1. Sub speciality PCI training in the United Kingdom Tim Gray Cardiology SpR Manchester Heart Centre

2. Current System Currently no formal arrangements for sub-speciality training: Currently no formal arrangements for sub-speciality training: Arrangements for sub-speciality training made at deanery and trust level Arrangements for sub-speciality training made at deanery and trust level No formal training programme No formal training programme Often ad hoc start to training Often ad hoc start to training No clear end goals No clear end goals No proficiency assessment No proficiency assessment

3. Current Training model Ad hoc apprenticeship based training Ad hoc apprenticeship based training

4. Proposed training model Apprenticeship based training Apprenticeship based training DOPS (Directly observed procedural skill) assessment DOPS (Directly observed procedural skill) assessment 3 monthly appraisal by Supervisors and exit appraisal by Training director 3 monthly appraisal by Supervisors and exit appraisal by Training director Examination (in association with European Society) Examination (in association with European Society)

5. Problems Now European Working Hours Directive European Working Hours Directive Reduced PCI exposure Reduced PCI exposure Reduced continuity of care Reduced continuity of care Reduced emergency experience Reduced emergency experience SpR competition leading to several trainees with partial training SpR competition leading to several trainees with partial training Competition for PCI from established consultants re-training Competition for PCI from established consultants re-training Dilution of training with other clinical pressures Dilution of training with other clinical pressures

6. Problems now BJCA survey 2005

7. Benefits of change Minimum standard for clinical competence Minimum standard for clinical competence Higher quality of candidates if competitive selection Higher quality of candidates if competitive selection Higher SpR motivation Higher SpR motivation Stimulates focus on peri-procedural care as well as cath lab time Stimulates focus on peri-procedural care as well as cath lab time

8. Benefits of change Allows focus on sub-speciality Allows focus on sub-speciality Allows for dedicated teaching sessions by motivated trainers. Allows for dedicated teaching sessions by motivated trainers.

9. Problems of change

10. The interview process The interview process Huge regional variation in first few years Huge regional variation in first few years Will there be a national recruitment? Will there be a national recruitment? Less likely to have higher degree Less likely to have higher degree Trainees themselves may be less likely to appreciate sub-specialities Trainees themselves may be less likely to appreciate sub-specialities Interview process needs to be open and transparent Interview process needs to be open and transparent

11. Problems of change What happens if fail to secure training placement? What happens if fail to secure training placement? Forced to choose different sub-speciality? Forced to choose different sub-speciality? Take time out to find appropriate placement? Take time out to find appropriate placement? Will trainees be expected to move around the country to find a programme? Will trainees be expected to move around the country to find a programme? ?encourage local vs regional vs overseas fellows ?encourage local vs regional vs overseas fellows

12. Possibility of increased training time Possibility of increased training time What happens about overseas fellowships? What happens about overseas fellowships?

13. Conclusion Change to a formal training programme is welcomed Change to a formal training programme is welcomed Ideal time to instigate change in sub- speciality training Ideal time to instigate change in sub- speciality training Need to decide on recruitment process soon. Need to decide on recruitment process soon.

14. Thank you Thank you Questions? Questions?