Minutes of the Surgery Specialty Training Board meeting held at 10.30 amon Friday 25 October 2013 in the Calman Room, 2 Central Quay, 89 Hydepark Street, Glasgow
Present: Dominique Byrne (DB) Chair, John Anderson (JA), Richard Buckley (RB), Ian Holland (IH) part meeting, Graham Mackay (GMcK), Audrey McPetrie (AMcP), Douglas Orr (DO), Mike Palmer (MP), Andrew Renwick (ARW),Angela Riddell (AR) part meeting, Hamish Simpson (HS),Jackie Sutherland (JS) part meeting, Ken Walker (KW).
By videoconference: Edinburgh (RoyalCollege) - Ian Ritchie (IR) part meeting; Edinburgh (Westport) - Lorna Marson (LM),Bill Reid (WR); Kirkcaldy – Satheesh Yalamarthi (SY).
By telephone: Rachel Thomas (RT) part meeting.
Apologies:Helen Biggins (HB),Angus Cain (AC), Laurence Dunn (LD), James Garden (JG), Alison Graham (AG), Gareth Griffiths (GG).Graham Haddock (GH), Brian Howieson (BH),Anthea Lints (AL), Jen MacKenzie (JMcK),Anas Naasan (AN),Rowan Parks (RP), Sai Prasad (SP).
In attendance: Helen McIntosh (HM).
1. / Welcome and apologiesThe Chair welcomed:
- Mr Satheesh Yalamarthi, new Core Surgery TPD – Eastward, to his first meeting;
- Ms Rachel Thomas joining the meeting by telephone;
- Ms Audrey McPetrie, Training Programme Team Leader, WoS, to her first meeting;
- Ms Jackie Sutherland, Medical Staffing Manager, NHS Highland, to her first meeting.
2. / Minutes of meeting held on 2 July 2013
With one amendment to the attendance list the minutes were accepted as a correct record of the meeting and will be posted on the website.
3. / Matters arising
3.1 / Verification of trainee logbook
DB noted email correspondence with Alison Howd in connection with the application by a Core trainee from Scotland to Cardiothoracic Surgery, following which it had been agreed that there was no outstanding issue and that Core training had been completed satisfactorily.
This led to discussion about the appointment of Academic Clinical Fellows in EnglandWales. WR noted that the GMC has visited various centres to consider academic training and that a move towards including these in the national recruitment process was gathering momentum.
3.2 / Applicants to Round 2 Core Surgery Recruitment
DB had received a response from Vicky Ridley-Pearson to the Board’s request for information about applicants to Round 2 of Core Surgery recruitment and, specifically, the number of these who had not applied to Round 1. There had been 24 such applications in Round 2 (ie. from individuals who had not applied to Round 1), the majority of whom were non-EU applicants and therefore not eligible for Round 1. DB has requested further information on the number of these applicants who had then been offered posts and will report back at the next meeting.
Action:
- DB to report back at next meeting on further information received.
3.3 / 2014 recruitment to Core Surgery
Recruitment will be co-ordinated by KSS Deanery and take place in Charing Cross Hotel in Londonon 20-24 and 27-31 January 2014. Panellists were sought for 40 interview-days in total. MP noted the loss of some people in Round 2 last year when those who did not get their first choice were offered posts later. As there may not be a Round 2 this year this may not be an issue. DB also noted English recruitment numbers to Core Surgery are scheduled to decrease, which could assist Scotland’s fill rate.
3.4 / Plastic Surgery trainee numbers
AN has agreed to check specialty view of Consultant requirements for the future and to discuss this with colleagues at the Plastic Surgery STC meeting next week. AN will then report back to DB and to the Board.
3.5 / FRCS exit exam eligibility criteria
Two tier eligibility had previously been proposed with separate criteria for each of the two parts of the exam. This has now been amended to a single tier for eligibility to sit the FRCS Exit exam with the stipulation that trainees should have an Outcome 1 at the end of ST6 (or ST5 for Urology and OMFS).
IH pointed out that the criteria as now stated remained unclear since there was no requirement for trainees to sit the exam at the start of ST7 (or ST6 for Urology and OMFS); thus, for example, there was no clear guidance on the eligibility of a trainee who, despite having an outcome 1 at the end of ST6, applied to sit the exam after receiving an unsatisfactory outcome at a subsequent ARCP; another situation which needed to be clarified was that of a trainee who might receive an unsatisfactory ARCP outcome between the two parts of the Exam. DB undertook to liaise with Gareth Griffiths (GG) on this issue.
