18th January 2018
Summary of key points:
Trainees can now log cases in elogbook through ISCP
JCST is to publish selection processes and training processes in all surgical specialties at some point in the near future
The GMC are still to define with clarity what credentialing is and how it might affect the workforce. There appears to be no immediate plans to introduce this within T&O at present.
Winter pressures raised as a key training concern but no solutions present
Changing population demographics over the next 25 years will be a huge factor in future workforce planning
I had the opportunity to attend the Joint Committee of Surgical Training committee held at the Royal College of Surgeons in England where many key issues were discussed.
The work of bullying, undermining and harassment working group (BUHD) was raised with key areas of concern raised included barriers to reporting, the absence of standardised reporting structures with many parallel reporting structures in place at both deanery and trust level. Although a structure exists with current clinical and educational supervisors, Miss Humm, President of the Association of Surgeons in Training raised that particularly in smaller subspecialties, trainee anonymity cannot be guaranteed if such matters were to arise. BOTA recognises the need for a standardised reporting procedure and will be discussed at a future BOTA committee meeting.
An excellent presentation from Professor Marson on professional mentoring was given to the JCST. Here she clearly set out how mentoring should be defined, its benefits and how any such schemes might achieve sustainability and longevity. This was followed by an excellent presentation given by Miss. Gemma Humm and the ASIT model to mentoring which has achieved success in both uptake and longevity. How mentoring should be delivered on a wider scale was discussed with suggestions including utilising the already existing TPD/CS/ES network; and allocating a mentor separate rom TPD/CS/ES which is done in the Republic of Ireland. The success of the ASIT model is to be commended and has been raised in previous BOTA meetings. The findings of this presentation will be relayed at future BOTA committees.
This was followed by a presentation from representatives from Health Education England presenting population demographic data trends over the next 25 years and workforce planning. The results drew into sharp focus the effects of an ageing population and how such populations will migrate to different parts of England and how health services will need to be utilised. The impact this will have on future Trauma and Orthopaedic consultant posts across the country is to be determined however it is clear that substantial investment will be required to delivering elderly care as by 2041, every area of England will have at least a 55% increase in hospital services utilised by the over 65s. Last year there were 114 unfilled consultant T&O posts in England alone however data by region was not available. Data unfortunately from the other devolved nations Scotland, Wales and Northern Ireland was not presented today. A workforce planning committee is to be set up in lliaison with the SAC leads and both BOTA and ASIT have requested trainee representation at these committees.
The subject of post-CCT fellowships was raised with a drive to national recruitment in certain fellowships. Both BOTA and ASIT raised concerns regarding the impersonal nature of this approach which might lead to trainees feeling disadvantaged. The JCST were keen to stress at this time that this proposed method will not replace existing fellowships and that funding of these fellowships are to be determined. BOTA will continue to monitor developments of this closely.
Broad based training was again discussed as an alternative to potential trainees who remain undecided regarding future specialty. This is not widely implemented and a surgical specific broad based training pathway is still to be determined.
The JCST is interested in resolving early certification for trainees and is intending on creating a process that is standardised and fair. A document on how this might be implemented is to be developed however at present, if trainees are on course to CCT early it is incumbent that the timeline of such events be planned in advance.
Credentialing was discussed at length. The GMC plans on applying this from April 2019 however there was discussion among the JCST that this system may be useful for SAS doctors, for specific highly niche examples (e.g. standardising thrombectomy services UK wide by increasing the number of people trained in this procedure) with a need for a standardised set of parameters. As much of credentialing remains undefined, the JCST encouraged SAC leads to make recommendations on how this may be relevant to their particular specialty. Credentialing does not represent an immediate intrusion into quality and delivery of T&O training specifically however BOTA will continue to actively monitor this situation closely.
BOTA and ASIT raised winter pressures once more to the JCST and although there was agreement that this is an important topic, there was recognition that a single statement might have been optimal. BOTA and ASIT did mention the need for trainees to make a separate statement as there appeared to be conflicting agendas and priorities as reflected in both the HEE and JCST statements. It was BOTA’s desire that as winter is an annual event that future responses could be co-ordinated with greater synergy between HEE, the JCST and BOTA/ASIT for which there was general agreement.