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National Basic Surgical Training Programme

Trainee Handbook July 2008

Royal College of Surgeons in Ireland

Trainees are advised to read the contents of this handbook carefully. Questions should be sent via email to surgicaltraining@rcsi.ie.

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Contents: §§ Welcome

§§ Operative Surgical Skills Programme

§§ Human Factors in the Surgical Arena

§§ SCHOOL for Surgeons

§§ BeST Online

§§ The CAPA Process – Competence Assessment and Performance Appraisal

§§ Training Portfolio

§§ Regional Postgraduate Vice Deans

§§ Help and Advice

§§ Sick Leave and Maternity Leave

§§ Rotations

§§ Basic Surgical Training Committee

§§ Quality Assurance & Hospital Accreditation

§§ Intercollegiate Membership Examination (IMRCS)

§§ Certificate of Completion of Basic Surgical Training (CCBST)

§§ College Facilities

Disclaimer:

This document has been devised to provide general guidance for trainees on the National Basic Surgical

Training Programme. The content is subject to regular update and review.

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Welcome Congratulations on your appointment to Basic Surgical Training (BST) and welcome you to your new career in surgery. I trust you will settle in well to your new post, which you will start next week. You are now on one of the eight Basic Surgical Training (BST) Programmes which are officially recognised for training by the Royal College of Surgeons in Ireland. BST is a carefully structured two-year programme which will introduce you to the principles of surgery in general. Towards the end of BST you will take the Intercollegiate Membership examination (IMRCS) and, following a satisfactory review of your training, you will receive a Certificate of Completion of Basic Surgical Training (CCBST). This will entitle you to apply for Higher Surgical Training in your chosen speciality. During your hospital rotations you will work with one or more Consultant Surgeons who will be specifically responsible for your training at hospital level. As soon as possible after your appointment you should make an opportunity to discuss your training plan and training needs with your Consultant. You will of course be expected to participate fully in the service needs and service provision of your team. You will also work under the supervision of a Regional Vice-Dean. The Vice Dean is responsible for the nature and timing of your appraisal sessions. Continuation on the BST programme is dependant on satisfactory performance appraisals. You will be called for an appraisal session every six months. The appraisal sessions are conducted according to the CAPA Process (Competence Assessment and Performance Appraisal) (see page 9). Clear and explicit guidelines as to what is expected of you are contained in this booklet. The award of the CCBST is dependent, among other things, on satisfactory workplace assessments and an active participation in the structured education programme. The College is here to support your education and training needs during Basic Surgical Training and should be consulted if you have difficulties or problems at any time. We have developed a comprehensive training curriculum which has three major components:

1. Core Knowledge 2. Technical Skills 3. Personal Skills

The “Core Knowledge” component of your education programme is delivered online via the SCHOOL for Surgeons. A group of Online Tutors work together with the Vice Dean for Distance Learning to develop weekly online teaching modules for trainees. Teaching modules are largely case-based and are based on actual clinical cases. There is an opportunity for clinical discussions and debates online and you will have access to BeST Online to enhance your educational experience. You will be given weekly assignments by the Online Tutors that you will be expected to complete by a clearly defined deadline (see CAPA Process). To maximise the value that you will get from SCHOOL for Surgeons you will need access to a computer and to the Internet. I have already written to hospital managers suggesting that computers and high speed Internet access be made available in your hospitals, but you should also have access to your own laptop / personal computer. The use of this distance-learning programme should greatly enhance your computer skills as well as your knowledge of surgery. Your user instructions for SCHOOL for Surgeons and BeST Online are enclosed in your registration pack. The second component of the educational programme is the “Technical Skills” component. The curriculum for operative surgery has been divided into modules which cover the entire spectrum of operative procedures appropriate to your level of training. Trainees in year one will complete the Basic Surgical Skills Course plus four modules, whilst trainees in year two will complete six modules. Each module corresponds with approximately one day of intensive technical skills training. The technical skills modules will be delivered in the specially commissioned surgical skills laboratory at RCSI and on the Mobile Surgical Skills Unit and a panel of surgical skills tutors will work with you to take you through the various operative procedures. It is anticipated that you will have a technical skills training day approximately every eight weeks. Attendance at the operative skills training days is mandatory and will form part of your continuous assessment.

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The “Personal Skills” component of your educational programme will focus on the important but often neglected areas of teamwork and leadership, interpersonal skills and conflict resolution, crisis management and avoidance of error, stress management and time management. It is anticipated that you will attend for three days each year for personal skills training. A calendar for the classes you have been allocated to for both the Operative Surgical Skills Programme (“Technical Skills”) and Human Factors Programme (“Personal Skills”) will be forwarded to you over the summer. As soon as you receive the calendar you should talk to your supervising Consultant or whoever is in charge of your rota to book time off. Clearly, the type of educational programme that you are about to undertake costs a considerable amount of money and we have already indicated to you that you will be charged a fee each year. I hope that you will quickly agree that the quality of the educational programme which we are about to provide for you is unlike anything which is available at the present time and that it represents excellent value for money. The College also provides other optional skills courses which are an important component of your training.

q The Advanced Trauma Life Support Course is an excellent course, which is run under franchise from the American College of Surgeons. It introduces trainees to the early management of the severely injured patient. I would urge you to register for this as early as possible.

q The Care of the Critically Ill Surgical Patient (CCrISP) Course provides very useful training in the

management of the acutely ill patient. Although the above courses can be taken at any time I would strongly suggest that you take the ATLS Course during your first year and the CCrISP Course during your second year. You will have received details of your login account for your e-logbook in your in your registration pack. It is very important that you keep your e-logbook up to date and ensure that the Consultant with whom you are now working with regularly signs it off. This is an important record of your surgical experience and will be closely examined prior to the award of your CCBST. Finally, I would like to emphasise that help or advice is readily available should you have any difficulties or any problems at any time during your training. You should, in the first instance, speak with the Regional Vice-Dean for your particular programme but I would like to stress that I would be happy to meet with you at any time if you so wish. Once again, WELCOME to Basic Surgical Training. Professor Oscar Traynor MCh FRCSI Professor of Postgraduate Surgical Education Director, National Surgical Training Centre

