Aims, principles and benefits ISCP Aims, principles and benefits

Overview Background, Aims, Key principles Curriculum components Benefits for patients, training, trainees The syllabus Skill levels Stages of training, stages diagram Curriculum standards Assessment system Learning opportunities Summary of curriculum competences

Background Project 2003-2007 Impetus for change created by the realisation that major changes were needed in surgical training Project funded by the UK and Irish Departments of Health and Royal Surgical Colleges The JCST and SACs led the process for curriculum development Produced on an intercollegiate basis In partnership with OCAP In collaboration with those charged with delivering health services Launched in 2007 Under the umbrella of the JCST

Aims Provision of excellent care for the surgical patient, delivered safely Highest standards of UK surgical practice through high quality surgical training Programme of surgical training from core to certification At completion of training, able to provide common, elective and emergency service and defined level of specialised service

Key principles Common format across all surgical specialties Systematic progression through stages of training Curriculum and assessment system that meet GMC standards Competence-based (time points are indicative) Professional and leadership skills Delivery by skilled clinicians, appropriately trained Learning partnership between trainee and trainer Involvement of qualified members of the multidisciplinary team Promotion of equal opportunities and diversity in training Collects data to evaluate and enhance training & assessment

Curriculum components Standards Assessment System & methods Learning portfolio Training structure Syllabus SAC development & review Stages of training Educational programme Appraisal & Learning Agreement Training roles for supervision Reflective practice QA Regulator approval

Benefits for patients Designed to produce surgeons who are able to provide excellent care for the surgical patient, safely Promotes effective working practices and service delivery Provides supervision and accountability through key roles Provides transparency through an explicit assessment system and portfolio Ensures lay and patient involvement in curriculum development and review

Benefits for training Provides a structured and supervised framework with a definable endpoint Promotes high-quality teaching and learning Based on clear standards covering all surgical specialties Reviewed and maintained by surgical SACs Promotes patient safety Affirms professional and educational values Rigorous and fully integrated assessment Meets GMC standards

Benefits for trainees Promotes consistent training experience in the UK Mandates the interaction between trainer and trainee Mandates the training of trainers Provides a clearly defined syllabus Provides explicit feedback on practice Provides a portable portfolio of conduct and practice Provides guidance for professional development Provides web-based access including Apps

Benefits for trainers Maps to standards for trainers Provides recognisable educational roles and training structure Provides guidance for trainers, assessors & supervisors Provides tools for recording discussions with trainees Helps to provide evidence of trainer engagement for appraisal and revalidation

Assigned Educational Supervisor Training Structure Multi-professional Team School of Surgery Postgraduate Dean Programme Director Assigned Educational Supervisor Trainee Clinical Supervisor

The PD role Organise, manage and direct the training programme Appoint local faculty as AESs and CSs Organise faculty development, trainee induction and training for MPT Oversee progress of individual trainees Ensure appropriate levels of supervision, training and support Identify remedial training and resources where required Work closely with Colleges SACs on curriculum delivery Administer and chair the ARCP

The AES role Overall educational and supervisory responsibility for the trainee Ensures induction of the trainee to the unit Ensures trainee works to the curriculum and assessment system Ensures patient safety in relation to trainee performance Acts as a mentor to the trainee Provides appraisal and a placement learning agreement Monitors the trainee’s portfolio to ensure educational progress Presents formative feedback to the trainee Keeps the PD informed of any issues that may affect training Involves senior faculty in the formal report to the annual review Provides an AES report for the ARCP

The CS role Under the delegated authority of the AES Ensure appropriate day-to-day supervision of the trainee Carries out WBA and delivers feedback Ensures patient safety in relation to trainee performance Liaises with the AES and faculty about trainee progress Keeps the AES informed of any issues about training Contributes to the AES report for the ARCP

The trainee role Takes responsibility for own learning Triggers WBA frequently Exploits learning opportunities Attends educational programme Agrees the learning agreement with the AES Raises issues and difficulties promptly Conducts self-directed learning e.g. peer and self-assessment and reflective practice Keeps an accurate and up to date portfolio

The syllabus Specialty-based knowledge Clinical skills and judgement 4 Domains: Specialty-based knowledge Clinical skills and judgement Technical and operative skills Professional and leadership skills

The syllabus Defines what trainees should know and be able to do Informs assessment Specialty overview of the scope of practice Key topics that all trainees must be able to manage Index procedures, indicative of all specialty procedures Topics can be used as learning objectives Skill levels indicate the required level of performance

