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3.5 million population 9 Acute Trusts Coast to Coast /Yorkshire to Scotland 315 (77+238) trainees

The Paradigm shift The view from a surgical school; past, present and future Tutors and Advisors RCSEng May 2009. 3.5 million population 9 Acute Trusts Coast to Coast /Yorkshire to Scotland 315 (77+238) trainees 379 Consultants Lester Sher Northern Academy of Postgraduate Surgery NAPS.

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3.5 million population 9 Acute Trusts Coast to Coast /Yorkshire to Scotland 315 (77+238) trainees

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  1. The Paradigm shiftThe view from a surgical school; past, present and future Tutors and Advisors RCSEng May 2009 3.5 million population 9 Acute Trusts Coast to Coast /Yorkshire to Scotland 315 (77+238) trainees 379 Consultants Lester Sher Northern Academy of Postgraduate Surgery NAPS

  2. Overview • The Context • The paradigm shift • Future direction • QM and the development of the TPA • QM in action / NAPS in action • Aspirations and challenges

  3. Deanery & Hospitals Wansbeck Freeman/ RVI/General Queen Elizabeth South Tyneside Sunderland Hartlepool North Tees James Cook Hexham Carlisle Durham Whitehaven Bishop Auckland Darlington Friarage

  4. Manpower context

  5. Performance context

  6. a paradigm shift

  7. PMETB Training Standards

  8. A curriculum is a statement of • Educational principles • Syllabus • Waypoints • Mode of assessment • Standards to be achieved “implicit becoming explicit”

  9. 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

  10. 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.

  11. MMC PROGRAMME BOARD TASK & FINISHGROUP ON QUALITY Jan 2009 Maintaining Quality of Training in a Reduced Training Opportunity EnvironmentDeaneries/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

  12. Can we specify “quality surgical education” “value for money” ? precise information is the key

  13. 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

  14. Action planning is an “empowering” activityif owned by local faculty

  15. NAPS QM 2007 Domain 5: Delivery of Curriculum incl Assessment

  16. Training Post Assessment(TPA) Quality monitoring of posts Providing feedback to trainers (faculty development) ?accreditation tool

  17. Over arching strategy

  18. 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

  19. Domain 1 Patient SafetySPECIALTY REPORT

  20. Domain 1 Patient SafetyTRUST REPORT

  21. Domain 5 Delivering the curriculum

  22. Domain 6 Support and development of trainees

  23. Domain 6 Support and development of trainees

  24. Domain 6 Support and development of trainees

  25. 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 Domain 6 Support and development of trainers PMETB STANDARDS FOR TRAINERS

  26. Never too late to learnPaul StreetsCEO PMETB Unlike GP trainers, the majority of trainers in hospital medicine are not trained to train, and they work in an environment characterised by increasing service pressures and the demands of the consultant contract and the job plan. GP trainers are selected, trained, and paid for the job. bmj.39491.559815.7D

  27. Sent to 379 Consultants; 146 returned (39% return rate) NAPS Consultant Survey “Counting the cost of surgical training”

  28. Educational Supervision 81% 62% 1 – 2 trainees 49% more than 3 meetings required Clinical Supervision 92% 68% 1 - 2 trainees 82% having a trainee extends lists/clinics Do you supervise? 51% had received no formal training to prepare them for roles.

  29. 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

  30. Time in Job Plan for Education 66%0 or don’t know 16% Less than 1 SPA 6% 1 SPA or more Job planning

  31. Domain 6 Support and development of trainers: faculty development

  32. Domain 6 Support and development of trainers: faculty development

  33. Domain 7 Management of Education and Training Strategic role of school: achievements • 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

  34. Domain 7 Management of Education and Training Strategic role of School: achievements • 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

  35. aspirations for the future expectations are becoming increasingly explicit

  36. For the trainee Ethos of self reliance Take control of learning • agenda, objectives • reflective activity • collection and maintenance of evidence Prepare for assessment • understand the requirements

  37. 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”

  38. 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

  39. 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.

  40. 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

  41. Perennial Tensions apprentice service training structured education The Role of the Surgeon Educator: Tutors and Advisors RCS Nov 2001

  42. The holistic challenge; can we reconcile? Education and training Manpower planning Service configuration

  43. 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

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