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Operative Surgical Skills Programme The Operative Surgical Skills Programme is based on the Syllabus for Operative Surgery, which has been drawn up by the Royal College of Surgeons in Ireland. The programme is run in the National Surgical Training Centre at RCSI and on the Mobile Surgical Skills Unit. A team of Surgical Skills Tutors leads the sessions in RCSI: Mr. Brian Lane, Vice Dean of Postgraduate Surgical Education and Professor Peter Gillen, Consultant Surgeon, Our Lady of Lourdes Hospital Drogheda are both Senior Surgical Skills Tutors with dedicated sessions in RCSI. Training on the Mobile Surgical Skills Unit is delivered by local faculty. The programme is designed to give trainees the knowledge and skills necessary to become competent technical surgeons. This is not intended to replace training in the operating theatre but rather is complementary to practical workplace experience. The programme aims to allow Surgical Trainees to become proficient in key surgical techniques and procedures in a skills laboratory setting so that their time in the operating theatre can be put to better, more productive and safer use. The Operative Surgical Skills Programme has been spread across six years. Each year contains six modules and each module is intended to be of one day’s duration. Trainees will take the modules in sequence, doing one module at a time, at intervals of approximately 7 – 8 weeks. The Operative Surgical Skills Programme aims to re-establish traditional core values in surgical practice. Great emphasis will be placed on correct theatre etiquette and on familiarity with surgical instruments, suture materials and stapling devices. Likewise, great emphasis will be placed on good surgical technique, including correct knot tying, sound suturing and proficient dissections. Trainees will also be taught the importance of good haemostasis and good principles of asepsis. A strong emphasis will be placed on an appreciation of the medico legal aspects of surgical practice, with particular emphasis on informed consent and proper operation notes and records. Each module (i.e. each training day) will have the following features: 1. Precise learning objectives 2. Anatomy teaching 3. Didactic and practical sessions using a variety of teaching methods (e.g. video/DVD, internet resources, live links to operating theatres, simulation) An important component of each module will be small group discussion between Surgical Skills Tutors and trainees. For this reason, there will be a high tutor to trainee ratio and each trainee should receive individual attention. Each module will have practical components in which the trainees learn a particular skill or technique and there will be an element of assessment of the trainees during each term. There will be a strong emphasis on surgical anatomy and there will be practical anatomy demonstrations as an integral part of each module. Trainees will be given training in the management of crises during operative procedures and in the early recognition of complications. The programme will also expose trainees to new technology in surgery and give them an understanding of the limits and dangers of new technology. When trainees have reached a satisfactory level of proficiency in techniques and procedures in the skills laboratory, they will then be encouraged to perform these techniques and procedures under supervision in the operating theatre (Supervised Structure Assessment of Operative Performance – see CAPA Process). Having demonstrated basic competence in the workplace they will then be encouraged to accumulate experience by repeated performance of procedures which will be documented in their logbooks and consolidation sheets. In conclusion, the Operative Surgical Skills Programme aims to improve the technical skills and procedural ability of surgical trainees in a non critical environment so that they reach a level of proficiency which will allow them to make better and more efficient use of operating theatre training and promote safer surgery with better surgical outcomes.

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Human Factors in the Surgical Arena Human Factors in the Surgical Arena is a programme of personal skills for surgical practice which has been developed by The Royal College of Surgeons in Ireland specifically for surgical trainees. It aims to give surgical trainees the personal skills and attitudes necessary for successful surgical practice as part of a multidisciplinary team. It is clearly important for all surgeons to have a sound knowledge and understanding of the theory of surgical practice. It is likewise important for surgeons to be technically adept at the craft of surgery. On their own, however, knowledge and skills are not enough. There are surgeons who know virtually everything there is to know in the surgical literature but are less than adequate in the operating room. Likewise, there are surgeons who are technically very expert in the operating theatre but consistently fail to get the results that would be expected from such expertise. Sometimes, surgeons with less knowledge and less technical expertise get better outcomes for their patients because they operate on the right patients at the right time, they continue to perform well under stress or in times of crisis, and they manage to successfully harness the support of a multidisciplinary team to get the best results for their patients. This is the “human factor” in surgery. It has been estimated that only 25% of the important events which occur during a surgical procedure are related to manual or technical skills and that 75% relate to human factors such as decision making (especially during crises or emergencies), communication, team work and leadership. Other human factors which are important in surgical practice include self awareness (i.e. insight), conflict resolution and error management. It has always been considered that personal skills such as those listed above are innate aspects of ones personality and that they can neither be taught nor acquired. Whilst some individuals seem to be born with these skills, many others can have these skills improved by formal education and training. Although it is unlikely that one’s innate personality can be changed it is undoubtedly possible to alter aspects of behaviour which impact negatively on colleagues and on the team in the work place. With appropriate training, individuals can improve their personal skills and thus function more affectively as part of the multidisciplinary team in which all surgeons work in the 21st century. The Royal College of Surgeons in Ireland has developed a programme in human factors training to equip surgical trainees with the personal skills and attitudes required for modern surgical practice. The programme is based on a clearly defined syllabus. This syllabus includes ten modules, each of which contains four tutorials. The syllabus is arranged so that the modules can be taken in any order and a system of credits will be used to signify satisfactory completion of individual modules. Each module is designed to be delivered over a one day period and it is intended that each trainee will take three modules per annum. The programme will be delivered by acknowledged experts in the individual subject areas of each module. Each module will have precise learning objectives. The training will be delivered by a combination of didactic teaching and practical work which will involve role playing and small group discussions. There will be a heavy emphasis on audio visual support. Trainees will be encouraged to find solutions to human factor problems for themselves and they will be given assignments on which to work between modules. There will be heavy emphasis on practical application in the work place and the assignments will reflect the importance of work place application. Participation in the programme will form part of the Competence Assessment and Performance Appraisal (CAPA) process for all trainees. Above all the Human Factors Programme is intended to be an enjoyable experience for surgical trainees rather than a chore. The skills learned in the Human Factors Programme are essentially “life skills” and are not unique to surgical practice. Trainees will undoubtedly realize the value of the programme as part of their personal development as well as part of their surgical training.

