1. Supporting and assessing the student SCP
Susan Hall
Senior Lecturer in Surgical Care Practice

2. Preceptorship session
Session objective
To introduce the key individuals in the education, support and assessment of Surgical Care Practitioner trainees
To provide an overview of the workplace based assessments required by the Royal College of Surgeons of England’s Curriculum Framework.
Preceptorship session

3. Preceptorship session
Key personnel
Clinical supervisor
Mentor
Educational supervisor
Teachers / supervisors
This latter group will comprise members of the multi disciplinary team and will include anaesthetists / qualified nurses / ODPs & surgeons in training
The educational supervisor is the course leader, with input from leaders of other modules that comprise the course
Every student will have their own learning style – research has shown that adult learners benefit from experiential learning and as discussed earlier, the RCS supports this by encouraging active involvement of students.
Preceptorship session

4. The clinical supervisor
Preceptorship session

5. The clinical supervisor - professional characteristics
Must be a current Fellow of a Royal College of Surgeons
Should be recognised as an Assigned Educational Supervisor or Clinical Supervisor
Preceptorship session

6. Preceptorship session
Responsibilities
Ensure opportunities for professional and personal development
Ensure that the assessment documents and SCP portfolio of evidence is discussed as early in the course as possible
Ensure that there is time allocated for initial and subsequent interviews
It is important for the clinical supervisor to be familiar with the practice document and subsequent speciality paperwork.
There must be a clear understanding on the part of the student for reflection on learning & practice to be embedded in their portfolio of evidence. This supports the RCS expectations and also those of the practitioner’s regulatory authority
Preceptorship session

7. Responsibilities (ii)
Identify and provide access to learning opportunities and resources
Teach the trainee within the clinical environment
Liaise with the mentor for the assessment of competence
Collate feedback from all learning events
Learning must be in and from practice and should follow a logical, planned progression
Teaching should be appropriate to the student’s stage of progression within the clinical programme – some of the current cohort of trainees come from a non perioperative background – this will, inevitably mean that they hit some of their milestones later.
Preceptorship session

8. Responsibilities (iii)
Provide an environment that permits students to plan their workplace based assessments & provide constructive feedback
Co-ordinate the results of the assessments to make a final, informed judgement of professional competence
Ensure that the trainee has sufficient opportunity, in a safe environment to be taught & learn the required skills
Take the lead and make the final decision in the assessment of the trainee SCP including the completion of documentation
Provide advice and support, address specific needs - eg difficulties in progression
Preceptorship session

9. Preceptorship session
The mentor
Preceptorship session

10. Preceptorship session
The mentor portal
This is a newly developed resource to support you and to enable a better understanding of the expectations placed on students.
At present the SCP site is under development, however it does contain documents that you may find useful
Preceptorship session

11. The Mentor professional characteristics
Senior hospital professional with suitable background to support the trainee
The appropriate education and training to perform the role of mentor
The Royal College of Surgeons has stated that mentors should hold a recognised mentoring qualification
That they should have an understanding of the assessment documents and the portfolio of evidence
Preceptorship session

12. Preceptorship session
Responsibilities
Have a clear understanding of the competencies to be achieved
Undertake assessments as required
Complete the necessary parts of the trainee’s portfolio of evidence (practice document)
Provide a learning environment that permits students to plan their workplace based assessments
There is also the requirement to be familiar with the assessment documents
To Liaise with the clinical supervisor with regard to practice related experiences and to confirm competence as required
To have an understanding of the trainee’s course of study
To be willing to share aspects of patient care (experience)
Preceptorship session

13. Responsibilities (ii)
To be approachable, supportive and aware of the student’s learning style
To ensure the provision of time for reflection, feedback and monitoring of progression
To ensure that the trainee receives constructive feedback & suggestions on how to make improvements
It has been argued that a humanist approach to teaching is more appropriate for adult learnings and that a good teacher develops a feeling for students’ emotional needs, cognitive development and social background. This interest in the welfare of students has a positive influence on learning
To encourage the student to use enquiry based learning and problem solving
To encourage the student to work in partnership with the interprofessional team
Preceptorship session

14. Preceptorship session
Assessment system
Competence:
the principle that enables the SCP trainee to practice safely.
Performance:
the repeated and consistent demonstration of competence.
The assessment of SCP trainees uses the domains established by the ISCP
COMPETENCE:
Grows from the flexible application of knowledge and skills
Performance:
Is necessary for progression through identified points in the training programme
Preceptorship session

15. Direct observation of procedural skills
Known as DOPS
Direct observation of a short procedural skill by a trained assessor
Recommendation as for (junior) surgical trainees – 6 per year
Assesses the trainees knowledge, judgement and surgical technique
Preceptorship SD introduction

