Core Training in Surgery Chris Munsch Joint Committee on Surgical Training Are we nearly there yet?

Principles of design Purpose Function Form

What is the purpose of core training? Acquire relevant competencies Determine career choice Determine suitability for that career Acquire relevant transferable competencies Allow movement into another (more appropriate) career

What should core training deliver? Generic professional competencies Generic surgical competencies Specialty specific competencies to allow progress into higher surgical training Career advice/direction

The structure of core training? The F2 question Career choice – when and how? Run through, themed or generic programmes? How long? Management of core training Assessment and selection The role of non surgical modules

The F2 Question Here to stay (for now) Generic or vocationally themed 2x6 or 3x4?

Career choice – when and how? Limited information, probably inconsistent Influence of undergraduate and F1/2 experience Most know what they don’t want to do If the system forces people to make a choice then they will

Career choice – when and how? Survey of timing of career choice by T&O surgeons (Willett) – 35% by year 1 – 56% by year 3 – 84% by year 5 – 77% previous experience was major factor in choice – 73% ‘what I want to do’ Data can be used to support or refute concept of run through Is T&O representative of all surgical specialities?

Run-through, themed or generic? T&O and Neuro (and Scotland) continue to favour run through Generic surgical programmes Themed programmes: – Musculoskeletal – Head and neck – Torso Mixed economy?

How long? (2 or 3 years) Nature of F2 Different for run through and core programmes? Acquisition of generic vs speciality specific competencies ST3 entry requirements not being consistently met by 2 year core eprogrammes EWTD – more to come

Foundation 2 ST1CST1 ST 2CST2 CST3 ST3 (Higher Specialty Training) Specialty Run Through Programme Core Surgical Programme Competency based progression Selection Generic Themed

Management of core Competencies defined in ISCP ‘Light touch’ from JCST Deaneries and Schools of Surgery determine delivery External QA? Oversight group for core surgery?

Assessment and selection Run through programmes - selection at end of F2 Entry to HST dependant on satisfactory progress Themed/generic – ‘soft’ selection at ST1 National selection into HST at end of core Selection ratio of 1.2 : 1.? MRCS exam generic within the context of three themes (musculoskletal, head and neck or torso)

Role of non surgical specialities General professional competencies relevant to surgery – A&E, HDU Speciality specific competencies – Neurosciences programme Do they add educational value? Require more programme time Transferable skills inform career choice and aid movement

Summary Core surgical training is not yet a ‘done deal’ 3 year core programmes are preferred Mixed economy might work but needs piloting Light touch from JCST More work is needed on factors affecting career choice Things will change