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SCHOOL for Surgeons SCHOOL for Surgeons (an acronym for Surgical Conferencing with enHanced Opportunities for Online Learning) is led by the Vice Dean for Distance Learning; Mr. Sean Tierney, Consultant Vascular Surgeon, Adelaide & Meath Hospital, Tallaght. Mr. Tierney was appointed by Council in 2003. Goal To provide a regular and comprehensive online education programme which will support and complement BeST Online and which will facilitate the application of BeST content into real-life clinical practice throughout the country. General Principles • To incorporate BeST Online into the daily and weekly learning programme for surgical trainees. • To promote a culture of life long learning among surgical trainees through regular interaction with an online tutor. • To encourage self directed learning among trainees whereby they are active participants in their own learning process rather than mere passive recipients of knowledge. • To give trainees the skills necessary to access information and to critically analyse information • To develop knowledge management systems in surgical trainees • To encourage trainees to become part of a community of learners and to work in learning sets. • To improve the computer, keyboard and information technology skills of surgical trainees. • To facilitate the appropriate use of clinical investigations by surgical trainees in their everyday work. • To integrate the education programme of surgical trainees into their everyday clinical work Methods The education programme will be delivered primarily by the regular (weekly) online interactive conference. The content will include some or all of the following: • Virtual Grand Rounds, derived from the surgical conferences and grand rounds of some of the major

teaching hospitals. The cases will include a combination of general surgical cases and specialty cases. Cases will be presented online along much the same format as occurs at Grand Rounds. Questions and challenges will be posed for the trainees at various points during the presentation and they will be encouraged to produce evidence based answers. The case conferences will not be “live” but instead will use asynchronous computer mediated conferencing. This means that the cases will be posted online and the trainees can log-on at any time during the week to study the case presentations and pick up their assignments. They can then go and reflect on the issues raised, discuss the cases with their colleagues and their trainers and come back within the specified time with their responses. The primary information source to support these answers will be BeST Online but they will be encouraged to explore other learning resources and web sites. Trainees will be encouraged to work in learning sets and to discuss clinical cases with other trainees and with their own Consultants. The participation of trainees will be monitored online and feedback will be given to the Regional Vice-Deans for review at the appraisal sessions.

• MRCS short cases • Journal club • Journal watch • Recent advances in specialist areas Trainees can log on at http://www.schoolforsurgeons.ie using the username and password enclosed in their registration day packs.

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BeST Online BeST Online is an e-learning programme developed by the Royal College of Surgeons in Ireland (RCSI), Harvard Medical International (HMI), and Intuition Publishing. The Royal College of Surgeons in Ireland has recently reviewed the content of BeST Online to ensure it remains significant to the Intercollegiate MRCS. BeST is divided into 93 tutorials. Each tutorial is structured according to an award winning educational system OCCE. Orientate: this introductory section gives an outline of the topics to be covered. Pre-test questions allow the user to decide whether he needs to study this topic. Communicate: this is the main content of the tutorial. The text is designed specifically for the screen in order to be easy to assimilate, and is deliberately interspersed (according to a predetermined formula based on pedagogic principles) with interactive features, images, diagrams and animations in order to hold the reader's attention. Connect: this is a realistic interactive scenario, which give the reader a chance to test his decision making and patient management skills. The trainee proceeds through the case by answering questions and receiving feedback if errors are made. Evaluate: this section is an exam preparation and contains MCQs. Trainees on the National Basic Surgical Training Programme will access BeST Online via SCHOOL for Surgeons. This will enable RCSI to capture each trainee’s participation records in one place. These records will eventually be used to form part of the trainees “e-portfolio” which the College proposes to introduce.

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The CAPA Process The CAPA process (Competence Assessment and Performance Appraisal) is an evaluation tool which has been designed to assess the progress of surgeons in training. It addresses the two elements of surgical evaluation, i.e. competence (what the trainee is capable of doing, based on defined standards) and performance (what the trainee actually does, within the limits of competence). The CAPA process is completed at the appraisal sessions which are mandatory for all surgical trainees. However, much of the information used for the appraisal is gleaned from activities and reports which are gathered prior to the appraisal session. The CAPA process examines the following areas: §§ Surgical knowledge and professional development §§ Technical skills and operative experience §§ Workplace performance and training post evaluation

Information used for the CAPA process is obtained from the trainees themselves, from the Consultant Trainers, from the Surgical Skills Tutors, and from electronic records. Surgical Knowledge & Professional Development: §§ SCHOOL for Surgeons: Each trainee’s participation in SCHOOL for Surgeons is electronically monitored

and a record of participation will be available at the appraisal session. More importantly, a record of participation in the assignments and other specialised areas of SCHOOL for Surgeons will be available. All trainees are required to achieve a grade of 60% or more in their assignments to pass this element of the CAPA process.

§§ BeST Online: The e-learning programme BeST Online is the recommended information source for RCSI

surgical trainees. Electronic records of BeST Online usage will be available at the appraisal session. Trainees who do not use BeST Online to study must be able to provide evidence that they are using an alternative study method.

NB: If a trainee has any difficulty whatsoever in accessing either BeST Online or SCHOOL for Surgeons they must put this in writing to the Surgical Training Office at the beginning of the term. The problem will be addressed by a member of staff and a record of this problem will be kept on the trainees file. Trainees who do not participate as outlined above will receive an unsatisfactory result.

§§ Postgraduate Courses: Attendance at approved postgraduate courses over the year will be noted at the

counselling session. §§ Examinations: Any examinations taken during the year (e.g. any part of MRCS) will be noted.

Technical Skills; Personal Skills and Operative Experience: Performance and ability in surgical skills will be assessed by a variety of means: §§ Attendance Record at Operative Surgical Skills Training Days: A record of attendance at the operative

skills training days at the National Surgical Training Centre and Mobile Surgical Skills Unit will be kept (where relevant) and trainees are expected to have a good record of attendance (a minimum of three out of four modules in first year and five out of six modules in second year). Attendance at this course is mandatory. Trainees who are unable to attend and cannot be accommodated on an alternative date should put reasons in writing.

