Minutes of the meeting of the Scottish Board for Training in Diagnostics Specialties held at 10.30 am on Thursday 21 February 2013 in Interview Room 2, Forest Grove House, Foresterhill, Aberdeen (with videoconference links)

Present: Dr Peter Johnston (PJ) (Chair), Dr Alan Cook (AC) part meeting, Mr Stewart McCracken (SM), Professor Gillian Needham (GN) part meeting,Dr Louise Smart (LS) part meeting.

In attendance: Ms Helen McIntosh (HM).

By videoconference: Dundee – Dr Tom Taylor (TT);Edinburgh –Mr Paul Hudson (PH);Glasgow– Dr Peter Galloway (PG) part meeting, Dr John Hood (JH),Dr Mark McCleery (MM),Dr Jennifer Tolhurst (JT); Inverness – Ms Tracy Rennie (TR) part meeting; Melrose – Dr Hamish McRitchie (HMcR).

By teleconference (part meeting): Dr Celia Aitken (CA), Dr Ingolfur Johannessen (IJ).

Apologies: Dr John Bremner (JB), Dr Fiona Ewing (FE),Professor Graeme Houston (GH), Dr Wilma Kincaid (WK), Dr Ronald MacVicar (RM), Dr Maeve McPhillips (MMcP), Dr Hannah Monaghan (HMo); Dr Shona Olson (SO), Professor Massimo Pignatelli (MP),Ms Karen Shearer (KS).Ms Jackie Sutherland (JS), Dr Emma Watson (EW).

