MMC and SHO Training in Anaesthesia

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MMC and SHO Training in Anaesthesia

• September 2006
• Dr Jo Lamb
• NEMSA SHO Training Director

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• Brief background information
• The Acute Care Common Stem Programme
• Guiding principles for framework development for
  Mid Trent
• MMC
• Deanery
• Educational aims
• School decision-making
• Interface with service needs

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(No Transcript)
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Specialist Training Programme in Anaesthesia

• Most trainees via ST1 and ST2 Anaesthesia
  training (equivalent to current SHO training)
• Minority via Acute Care Common Stem Programmes
  (acute medicine, emergency medicine,
  anaesthetics, ICU). ACCS trainees destined for
  Anaesthesia or Anaesthesia with ICM would enter
  at anaesthetic training at ST2 and would not need
  to compete again
• Major logistical problem if all new anaesthesia
  specialty trainees start on one date a year.

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RCoA statement Selection for TP in Anaesthesia

• Selection into ST1 No requirement for exams or
  anaesthetic experience
• Must have completed foundation training or SHO
  training in an approved post
• Selection methodology unresolved, probably
  electronic sifting then a combination of
  portfolio and assessment centre /- interview
• (Selection into ST2 and ST3 criteria not yet
  published)

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Local situationAnaesthetic and ICU SHO Posts
funded by Mid Trent (excludes Grantham and
Chesterfield)
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Number of ST posts to feed SpR numbers

• 60 SpRs in NEMSA, equates to 12 a year in a five
  year SpR programme.
• RCoA recommends a 7 year Specialist Training
  programme ie no change to SpR time and no plans
  to change SpR numbers
• Therefore need 12 ST 1 and 12 ST 2 places a year
  (total of 24 SHO equivalents).
• Deanery plans for a 10-20 reduction in order to
  avoid potential over-recruitment, DW suggests 9
  ST1 and 9 ST2 (ie 18 SHO equivalents)

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What will happen to excess posts?

• David Sowden (22.06.06)
• Whilst MMC will see the abolition of the SHO
  grade from Aug 1st 2007 I would like to emphasize
  that TMPD does not have any short term plans to
  reduce the total number of training posts at this
  level. However the designation of these posts
  will change. In the longer term, discussions
  will need to take place between the Deanery and
  Trusts to determine the extent to which they wish
  to maintain their current establishment of SHO
  equivalent posts.

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Other drivers for considering conversion to non
training posts

• Recruitment difficulty especially experienced
  doctors
• RCoA Trainee numbers historically related to
  service needs (rather than workforce planning)
  and the current situation of trainees delivering
  service is unsustainable
• RCoA estimate continuing to use same number of
  trainees to deliver service would result in
  overproduction of 240 CCT holders a year bad
  news for the profession
• If service work is transferred to career grade
  posts, trainee numbers will fall to the number
  needed to replace retirements

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What will happen to excess posts?We have 75 and
we need 18 for ST

• Some posts will go to Acute Care Common Stem
  Programme (current plan is for 6).
• Option for conversion to F2
• Posts will be converted to Fixed Term training
  posts FTSTAs.
• (DW plan for a total of 10 FTSTAs to cover
  potential ST gaps)
• Some departments may convert posts to career
  grade posts (lose deanery funding)

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Mid Trent ACCS Programme

• Only point of entry for EM (AE) Specialist
  training, therefore minimum number of posts is
  that needed to feed that TP (min. 4/year)
• Main point of entry for Acute medicine specialist
  training therefore should allow capacity for that
  TP (? 2- 4 /year)
• ICM trainees still need parent specialty (Anaes
  or Medicine) allow capacity

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Mid Trent ACCS Programme

• Current plan is for a programme with 24 trainees
  with 12 in each year and at any one time 6 ACCS
  trainees in anaesthetics.
• 3 trainees will do 4/12 anaesthetics and 3 will
  do 8/12 anaesthetics. For purposes of service
  regarded as novices.
• EM and Acute Medicine do not link to Lincoln or
  Boston, for educational supervision aim to place
  at QMC (2), NCH (1), KM (1) and Derby (2)
• Plan for this template and the Deanery can
  designate posts as ST or FTSTA and destinations
  at a later date.
• Need to decide how many ST2 places NEMSA will
  reserve for ACCS trainees (?2)

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Summary so far

• 68 Mid Trent posts
• 9 for ST1
• 9 for ST2 2ST2 from ACCS
• 6 for ACCS
• 6 for FTSTA ST1 backup
• 4 for FTSTA ST2 backup Total 36
• Estimate for mid Trent 32 funded posts left
• BUT some of these are really ICU posts

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RCoA Training requirements

• General anaesthesia competencies
• At least 3 months ICU in one block
• Obstetric competencies
• Exposure to trauma
• Local considerations
• No trauma at NCH
• ICU dilutes anaesthesia experience in Boston
• ICU blocks only available QMC, NCH, Derby

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The Novice Problem

• Mainly a service not a training problem
• Major logistical consideration in setting up
  programmes
• Must be able to identify novice posts for ACCS
• Should identify enough novice posts for FTSTAs to
  avoid recruitment problems
• Implications for on call rotas

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The Novice Problem

• Novice posts identified
• QMC 4/14 28 11 /2 rotas served
• NCH 3/10 30 11 /2 rotas served
• KMH 2/7 28.5 1 rota served
• Lincoln 2/6 33 1 rota served
• Boston 1/7 14 1 rota served
• Derby 4/ ?
• Maximum of 16 novices in mid Trent at any time

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Principles for local framework draft

• Training divided into 4 month blocks
• Novice places available as set out earlier max
  16 Aug-Nov, 11 Dec-Mar, 0 Apr-July
• All ST and programme FTSTA trainees do 4 mths
  ICU in year 1 delivered at QMC, NCH or Derby
• All trainees work at 2 Mid Trent hospitals
• Minimum time at any hospital is 8 mths
• All trainees spend minimum of 8 mths at QMC or
  NCH except one ACCS entering ST2 in Derby
• Try to agree template for ST (incl ACCS) trainees
  and programme FTSTA trainees and then decide
  what to do with the remaining posts.

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Service Considerations

• There will be higher proportion of novice
  trainees than at present
• Novice trainees may need to be released for
  centrally run teaching sessions
• There will be a higher proportion of trainees
  with less than 12 months experience than at
  present
• There is a lot to learn in 24 months
• It is not educationally sound for a significant
  amount of training time to be spent
  asleep/resting
• There may be more F2 posts, ? consider putting in
  a rota with other inexperienced trainees

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• Questions?