JCST Meeting
10th October 2018
Royal College of Physicians and Surgeons of Glasgow, St Vincent Street, Glasgow

BOTA representative: Mr Matthew Brown

 

Winter Pressures

Mark Bowditch, SAC Chair for T&O, explained that a review of logbook data, comparing summer and winter, has been submitted to the BMJ for consideration for publication. In summary, the primary finding was that trainees in T&O were predicted to have to extend their training by 6 months. Jon Hossain, HEE representative, highlighted that there was no significant increase in the number of general surgery ‘no fault’ ARCP outcomes in the past 12 months compared to previous years (the comparative statistics for T&O were not known). BOTA stated that their national trainee survey on winter pressures has been accepted by the Journal of Trauma & Orthopaedics (JTO) for publication. The survey was completed by 10% of UK T&O trainees (95 trainees) and identified 76% trainees being affected by cancelled elective operating lists. It was noted that respondents are most likely to have been affected by the effects of winter pressures. Gareth Griffiths, JCST Chair, asked Mark Bowditch if their logbook data could be repeated in future years with comparisons being made; there is scope for this, however no decision has been made.

 

Training in the Private Sector guidance

Guidance for TPDs will appear on the JCST website regarding trainees completing elective surgical training within the private sector. JCST cannot mandate training in this area but with increasing number of patients, especially low risk (ASA 1) cases, being managed in the private sector, there was recognised to be a need for improved guidance in this area, particularly for T&O training. ASiT and BOTA supported amendments that would make it clear that this document related to surgical training in the operating theatre environment alone. Secondly, it was confirmed that this related to sessions with a sufficient mix of first surgeon experience and not lists where the trainee was purely intended to provide assistance. Thirdly, it was agreed that this guidance related to work completed during contracted hours and not for work completed during ‘off days’ (which would be completed at the trainee’s discretion).

 

JCST-accredited post-CCT Fellowships

See separate notes from meeting held at RCS England on 2nd October 2018.

Mark Bowditch, T&O SAC Chair, highlighted that overseas fellowships may offer improved training compared to the proposed JCST-accredited fellowships but will be exempt from this process. Trainees with international fellowship experience may be overlooked at the point of consultant appointment in favour of the proposed accredited fellowships, with the latter provided with a potential badge of superiority. BOTA recognise and empathise with this concern. Gareth Griffiths confirmed that individual SACs will decide if their particular specialty will engage with the proposed fellowships and there is no requirement for specialties to propose subspecialist areas if they do not see a need.

 

Reflective Practice

Academy of Medical Royal Colleges (AoMRC) have uploaded guidance for trainees relating to reflective writing. The full document can be found via the link below.

http://www.aomrc.org.uk/wp-content/uploads/2018/09/the_reflective_practioner_guidance_single_page.pdf

 

Transferring between specialties

Version 7 of the GMC’s “Guidance for Flexibility in Postgraduate Training and Transferring between Specialties” was circulated. It was noted that the document was long (total 24 pages) and that this could prevent meaningful engagement by many.

 

Medical and Dental Recruitment and Selection (MDRS) group

A re-written core surgery training ‘equivalent’ certificate is available for doctors meeting the objectives of Core Surgery Training (CST) but not having been on this training programme. This certificate has been available for the past 7 years. This can apply to both UK and international medical graduates.

It was reported that 4 years after completion of CST, only 56% of doctors were identified as having progressed to a Higher Surgical Training programme. It was appreciated that many were likely to still be working in the NHS, however.

 

ISCP Unplanned Downtime

The ISCP website failed during 1500-2200 on Friday 14th September. Data uploaded by trainees during this time was lost. This was a result of hardware failure by the external server that provides for the Royal College of Surgeons platform. In response, and as a result of the absence of out-of-hours IT cover, the website was frozen for the weekend until Monday 17th September. It was highlighted that T&O ARCPs, notably those in London, were forced to proceed using paper forms (i.e. London Deanery ‘Purple Form’ and ‘Form R’) with ISCP (and the WBA and MSF entries) not used. The Presidents of the four Royal Colleges had apologised to trainees at the JSCM yesterday. Recommendations have been made and we requested that these will be shared with BOTA, ASiT and trainees. It was requested that these recommendations be made available and that they are actioned as a matter of urgency.

The JCST October newsletter states: “We are pleased to say that ISCP is now running on two servers, so these problems should no longer be an issue in future.”

The ISCP website was restored to the last good backup, namely 1500 on Friday 14th September meaning that data entered by users during the downtime will have been lost.

If safeguards cannot be made by the dual server, BOTA requested that out-of-hours IT support be made available for the months of August (non-London ARCPs) and September (London ARCPs) to prevent future ARCPs being completed without access to the ISCP website.

 

Surgical Curricula approval

Stage 1 GMC approval has been achieved for the new ENT and cardiothoracic curricula. Stage 2 (final) approval is awaited. Approval from the GMC’s Curriculum Oversight Group (COG) is dependent upon satisfying five items in the Shape of Training review. Submission of the new T&O curriculum is currently on hold, with submission planned for when after lessons are learnt (and amendments incorporated) following successful approval of the other specialty applications above.

 

JCST Fee

Announced in March, the JCST fee has been frozen at GBP 260 for the academic year August 2018 to August 2019 (the last increase was in 2017 and amounted to GBP 5). ASiT highlighted dissatisfaction with the JCST fee, which has increased by over 70% since being introduced in 2008. It currently costs trainees GBP 260 per year. This is tax deductible if trainees make a claim using HMRC form P87. A breakdown of how the JCST fee is spent is published each year. The fee is decided by the four surgical Royal College CEOs and Presidents each year (RCSEng, RCSEd, RCPSGlas, RCSI). It covers the day-to-day running costs of the JCST (including the administrative support team) and the running of the ISCP website. The JCST committee has little influence on the fee, however the JCST Chair, Gareth Griffiths, meets with the Royal College Presidents every 3-4 months at the Joint Surgical Colleges meeting (JSCM) and he stated that the fee is highlighted as a point of contention at almost all JSCM meetings. Mr Griffiths explained that the government initially funded JCST in its entirety, but suddenly removed this funding 10 years ago, with the Royal Colleges expected to cover the costs. The costs were passed onto trainees by the surgical Royal Colleges. BOTA and ASiT will continue to work together to limit increases and ensure value for money.

The official JCST Fee FAQ webpage can be found below.

https://www.jcst.org/uk-trainees/str-trainees/jcst-fee/faqs/

 

ASiT ARCP Survey

ASiT presented the results of their trainee survey regarding attitudes to the ARCP process across all regions and specialties. The breakdown of results will be prepared for publication in due course but the results demonstrated predictable inconsistencies between regions and specialties. It was recommended that the results be presented to the Conference of Postgraduate Medical Deans (COPMeD), which reviews the ARCP process. BOTA supports ASiT in their efforts and added that too few ARCPs provide wider careers guidance and more holistic and pastoral care, which would be welcomed by trainees.

BOTA highlighted that too few trainees exit the ARCP process after 10 minutes with little more than thumbs up or thumbs down and little in the way of advice or guidance. Time should be allocated to career planning, general advice, signposting to services and training opportunities relevant to an individual trainee’s needs.

 

Next meeting of the JCST will be held in January 2019.