Skill levels Indicate the level of competence to be achieved Ensure learning is based on progression Increase with depth and complexity of practice Increase as the need for supervision decreases and trainees become more proficient Correspond with logbook supervision levels

Knowledge skill levels 4. Knows specifically & broadly CORE e.g. Can: Interpret Distinguish Compare/contrast 3. Knows generally e.g. Can: Explain Identify Locate 2. Knows basic concepts e.g. Can: Define Discuss Describe 1. Knows of e.g. Can: List Name

Knowledge skill levels 4. Knows specifically & broadly Intermediate/Final e.g. Can: Manage Judge Rate / Estimate 3. Knows generally e.g. Can: Interpret Distinguish Compare/contrast 2. Knows basic concepts e.g. Can: Explain Identify Locate 1. Knows of e.g. Can: Recall Discuss Describe

Clinical / Technical skill levels 4. Competent to do without assistance, including complications Manages common and difficult cases; UK consultant level; Can supervise. 3. Can do whole but may need assistance Deals with common problems, variations; Requires advice rather than help. 2. Can do with assistance Knows rationale; Straightforward procedures; Knows when to ask for assistance. 1.Has observed Knows steps; Handles instruments; Performs some parts. Knows of

Stages of training Defined to reflect the training pathway of the specialty Provides a means of charting progress against domains of knowledge, skills and behaviours Allows benchmarking of progress Core component is common to all specialties supplemented by a small specialty-specific component Intermediate and final stages reflects the increasing scope of specialty practice

Stages diagram

Curriculum standards Each training stage is underpinned by explicit outcome standards in 4 domains Standards form the basis for specifying syllabus content Organise workplace training in terms of case mix and case load Basis for identifying relevant teaching and learning opportunities

Assessment system Learning Agreement Determines whether trainees are meeting the standards of competence Learning Agreement Assigned Educational Supervisor (AES) Report Workplace-Based Assessment + Logbook AoA CEX / CBD / DOPS / MSF / OoT / PBA Courses: ATLS / APLS Annual Review of Competence Progression (ARCP) MRCS Examination FRCS Examination

WBA methods WBA Clinical Evaluation Exercise - CEX Case Based Discussion – CBD Direct Observation of Procedural Skills – DOPS Multisource Feedback - MSF Procedure Based Assessment – PBA Observation of Teaching – OoT Assessment of Audit – AoA

Learning Agreement Comprises PD Global Objective Syllabus topics for the stage of training Agreed learning opportunities and resources Agreed evidence required - WBA, Exams, Audit etc. AES Comments Trainee Comments Link to portfolio of progress CS Report AES Report

Learning opportunities 3 broad areas: Learning from practice Learning from formal situations Self-directed learning

Learning opportunities Learning from practice Any workplace interaction has the potential to become a learning episode Workplace assessment Shadow peers and consultants On-going systematic feedback, both formal and informal Reflection on practice

Learning opportunities Learning from practice - settings Theatre Operative units Clinic Ward Multi-disciplinary meetings Community

Learning opportunities Learning from formal situations Educational programme arranged locally Local, national and international level e.g. courses, seminars, meetings, simulation (technical and human factors)

Learning opportunities Self-directed learning Trainee-led Vital component of continuing professional development Study groups, journal clubs and peer review Learning with peers at teaching sessions Personal study Written reflections on practice Research, projects and audits

Learning portfolio Repository of evidence of the trainee’s practice Audit trail of training Web-based and password protected Fitness to practise Planning personal development Appraisal and the learning agreement Workplace-based assessment (WBA) and reflective practice Record of educational achievement Annual review Foundation for continuing professional development

Reflective practice Purposeful use of experience/feedback to improve practice Requirement of the curriculum and part of CPD Appended to WBA MSF Self-assessment Linked to Case-Based Discussion (CBD) Personal Development Plan Journal Entries must respect confidentiality of colleagues and patients

Summary of curriculum competences Clinical Care History taking, examination skills Taking consent Relevant knowledge and diagnostic skills Ability to formulate appropriate management plans Procedural (technical) skills Record keeping Maintaining good medical practice Ability to manage time and work under pressure Decision making and implementation skills Reflective practice and awareness of own limitations Initiative and leadership skills Focus on patient safety Learning and teaching Willingness to ask for feedback and to learn from it Teaching Relationships with patients & colleagues Communication with patients and their relatives Communication with colleagues Active involvement with your team Accessibility and reliability