Action
- DB to seek clarification of eligibility criteria/wording from GG.
3.6 / MTI: Expressions of interest
IR introduced his paper and sought the STB’s support for the proposal that the Royal College of Surgeons of Edinburgh work in conjunction with the Surgical Specialty Training Board and other parties to develop educational opportunities for surgeons from the international community to come to the UK, often with their own funding. He stressed the intention was not to fill rota gaps but to provide extra experience to bring people up to international standard. It might be possible to provide some NHS salary for others with insufficient funding but this would require an HR view. The College has significant experience in helping people to obtain the necessary visas and could assist with advance arrangements.
WR said the PG Deans’ role was to ensure that delivery of training in existing programmes was not adversely affected by MTIs. He noted involvement in MTI applications for 5/6 years and while he felt that applications could generally be gaugedat Deanery level, guidance would be required from TPDs. Dr Donald Farquhar was the International Dean for RCP and therefore also has much experience of these posts. WR stressed that NES was keen to develop and maintain overseas links and that he had spoken informally to Mr Ian Finlay at Scottish Government about how to formalise a process. He noted there were legal considerations relating to pay including agreed minima, and that salary could be augmented by ‘on call’ payments for those coming to the UK without funding.
IR confirmed there would be no conflict between Glasgow and EdinburghCollegeson this issue and proposed that the College could act as a ‘dating agency’ liaising with NES/service to match up applicants to identified opportunities. The College’s aim was for a sophisticated system of matching individuals to available posts and would include existing units and local contacts. He did not have any concern about who maintained the information on capacity, although clearly this information had to be kept somewhere, and confirmed that the College would ensure there was no adverse impact on existing trainees. Details re funding/advertising/competitive appointments would be worked out by HR colleagues.
WR confirmed he was in favour of supporting the proposal as long as it was not at the expense of local trainees but to re-establish international links. The STB agreed the proposal. DB and WR will discuss arranging a meeting of a small group including themselves, IR, others and HR representation to consider the detail of the proposal and how to identify capacity.
Action:
- DB and WR to discuss arranging meeting of small group to consider detail.
3.7 / Proleptic appointment to consultant positions
Cardiac Surgery had enquired whether this process could take placeearlier than 6 months before a trainee’s expected CCT date; SAC and GMC both stated that trainees have to be within 6 months of their expected CCT date to be eligible for such appointments. WR stressed that this would be appropriate only if all elements were on track for CCT at the expected date.
JS suggested that there was precedent for proleptic appointments being made earlier than this and cited one example in Scotland. WR and DB reaffirmed that this was not the advice given by SAC or GMC. DB would enquire further from Gareth Griffiths on possible exceptions.
Action
- DB to seek clarification of possible exceptions to rules for proleptic appointment to Consultant posts from GG.
4. / Changes in membership of STB
Changes were as noted.
In addition, DB also noted Ruth McKee has demitted as ISCP representative on the STB. He recorded the thanks of the STB for her contribution and support.
Alison Howd has also demitted office and has been replaced by SY. DB thanked her for her work on the STB, especially on developing core training and recruitment.
5. / Recruitment
5.1 / Proposal for 2014
The proposal discussed by the STB at its last meeting has been submitted to Scottish Government. Noted: Professor Paul Padfield has retired from his post at Scottish Government and has now been replaced by Mr Ian Finlay. While awaiting the Shape of Training (Greenaway) Report, the STB’s proposal has not yet been formally agreed or rejected.
WR reported that the Shape of Training Report will be published next week and is likely to impact significantly on the STB’s plan. The main contents of the Report were largely known and had been well received. It will contain 19 recommendations the main ones being:
-full registration to move to the point of graduation – this will impact on Medical Schools;
-Foundation to remain, possibly with licensing towards the end of training;
-strengthening of the role of the generalist.
It was likely that a 4-nations delivery board will be established to discuss and make recommendations for implementation, ensuring a consistent approach. There will be an impact on some College curricula and a possible return to more generalism in early years. Training would also be considered as ‘cradle to grave’ with programmes taking 4-6 years to complete to CST (Certificate of Specialty Training), at which point individuals will become Consultants, followed by credentialing in specialties and subspecialties. The Report will stress that cross-recognition of experience was fundamental and individuals should not be disadvantaged by changing specialty.