§§ Objective Assessment / MCQ of Technical Skills (Summer Session): In the weeks prior to the summer

appraisal session all trainees will have a formal test of their technical skills at one of the operative skills training days. An objective scoring system will be used to grade the technical performance of the trainees.

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§§ Attendance Record at Human Factors Training Days: A record of attendance at the Human Factors

training days at the National Surgical Training Centre will be kept (where relevant) and trainees are expected to have a good record of attendance (a minimum of two out of three modules). Attendance at this course is mandatory. Trainees who are unable to attend and cannot be accommodated on an alternative date should put reasons in writing.

§§ Surgical E-Logbook and Consolidation Sheets: Trainees are expected to keep an e-logbook of their

surgical procedures which should be kept up to date and signed off by their Consultant Trainer. Also, a consolidation sheet of surgical procedures should be prepared on a six monthly basis and also signed by their Consultant Trainer. The e-logbook and consolidation sheets will be inspected at the appraisal meeting.

§§ Supervised Structured Assessment of Operative Performance (SSAOP): All trainees are expected to

undertake two surgical procedures in each six month period under the supervision of their Consultant Trainer or a Specialist Registrar using the standard structured assessment sheet. The surgical procedures can be any surgical procedure which is appropriate to the level of experience of the surgical trainee. These assessment sheets should be returned to the Surgical Training Office at least one week prior to the appraisal session.

NB: Trainees working in Emergency Medicine should state this on the SSAOP. They should complete a minor procedure and complete the relevant parts of the SSAOP indicating “N/A” for items that were not applicable.

Trainees who do not participate as outlined above will receive an unsatisfactory result.

Workplace Performance and Training Post Evaluation: §§ Trainers Assessment Form: A detailed assessment form should be completed by the Consultant Trainer in

respect of each surgical trainee using a structured assessment form. The trainer’s assessment form should be submitted to the Surgical Training Office one week prior to the appraisal session.

§§ Trainee Self-Assessment Form: Each trainee is expected to perform a self-assessment on a carefully

structured form, using the same criteria that are assessed by the Consultant Trainer. The self-assessment form should be submitted to the Surgical Training Office one week prior to the appraisal session.

§§ Individual Training Plan: All trainees are required to maintain an Individual Training Plan relevant to their

specialty on a six monthly basis. The function of the Individual Training Plan is to encourage trainees to meet with their Consultant Trainers at the beginning, middle and end of each training post and to give the trainee an insight into what is expected of him / her. It forms an important part of the trainee’s continual assessment. This ITP contains a list of target procedures, specific to the specialty, to be carried out during a six month rotation. Trainees who do not meet these targets will not be penalised. The data will be used to assess the suitability of the post for training. ITP forms are available to download on the RCSI website and on SCHOOL for Surgeons.

At the appraisal meeting, the trainees will meet a panel of assessors and their performance will be discussed. Shortly after the assessment meeting all trainees will receive written notification which will indicate whether the appraisal result was “satisfactory” or “unsatisfactory”. Trainees who receive a “satisfactory” appraisal will progress as normal. Trainees who receive an unsatisfactory appraisal should arrange to meet their Regional Vice-Dean / Consultant to discuss the problem areas and to identify remedial action which needs to be taken. Any further support needed to implement the remedial action will also be identified. The next appraisal meeting, six months later, will review the situation. Trainees must receive three satisfactory assessments to qualify for the Certificate of Completion of Basic Surgical Training (CCBST). Trainees receive less than three satisfactory assessments must continue training until they meet these requirements. Trainees should present / discuss their CAPA result to the supervising Consultant at the beginning of their next rotation.

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Trainees who receive continuous unsatisfactory assessments following remedial action will be exited from the programme. The College reserves the right to exit trainees from the training programme where there are serious concerns regarding clinical competence. The following are some examples of why trainees are awarded an unsatisfactory assessment: • SCHOOL for Surgeons – poor participation (i.e. less than 60% overall grade per term) • Deficient E-logbook • Missing Trainers Assessment Form (trainees cannot be signed off until the trainers form is received) • Poor/Deficient Trainers Assessment Report • Operative Surgical Skills Programme – poor attendance • Human Factors Programme – poor attendance The CAPA process is designed to give trainees an idea of what is expected of them during the programme. It allows trainees to validate their level of competence and performance and to monitor their progress on a year by year basis. Trainees will be awarded scores for various elements of their Competence Assessment and Appraisal Session. These scores will be carried forward towards selection into Higher Surgical Training.

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Training Portfolio Although RCSI will maintain a “Correspondence file” and “Competence Assessment and Performance Appraisal file” on each Trainee these records will not always reflect the most up to date or comprehensive record on the trainee. Trainees are encouraged to maintain a personal training portfolio. The portfolio should contain the following records: § Curriculum Vitae – outlining all relevant experience and qualifications § Basic Medical Degree § Medical Council Certificate(s) § Clinical Experience – confirmation of satisfactory completion of training posts completed outwith the

RCSI programme should be maintained. These should indicate duration and level of appointment. § Research, Publications, Presentations, Prizes – relevant documentation should be maintained § Courses Completed – including official certification / relevant correspondence from awarding body § Examinations Completed – including official certification / relevant correspondence from awarding

body § CAPA Results – trainees should receive four CAPA result letters during Basic Surgical Training § Elogbook – trainees should maintain a validated record of operative experience using the elogbook. § Audit – a record of any audits you participated in

RCSI plans to develop an e-portfolio where the above records can be stored and validated. The above records will be required time and time again throughout a surgical trainees’ career and it is imperative that the trainee takes time to maintain these records to a high standard.