1. / Welcome and apologies
The Chair welcomed Mr Stewart McCracken to his first meeting as lay representative. He noted Ms Tracy Rennie was deputising for Ms Jackie Sutherland at today’s meeting. Apologies were noted.
2. / Minutes of meeting held on 18 December 2012
Thefollowing amendment was noted:
Page 2, Item 4.4, final sentence to read ‘…if Scotland was part of the process next year it may have an opportunity …’
With this amendment the minutes were accepted as a correct record of the meeting and will be posted on the website.
3. / Matters arising/actions from previous meeting
There were no matters arising to discuss.
4. / Recruitment
4.1 / Virology update
Two joint training posts will go into Round 2 recruitment with interviews held in May. All information was posted on the website and all arrangements were in hand. One trainee has been appointed to a consultant post in Glasgow and there was one LAT post in Edinburgh.
PJ noted the announcement this week that Chemical Pathology and Metabolic Medicine was part of the UK recruitment process due to the principleregarding previous UK national recruitment processes. This was not an issue for Medical Microbiology. Virology will recruit via Forth Valley Health Board this year. Each of the STBs will be asked for feedback on the UK process after recruitment was completed; the process will then be reviewed.
IJ noted Virology only training was still on offer in England. PJ said the GMC has barred new specialties while the Shape of Training review was underway stalling further discussion of ID training. Informal feedback from the review indicated support for Foundation training and for greater flexibility in specialty training. CA said it would not be a problem if the specialty had to return to single training however the issue remained of sufficient people coming from core although they could always appoint LATs.
CA noted concern regarding Paper 5 for the later agenda item on current curriculum. PJ felt anomalies will always exist however the aim was to provide trainees with the most up-to-date curriculum and programmes regardless of the time taken by individuals to train. This would give trainees the opportunity for up-to-date rather than outdated practice.
4.2 / SMT recruitment 2013: update
TR confirmed all interviews have been held and all posts offered. Medical Microbiology has offered 6 posts of which 2 were being held and a decision required by 7 March; Chemical Pathology recruited to 4 vacanciesand made 3 offers all of which were accepted and the fourth post will go into ST3 recruitment. TR will confirm there was one post plus one recycled post for ST3 recruitment and will liaise with PG and ensure the appropriate people were informed.
Medical Microbiology
JH reported an issue in Medical Microbiology shortlisting; a large number of Greek graduates with more than 18 months experience and who were also on the specialist register had applied and were rejected. The rejection was strongly challenged. He noted the need to make this explicit in future.
A complaint had also been received from a candidate who did not bring evidence to interview; the individual was now seeking to make a formal complaint.
If the 2 remaining applicants accepted posts in other specialties while offered candidates continued to hold, this would leave only candidate in reserve. She will keep an eye on the situation.
Radiology
TT reported on the national process held in London. This was very well organised; panels were led by lay chairs and the process streamlined with various stations and facilitators ensuring the process was very efficiently run. The schedule was relentless with 10 minutes allocated to each station and questions scripted. Scoring was within a narrow range 0-3 and panellists were not permitted to compare notes. This meant they had no clear idea of how candidates were doing or who were Scottish candidates. A high number of people did not turn up for interview. 587 candidates were interviewed for 199 vacancies of which 20 were in Scotland; 21 candidates were first preference Scotland which was disappointing however they were on track for filling vacancies. He will check whether Scottish vacancies could be offered to those with Scotland as a lower preference. He noted NoS was very happy with the process. He will produce information on costs of the process in his report.
Histopathology
LS reported interviews took place this week and provided an update to the STB; she noted HMo will provide a full report with input from LS and others.
There were 110/111 applicants; the process of longlisting was very laborious with 107 candidates advancing to shortlisting. Three Scottish representatives were involved in online shortlisting which was also a laborious process and did not further reduce numbers but provided a score for ranking. They interviewed 107 candidates for 100 posts; a number of candidates did not attend. Facilities in the London Deanery were good and panels were run by lay chairs. The interview process was very condensed comprising 6 x 5 minute stations which made it difficult to get an impression of candidates. Candidates were seen in groups of 6 and each station had 2/3 interviewers however only 2 scores per candidate were used. There was little time between the groups of candidates and little time for discussion. Marking was 0-4 with positive and negative indicators at each extreme. Interviews took place over 1.5 days and the cut off was decided based on previous years. They looked briefly at candidates who scored 0-1 and they were still deemed appointable. Offers will be made 1-7 March and upgrades continue until 14 March. There could be other candidates who have preferenced Scotland but she felt they could struggle to fill and it was likely they will need a further round.
In terms of costs, 3 people were away for 2.5 days which could have reduced to 2 days. Travel and accommodation costs were being met by the College. Much time was spent longlisting and shortlisting without clear benefits.
Action:
  • TR to confirm the number of Chemical Pathology posts for ST3 recruitment and liaise with PG.
  • TT to check whether Scottish vacancies could be offered to those with Scotland as a lower preference.
  • TT to provide report on Radiology recruitment process.
  • HMo to provide report on Histopathology process.

