Organising rotations in higher surgical training; mapping the job to the curriculum Steve Bale Programme Director T & O Lancashire Teaching Hospitals NHS Foundation Trust Regional Representatives Meeting RCS June 2010

Regional Representatives Meeting RCS June 2010

Present A competency based curriculum Trainees are sent to a hospital Hopefully given the training they need How do we know it’s the best place? Regional Representatives Meeting RCS June 2010

Why? Loss of SAC visits Ballooning Consultant numbers Amalgamation of units Stagnation of some units RITA/ARCP feedback PMETB standards Deanery Q & A Regional Representatives Meeting RCS June 2010

Hospital Visits Visited all training hospitals Team Informal Trainees not involved 3 separate periods to cover all hospitals Information requested Trainees questioned separately Regional Representatives Meeting RCS June 2010

Feedback Reports to each STC member Visitors findings Trainees assessment Regional Representatives Meeting RCS June 2010

Mr. M. Aqeel Bhutta Orthopaedic Registrar STC Trainee Representative

Driving Force NEW EWTD MMC TRAINER:TRAINEE HISTORICAL OPERATIVE EXPOSURE

Survey Programme Director Election manifesto Trainees (Playschool) Personal experience Trainers Sources

The Survey BACKGROUND  Very simple Feedback questionnaire with traffic light system from  The updated survey has been collected from 2007 to date for each 6 month placement.  Anonymous when presented to STC. QUESTION SCORING - Graded from strongly disagree to strongly agree, and weighted 1 to 5. - Questions created/phrased to allow scoring to be correctly weighted when assessing scores. A score of 3 (neither agree or disagree) was a negative sign.

THE SURVEY TRAINEE INDENTIFIERTHE UNITTHE TRAINER TRAINEE’S SUMMARY of PLACEMENT

THE UNIT  Direct question about the unit.  Specific indicators - Are all consultants satisfactory trainers? - Are there Regular trauma/audit and journal meetings? - Is there a adequately equipped registrar room? - Is the Job Plan variable/service provision? 8 questions: max score of 40

THE TRAINER  Sub-speciality of orthopaedics that ‘trainer’ believes is provided.  TRAINER 4 questions Approachable/supportive/interested in training/adapted to your training needs  Surgical supervision:- Trauma & Elective :- 4 Q’s  Out-patient supervision :- 3 Q’s  Mini-logbook. Based on OCAP index procedures. Number procedures as primary surgeon Total number of procedures with trainer  OCAP compliance  Research and Audit support.

TRAINEE SUMMARY  Trainee selects what the placement delivers in terms of sub-speciality training.  Appropriate trainee level for the placement.  Mini-logbook for the entire attachment  Placement recommended to a colleague (they got on with!!!)  Open comments of how to get the most out of the attachment  FEEDBACK ON THE SURVEY

<24 POOR UNIT 24-<32 BORDERLINE/POOR UNIT =>32 ACCEPTABLE/GOOD UNIT

The Future STC Initial Training Slots Data Post Training Slots Allocation Trainers

Next phase Ask Trusts whether they want remain as training Trusts Ask individual Trainers whether they want to remain as Trainers Ask what training can be offered Invite bids from pairs of Trainers for training opportunities from ST3 – ST8 Regional Representatives Meeting RCS June 2010

Results Bid quality varied hugely Bids assessed by same committee Trainees intimately involved Excess bids over slots Regional Representatives Meeting RCS June 2010

Next phase Year 1 – Hip 1, Knee 1 Year 2 – Shoulder & Elbow, Foot & Ankle Year 3 – Hip 2, Knee 2 Year 4 – Hands, Paeds, Spines* Year 5 - Subspeciality Year 6 - Subspeciality Regional Representatives Meeting RCS June 2010

Each programme, and every trainer, will wish to retain a degree of individuality, whether of organisation (4, 6 or 8 month attachments) or specialty selection. It is intended that the curriculum design will be able to recognise this, whilst providing a consistency of standard and outcome. Regional Representatives Meeting RCS June 2010

Outcome Successful allocation of bids to slots Gains by some Trusts Losses by others Trainees very happy - 4 year programme of specific Trainee/Trainer contracts Regional Representatives Meeting RCS June 2010

Deanery permission / finance Dean to ratify Chief Executives Financial implications Tight for August 2010 Regional Representatives Meeting RCS June 2010

On-going Q & A Reassessment Waiting in the wings New Consultant Trainers Review every 2 -3 years Regional Representatives Meeting RCS June 2010