Core Training in Surgery

1
Core Training in Surgery
Are we nearly there yet?

• Chris Munsch
• Joint Committee on Surgical Training

2
Principles of design

• Purpose
• Function
• Form

3
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

4
What should core training deliver?

• Generic professional competencies
• Generic surgical competencies
• Specialty specific competencies to allow progress
  into higher surgical training
• Career advice/direction

5
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

6
The F2 Question

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

7
Career choice when and how?

• Limited information, probably inconsistent
• Influence of undergraduate and F1/2 experience
• Most know what they dont want to do
• If the system forces people to make a choice then
  they will

8
Career choice when and how?

• Survey of timing of career choice by TO 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 TO representative of all surgical
  specialities?

9
Run-through, themed or generic?

• TO and Neuro (and Scotland) continue to favour
  run through
• Generic surgical programmes
• Themed programmes
• Musculoskeletal
• Head and neck
• Torso
• Mixed economy?

10
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

11
Foundation 2
Competency based progression
Selection
Specialty Run Through Programme
Core Surgical Programme
ST1
CST1
Generic
ST 2
CST2
CST3
Themed
ST3 (Higher Specialty Training)
12
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?

13
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)

14
Role of non surgical specialities

• General professional competencies relevant to
  surgery
• AE, HDU
• Speciality specific competencies
• Neurosciences programme
• Do they add educational value?
• Require more programme time
• Transferable skills inform career choice and aid
  movement

15
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