5. / Quality remit
5.1 / Radiology Trainee Survey result
The document showed most trainees were happy, excluding those undertaking research, and overall the picture in Scotland was a positive one. Trainees reported good access to resources and study leave. The response rate from Scotland was the highest at 72%; 70% from WoS and 100% from NoS and a UK overall response rate of 60/62%. MM offered to provide a breakdown for individual Deaneries on request.
Research was a long-standing problem with individuals experiencing difficulty in finding mentors and the College has put various initiatives in place to address this. .He felt that some of the other issues raised were more opinion than quantifiable data eg formal time allocation to access on-line resources which he considered should be classed as private study time. There were no major issues identified other than ‘handover’ but again this was a matter of opinion on what constituted ‘formal’ handover.
TT will take the information produced by the survey to the PG Education Committee. PJ felt it would be useful to circulate the information more widely eg to Scottish STCs.
GN cautioned against overburdening trainees with too many surveys and questionnaires and felt they should prevent duplication of other surveys. Surveys undertaken should add knowledge and findings should be feedback effectively to respondents. MM said the survey was based on one undertaken by Oncology; it will be carried out every second year with the aim of achieving a 75% response rate and was designed not to duplicate the national survey. A report of the survey findings was being written up and will be published as a supplement and feedback will be widely available and disseminated by each Deanery trainee representative.
5.2 / START Alliance update
This was an initiative from NES MDET led by Professor McLellan, ProfessorParks, Anne Dickson and Dr MacVicar. The aim was to provide a strategy to market the attractiveness of training in Scotland by first identifying the problem before applying a solution.
The picture amongst the Diagnostics specialties varied and a significant amount of Foundation trainees were lost from Scotland each year with no clear sense of where they went.
TT felt they should consider running Careers Fairs in Scotland. The NoS run ‘speed dating’ mini careers fairs where Foundation doctors speak to trainees and this was found to be popular and useful. The MedicalSchool ran something similar.
PJ asked board members to consider the START document and to feedback any information or suggestions to Professor McLellan or Dr MacVicar.
6. / Introduction of new CCT programme in Neuropathology: governance arrangements and discussion with Dr John Read
The item was deferred to a future meeting.
7. / SAS Doctors
AS there were only a small number of doctors in this category in Diagnostics specialties it was agreed this was not very relevant to the STB unless it was of interest for the future. GN felt the initiative fitted well with the Shape of Training work. She noted the programme for the PGMEC conference on 30 included a number of workshops one of which will focus on this area and this would provide a means of engagement for the STB.
8. / College restructure: Education
The College of Pathology was proposing to change its structure and to combine its national committees. PJ asked for comments on the proposal to be sent to him and he will raise them on the STB’s behalf at the next regional council meeting.
Action:
  • All to send comments on restructure of College of Pathology to PJ.

9. / Update reports
9.1 / Liaison Dean
GN highlighted:
  • Francis Report has been received and she and colleagues will reflect on it and on actions to be taken; she noted the report made 291 recommendations. The STB needed to understand the consequences for the NHS in England and the NHS broadly. PJ felt this provided an opportunity to look closely at the systems operated and to realign the Health Service with its professional beliefs.
  • Shape of Training Review; this was ongoing. Professor Greenaway attended and participated in a question and answer session at the recent COPMeD conference. The report was due to be published in the autumn.
  • GMC recognition of trainers. By July NES will have a database available to gather evidence for recognition. The process will be made as straightforward as possible and recognise training already undertaken and make use of and develop existing Scottish training packages eg SCOTS and STAR. It was also likely the Colleges will develop specialty specific packages. The process will be automated as far as possible and eventually will feed into SOAR and revalidation. The named Clinical or Educational Supervisor must be formally recognised by the time of full implementation in 2016 and all consultants were likely to be in scope. At present work was taking place in conjunction with undergraduate colleagues on the infrastructure. They were working with DMEs in Health Boardson job plans and definitions ie clinical governance as distinct from educational governance. Only recognised named clinical supervisors will have to go through the formal process but all must be aware of their responsibilities regarding patient care and safety.
  • Medical Vision. Work was continuing on structures to support trainers and trainees within the context of best value. This will be further discussed at the MDET Away Day in March.