16. Mini clinical evaluation exercise
Known as ‘miniCEX’
Assessor observes the trainee dealing with a patient in the Outpatient , A & E , or ward environment
History taking
Examination
Investigation
Management plans
communication
Recommendation as for surgical trainees – 6 per year
This exercise assesses the trainees knowledge / judgement / technique and professional performance
Preceptorship SD introduction

17. Other clinical assessment tools
Assessed ISCP domains
Frequency
Case Based Discussion
Knowledge and judgement
1 per two months
Mini Peer Assessment Tool (Mini-PAT)
Knowledge, judgement, technique & professional
Annually
Multisource feedback
Annual progress review
This assesses the trainee’s knowledge and judgement
A case based discussion could be fitted in at the end of an M & M meeting or after a journal club session
An acute care assessment may be undertaken during a ward round. This WPBA appears to have been replaced in the ISCP scheme of assessments, however, the RCS have retained it within the Curriculum framework.
This could be managed by the a CBD with the focus on the acute management of a patient
Preceptorship session

18. Preceptorship session
Levels of supervision
Level 1
Supervising surgeon in the immediate vicinity
Level 2
Tasks undertaken as delegated by the operating surgeon who may not be in the immediate vicinity
The supervising surgeon does not have to be the student’s clinical supervisor. It may be a trainee or staff grade surgeon who has the necessary skills and knowledge to act in this capacity and who has been delegated to undertake this role by the clinical supervisor
From personal experience as a tenured SCP when I unfortunately worked for a surgeon who on occasion felt it appropriate to leave the building whilst I was still working on the last patient I can assure you, this is NOT level 2 supervision!!!!!
Preceptorship session

19. Preceptorship SD introduction
The take home message
The modern Surgical Care Practitioner must be suitably educated and qualified
The standard of competence required of an SCP delegated to perform a task is that of the medical practitioner they are replacing
The time required to acquire the necessary experience is enormous
We have covered a tremendous amount of ground this morning,
However, I feel that the take home message is:
If can be difficult for departments who have not employed SCPs before to find a balance between service provision and the needs of the student.
For me, the thing that stands out most is the need for TIME
For the trainee
For the clinical supervisor & mentor
For the manager.
Master’s education is what is required to support the decision making that is expected of this group of practitioners – for this they need this very valuable commodity.
Preceptorship SD introduction

20. References & resources
Bartter, K., Ethical Issues in Advanced Nursing Practice. Oxford: Butterworth Heimann.
Bolam V Friern Hospital Management Committee (1957).
Department of Health, Advanced Level Nursing: A Position Statement, COI for the Department of Health.
Dimond, B., Scope of Professional Practice in theatre nursing. In: Legal Aspects of Nursing. 7th ed. Harlow: Pearson Education Ltd, p. 659.
Gibb, G., Medical Malpractice Lawsuit Accuses Surgeon of Leaving Procedure Early. [Online] Available at:
Hall, S., Quick, J., Hall, A. & Jones, A., Surgical Assistance: who can help?. Annals of Royal College of Surgeons of England (Suppl), July, Volume 96, pp
Health Care Professions Council, Professional indemnity cover and your registration. [Online] Available at:
Health Care Professions Council, Aims and vision. [Online] Available at:
Healthtrust Inc vs Cantrell (1997).
Hughes, S. & Quinn, F., Quinn's principles and practice of nurse education. 6th ed. Andover: Cengage Learning.
Kirk, R., Basic Surgical Techniques. 6 ed. Edinburgh: Churchill Livingstone Elsevier.
Nursing & Midwifery Council, The Code: Professional standards of practice and behaviour for nurses and midwives. London: NMC.
Nursing and Midwifery Council, Professional indemnity. [Online] Available at:
Perioperative Care Collaborative, Position Statement. Surgical First Assistant (formerly the 'Advanced Scrub Practitioner'). Perioperative Care Collaborative.
Rothrock, J. C., The RN First Assistant. 3rd ed. Philadelphia: Lippincott
Rothrock, J. & Seifert, P., Assisting in Surgery: Patient Centred Care. Competency and Credentialing Institute.
Royal College of Surgeons of England, Surgical Assistants. Position Statement.
Royal College of Surgeons of England, Surgical Care Practitioner (SCP). [Online] Available at:
Royal College of Surgeons of England, Good Surgical Practice. London: Royal College of Surgeons of England.
Royal College of Surgeons of England, SCP curriculum. [Online] Available at:
Royal College of Surgeons, Statement on Duty of Candour. London: RCS.
Simpson, J. & Rowlands, B., Trainees and Trainers: rights and duties. Surgery, October, 26(10), pp
Wilsher v Essex Health Authority [1988] 1 AC 1074 (1988).
Preceptorship SD introduction