JCST Meeting 15th May 2019
Royal College of Surgeons, England
I had the opportunity to attend the Joint Committee of Surgical Training (JCST) meeting on Wednesday 15th May 2019 at the Royal College of Surgeons, England alongside the President of the Associations of Surgeons In Training (ASIT) Miss. Deirdre McNally which covered several important areas of surgical training.
One of the main areas of discussion included “Improving Surgical Training” (IST) which is the Health Education England recommendation to change the way trainees in T&O in England undergo surgical training. This currently has no bearing on those trainees in Scotland, Wales and Northern Ireland. IST has been discussed in a number of forums including the Core Surgical Training Committee (CSTAC), and the Confederation of Postgraduate Schools of Surgery (CoPSS). The principle change would be the introduction of “run-through” training numbers alongside “decoupled” training numbers over the next few years. The CSTAC, CoPSS, JSCT, BOTA and ASIT views are all aligned in raising a number of concerns. These include the potential dilution of training and the creation of a “two-tiered” system of training, consultant workforce implications if new ST3 numbers are to be created alongside IST numbered trainees, how benchmarking will occur in the transition between ST2 and ST3, the current lack of funding for posts and the lack of robust review process during the current trial period before it is rolled out. BOTA recognises the model of run-through training being a success in Scotland and the JCST recognises a mixed economy of both “run-through” and “decoupled” trainees is positive for the surgical workforce as it allows a degree of flexibility in trainees who may be undecided in their specialty.
At present, a series of statements from JCST, CoPPS, CSTAC, and BOTA/ASIT will raise concerns over the current implementation of IST with recommendations that robust reviews need to have occurred during the pilot phase that demonstrate the benefits of IST prior to national rollout and that all of the above concerns are satisfactorily addressed. BOTA will continue to monitor the situation closely.
JCST branded post-certification fellowships through national recruitment were raised and a number of pilots proposed for cardiothoracics, ENT and General Surgery are in discussion. BOTA supported ASIT’s concerns with regards to the need for these posts to undergo national selection and the implications of this for post-CCT trainees. There are no plans at present to introduce JCST branded post-CCT fellowships for T&O specifically however this is an area we will continue to monitor.
Credentialing was briefly highlighted and at present, there doesn’t appear to be any direct relevance to T&O with proposed credentialing pilots to be confined to thrombectomy services, remote and rural health, liaison psychiatry and cosmetic surgery.
Additionally The JCST has published guidance on early certification which can be found on their website.
ISCP has been successfully introduced in Iceland and Icelandic trainees are responsible for paying the set up costs and use of ISCP at the same rate as British and Irish trainees. There are provisional discussions with regards to allowing the use of ISCP to expand in Egypt. At present, the JCST emphasised that access to ISCP provides access to the curriculum only and does not translate into a proxy training scheme of a similar standard and recognition to British and Irish Higher Surgical Training. Both BOTA and ASIT raised that if income is generated from future foreign investment and use into ISCP use then this should be translated in a reduction of costs for trainees as a whole for which there was general agreement from the curriculum lead.
The Capabilities in Practice (CIPS) standards introduced by the General Medical Council (GMC) is to be implemented through the Multiple Consultant Report (MCR) for which a number of trials will be introduced over the coming months. The ISCP Management Committee has taken on board feedback from multiple areas including BOTA with regards to the main areas that represent a challenge to implementation. The current timeline for introduction is proposed to be February 2020. JCST recognises that extensive educational support will be required to implement this and several areas remain unanswered including how the MCR will integrate with meetings, the potential lack of face-to-face time with trainees, the time constraints on trainers to complete this and trainee sign off. BOTA will aggressively pursue answers to this and have the opportunity to positively shape this over the coming months before implementation.
Finally, BOTA raised a number of issues regarding support available to trainees who elect to take parental leave and returning to work. Trainees who are out of training for any reason e.g. parental leave/OOP are able to access ISCP at a discounted rate depending on the time required to use it and can email the ISCP Helpdesk who can advise.
The next JCST meeting will take place in October 2019.