9.2 / Histopathology
LS reported specialty representatives met in early December to discuss recruitment and other topics. They were happy 3 Scottish consultants were involved in national recruitment but Scotland had no influence on the process. They also discussed the quality remit and specifically trainee surveys which generally received good feedback and allowed examination of local issues; in NoS ‘undermining’ was flagged as an issue. They also discussed the issue of new specialties and how to liaise with them re governance/integration/ number of posts and were planning discussion with Paediatric Pathologists. The NoS had received a red flag on study leave and they were addressing this by developing Scottish courses eg they have set up a cytology course in Edinburghfor ST3s. Discussion also highlighted access to sufficient numbers of post mortems.
9.3 / Radiology
TT highlighted:
  • Interventional Radiology. Although it was agreed new posts were needed as this was an expanding specialty there was no clear mechanism for funding salaries. The specialty was asked to consider reducing Diagnostic posts to transfer to Interventional Radiology. Interventional Radiologists have clearly stated the view that Interventional Radiology trainees must come from the Diagnostic Radiology pool. However Diagnostic Radiology considered it needed more trainees. He has compiled all information received and sent this to PJ. PG Advisers saw the merit in both arguments. It was agreed they needed to continue to lobby for funding; to press for an increase in Diagnostic Radiology posts; they may have to accept short term decrease in Diagnostic Radiology for Interventional Radiology recruitment.
GN said this was a good example of how subspecialties needed to be properly planned; the same was true for Vascular Surgery. She encouraged the specialty to continue lobbying via all available committees eg Steering Committee, STB, SMASAC. HMcR reported the issue of Interventional Radiology was discussed when the Scottish Steering Committee met CMO. He has also reported to SMASAC so channels were already being used. He noted a cohort of Interventional Radiologists was due to retire within the next 5 years and this would create a difficult situation for the future. PJ thanked TT for the work on this. He will write on behalf of the STB to Professor Padfield presenting this information and the 3 conclusions as above. He felt there were some specialties where disestablished posts could be used; GN also noted the NoS continued failure to fill a Clinical Radiology post and felt this could have absorbed Interventional Radiology training in its programme.
  • Diagnostic Radiology post in NoS: there was a salary but no NTN available.
  • A meeting was being organised for the Chair and Deputy of the Scottish Standing Committee with Professor Padfield. For the meeting they were seeking information on how many unfilled Radiology consultant posts there were in Scotland. MM will access this information via a contact at ISD and send the information to PJ.

Action:
  • PJ to write on behalf of STB to Professor Padfield re Interventional Radiology.
  • MM to access information on unfilled Radiology posts in Scotland; to send information to PJ.

9.4 / Medical Microbiology
JH noted that at the recent College meeting there was much anxiety expressed concerning the lack of progress on Infection training. London will only appoint to joint training and Edinburgh was doing the same but if Infection training was agreed this would be problematic.
PJ felt the answer could be to use CMT posts. However JH said Scotland had a higher proportion of Infection training units than elsewhere; if they were not able to provide this training nowhere else would be able to do this. He felt they should have enough capacity in Scotland to train half in Medical Microbiology and half in Virology. PJ will feedback these comments to MDET.
Action:
  • PJ to feedback comments re ID training to MDET.

9.5 / Chemical Pathology and Metabolic Medicine
PG said it was difficult for trainees to get competencies in Stage D without extending programmes and he acknowledged that Stage D was not an extension but part of the programme.
He noted he has written to the PG Dean re one StR post as yet without response.
9.6 / Trainees
PJ noted that Dr Richard White, BMA trainee representative, has been appointed to a consultant post in Cardiff and has left the STB. PJ formally noted Dr White’s efforts on behalf of the trainee group and wished him well in his future career. A replacement representative will be appointed in due course.
9.7
9.8
9.9 / Academic issues
Service issues
Lay representative
No update reports were received.
10. / Report of meetings attended
10.1 / MDET/STB Chairs joint meeting on 4 February 2013
Noted in Liaison Dean update.
10.2 / National Association of Clinical Tutors
PJ and JH attended this meeting in London where the Shape of Training Review and Foundation training were discussed. This was a very good meeting and it was felt Scotland would benefit from representation.
11. / Received for information
11.1 / PGMEC event: 30 April 2013 draft programme
The draft programme was noted.
11.2. / Moving to the Current Curriculum: GMC position statement - November 2012
PJ asked all to ensure colleagues were aware of the statement.
12. / AOB
No other business was raised.
13. / Date and time of next meeting
The next meeting will take place at11.00 am on Tuesday 19 March 2013 in Meeting Rooms 3 and 4, Westport, Edinburgh. To note this will be an ‘in person’ meeting.

Actions arising from the meeting