M62 April 7th 2005 An Update on Reform of Training

PMETB OBJECTIVES 1. Safeguard the health and well- being of patients 2. Ensure that the needs of trainees are met by standards set

PMETB OBJECTIVES 3. Ensure that the needs of employers and NHS contracting authorities are met by standards set

PRINCIPLES 1. PMETB is the sole competent authority 2. “Colleges and Faculties will have a central role” 3. It will delegate nothing but will happily sub-contract (?)

PMETB CURRENT AGENDA 1. Control the visiting process 2. Assess applications under Article Write rules and service level agreements

VISITS 1. Must include a lay presence 2. Reports must be in a standard format and will be published 3. Disruption to service must be minimised i.e. visits will be combined and regional

SPECIALIST REGISTER UK trained doctors will apply in the normal way as for the CCST The standard for the CCT will continue at the same level as the UK CCST

CCST or CCT What’s in a name? that which we call a rose By any other name would smell as sweet

TWO MORE ROUTES TO THE REGISTER 1. Article 14(4) 2. Article 14(5)

Under Article 14(4) Applicants can apply for entry to a CC(S)T specialty and may count experience wherever gained mapped to the standards for the UK CC(S)T

Under Article 14(5) Applicants can apply for entry in a non-CC(S)T specialty may count experience wherever gained mapped to the knowledge and skills of a consultant in the NHS

the ‘ gateway ’ to Article 14(5)(a) is that an applicant must have gained training or specialist qualifications anywhere outside the UK in a non CCT speciality. Only after an applicant has achieved this can their experience /current levels of knowledge skills and experience gained anywhere be taken into account

BUT Patient safety and maintenance of standards must be intrinsic to our proposals Existing trainees must not be disadvantaged Tensions between workforce requirements and standards and public safety will be faced and open debate prompted

JCHST Proposals Regular clinical practice for previous six months Must present log books, appraisals and CV Structured references required Must take the Intercollegiate Board Exam or present evidence of having taken and passed an equivalent

What is wrong at the moment? BST takes five and a half years SHOs are no longer surgical trainees, they are rota fodder Medical Schools do not teach basic sciences particularly anatomy

What is right at the moment? The end product is of a high standard The mix of generalist/emergency and sub- specialist training is “fit for purpose” The Intercollegiate Exam is fair and relevant

SAC Principles for MMC 1 A transition/probationary/generality year in PGY3/ST1 spent in general surgical posts The SAC must supervise this year if it is to count towards the CCT

SAC Principles for MMC 2 An entry examination based on the present MRCS The first part of this should be largely in anatomy and taken at the end of PGY3. The second part could be in physiology and pathology with a clinical element, and taken in the first year of HST

SAC Principles for MMC 3 Training proper should last for six years but these are indicative years and the process will take significantly longer if acquisition of the required competences is delayed by loss of experience brought about by shorter working hours or transfer of patients to Treatment Centres

SAC Principles for MMC 4 All trainees will have one or more subspecialty interests and general and subspecialty training will be in parallel CCT will be the same standard as CCST and therefore most subspecialty training will be done before consultant appointment

SAC Principles for MMC 5 The Intercollegiate examination will continue as at present

Two Six Month Posts in General Surgery MRCS (Basic Sciences) 1 (Anatomy) Foundation Year 2 Foundation Year 1 9Intercollegiate FRCS & CCT 8 7Sub-specialty 6Training General Training 5 4 MRCS (Basic Sciences) 2

The Transition What about the generation out there who have completed BST? They will not be abandoned There is a precedent More training numbers in 2007

Coloproctology The CCT will be in General Surgery Most sub-specialty training will be done before CCT

Post-CCT Training Will be for only a few, in highly sub- specialised areas There will be “Fellowships” at home and abroad as at present Much will be informal by mentoring after consultant appointment (often long after!)

Is Coloproctology a Safe Career? Peptic Ulcer surgery disappeared overnight Vascular surgery is on the way out Coronary artery bypass is being replaced with stenting

What’s next to disappear ? Breast Surgery Most Oesophageal, Gastric and Pancreatic resections Inflammatory Bowel Disease None of the above, but something quite unexpected

What’s Safe? Emergencies in the elderly Congenital anomalies e.g. hernias, gall stones, appendicitis Degenerative diseases e.g. diverticular disease Trauma

The Future Coloproctologist Will be on the emergency take rota Will do most abdominal operations laparoscopically Has good career prospects Good luck!