3.5 million population 9 Acute Trusts Coast to Coast /Yorkshire to Scotland 315 (77+238) trainees 379 Consultants Lester Sher Northern Academy of Postgraduate Surgery NAPS The Paradigm shift The view from a surgical school; past, present and future Tutors and Advisors RCSEng May 2009

Overview The Context The paradigm shift Future direction QM and the development of the TPA QM in action / NAPS in action Aspirations and challenges

Deanery & Hospitals Hexham Carlisle Durham Whitehaven Bishop Auckland Darlington Friarage Wansbeck Freeman/ RVI/General Queen Elizabeth South Tyneside Sunderland Hartlepool North Tees James Cook

Manpower context

Performance context

a paradigm shift

PMETB Training Standards

A curriculum is a statement of Educational principles Syllabus Waypoints Mode of assessment Standards to be achieved “implicit becoming explicit”

Future direction expectations are becoming increasingly explicit MMC PROGRAMME BOARD TASK & FINISH GROUP ON QUALITY Jan 2009 Maintaining Quality of Training in a Reduced Training Opportunity Environment

The DH should make the measurement of the quality of training provided by Local Education Providers part of the remit of the Care Quality Commission. The DH must consider mechanisms specifically to incentivise high quality training provision.

MMC PROGRAMME BOARD TASK & FINISH GROUP ON QUALITY Jan 2009 Maintaining Quality of Training in a Reduced Training Opportunity Environment Deaneries/SHAs should be proactive in assuring themselves of “value for money” for their investment in training NAPS Annual Salary bill for surgical trainees=£12.5 M

precise information is the key Can we specify “quality surgical education” “value for money” ?

PMETB Domain 2 Quality Assurance Review and Evaluation Mandatory and annual Owned by local faculty Programme evaluation Driver for improvement with the development of an “action plan” Centre to provide externality

Action planning is an “empowering” activity if owned by local faculty

NAPS QM 2007 Domain 5: Delivery of Curriculum incl Assessment Early Years GeneralT & OENTNeuroPlasticsPaedsCardiacMaxFaxUrology 5.1 Enough practical experience 5.2 Must show how posts combine 5.3 Access to training days & materials 5.4 Assessment system must be applied 5.5 Regular feedback to trainee

Training Post Assessment (TPA) Quality monitoring of posts Providing feedback to trainers (faculty development) ?accreditation tool

Over arching strategy

Training Post Assessment (TPA) Unique to NAPS Resonates with PMETB domains Mandatory Web based Work started Sept 06, continuous refinement currently 641 returns. 2 reporting formats, specialty and hospital

Domain 1 Patient Safety SPECIALTY REPORT

Domain 1 Patient Safety TRUST REPORT

Domain 5 Delivering the curriculum

Domain 6 Support and development of trainees

Level of supervision appropriate to the trainee=ability to give constructive feedback on performance Suitable job plan with appropriate workload and time to develop trainees PMETB STANDARDS FOR TRAINERS Domain 6 Support and development of trainers

Never too late to learn Paul Streets CEO PMETB Unlike GP trainers, the majority of trainers in hospital medicine are not trained to train, and they work in an environment characterised by increasing service pressures and the demands of the consultant contract and the job plan. GP trainers are selected, trained, and paid for the job. bmj D

Sent to 379 Consultants; 146 returned (39% return rate) NAPS Consultant Survey “Counting the cost of surgical training” Sent outReturned Cardiothoracic185 ENT3718 General Surgery11949 Neurosurgery176 OMFS143 Paediatric Surgery71 Plastic Surgery2110 T & O11547 Urology

Do you supervise? Educational Supervision 81% 62% 1 – 2 trainees 49% more than 3 meetings required Clinical Supervision 92% 68% trainees 82% having a trainee extends lists/clinics 51% had received no formal training to prepare them for roles.

Level of concern re trainees undertaking procedures 63% Moderate/High concerns 48% patient safety 33% quality of procedure /standards of care 12% extended time taken Clinical supervision is major task

Job planning Time in Job Plan for Education 66% 0 or don’t know 16% Less than 1 SPA 6% 1 SPA or more

Domain 6 Support and development of trainers: faculty development

Domain 7 Management of Education and Training Clear Roles and responsibilities across the school Integrated Induction Conduct of programmes “themed” ST1/ST2 with single educational supervisor of parent specialty setting objectives including out of specialty placements assessment strategy specified at induction rationalisation of early years jobs Strategic role of school: achievements

Domain 7 Management of Education and Training Structures and Resources STC structure/representation PDs (all now remunerated) 0.8 WTE to 3.8 support workers “Faculty Development” strategy for school “School identity” STC, Trust and CEO presentations faculty survey, “NAPS” newsletters Strategic role of School: achievements

aspirations for the future expectations are becoming increasingly explicit

For the trainee Ethos of self reliance Take control of learning agenda, objectives reflective activity collection and maintenance of evidence Prepare for assessment understand the requirements

For the trainer Understand your responsibilities and become actively involved in developing your expertise to discharge these Recognize that Quality Monitoring ensures healthy critique and consequent “action planning”

For the employer Education and Training are to be valued and regarded as equally fundamental to health as good clinical care and shorter waiting times

For the RCSs and SACs Provide standards that define surgical trainers capable of providing quality feedback that define a working environment conducive to surgical education and training that define a surgical job plan that adequately recognizes these issues.

Training Standards? Trauma experience in the UK and Ireland: An analysis using the FHI elogbook. Jameson, Lamb, Wallace, Sher, Marx, Reed. Injury

apprentice training structured education service Perennial Tensions The Role of the Surgeon Educator: Tutors and Advisors RCS Nov 2001

Manpower planning Education and training Service configuration The holistic challenge; can we reconcile?

MMC PROGRAMME BOARD TASK & FINISH GROUP ON QUALITY Jan 2009 Maintaining Quality of Training in a Reduced Training Opportunity Environment Local Education Providers must ensure that trainers and trainees have sufficient, accessible time in their job plans for training and education