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Regional Postgraduate Vice Deans The Regional Vice-Deans for Postgraduate Surgical Education play a key role in the supervision and monitoring of standards of surgical training in the Republic of Ireland on behalf of the Royal College of Surgeons in Ireland. The College relies on its network of Regional Vice-Deans to support surgical education and training in the various regions around the country. Vice Deans are appointed by the Council of the Royal College of Surgeons in Ireland following nomination by their Regional Basic Surgical Training Committee. The current Regional Vice Dean appointments are as follows: Cork University BST Programme Mr. Morgan McCourt, Consultant Surgeon Cork University Hospital Cork Federated BST Programme Mr. Ger McGreal, Consultant Surgeon Mercy University Hospital Dublin Region BST Programme Mr. Paul Neary, Consultant Surgeon Adelaide & Meath Hospital, Tallaght Midlands Region BST Programme Mr. Sean Johnston, Consultant Surgeon Midlands Hospital, Tullamore Mid-Western Region BST Programme Mr. Eamon Kavanagh, Consultant Surgeon Mid-Western Regional Hospital, Limerick North Eastern Region BST Programme Mr. Joe P. McGrath, Consultant Surgeon Our Lady’s Hospital, Navan South Eastern Region BST Programme Mr. Simon Cross, Consultant Vascular Surgeon Waterford Regional Hospital Western Region BST Programme Professor Michael Kerin, Consultant Surgeon University College Hospital, Galway The Regional Postgraduate Vice-Deans are supported in some areas by local administrators: South Eastern Region Administrator Jennie O’Leary Waterford Regional Hospital 051-842684 Western Region Administrator Grace Clarke University College Hospital, Galway 091-771117 Cork University Region Administrator Mary Redmond Cork University Hospital, Cork 021-4922318 Cork Federated Region Administrator Aoife Board Mercy University Hospital, Cork 021-4935501

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Mid-Western/ Limerick Region Administrator Noreen Noonan Limerick Regional Hospital 061-482761 Dublin, Midlands & North East Region Administrator BST Administrator

Surgical Training Office 01-4022231

Help and Advice Trainees may need to seek help and advice during their training. Trainees should always approach their Regional Vice-Dean for advice in the first instance. If the trainee is not satisfied he / she should put their request in writing to: Professor Oscar Traynor Professor of Postgraduate Surgical Education / Director, National Surgical Training Centre Surgical Training Office Royal College of Surgeons in Ireland Dublin 2 If a request can be dealt with by a member of the administration team they will contact the trainee directly. Otherwise an appointment will be made to meet with Professor Traynor. The Surgical Training Office has dedicated administrative staff that can assist you with any queries you have in relation to surgical courses and training programmes run by the Royal College of Surgeons in Ireland. The following is a list of contact details for the Surgical Training Office: Email: surgicaltraining@rcsi.ie Surgical Training Officer 01-4022743 Administrative Assistant 01-4022369 Basic Surgical Training Programme 01-4022231 CCBST 01-4022719 Hospital Recognition Irish Surgical Residency Programme 01-4028624 Operative Surgical Skills Programme Dublin 01-4022166 MSU 01-4022243 SCHOOL for Surgeons 01-4022166 Human Factors in the Surgical Arena 01-4022166 Care of the Critically Ill Surgical Patient (CCrISP) 01-4022243 Advanced Trauma Life Support (ALTS) 01-4028642 The staff from the Surgical Training Office will regularly post notices on SCHOOL for Surgeons regarding your training. You should ensure to check the “news and announcements” forum once per week.

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Sick Leave and Maternity Leave A Basic Surgical Trainee can have up to two weeks’ sick leave in addition to annual and study leave and still obtain the full six months’ educational approval for the post. If, however, the illness lasts for a longer period, the trainee will need to spend a longer time in that specialty to obtain recognition. The same applies for those on maternity leave. Consultant Trainers will be asked to verify that trainees have completed the post satisfactorily. When a trainee on the BST Programme does not obtain a full six months educational approval for a post due to illness or maternity leave they must make this time up after completing Basic Surgical Training. On completion of the originally assigned Basic Surgical Training rotation such trainees are required to seek their own clinical training post via HSE advertisements in the specialty of their choice. They must ensure their rotation complies with the CCBST regulations. The regulations are available to download at www.rcsi.ie. As soon as they secure a training post the Surgical Training Office should be notified so that trainee records can be maintained accurately. Trainees will be called for an appraisal session for this period. Trainees may contact the Surgical Training Office in January (regarding July appointments) or August (regarding January appointments) to see if there are any suitable vacancies. RCSI cannot guarantee placements that were not part of the original BST rotation. It is imperative that trainee records and CAPA documentation are maintained accurately for the purposes of CCBST and application into Higher Surgical Training.

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Rotations Hospital Notification The Surgical Training Office notifies Hospital Management regarding trainee appointments in April (for posts commencing 1st July) and September (for posts commencing 1st January) of each year. Special requests from trainees must be received at least three months prior to the commencement date. It is not acceptable for trainees to withdraw from the Basic Surgical Training Programme without giving at least three months notice. Trainees who fail to give sufficient notice will be report to the Irish Medical Council under “Ethical Conduct and Behaviour” and will not be accredited for training already completed with RCSI. Swapping Rotations The Surgical Training Office regularly receives requests from trainees to swap jobs on their rotations. The current protocol is as follows: §§ Trainees must agree in principle to swap before approaching the Surgical Training Office. The Surgical

Training Office will not arrange swaps for trainees or disclose trainee information. §§ Only direct swaps (i.e. between two candidates) will be considered §§ Trainees must ensure that their rotation still meets the training requirements outlined in the CCBST

Regulations (www.rcsi.ie) §§ Trainees must get permission from the Consultant supervisors of the posts involved. §§ Trainees must get permission from their Regional Postgraduate Vice-Dean. §§ Trainees must submit their request in writing to the Surgical Training Office together with documentation

from the relevant Consultants’ and Vice Dean supporting their request. §§ If the request is sanctioned the Surgical Training Office will formally notify the hospitals concerned and

update trainee records. §§ All paper work must be received at least two months prior to the rotation commencement date §§ Trainees are not permitted to swap more than one rotation; special requests will be made at the discretion

of the Surgical Training Office. Changing Rotations Trainees occasionally apply for jobs outwith the training programme and seek approval from RCSI to sanction this as part of the Basic Surgical Training Programme. RCSI does not permit trainees to change rotations, especially when this will leave another post vacant at short notice. Special requests received in writing a minimum of three months prior to the commencement date will be considered on an ad-hoc basis taking into consideration individual circumstances. Hospital Contracts & Occupational Health Trainees on the Basic Surgical Training Programme are required to fully co-operate in relation to hospital contracts and the local policy on occupational health.

