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BOTA's Top 5 Priorities

BOTA Top 5 Priorities for Trainees 2024

   Following the publication of the 2023 RCS England Census and 2022 BOTA’s Census, the BOTA Committee, with representation from all devolved nations, have discussed in detail trainees’ education, training and well-being matters. The BOTA Committee has produced our ‘BOTA’s Top 5 Priorities for Trainees’. This is a Top 5 list of matters which we feel need to be addressed urgently by all four Royal Colleges of Surgeons and employers in order to improve the working lives and well-being of surgical trainees.

   1. Protect and increase access to training opportunities for trainees
   Dedicated training opportunities in job plans must be timetabled and prioritised for surgical trainees in possession of a national training number (NTN). Training opportunities in the operating theatre must be protected for surgical trainees as the consultant surgeons of tomorrow. Every case should be a training case. Elogbook data can be used by trainers and TPDs to analyse trainee involvement in cases and to make improvements in training.

   There needs to be a concerted effort to increase access to robust training opportunities, including NHS cases outsourced to the independent sector. It is essential that training opportunities are not lost when NHS funded care is delivered in independent sector hospitals. BOTA advocates to increase training and education opportunities for NHS patients cared for in the independent sector in line with Health Education England’s Guidance for Placement of Doctors in Training in the Independent sector (also known as Postgraduate medical trainees).
   Surgical trainees are the consultant surgeons of the future. Opportunities for training and operative experience must be prioritised and protected for trainees in the context of expansion of Medical Associate Professional (MAP) roles. BOTA are actively involved in stakeholder discussions with the BOA and the Royal Colleges of Surgeons to advocate for the protection of training opportunities and operative experiences for trainees, and to define scope of practice of MAPs.

   2. Reduce cost of training
   Surgical training must be financially cost-neutral for trainees. Trainees should not be paying out of their own pockets to acquire the necessary skills and knowledge to enable them to perform and excel at their job. Costs of mandatory requirements to practise and train in a training programme, such as subscription fees for GMC and ISCP and membership fees for Royal College of Surgeons, and mandatory post-graduate exams MRCS and FRCS, should be reimbursed in full to trainees. Reimbursement for essential courses ATLS, Research Methodology course, Leadership & Management course should be consistent throughout all regions.
   In addition to reimbursement for essential courses, funding for highly desirable, almost-essential orthopaedic courses and conferences should be provided equally at the national level to ensure equal access to all trainees. These courses include, and are not exclusive to: AO Basic/Advanced Principles of Fracture Management; Anatomy and Surgical approaches courses; Basic Science course; Specialist Skills Course; and FRCS revision courses. The process of reimbursement should be streamlined, user friendly and accessible to all trainees. No trainee should be financially burdened to practice, to train and develop surgical skills and knowledge, and to access educational opportunities.
   The non-financial costs of training, such as poor work-life balance and the negative impacts on mental and physical wellbeing, leading to high risk of burnout, cannot be underestimated and must also be addressed. The BMA guide for improving doctors’ wellbeing at work should be implemented.
   3. Working conditions
   BOTA asks all employers to sign up to the standards for rotas and facilities as stated in the ‘BMA Fatigue and Facilities Charter’.

   a. Rotas and job plans to include all JCST Quality Indicators for T&O training and accurately reflect the work we do
Rotas must be issued to trainees at least 6 weeks in advance. Job plans should include, at the minimum, all the JCST Quality Indicators for T&O Training
       • All trainees in T&O should have the opportunity to attend at least three consultant-supervised theatre sessions each week (on average).
       • All trainees in T&O should have the opportunity to attend at least two consultant supervised outpatient clinics each week (on average), including fracture and specialty clinics, and should see a mix of new and follow-up patients.
       • All trainees in T&O should have the opportunity to be involved with the management of patients presenting as an emergency at least one day each week (on average), under supervision and appropriate to their level of training.
       • All trainees in T&O should have the opportunity to attend one MDT meeting, or equivalent, each week (on average).
Job plans must accurately reflect the actual hours worked by trainees during various clinical activities. T&O Higher Surgical Trainees often work additional unrecognised hours than contracted. For example, on theatre days, trainees often come into work at 07:00-07:30 to see patients pre-operatively, but the contracted start time is 08:00. Recognising there are regional variations in contracted hours, we provide some examples of actual hours worked by trainees. We ask individual employers to adjust contractual hours to accurately reflect the actual hours worked by their local trainees in their trust.

   Annual and study leave should be approved if submitted 6 weeks in advance, and considerations made to accommodate for significant personal life events. As stated in the ‘BMA Fatigue and Facilities Charter’, employers must ensure rosters and staffing numbers are sufficient to allow safe cover if doctors are unexpectedly absent, e.g. for sickness or compassionate leave.

   b. Improving the environment of the workplace
BOTA encourages employers to provide a good workplace environment up to the standards stated in the ‘BMA Fatigue and Facilities Charter’. Workplace facilities should provide a good environment for trainees to work, learn and rest. This includes having dedicated office space for admin, adequate resting facilities, access to hot and cold food and beverages at all times, safe lockers for belongings, and protected spaces for breaks and meals.
   Rotational training can add additional burden to the trainee due to long commutes, stress of settling into a new department, and variable experiences with induction at new trusts. TPDs should endeavour to minimise geographical spread of 12 monthly placements and aim to keep trainees in one hospital for at least 12 months, except when needed to meet subspecialty requirements.

   4. Professionalising Training for Trainers
   Trainers must have dedicated time in their job plans to train surgeons in training. This involves establishing structured and standardised sessions to ensure that trainers have protected time to deliver teaching to trainees. Access to and time with trainers must be protected for surgical trainees. Trainers should be recognised and rewarded for their efforts in training. Excellence in surgical training contributes to excellent and safe patient care.
   As Trainer consultant surgeons of tomorrow, BOTA advocates for the professionalisation of the surgical trainer role, that enables us to deliver surgical training of the highest standards to our future junior colleagues. We support the goals of promoting and enhancing the role of the surgical trainers, such as that of The Royal College of Surgeons of Edinburgh Faculty of Surgical Trainers, built upon the GMC and Academy of Medical Educators Professional standards for medical educators framework for trainer recognition.

   5. National Core Surgical Training Programme job plan to enhance training opportunities for Core Surgical Trainees
   RCS England Census 2023 demonstrated that Core Surgical Trainees (CST) are least satisfied with their current training experiences. CSTs are often placed on a generic SHO rota for service provision, without protected training time. CSTs must have dedicated and protected operative training opportunities to equip trainees with the skills, knowledge and capabilities to enter Higher Surgical Training. CSTs need to be trained to learn the craft of surgery and be familiar with the theatre environment. CST training must be protected to sufficiently prepare trainees to be Higher Specialty Training Registrars. We propose the development of a national CST job plan that trainees can take to their trust that ensures all CST trainees have dedicated and protected training opportunities.
   BOTA acknowledges that industrial action for pay restoration is an important matter for trainees. We believe the topic of industrial action is a trade union issue and outside the remit of BOTA, and is being addressed by the relevant organisations.

h April 2024

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