JCST Meeting 9th May 2018 RCS England, London
Minutes from January 2018 and action points reviewed.
Training in the Private Sector
A draft JCST document concerning training in the private sector was reviewed. The situation is of particular relevance to surgical trainees in England, where NHS services continue to be provided outside NHS hospitals. The document, ‘Training Implications and Principles to Consider’, aims to detail the roles and responsibilities of private hospitals, trainees, supervising Consultant trainers and TPDs to ensure that training opportunities are not lost when NHS patients are managed in a private facility. Hospitals must be accredited as a training institution for each surgical subspecialty. Post-operative patient care will be missed by trainees (raised by Mr Mark Bowditch, SAC T&O Chair). I raised the need for additional time (or fewer cases) when trainees are expected to operate in private sector lists. Trainee absence from their employing Trust may have implications for ‘on-call’ duties, which could otherwise run parallel to a trainee operating list. Additional Consultant lists delivered in a private facility are remunerated on a payment by case basis, and it was noted that the incentive for providing training opportunities will be reduced during such lists. Comments will be incorporated.
Recent GMC training requirements
The Shape of Training review in 2013 recognised the importance of developing a ‘Generic Professional Capabilities’ framework for UK medical and surgical training. The GMC document ‘Excellent by design: Standards for postgraduate curricula’ stipulates that training should be outcomes-based, not time-based, with all curricula including specific ‘Capabilities in Practice’ (CiP) that relate to the technical and non-technical aspects relevant to professional encounters. These documents are available online at gmc-uk.org.
Nine CiP areas are relevant to surgical training, including out-patient clinic, emergency take, operating list, MDT working, quality improvement and others. The level of entrustment or supervision for each CiP domain (graded I to V) ranges from ‘able to observe’ to ‘gained mastery’. Multiple Consultant report of CiPs and trainee self-assessment will complement the existing assessment framework (learning agreements, examinations, MSF, WBAs, CS reports) and will be considered at ARCPs. This is an additional assessment but will be accompanied by a reduction in the number of existing assessments (details not provided).
The new T&O Curriculum (not yet submitted to the GMC) includes CiPs.
JCST fee was discussed by the JCST Chair, Mr Gareth Griffiths, and the Joint Surgical Colleges Meeting (JSCM) agreed to freeze the fee at £260 for the coming academic year (2018-19).
Fellowships in surgical training
The JCST proposes to develop its capacity to oversee and manage non-GMC regulated post-certification surgical fellowships. The work will cover UK fellowships only, although international fellowships may wish to align themselves voluntarily. The GMC is introducing ‘credentialing’, which proposes to “provide a framework of standards and accreditation in areas where regulation is limited or absent” (gmc-uk.org). The JCST scoping exercise will review how future accredited fellowships will meet future credentialing requirements.
Fellowships can be GMC regulated Training Interface Group (TIG) fellowships, or non-GMC regulated. The former are delivered within the GMC’s regulatory framework, prior to the award of certification and are managed by the JCST. The latter may be undertaken pre-, peri or post-certification. A small proportion is quality assured by the Royal College of Surgeons of England with input from the Specialty Advisory Committees of the JCST. Many others have no formal quality assurance process and funding is form a variety of different sources. HEE will support the administrative costs associated with completion of the JCST’s scoping exercise. The scoping exercise is expected to last 6 months and will precede a pilot program for a small number of fellowships.
The RCOG run accredited fellowships. These are noted to be high-quality, prestigious and highly competitive posts.
The administrative burden for overseeing accredited post-certification fellowships will incur costs. The JCST is currently funded as a pre-certification committee. It was highlighted that trainees would not want to incur additional costs to fund a new accreditation system. That being said, accreditation would likely improve the quality of fellowships, which is to be welcomed.
ASiT and BOTA highlighted that the primacy of CCT should not be undermined or diluted by this process. We stated that accredited fellowships should not become an extension to current postgraduate specialist training, which ends with the award of a CCT. The JCST Chair confirmed that this was not being considered and that CCT will, and should continue to, produce trainees who are sufficiently trained to work as independent practitioners (i.e. Consultant surgeons).
Advanced Care Practitioners
ACPs are now authorised to use the ISCP website for their portfolio and assessment. ISCP will also host the ACP curriculum, currently in development under the guidance of HEE. ACPs will be performing the non-technical tasks of Core Trainees and junior trust grade doctors and the curriculum will borrow from the Core Training curriculum. ACP users will pay the full training fee.
BOTA and ASiT welcomed that new users will be expected to pay the full fee. We highlighted that Consultant trainers (encouraged to use ISCP as a trainer portfolio) should also pay a user fee.
English Deans met in recent weeks and concluded that the effects of winter pressures were not widespread and that issues should be resolved at a local level. This followed a letter from the President of the RCS England to HEE that detailed his concerns regarding the effects on surgical training. Today it was highlighted by the T&O SAC chair that more than 50% of T&O TPDs recently stated that they expected to delay trainee CCT dates as a result of lost elective operating secondary to winter pressures. BOTA will be distributing a survey to its membership this week specifically covering the effects of winter pressures.
Trainees should reflect on ISCP if they are affected by winter pressures and ensure their CS/AES clearly documents reasons for low numbers. Outcome 3 does not imply trainee fault (4.91 Gold Guide), however ASiT and BOTA highlighted this is not universally acknowledged by TPDs, trainers and trainees, with outcome 3 often seen as a trainee-dependent outcome. Outcome 3 can be appealed by the trainee (via their Deanery) if they feel that their training has been adversely affected by factors outside of their control, with outcome N being the alternative.
The JCST Chair has agreed to publicise guidance on outcomes 3 and N to help clarify. The Gold Guide also provides information.
Those not in training
The JCST contacted the GMC to identify the destinations for doctors who have completed Core Training between 2012-2016 and did not pursue higher specialist training. The vast majority during this period were continuing to work in NHS institutions but not within a training scheme (few were registered as working abroad).
Next meeting to be held in Glasgow on 10th October 2018.