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Basic Surgical Training Committee The Basic Surgical Training Committee is responsible for all matters relating to Basic Surgical Training including Hospital Accreditation. Its role is to advise College Committee, and through it, Council, on all matters relating to Basic Surgical Training. The remit of the BST Committee is as follows: 1. Hospital Recognition:

o To oversee recognition of basic surgical training posts o To maintain a schedule of due dates for inspections o To maintain a register of, and organise training of, inspectors for the above purpose o To notify hospitals of the due dates for inspections, and to organise these inspections as

required o To consider reports of hospital inspections, and make recommendations arising from them o To consider, and make recommendations on, requests for recognition of additional posts in units

already approved o To maintain an updated register of approved posts o To liaise with other training bodies on generic inspection, information and co-ordination

2. Regional Training Programmes

o To co-ordinate, and assist in the maintenance of, regional training programmes o To receive and review regular reports from the training programmes o To receive trainee and training post assessment forms, to evaluate same and to initiate remedial

action when appropriate o To act as the first line of appeal in the event of a trainee or trainer demurring his / her

assessment 3. Courses

o To ensure the provision of courses relevant to Basic Surgical Training o To receive and review regular reports from these courses o To advise on overseas courses

The BST Committee meets five times per year in RCSI. The Chairman of the BST Committee is: Mr. Ken Mealy Consultant Surgeon Wexford General Hospital Mr. Mealy succeeded Mr. J. O’Beirne, Consultant Orthopaedic Surgeon, Waterford Regional Hospital who was Chairman from September 2000 – June 2006.

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Quality Assurance & Hospital Accreditation The function of Hospital Recognition for Basic Surgical Training is dealt with by the Basic Surgical Training Committee. The committee maintains a continuously updated schedule of all hospital inspections due. Usually, if the previous report is satisfactory, routine re-inspection occurs at five yearly intervals. However, in the case of a hospital (or department) for which a shorter interval has been recommended, this will automatically be incorporated into the schedule of inspections. When an inspection is due, the secretariat notifies the hospital Chief Executive (or equivalent) approximately six months prior to the expiry date for recognition. An application form is sent to the hospital. Upon receipt of a satisfactory application form, the committee nominates a team of inspectors. The team consists of two inspectors, one of whom should be a member of the committee. The following criterion is recommended for the recognition of SHO posts for Basic Surgical Training. If you find that your training post deviates substantially from the criteria outlined you may notify the Chairman of the BST Committee or express this on your “Training Post Assessment”. Such instances will be investigated accordingly and remedial action will be taken where appropriate, at the discretion of the BST Committee. General Criteria for Recognition of Basic Training Posts by the Royal College Of Surgeons In Ireland I. The post must be in the grade of Senior House Officer or equivalent. II. All posts must be in a hospital offering the trainee adequate clinical opportunities for training, through working with consultants who have a commitment to teaching and training, and whose names are on the appropriate specialist register. The unit in which the trainee works must have at least two such consultants, whose combined sessional commitment amounts to at least one whole time equivalent. In the case of individual subspecialties, it may be acceptable to have one consultant, as long as the SHO post forms part of an appropriate wider department. The ratio of consultant to trainee may vary from hospital to hospital depending on circumstances. The ideal ratio is 1 trainer to 1 trainee, with a maximum of 1 trainer to 2 trainees. III. There must be adequate throughput to offer wide experience across a broad range of conditions and procedures within the specialty. The Individual Training Plan and record of procedures ensure that both trainee and trainer are aware of what is expected from them during each six month period of training. IV. The post must provide the trainee with experience in the initial assessment, investigation and treatment of a wide range of surgical conditions and in continuing care. V. The trainee’s weekly timetable must provide a balanced programme in accordance. As an absolute minimum the programme should include at least two notional half days in theatre, at least one outpatient clinic, and at least one notional half day of protected study time. The programme should provide for formal teaching sessions including ward rounds and departmental seminars, and it should offer some administrative experience in the management of the ward and the operation of the unit. VI. The trainee should be given opportunity in clinics to investigate and diagnose new patients, and to recommend admissions in consultation with senior colleagues. VII. The trainee must be given, under supervision, progressive responsibility to perform operative procedures with appropriate assistance from senior members of the team. The experience gained, both as operator and assistant, must in be accordance with the guidelines in the Individual Training Plan (RCSI). The trainee must maintain a log-book of operative experience for regular inspection by consultants and as part of the requirements for the CCBST (Certificate of Completion of Basic Surgical Training).

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VIII. The post must provide the trainee with formal educational opportunities. These should include departmental tutorials and case conferences, and X-Ray and pathology meetings where appropriate. In addition, the post should be linked to a regional BST Programme, which offers a schedule of teaching sessions, structured, so as to prepare candidates for the MRCS Examination. IX. A minimum level of audit is required. Audit may be thought of as review of practice. The most obvious example is morbidity and mortality conferences. These must be comprehensive in that all relevant cases are brought for discussion, i.e., it is non-selective. All of the surgical team, from interns to consultant, must be involved, and a record of attendance will be kept for inspection by the inspection team. X. The trainee must be allowed prescribed protected study time. XI. Consultant trainers must have protected time for involvement in postgraduate surgical training e.g. teaching, trainee reviews and participation in relevant College activity. XII. There must be ready access to a library stocked with contemporary surgical textbooks and major journals and IT services. There should be adequate provision within the unit of “bench books” – reference copies of key publications. In addition, there should be high speed internet access available on a 24 hour basis. In situations where the library is closed out of hours or at week-ends such a facility needs to be available in an alternative location, preferably in a doctors office, to which the trainees have access at all times. XIII. The post should provide opportunities to teach medical students and/ or nursing and paramedical staff. XIV. All units must be located within a hospital offering access to a full range of supporting services including haematology, microbiology, biochemistry, blood transfusion, (intensive care), pathology and radiodiagnosis. There should also be an adjacent general medical unit or adequate alternative arrangements for consultation on medical problems in surgical patients. XV. Adequate residential accommodation and sustenance must be available if required during the trainee’s period on duty. XVI. Any significant change to the arrangements as set out on the application form seeking recognition of a post must be notified to the College immediately. Guidelines for the Recognition of Training Posts (SHO) in Emergency Medicine Departments Introduction Minimum standards are presented for an Emergency Medicine Department but it must be recognised that local factors and geography should be taken into consideration. It is expected that an Emergency Medicine Department will be open for 24 hours each day and for seven days each week. Workload 1. The recommendations for NCHD (Non Consultant Hospital Doctors) / Junior Hospital Doctors hours of work must be followed. 2. The NCHD roster and the size of the department should be such that the throughput one trainee can expect to see at least 1,750 new cases during a six month attachment. Staffing 1. The department must be under the clinical and administrative control of one or more Emergency Medicine Consultants devoting the whole or major part (eight or greater sessions) of their clinical time to the day-to-day supervision and training of the junior medical staff.

