Organising rotations in higher surgical training; mapping the

job to the curriculum

Steve BaleProgramme Director T & O

Lancashire Teaching HospitalsNHS Foundation Trust

Regional Representatives MeetingRCS June 2010

Regional Representatives Meeting RCS June 2010

Present

• A competency based curriculum

• Trainees are sent to a hospital

• Hopefully given the training they need

• How do we know it’s the best place?

Regional Representatives Meeting RCS June 2010

Why?

• Loss of SAC visits• Ballooning Consultant numbers• Amalgamation of units• Stagnation of some units• RITA/ARCP feedback• PMETB standards• Deanery Q & A

Regional Representatives Meeting RCS June 2010

Hospital Visits

• Visited all training hospitals• Team• Informal• Trainees not involved• 3 separate periods to cover all hospitals• Information requested• Trainees questioned separately

Regional Representatives Meeting RCS June 2010

Feedback

• Reports to each STC member

• Visitors findings

• Trainees assessment

Regional Representatives Meeting RCS June 2010

Mr. M. Aqeel Bhutta

Orthopaedic Registrar

STC Trainee Representative

Driving Force

Sources

The Survey BACKGROUNDVery simple Feedback questionnaire with traffic light system from 2005.The updated survey has been collected from 2007 to date for each 6 month placement.Anonymous when presented to STC.

QUESTION SCORING-Graded from strongly disagree to strongly agree, and weighted 1 to 5.-Questions created/phrased to allow scoring to be correctly weighted when assessing scores. A score of 3 (neither agree or disagree) was a negative sign.

THE SURVEY

THE UNIT Direct question about the unit. Specific indicators

- Are all consultants satisfactory trainers?- Are there Regular trauma/audit and journal

meetings?- Is there a adequately equipped registrar

room?- Is the Job Plan variable/service provision?

8 questions: max score of 40

THE TRAINER Sub-speciality of orthopaedics that ‘trainer’ believes is

provided. TRAINER 4 questions

Approachable/supportive/interested in training/adapted to your training needs

Surgical supervision:- Trauma & Elective :- 4 Q’s Out-patient supervision :- 3 Q’s Mini-logbook. Based on OCAP index procedures. Number procedures as primary surgeon

Total number of procedures with trainer

OCAP compliance Research and Audit support.

TRAINEE SUMMARY Trainee selects what the placement

delivers in terms of sub-speciality training. Appropriate trainee level for the placement. Mini-logbook for the entire attachment Placement recommended to a colleague

(they got on with!!!) Open comments of how to get the most out

of the attachment FEEDBACK ON THE SURVEY

<24 POOR UNIT24-<32 BORDERLINE/POOR UNIT =>32 ACCEPTABLE/GOOD UNIT

Trainer surgical clinical1 19 19 8.5

2 12 12 9

3 16.5 16 7

4 14 12 9

Trainer surgical clinical1 19.5 18.5 14.5

2 16 16 15

3 20 20 14

4 20 16 12

5 20 16 12

6 18 20 13

The Future

STC

Initial TrainingSlots Data

Post Training Slots Allocation

Trainers

Next phase

• Ask Trusts whether they want remain as training Trusts

• Ask individual Trainers whether they want to remain as Trainers

• Ask what training can be offered• Invite bids from pairs of Trainers for training

opportunities from ST3 – ST8

Regional Representatives Meeting RCS June 2010

Results

• Bid quality varied hugely

• Bids assessed by same committee

• Trainees intimately involved

• Excess bids over slotsRegional Representatives Meeting RCS June

2010

Next phase

• Year 1 – Hip 1, Knee 1• Year 2 – Shoulder & Elbow, Foot & Ankle• Year 3 – Hip 2, Knee 2• Year 4 – Hands, Paeds, Spines*• Year 5 - Subspeciality • Year 6 - Subspeciality

Regional Representatives Meeting RCS June 2010

Each programme, and every trainer, will wish toretain a degree of individuality, whether of

organisation (4, 6 or 8 month attachments) orspecialty selection. It is intended that the curriculumdesign will be able to recognise this, whilst providing

a consistency of standard and outcome.

Regional Representatives Meeting RCS June 2010

Outcome

• Successful allocation of bids to slots

• Gains by some Trusts

• Losses by others

• Trainees very happy - 4 year programme of specific Trainee/Trainer contracts

Regional Representatives Meeting RCS June 2010

Deanery permission / finance

• Dean to ratify

• Chief Executives

• Financial implications

• Tight for August 2010

Regional Representatives Meeting RCS June 2010

On-going Q & A

• Reassessment

• Waiting in the wings

• New Consultant Trainers

• Review every 2 -3 years

Regional Representatives Meeting RCS June 2010