JCST Quality Assurance Committee Meeting – 12th March 2018

JCST Quality Assurance Committee12th March 2018RCS England, London

ASiT, BOTA & JCST Morale Survey 2016-2017

The JCST trainee morale survey was reviewed. All trainees with a National Training Number (NTN) at Core Surgical Training and specialty surgical training level will have received an email with instructions on how to take part.

ASiT will be running a review session at their forthcoming conference in Edinburgh. It will include a consensus session during which a statement of intent will be agreed. The BOA has recently contacted members (trainees and consultants) with their ‘trainee and trainer bullying questionnaire’, which will help define experiences of bullying and help inform future BOA advice and policy.

The lack of anonymity in the morale survey (and the annual GMC survey) was highlighted as an issue. The morale survey will not be repeated in its entirety, however BOTA and ASiT requested that a selection of questions be included in the annual JCST Trainee survey.

Training and Private Providers

More elective NHS work is being completed in the private sector. It was agreed that the JCST QA committee will review its role in relation to identifying guidance for trainees and their training regions. It was highlighted that training opportunities are being lost, especially in orthopaedics where large joint arthroplasty (and other operations, such carpal tunnel decompressions) were being completed outside the trainees’ usual work environment. The Wessex training region has taken a commendable lead on this, with a template detailing the roles and responsibilities of both trainees and their role within private hospitals, including occupational health clearance, liability and confirming non-admitting rights. Each SAC has been asked to identify procedures ‘at risk’ in their own specialty.

Draft Surgical Curricula (all surgical specialities)

The SAC plan for all surgical specialty curricula to be updated and submitted for approval before 2020. The first three surgical curricula (including cardiothoracic surgery, not including T&O) were submitted in late 2017. All three were rejected by the GMC, largely due to procedural inadequacies rather than content. All underwent a two-stage GMC review process (Curriculum Advisory Group and Curriculum Oversight Group). Details requiring review relate to (1) how curricula will address the ‘Shape of Training’ review, and (2) increased clarity of quality assurance structures within each curriculum. Areas relating to the Shape of Training include: (1) meeting patient and service needs, (2) providing care in the community, (3) curricula permitting flexibility in training (including choosing specialist interests), and (4) details on how trainees choose their specialist interest.

The new T&O curriculum, being developed by the BOA Training Standards Committee is yet to be submitted and will be delayed until all rejected curricula are reviewed and updated.

Review of subspecialty training regions (proposal)

Currently, regions can be assessed according to three outcomes: GMC survey, JCST survey and SAC Liaison reports.

The cardiothoracic SAC has reviewed all training regions according to TPD reports (operative numbers), FRCS pass rates part 1 and part 2 (NTNs), and rates of conversion from CCT to Consultant post. The cardiothoracic SAC may assign a program ‘performance score’, however the JCST QA Committee agreed that ranking training regions would not be helpful. Highlighting areas requiring improvement will help drive improvements in training.

It is hoped that a similar ‘T&O Dashboard’ will help achieve excellence and parity within and between training regions. Trainees and TPDs are providing much of the domain data and the first report is expected in the first half of 2018. The T&O Dashboard is reviewing the following nine domains:

  1. FRCS exam pass rates

  2. GMC Survey results

  3. Research opportunities and output

  4. Simulation

  5. Enhanced induction

  6. Subspecialty access

  7. Professional support

  8. Education

  9. Study leave funding

BOTA highlighted that each report should be made available to trainees (NTNs) and prospective trainees (CTs) to help inform training region choices at ST3 interview.

JCST Quality Indicators for Surgical Training – Annual Review

The updated ‘JCST QI Indicators’ for each subspecialty (including Core Surgery and TIG Fellowships) were reviewed and finalised. Although the minimal number of WBAs per year may not continue to be mandated by ISCP in the future (with consultant reports prioritised), minimum WBAs (40 plus 1 MSF per year) will be retained until the situation becomes clearer. I emphasised the need to retain a stipulation to maintain one half day of personal study/research period per week, despite many departments not providing this following the new contract for England and Wales. The 21 QIs for T&O are rather generic and will hold few, if any, surprises. For example, ‘all trainees in T&O should have the opportunity to attend a minimum of 3 consultant supervised theatre sessions each week’.

GMC Career Progression Report 2017

Since 2011, the GMC has been publishing information on the progression of doctors through training programmes. In 2016 the report reviewed socioeconomic status for the first time and demonstrated that a smaller proportion of doctors from deprived socioeconomic backgrounds (using home postcode on UCAS applications) achieve successful outcomes compared to those from more affluent backgrounds.

Additional findings (2016):

  1. Groups with a primary medical qualification from overseas have a lower proportion of successful outcomes than graduates from medical schools in the UK.

  2. When split by ethnicity, white cohorts have a higher proportion of successful outcomes than black and minority ethnic (BME) cohorts.

  3. As a group, women have a higher proportion of successful outcomes than men.

  4. A higher proportion of doctors in younger age bands have successful outcomes than those in older age bands.

The GMC published a paper on the subject of trainee progression from FY2 to CT1/ST1 in November 2017, which is available online here

The GMC’s full progression dataset can be found online here

In 2017, the data specific to surgical training (Core and specialty) suggest that female surgical trainees tend to report fewer successful outcomes than their male colleagues.

JCST Trainee Survey 2016-17

There was a general trend towards worse outcomes, albeit mild, across all surgical specialties, with the most common deterioration seen related to ‘Training opportunities impacted by rota gaps’ (exceeded 10% in every specialty except ENT, OMFS and T&O). In T&O, none of the 18 domains demonstrated an improvement and 3 had worse outcomes compared the previous survey (2015-16). The domains specific to T&O were not included in summary document reviewed.

Enhanced guidance for AES reports

Higher Education England (HEE) has highlighted the importance of Assigned Educational Supervisor (AES) reports. The committee reviewed ways in which the website could provide with improved guidance, with the aim of making them more impactful and useful during the ARCP review process. Multiple options were discussed with final details not confirmed.

The next JCST Quality Assurance will take place in mid-October 2018.The main JCST committee (proper) will take place on 9th May 2018.

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