1. William Allum Chair, Joint Committee of Surgical Training Current State of Surgical Training

2. Current Issues Profile of Surgical Training – Shape of Training – Opportunity to improve – Workforce – Credentialling Generic Professional Capabilities Simulation v10 - ISCP / e Logbook – Trainers Surgeon Outcomes Budget

3. Shape of Training An agreement between – Medical Education England – Academy of Medical Royal Colleges – GMC – Council of Postgraduate Medical Deans – Medical Schools Council – NHS Education Scotland – NHS Education Northern Ireland – NHS Education Wales

4. Key broad recommendations Service requires Doctors with more general skills Requirement for Specialists remains Training – to CST within 6 years Credentialing for specific competencies Training must be more flexible and respond to patient/service needs Blurring the primary/ secondary care interface

5. Issues Blurring of primary / secondary care interface What is the level of CST? No extra money Cost of Credentialling? Generalist and Specialist Service reconfiguration - Future of DGH?

6. What has Happened? UK-wide implementation group, chaired by Professor Ian Finlay (2014) Division of the report into six workstreams (Autumn 2014) Workstreams fed back to the implementation group Report to 4 DH Ministers (Winter 2014/15) 4 DH Ministers Statement (February 2015) Implementation Group extended (Spring 2015)

7. Workshops General themes and progression to CST Primary – secondary care interface Interaction with employers Issues relating to SAS doctors Academic pathway Credentialing

8. What has Happened? UK-wide implementation group, chaired by Professor Ian Finlay (2014) Division of the report into six workstreams (Autumn 2014) Workstreams fed back to the implementation group Report to 4 DH Ministers (Winter 2014/15) 4 DH Ministers Statement (February 2015) Implementation Group extended (Spring 2015)

9. DH Statement 1. Implementation in an incremental fashion to minimize service disruption (short and medium term ) 2. Preserve current fit for purpose structures 3. Continue the UK Steering Group supported by 4 Nation Implementation Groups 4. Commission an impact assessment to report by summer 2015 5. Implement the recommendation that the careers of SAS doctors should be enhanced. 6. Pilot credentialing (eg cosmetic surgery) 7. Seek draft descriptions of training pathways to include CST within 6 years and credentialing for each theme

10. What might the implications be for craft specialties? Relatively little Broad disciplines will remain Training will be general enough to permit most doctors to participate in and treat emergency patients Specialist interest will remain Some sub-specialist activities will be credentialed

11. What might the implications be for craft specialties? Training Fewer trainers but better recognition More use of simulation techniques Immersion training Competency based rather than time based Training to enter team structures ? Formal mentoring after CST

12. Strategy for Change in Surgical Training Opportunity for Surgery Improve quality of teaching and training – commitment from LEPs Time for training and supervision Rota review for emergency service provision Role of Allied Healthcare Professional workforce

13. Improving Early Years Training Improve d 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

14. Improving Surgical Training What are the Objectives To improve quality of surgical care To improve the quality of surgical training

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

16. Process Induction 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 Modular More independent Supplemented by refreshers

17. Basic Surgical Skills Modular To include EGS, Urology, Paediatric surgery, Critical care, Vascular Emergency General Surgery Modular To Include UGI, LGI Post CCT Training UGI Colorectal HPB Run Through, Competence Based, MRCS required for progression National selection

18. Contemporary Challenges to Delivery of Surgical Simulation

19. Framework for Technology Enhanced Learning

20. Simulation - Drivers Clinical Experience Change in working practices EWTR Technological and Scientific advances Efficacy of Simulation

21. Challenges Human Resources Trained Faculty – Design curriculum – Provide structured feedback – Role model Time for Training – Service vs Training – Patient safety demands on trained surgeons

22. Challenges Educational Strategy Structured curriculum – Learning outcomes – Assessment instruments – Formative and summative feedback Trainee clinic time vs simulation time – SDL Trainee Awareness

23. JCST Survey In this post, did you receive simulation and clinical skills training?

24. YesNoN/A East Midlands42.1%36.3%21.5% East of England44.4%38.5%17.1% KSS65.4%27.5%7.1% London51.1%32.6%16.3% North West Mersey35.9%45.9%18.2% North West40.3% 19.4% Northern East65.4%19.8%14.8% N Ireland27.4%48.0%24.6% Scotland41.0%39.8%19.2% South West32.9%47.8%19.3% Thames Valley48.6%37.0%14.4% Wales38.9%44.3%16.8% Wessex36.0%42.5%21.5% West Midlands39.1%38.3%22.6% Yorkshire / Humber58.3%29.8%11.9% TOTAL46.0%36.5%17.5% Availability of Simulation by Deanery

25. Availability of Simulation by Specialty YesNoN/A Cardiothoracic Surgery60.3%23.3%16.4% Core49.8%36.7%13.5% General Surgery40.7%43.8%15.5% Neurosurgery33.6%43.4%23.0% Oral and Maxillofacial Surgery27.5%30.8%41.7% Otolaryngology57.6%23.5%18.9% Paediatric Surgery57.6%34.9%7.5% Plastic Surgery41.9%36.9%21.2% Trauma and Orthopaedic44.7%34.0%21.3% Urology53.4%30.1%16.5% Vascular Surgery58.3%41.7%0.00%

26. Challenges Logistics Task and Procedural Simulators Space for hardware Space for learners Funds to support and maintain Centralised resources Sharing resources

27. ISCP – What’s it for? Personal study Teaching Informal assessment Feedback Formal Assessment Curriculum Tells you what you need to know Guides learning Provides structure Improves feedback Improves training Records outcomes Guide to learning

28. ISCP v10 First ever complete re-write Faster Better prepared for future developments Planned for July / August release Beta version available now

29. ISCP v10 Web design Navigation Features Content v10 aims to keep ahead of the field Easier to use More intuitive Simpler appearance Quicker Improve feedback Reduce tick box culture To improve training and learning To meet objectives of ISCP evaluation

30. http://v10beta.iscp.ac.uk

31. Learning Agreement Central feature Planning of objectives Review of progress Simpler to complete – Logical – No longer needs downloading of topics BUT – Evidence will still be linked to topics

32. Improved WBAs Emphasis on feedback Structured free text at the top – Strengths – Weaknesses – Actions Anonymous assessment of trainer quality Reflective record

33. Supervisor Reports Clinical supervisor Educational supervisor Structured feedback – 9 domains: knowledge, clinical skills...... – Performance descriptors for each – Free text and performance grade for each domain

34. GMC Developments Generic Professional Capabilities Standards for Training Equality and Diversity Guidance for Curricula and Assessment Standards for Curricula and Assessment

35. Generic Professional Capabilities – Effective communication – Leadership, team working, improving quality and patient safety – Complex and vulnerable groups – Education and training – Research

36. Generic Professional Capabilities Generic Professional Skills – Practical skills – Clinical skills Generic Professional Knowledge – NHS structure

38. JCST Budget

39. JCST Finances SourceAmount (£) Trainee fee1,203,048 GMC – for CESR work*129,737 Total external income1,332,785 Funding of JCST 2013-14

40. JCST Finances FunctionExpenditure (£) Trainee enrolment and certification ISCP QA 1,421,893 CESR – equivalence work109,082 Outgoings of JCST (by JCST function) 2013-14

41. JCST Finances Area of SpendingAmount (£) Staff821,000 Honoraria70,000 Travel23,000 Catering and AV30,000 Office Costs14,000 Accommodation, service and other charges 573,000 Overall total1,531,000 Outgoings of JCST by Type of Spending 2013-14