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2. Experienced senior staff must be immediately available throughout the 24 hours to provide advice and assistance when required. In the absence of a consultant / higher specialist trainee in the department, the trainee must know exactly whom he/she should turn to for advice throughout the 24 hours. Advice from an inexperienced Senior House Officer does not provide adequate education for the Emergency Medicine trainee. 3. The department must be supported by adequate numbers of nursing, clerical, radiographic, portering and other staff at all times. Department Facilities 1. Adequate resuscitation facilities and equipment must be available. These should include anaesthetic facilities including airway and ventilatory equipment, oxygen supply and suction. Adequate facilities for monitoring should be in place including pulse oximetry, ECG monitoring and non-invasive blood pressure monitoring. Facilities should be on hand for cardiac defibrillation, chest drainage and spinal immobilisation. 2. The accommodation must be of acceptable size and decor to offer privacy and good clinical care to patients. 3. Adequate communication systems should be available within the department to ensure rapid summoning of staff/help and allow easy communication with inpatient specialties, the general practitioners and other emergency services. Hospital Facilities 1. The greater the size of the Emergency Medicine Department, the greater will be the number of inpatient specialties required to be on-site. Patients requiring inpatient treatment should, whenever possible, be treated on the site at which they attend. 2. The following specialties must, as a minimum, be available and readily accessible on site:- • Acute General Medicine • Acute General Surgery (including major theatre availability 24 hours per day) • Anaesthetics • Intensive / Coronary Care / HDU Facilities • Twenty-four hour access to CT scanning or radiology • Pathology (Haematology, Chemical Pathology and access to blood transfusion products 24 hours per day). 3. If a department receives paediatric Emergency Medicine patients and psychiatric patients then there must be ready access to allow advice/support to be given. Ideally, these facilities should be on-site. 4. The following specialties need not necessarily to on-site but again ready access is required:- • Acute Gynaecology • Ear, Nose and Throat Surgery • Ophthalmology • Care of the Elderly • Neurosurgery and Neurology • Obstetrics • Cardiothoracic Surgery • Oral and Maxillofacial Surgery • Plastic Surgery (and Burns Unit) • Genito-Urinary Medicine • Other specialist surgery, e.g. Vascular Surgery, Urology • Trauma / Orthopaedics

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5. The hospital should have adequate protocols established for dealing with major trauma and cardiac arrest. Training 1. The supervising consultant(s) must have suitable training, background and experience in the specialty to provide adequate post-graduate education to the junior medical staff. 2. All new medical staff must have a proper induction training programme. 3. The department must demonstrate appropriate audit activity. 4. A good supply of up-to-date mainstream textbooks must be available for reference in the department (in addition to the normal hospital medical library facility). 5. Radiographs must be reported upon, ideally within the next working day, and there must be a mechanism for feedback to the medical staff and follow-up of any missed diagnosis. 6. Adequate time must be set aside for ongoing medical education with a structured teaching programme. 7. Guidelines for the treatment of common conditions are desirable and should be readily available to medical and nursing staff. 8. Trainees must carry out the primary assessment of new patients, take part in the resuscitation of the severely ill and injured and carry out simple surgical procedures such as suturing of wounds, drainage of abscesses and reduction of minor fractures and dislocations. The adequacy or standard of this treatment must be assessed by a senior member of the department at the time or at subsequent follow- up clinics and the trainees must be aware of the results of their treatment.

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Intercollegiate Membership Examination (IMRCS) Intercollegiate Membership Examination (IMRCS) is aimed at trainees in Basic Surgical Training. Only trainees who have been awarded the IMRCS from one of the Surgical Royal Colleges will be eligible to apply for the Certificate of Completion of Basic Surgical Training. The CCBST is an entry requirement for Higher Surgical Training. To view regulations, sample MCQ’s and calendars for the IMRCS (Ireland) please visit the RCSI website www.rcsi.ie/postgraduate_surgery. Purpose of the Examination The purpose of the Intercollegiate MRCS examination is to determine that trainees have acquired the professional knowledge, skills and attributes required to progress to specialist training in surgery The examination is in three parts: Part 1 - Applied Basic Sciences MCQ paper Part 2 - Clinical Problem-Solving MCQ paper Part 3 - This part comprises three separate components, the Oral Component, the Clinical Component and the Communication Skills Component. 1. Parts 1 and 2 - MCQ papers Parts 1 and 2 of the MRCSI examination each consist of one MCQ paper: Part 1 - Applied Basic Sciences (ABS): this consists of Single Best Answer (from September 2006) and Multiple True False questions. Part 2 - Clinical Problem-Solving (CPS): this consists of Extended Matching questions only. The paper sat at any of the Colleges at any particular sitting is identical between all four Colleges. • Part 1 and Part 2 are three hours in length. • Parts 1 and 2 are held up to three times a year in centres worldwide. The examinations are held almost simultaneously at all centres. • Each Part stands alone, candidates being awarded either a “pass” or a “fail”. • Candidates may enter Part 1 and Part 2 in any order. Both parts may be entered at any time after gaining an acceptable primary medical qualification. However, candidates are recommended to undergo one year’s training before entering and to sit Part 1 before Part 2. • Candidates may re-sit Parts 1 and 2 repeatedly. However, candidates should note that they will have 3½ years in which to complete all parts of the examination dating from their first attempt at Part 2. This regulation applies even if they choose to sit Part 2 before Part 1. • Candidates may sit Part 1 and Part 2 with different Colleges. • Candidates must pass both Part 1 and Part 2 before proceeding to Part 3 of the examination. 2. Part 3 Part 3 of the MRCSI consists of three components: the oral, the clinical and the communication skills. All components are held up to three times a year in centres worldwide. Candidates must take all components with the same College.

