1. IST – The HEE perspective
Paul Sadler
Interim PG Dean
HEE Wessex

2. Why am I here? Collaboration HEE and RCS
Lead Dean for IST (& 2 surgical SACs)
My background
Critical Care and Anaesthesia
CCrISP / ATLS Course Director
Director of Education / Deputy Medical Director
Common issues in the past
“missed training opportunities” “no time in theatre” “no one else on wards”
“supervisors have no time” “service focus” “ok as long as rota is full”
“if get to theatre I just hold the retractor” “teaching just doesn’t happen”
“I felt isolated”
Backed up by JCST / GMC survey

3. IST: History 2013 Shape of Training report published 2014
HEE mandated to explore implementation of Shape recommendations
2015
IST report commissioned by HEE, produced by RCS
2016
IST project funded by HEE
2018
Planned start of IST pilot

4. Improving Surgical Training
A new competence-based, run-through training programme in General Surgery.
HEE and RCS working together
The pilot will trial:
improvements in the quality of training,
better balance between service and training,
professionalise the role of the trainers
Develop members of the extended surgical team to work alongside surgical trainees to improve patient care

5. The HEE Perspective HEE Perspective There is no more money CCT not CST
Consider the patient and service perspective
Consider the wider team
Don’t be constrained by traditional boundaries
FY2
Be radical

6. HEE Perspective Define the Service Define the Team composition
Define the role of the Consultant
Define the Training Programme

7. Process Induction High Volume, Low Risk Low Volume, High Risk
Intensive
Boot camp
Simulation
Human factors
High Volume, Low Risk
Modular
High level of support and supervision
Day Unit, Surgical Assessment Unit, Emergency theatre etc
Supplemented by refreshers
Low Volume, High Risk
More independent

8. Process Surgery: HEE trainee perspective
Periods of Acute/Core Skills
ITU and peri-operative medicine
Generic surgical technical skills
Non-clinical skills
On-calls
Simulation
Periods of ‘Intensive surgery’
Specialist surgery
Acute/trauma training
Longer rotations
No on-calls
Periods of Specialist Surgery with on-calls
Specialist on-calls
Post-CCT:
Fellowships for sub-specialisation
Upkeep of acute, general and specialist skills

9. Project Principles Enhanced training Increased time for training (60%)
Professionalised, better-trained trainers
Simulation
Technical and Non-Technical Skills
Extended Surgical Team
Surgical Care Practitioner curriculum – related to ISCP
Re-structuring of rotas
Minimum of 10 in a full shift ‘cell’, including non-medical workforce in Core-level on-call rota
Curriculum modification
“Excellence by Design”
Embedded, enhanced induction (‘boot camps’)
Centrally managed and funded post-CCT fellowships
True competence-based progression
Run-Through progression (with min and max duration and enhanced ARCP)
Think back to those comments trainees made at the beginning

10. Improving Early Years Training
Improved quality of core training
Apprentice style training
Better and more simulation
Better preparation in foundation
Longer placements
Adjusted service role
Broader based training
Changed structure of surgical team
What constitutes simulation needs to be clear
What is training often still needs explaining
Foundation review is happening across the board

11. HEE ARCP Review
The purpose of the ARCP process should be recognized as:
Assessment of competence to progress to the next stage / completion of training
Ensuring trainees fulfil GMC revalidation requirements
Ensuring trainees are regularly appraised receiving formative feedback and careers advice
A consistent, robust and fair process

12. HEE ARCP Review Assessment – meaningful and achievable Appraisal
ES / CS role
ARCP members role
QA of ARCP
Logbook and case numbers important
Value of CEX as opposed to a MCR in demonstrating achievement of required competence

13. HEE Plans Schools started What works What doesn’t Plans for expansion
Schools not started
Plans to start
If not why not
No support
Not possible
Local HEE Offices
Deans
Employers
Trainer job plans
Promote EST
Local Champions (£5k)

14. Challenges Moving to business as usual School / Employers Rotas
Trainer Time
Simulation access
What is simulation?
ST3 numbers
EST

15. ?

16. Summary Holistic review of Surgical Training Protects training time
Emphasis on the value of the trainer
Requires changes in EST to make it work
Values General / Acute work through programme
Good for patients?
I WANT TO BE HERE!