – Antenatal complications • Module 5 - Intrapartum care • Module 6 – InfectionAdditional considerations • A third of the competencies in MFM SST were exactly the same as competencies in core and needed sign off by the end of ST5 • There was a building belief that maternal medicine and fetal medicine SST should be ‘split’

14. Non-technical skills (pre-2019) • Generic Module 1: Communication, team working and leadership skills • Generic Module 2: Good Medical Practice and Maintaining Trust • Generic Module 3: Teaching • Generic Module 4: Research • Generic Module 5: Clinical Governance and Risk Management • Generic Module 6: Administration and Service Management • Generic Module 7: Information use and management • Not consistently used and not referred to in the ESR or the subspecialty matrices

15. Non-technical skills (2019) • ST6/7 trainees on the new core curriculum will be progressing through the generic core CIPs, and are expected to reach ST6/7 level for these core CIPs using evidence collected during subspecialty training • ST6/7 trainees remaining on the old core curriculum, and post CCT subspecialty trainees will be expected to show evidence of advanced progress in the following areas using evidence collected during subspecialty training:Governance and Risk managementTeachingResearch and PublicationsLeadership and Management

16. Assessing the progress of a subspecialty trainee • The CIPs within the subspecialty curricula are all ‘clinical’ • These should be assessed against the entrustability scale 1-5 • Remember, it is the High Level Learning Outcome (the banner statement) which the trainee and the ES should judge against • Global judgement, not the minutiae • Procedures still need three summative OSATs • No minimal level of evidence: quality, not quantity • Do not forget the generic non-technical skills; the core CIPs 1-8, 13, 14, OR the list mentioned earlier

17. Matrix of Progression • Requirements for satisfactory progress at the end of year 1, 2 and possibly 3 • Simple to make a list of what is required by the end of subspecialty training • More difficult to say what is adequate/inadequate progress at assessment points throughout the subspecialty training • Concept of ‘whole time equivalent months of training’ (WTEs) • We need some kind of guidance over what would be expected at the end of 12 months WTE clinical training (ie not including research time)

18. Transferring onto the 2019 subspecialty curriuclum • MANDATORY (after 31st October) • Review progress through the ‘old’ modules and decide what entrustability level you feel the trainee is at with the new SST CIPs • All evidence on the old eportfolio will comes as PDF files to the trainee • This does NOT all need to be moved into the new eportfolio, but the trainee may choose to move some of their evidence • The role of the ES at this transfer point