EBSQ Jim Hill Chairman Education and Training Committee ACPGBI

Is coloproctology certification/assessment required? Same qualification breast/vascular/transplant colorectal 64 coloproctology training units –183 surgeons > 75% activity in coloproctology Article 14 Allow members of the general public to identify who is a trained colon and rectal surgeon and assure the public that the trainee is ready for unsupervised practice

Union Europeene Medecins Specialistes - coloproctology Main objective is to guarantee to patients the highest standards of care in the field of coloproctology Recognised by EU but not by member countries statutory medical bodies

UEMS coloproctology Define the content of coloproctology training Criteria for identification of training units and maintenance of standards Development diploma EBSQ Coloproctology Develop criteria for evaluation of Continuing Medical Education

Exam components Eligibility –Proof of identity and presentation of CCST or equivalent –General surgery five years –Coloproctology two further years Examination –Written –Oral

Operative experience IndexprocedureA (1 pt) PA (4 pts) P (3 pts) To Anterior resection Rectal prolapse/ Total colectomy 1055 Haemorrhoidectomy Fistula in ano Totals

Eligibility Quality of training – not specified Emergency experience – required, not specified Proof of diagnostic skills – colonoscopy not essential Research - optional Relationship with National Certification Body

Examination Written clinical examination Viva –30 mins on written examination –30 mins on selected paper from literature –30 mins general topics in coloproctology

PMETB Nine standards for assessment Most UK examinations did/do not meet these standards

Principle 1 The assessment system must be fit for a range of purposes Overall purpose needs to be documented and in public domain Purposes of each component need to be specified and available to trainees, educators, employers, professional bodies and the public Sequence of assessments must match the progression through the career pathway

Purpose Overall purpose: To determine whether the candidate has proficiency to act as an independent practitioner in the field of colon and rectal surgery and acquired particular skills and knowledge of the medical and surgical management of diseases of the colon and rectum and perianal region. The examination will allow members of the general public to identify who is a trained colon and rectal surgeon and assure the public that the trainee is ready for unsupervised practice

Principle 2 The content of the assessment (sample of knowledge, skills and attitudes) will be based on curricula for postgraduate training Assessment will systematically sample the entire content appropriate to the level of training with reference to clinical problems that the trainee will encounter in the workplace and to the wider base of knowledge, skills and attitudes that the doctor will require. The blueprint from which the assessments are drawn will be available to trainees and educators in addition to assessors/examiners

ACPGBI assessment in coloproctology Examination “Blueprint” ROWS BABenign anorectal BCBenign colon CRNColorectal neoplasia INFInflammatory bowel disease and stomas FDFunctional disorders A&EAnatomy and embryology PHYPhysiology ENDEndoscopy PTHPathology RADRadiology PAEDPaediatric GENGeneral questions related to multiple body systems COLUMN EMQ and MCQ AETAetiology ANATAnatomy CPClinical presentation PATHPathology – microscopic and macroscopic and molecular processes PYSPathophysiology/physiology DIAGDiagnosis INVInvestigations MMMedical management PROCProcedures OPSOperations IN/CINDIndications/contraindications COMPComplications PRE/POSTPre and post operative care MCQ only PROGPrognosis CLASSClassifications STAGStaging CGClinical governance CONConfidentiality

Principle 3 The methods used within the programme will be selected in the light of the purpose and content of that component of the assessment framework The rationale for the choice of each assessment method will be documented and evidence based. The examiners will be trained to administer and score the examination and document the candidates performance The scoring forms and rules will provide examiners with defined guidelines to evaluate a candidate’s clinical decisions against preset standards The psychometric properties of the examination will appropriate and documented including reliability (eg examination reliability, case difficulty, examiner/case difficulty, overall exam consistency) and validity (e.g exam scores measure performance in making clinical decisions).

Principle 4 The methods used to set standards for classification of the trainee’s performance/competence must be transparent and in the public domain Standards in tests of competence will be set using recognised methods based on test content and the judgement of competent assessors. Information from the performance of reference groups of peers will inform the standard The precision of the pass/fail decision will be reported on the basis of data about the test. The purpose of the test will determine how the error around the pass/fail affects decisions about borderline candidates Reasons for choosing either pass/fail will be described

Principle 5 Assessments must provide relevant feedback Need policy for providing feedback to trainees following assessments – needs documentation and be in public domain Form of feedback must match purpose of the examination Outcomes of assessment must be used to provide feedback on the effectiveness of education and training where consent from all interested parties have been given

Principle 6 Assessors/examiners must be recruited against criteria for performing the tasks they undertake The roles of the assessors/examiners will be specified and used as the basis for recruitment and appointment Assessors must demonstrate their ability to undertake the role Assessors will only assess in areas where they have competence The relevant professional experience of assessors should be greater than that of the candidate being assessed Equality and diversity training will have been completed by the assessors

Principle 7 There will be lay input into the development of assessment Principle 8 Documentation will be standardised and accessible nationally Principle 9 There will be sufficient resources to support assessment

Conclusions EBSQ only coloproctology assessment in Europe EBSQ does not currently meet PMETB standards Not feasible for the ICE in General Surgery to assess competency/completion of coloproctology training

What is required Work place based assessment –PBAs, numbers, robust RITA assessment Assessment Meet PMETB standards High reliability Confidence of trainees (80% pass rate) Administered by speciality associations under auspices of ICE/EBSQ BETTER INTEGRATION OF SAC/ICE/ACPGBI

The future

Documentation will record the results and consequences of assessments and the trainee’s progress through the assessment system Information will be recorded in such a way as to be disclosable and available for appropriate access within the confines of data protection Documentation will be suitable for submission of purposes of registration and performance review Documentation will provide evidence for compliance with Good Medical Practice Documentation will be transferable and accessible as the trainee moves through location Documentation will be comprehensive and accessible to the trainee and those responsible for training

Resources will be made available for the proper training of assessors Resources and expertise will be made available to develop and implement appropriate assessment methods

Principle 1 To determine whether the candidate has proficiency to act as an independent practitioner in the field of colon and rectal surgery and acquired particular skills and knowledge of the medical and surgical management of diseases of the colon and rectum and perianal region. The examination will allow members of the general public to identify who is a trained colon and rectal surgeon and assure the public that the trainee is ready for unsupervised practice It will provide evidence for the award of a CCT It will be a stimulus to learning for the candidates. It will provide feedback to the trainee about progress and learning needs

Principle 2 The curriculum has been written and has defined knowledge, skills and attitudes that the trainee will require at the end of their training. This Intercollegiate Curriculum Surgical Project* is accessible on the internet to all interested parties. These assessments will comprise eligibility criteria of satisfactory work place based assessments, the testing of knowledge with a written examination and testing of the management of clinical problems will be tested with an oral examination. An examination blueprint will be written to ensure that the entire content of the curriculum is sampled