Current status of training: Is it good enough?

Transcription

1 Current status of training: Is it good enough? Alison Waghorn Head of School of Surgery for the North West Is good enough, good enough??.excellence Nigel Standfield, 23 Nov The Guardian 2011 Does UK surgical training provide enough experience? Charlotte Thomas et al BMJ Careers 11 th May % had 1600 indicative numbers at CCT 73% demonstrated competence in key procedures

2 Influences Negative? Full Night shift work: 13 hours out of a 48 hour week -?seniors Lack of middle grade doctors in UK Lack of Recognition for educators Drive for Service Delivery New contract Time Low risk cases- private sector Rotas Positive? New curricula Indicative numbers CCT requirements Good Medical Practice Domains New contract - education Non-medical health care workers???ewtd - BWTD

3 UNIT HOSPITAL SUPERVISOR (TRAINEE)

4 Operate, personalised decision making, communicate Assess the literature, Educate others Manage, Lead, Professional behaviour with other staff, Quality assurance

5 What is our end point? - CCT Fit for purpose - Consultant within the NHS in UK Today -? 1990 s Just adequate operative and clinical skills at CCT (Generalists) Not being suspended in the first 2 years as a consultant (GMP)

6 Operative competences CCT indicative numbers OMFS : lots of experiences at (even observation ) STS ( PBA level 1-4 )- 1 fronto-orbital advancement Plastics: Breast reconstruction 40 - STS or performed No PBA level Neurosurgery : research criteria excellent, modular, need for index procedures and PBA levels Paediatrics 1 PBA level 4 index operations in each area ENT : Minimum emergency operation : 10 mastoids ; Specialist needing >100 no PBA requirements Cardiothoracic Surgery : 200 major operations: -No PBA s defined - STS PBA level 4 -isolated coronary at ST6 but also at ST8 T and O indicative numbers specific operations - no PBA level explained Urology: competence level PBA level and indicative numbers index procedures General Surgery : defined - 3 PBA s Level 4 all index procedures and the subspecialty level 4 laparoscopic cholecystectomy breast trainee?

7 Set the bar Indicative numbers : each post Index procedures PBA level Subspecialty procedures PBA level at CCT PBA levels in certain key common operations at ST4, ST6, ST8 QI indicators get to clinics and operating lists GMC and JCST e.g. induction handover

8 Credentialing : is defined as: 'a process which provides formal accreditation of competences (which include knowledge, skills and performance) in a defined area of practice, at a level that provides confidence that the individual is fit to practise in that area ' Fellowships/attachments: written statement of competence I would let X undertake a simple thyroidectomy by themselves. (multiple PBA level 4 10 P) A large retrosternal thyroid they will need support. ( PBA level 3) Complex redo surgery. Unable to do alone ( PBA level 2) Has insight into personal limitations and will ask for help appropriately If the generalist disappears or lower bar : this becomes more relevant

9 Does revalidation/iscp site pick up the failing surgeon/trainee? WBA s Reflection? Bias Selection: e.g MSF, PBA AES/CS reports Good Medical Practice Domains: Patient Care, Patient Safety, Probity, Knowledge Defining the difficulty??? Peer to peer figures : data analysis

10 Are CCT guidelines relevant to Consultant practice and consultant posts in NHS? Teaching section : do Training the Trainers evidence to be a Clinical supervisor (GMC domains 1-5) Research section : Peer review papers (1-3) - Neurosurgery example- GCP, GMC guidelines Management section : Do a management course.. Write a business plan?, manage complaints, organise rotas Exam/s Generalist or Specialist Components

11 Can we identify those educators/hospitals who are not delivering? Then help them deliver.. The numbers game : the ARCP or interim review Marks out of Ten Numerous surveys: GMC, JCST, HEE monitoring visits Hospital consultant and trainee rotas incompatible with training SAC : Minimum Indicative/ Modular Numbers 20 hernias for ST3 in GS, 11 DHS / arthroplasties at CST for ST3, - Education exception reports Comparative data the desirability index

12 Thank you % excellent delivery of training >8 out of 10 Trainers/Educationists involved in rota formation Involved in theatre allocation Involved in clinic creation Putting training up the agenda Clinical supervisors making an extra effort on a post take ward round Units who discuss trainees progress regularly at their consultant meetings

13 Fit for purpose for all trainees Find the need and deliver the education