The Reshaping Board was due to meet later in the week and although an increase of 54 posts in Scotland has been proposed there was as yet no available funding for this. It was likely there would a review of Scotland’s requirements as part of the Shape of Training work and the work already done by STBs was vital in providing advice to Scottish Government in its future calculations.
At the date of the STB meeting, no decision could yet be made regarding proposed increases or decreases to specialty recruitment numbers.
5.2 / Decreasing application numbers - letter from Heads of School
A letter sent to the President of the RCS in London on behalf of the Heads of School of Surgery in the rest of the UK was circulated for consideration. This outlined concerns about the falling numbers of applications to surgical training and the apparent loss of attractiveness of Surgery as a career.
DB said Scotland aimed to match core surgery to ST3 vacancies on a one to one basis. This differed from the English situation which had a much higher ratio and the STB agreed Scotland should not encourage more applicants.
LM noted the gender imbalance in Surgery and stressed the need to work harder to address this and noted the top 25% trainees in Edinburgh last year were female. Although the imbalance was gradually being corrected, women were not coming through as quickly in Surgery at consultant level as they should. RT said the undergraduate perception was that those in Surgery worked harder than any other specialties and this could be the reason the specialty was less attractive. It was also noted that some Medical Schools appeared not to promote Surgery in the undergraduate curriculum and that there was a lack of provision of surgical experience in many Foundation programmes as well as a proposal to remove surgery entirely from some.
While the Board did not share the concern expressed in the letter about the decreasing number of applications to Surgical training, it was agreed that efforts should be made to maintain the profile and attractiveness of Surgery. DB would write to the Presidents of the Glasgow and Edinburgh Surgical Colleges in this regard on behalf of the STB.
Action
- DB to write to Presidents of Surgical Colleges.
5.3. / Trauma and Orthopaedic Surgery recruitment
HS and JS met before the meeting to work on arrangements. English interview dates were set for February; however it should not be an issue if Scottish dates clashed as those who wanted to train in T & O in Scotland will preference programmes. They will discuss and confirm dates and programme numbers.
Action:
- HS and JS to discuss and confirm interview dates and numbers.
6. / Updates
6.1 / Service
No service update was received.
6.2 / Specialties
- General Surgery
- Vascular Surgery
- OMFS
No other specialties had specific issues to report.
6.3 / SAC update: JCIE Revised Structured Reference form
Following discussion, the STB agreed wording on the form regarding sign off for outcomes should be amended; DB will speak to GG (see item 3.5 above).
The revised curricula have been submitted for approval to GMC. Elements of simulation are now included and whereas these are only classed as desirable at present, it was likely that by 2016 some mandatory simulation elements would be included.
There has been talk of a need to re-instate Deanery visits to inspect training programmes, and it is likely that College representation would be required for these. It was felt that the SAC liaison rep would probably be the most appropriate College representative for Specialty programme visits. WR noted this would require JCST/SAC members to undertake GMC visit training.
The JCST’s Guidelines for trainees to move to the most up-to-date curriculum according to their expected CCT date were noted.
6.4 / Academic
No academic update was received.
6.5 / MDET
WR noted that the restructuring of the Scottish Deaneries had been approved by the NES Board at its recent meeting. This would result in a single Scottish Deanery from April 2014 with regional offices continuing to provide consistent input. This would involve more internal than external facing changes.
6.6 / Colleges
There was no additional information to report.
6.7 / Trainees
RT noted concerns raised by trainees regarding the number of required assessments on ISCP. DB said this was a matter for JCST and the number required depended on specialty with 40 per year for most. He noted the London Deanery required 80 per year but that, according to ISCP reports, this higher requirement was in fact not strictly enforced.
6.8 / ISCP
DB reported ISCP planned to produce an annualised report for TPDs to show the use of assessments by trainees/programmes/Deaneries. Most trainees in programmes were producing around 40 per year and failure to achieve this figure would indicate a lack of engagement which would concern the STB.
DB had discussed with Ruth McKee a replacement ISCP representative for the STB. Following discussion it was agreed she will not be replaced and DB will request regular reports with additional reports sought as required. He will ask ISCP to provide the reports.
The content of the reports might vary according to time of year. DB asked members of the STB for suggestions of the information which they felt would be useful.
