3.5 million population9 Acute TrustsCoast to Coast /Yorkshire to Scotland315 (77+238) trainees 379 Consultants

Lester Sher Northern Academy of Postgraduate Surgery NAPS

The Paradigm shiftThe 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

0.0

5.0

10.0

15.0

20.0

25.0

North E

ast

North W

est

Yorksh

ire a

nd the

Humber

East M

idla

nds

Wes

t Mid

lands

East

London

South E

ast

South W

est

Wal

es

ON

S E

xces

s W

inte

r D

eath

Ind

ex (

%)

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 & FINISHGROUP ON QUALITY Jan 2009

Maintaining Quality of Training in a Reduced Training Opportunity Environment

MMC PROGRAMME BOARD TASK & FINISHGROUP 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 & FINISHGROUP 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 2Quality 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

General

T & O ENT Neuro Plastics PaedsCardiac

MaxFax

Urology

5.1 Enough practicalexperience

5.2Must show how posts combine

5.3Access to training days & materials

5.4Assessment system must be applied

5.5Regular 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 SafetySPECIALTY REPORT

Domain 1 Patient SafetyTRUST REPORT

Domain 5 Delivering the curriculum

Domain 6 Support and development of trainees

Domain 6 Support and development of trainees

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 learnPaul Streets CEO PMETB

Unlike GP trainers, the majority of trainers inhospital medicine are not trained to train, andthey work in an environment characterised byincreasing service pressures and the demandsof the consultant contract and the job plan.

GP trainers are selected, trained, and paid for the job.

bmj.39491.559815.7D

Sent to 379 Consultants; 146 returned (39% return rate)

NAPS Consultant Survey “Counting the cost of surgical training”

Sent out Returned

Cardiothoracic 18 5

ENT 37 18

General Surgery 119 49

Neurosurgery 17 6

OMFS 14 3

Paediatric Surgery

7 1

Plastic Surgery 21 10

T & O 115 47

Urology 31 7

379 146

Do you supervise?

Educational Supervision 81%

62% 1 – 2 trainees49% more than 3 meetings required

Clinical Supervision 92%

68% 1 - 2 trainees82% 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

Feedback

0

10

20

30

40

50

60

70

80

90

100

1 2 3 4 5 6 7 8 9 10 11 12

Rank

Sc

ore

(%

)

Domain 6 Support and development of trainers: faculty

development

Feedback

0

10

20

30

40

50

60

70

80

90

100

1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37

Rank

Sc

ore

(%

)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

evidencePrepare 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 2008. 39. 844-852

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 & FINISHGROUP 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