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2.1 The Oral Component The oral is the first component of Part 3 of the MRCSI. The oral component is a knowledge-based part comprising three individual question and answer sessions, each lasting 20 minutes, in: - Applied surgical anatomy & operative surgery; - Applied physiology & critical care; - Applied surgical pathology & principles of surgery. Candidates will be awarded a mark in each part of the oral and a pass or fail overall in the oral component. Candidates must pass the oral component in order to proceed to the clinical and clinical communication skills components. Candidates who fail the oral component are not required to re-sit Part 1 and Part 2; they are only required to re-sit and pass the oral component of Part 3 before attempting the clinical and clinical communication skills components of Part 3. 2.2 The Clinical Component The clinical is the second component of Part 3 of the MRCSI. Candidates must have passed Parts 1 and 2 and the oral component before sitting the clinical component. The clinical short cases will be organised into four 15-minute bays. The bays will require candidates to be able to diagnose, elicit physical signs from and be familiar with the treatment of patients with conditions in the following areas: trauma and orthopaedics; vascular; endocrine, breast, skin, head and neck; and trunk, groin and scrotum. There are two examiners in each bay and candidates will be awarded a mark by each examiner; all bays are equally weighted. Candidates who fail the clinical component will not be required to re-sit the oral component or Parts 1 and 2; they will only be required to re-sit the clinical component. 2.3 The Communication Skills Component The communication skills is the third component of Part 3 of the MRCSI. It is held at the same time as the clinical component and does not require a separate application form (unless the candidate is re-sitting only this component) Communication skills will be assessed in two bays. One bay will assess the giving of information and one will assess taking and presenting a history. The total assessment time will be 30 minutes. Candidates will be required to demonstrate the ability to provide information to, and receive information from, patients, their relatives and other healthcare professionals. There are two examiners in each bay. In the Information Giving bay each examiner will award one mark. In the Information Gathering bay each examiner will award two marks, one mark for the history taking and one for the presentation of the history. Candidates who fail the communication skills component but have passed the clinical component will only be required to re-sit the communication skills component. Further information on the examination, its structure and outline including the regulations are available on the college website, www.rcsi.ie or by contacting Ms. Yvonne McLaughlin by email at ymclaughlin@rcsi.ie.

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Certificate of Completion of Basic Surgical Training On satisfactory completion of Basic Surgical Training, Trainees may apply online (www.rcsi.ie) for a Certificate of Completion of Basic Surgical Training (CCBST). The following is an extract from the CCBST regulations for trainees who have completed a recognised training programme (full regulations can be downloaded from www.rcsi.ie: §§ Trainees must hold a Basic Medical Degree which appears on the World Health Organisation list

(www.who.int) §§ Trainees must have completed twenty four months of approved basic surgical training. During their

training trainees must have trained in at least three different SAC specialties in which a significant proportion of the work is spent dealing with surgical emergency and / or the care of the critically ill patient. Posts should normally be of six months duration, but more posts of three or four consecutive months duration in a range of specialties could be considered (this does not apply for the National Basic Surgical Training Programme – trainees cannot deviate from their assigned rotations). A maximum of six months in Emergency Medicine is accepted. Six months in a sub-specialty of General Surgery or Trauma & Orthopaedics may also be accepted provided it is approved by one of the Surgical Royal Colleges.

§§ Trainees must have completed a Basic Surgical Skills Course approved by one of the Surgical Royal Colleges of Great Britain and Ireland.

§§ Trainees must hold a training logbook / portfolio which fully reflects their surgical training. Each element should be validated and signed by the trainees supervisor.

§§ Trainees must provide evidence of satisfactory performance and progression for eighteen months in approved Basic Surgical Training in at least three SAC specialties (RCSI will maintain these records for trainees who completed the National BST Programme)

§§ Trainees must have passed all sections of the Intercollegiate MRCS Examination

Documentary evidence is required by RCSI when processing applications for the CCBST. Trainees who complete the National BST Programme must ensure that their CAPA documentation maintained accurately with RCSI. For further information on the CCBST please contact: CCBST Administration Surgical Training Office Royal College of Surgeons in Ireland 123 St. Stephens’ Green Dublin 2 Email: surgicaltraining@rcsi.ie Phone: 01-4022719

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College Facilities Computing and Networking Systems On commencement of Basic Surgical Training all trainees are issued with a username and password for the Royal College of Surgeons in Ireland computing and networking systems. This username and password allows trainees to access the following services: • SCHOOL for Surgeons • RCSI Webmail (your personal RCSI email address) • BeST Online • Online Databases (i.e. Library) It is important that trainees do not give their username or password to others or allow them to use their identity online. Activity in the above is logged against each trainees name and used to monitor performance under the CAPA Process. Trainees will be required to complete an online acceptable use policy in accordance with the procedures for accessing these services. Any difficulties logging on to these services should be notified to the College at the beginning of the term. In the first instance queries should be directed at the IT helpdesk: Phone: 01-402 2273 Email: helpdesk@rcsi.ie If the matter is not satisfactorily resolved trainees should write the Surgical Training Office at the address below outlining the nature of the problem: BST Administration Surgical Training Office Royal College of Surgeons in Ireland Dublin 2 Library All trainees registered on the Basic Surgical Training Programme are entitled to full access to the RCSI library services. Comprehensive details are available in your registration pack. ID Card On commencement of Basic Surgical Training all trainees are issued with an RCSI ID card. This card will enable trainees to access various areas of the College and in particular the Library (after registration).