Action:
- STB members to make suggestions of desired content of ISCP reports
- DB to ask ISCP to provide regular reports and additional reports on request.
6.9 / JCST
DB reported that concerns had been expressed over the non-competitive appointment of Academic Clinical Fellows to NTN-posts. The proposal was that ACFs should apply to National Recruitment where they would be interviewed, thus allowing for benchmarking to be established before allowing direct progression to ST3 conditional on this process.
6.10 / CSTC
Noted: the committee was currently undergoing restructuring.
6.11 / CoPSS
As already noted; concern was raised around the decreasing number of applicants.
7. / Simulation
7.1 / Simulation in Surgery
KW presented to the STB on the work of the Scottish Surgical Simulation Collaborative. In particular he outlined the draft recommendations for Core Surgery, the first programme they have been working with. Courses are a Boot Camp at the start, a CCRISP course and a cadaveric whole procedures course at the end of CT2. Courses form only the tip of the pyramid, being expensive and infrequent. The monthly teaching programmes in the various Skills centres will be the main work, with time freed for simulation by shifting didactic components into evening webinars, already run by the 2 Colleges. Finally the hardest part to drive will be frequent practice, and there is a novel opening project to incentivise practice at home on laparoscopic simulators. These recommendations can only be “highly recommended” rather than mandatory, because the cost exceeds study leave budget. Unfortunately the GMC have stopped short of mandating, for the same reason.
Discussion/comments
- There was a widespread perception that trainees attended courses elsewhere for highly technical training but this should not necessarily be the case and ways of implementing simulation locally/regionally should be sought.
- DO was keen to establish a residential “Boot Camp” for Scottish Vascular Surgery trainees with KW’s involvement. A number of old style Vascular Surgery trainees remained within the General Surgery programmes and it was important to ensure their training was as good as the new Vascular Surgery trainees’. The hope is that the introduction of simulation in Vascular training would also include trainees from General Surgery with a Vascular interest over the next few years and assist them in completion of the new programme.
- HS felt non technical skills were often at a low standard; however KW considered the Surgical specialties were now better at recognising deficiencies and have established meaningful and agreed language.
- ARW felt it was important to include simulation as part of Scottish induction and to ringfence funding to ensure this was undertaken by all core surgery trainees this. DB noted the SSSC’s recommendations were not currently mandatory. He also noted that elements of Endoscopy training were now mandatory with funding provided by Scottish Government.
- KW felt the key was not simply to provide a Boot Camp but to establish an integrated simulation programme. To that end they should recommend what was required in the programme and costs involved and make a case for central funding. However WR said that untilrequired by the curriculum there was no obligation to fund. The current cost of each course was £650 per head which exceeds the annual Study Leave funding allocation for a trainee. While simulation was desirable/recommended at present, from 2016 some elements would be mandatory according to the curriculum and separate funding would then be required.
- KW queried whether the way forward was to seek an increased budget for craft specialties or to seek extra input from Scottish Government, along similar lines to the Patient Safety Programme. He and IR and Rowan Parks had discussed, and were of the opinion now might be a good time to ask. WR confirmed the correct route was via MDET to Scottish Government and to provide supporting evidence and different models of delivery.
- The question was raised whether the Core recommendationswere too biased to General Surgery. KW stressed the recommendations did not focus on particular specialties. For frequent practice Laparoscopy was used as the easiest to pilot and he believed provided many transferable skills.
- KW asked for programmes to volunteer to be the next for the SSSC to work with DO said Vascular would be keen. KW said Urology would also be invited.
- DB asked whether there were any plans to provide simulation training for T & O trainees as they did not come via Core. HS said this was not currently the case; however, he would discuss this with colleagues at the specialty training meeting due to take place later in the day.
Actions:
- HS to discuss with colleagues provision of simulation training for T & O trainees.
- DB, KW, WR and College representative to discuss Simulation training.
8. / AOB
No other business was raised.
9. / Dates of meetings in 2014
- 10.30 am on 17 January 2014 in Room 6, Westport, Edinburgh
- 10.30 am on 24 April 2014 in the Mackay Room, 2 Central Quay, Glasgow
- 10.30 am on 2 July 2014 in Room 1, Westport, Edinburgh
- 10.30 am on 2 October 2014 in the Mackay Room, 2 Central Quay, Glasgow.
Actions arising from the meeting