ISCP

1. ISCP Aims, principles and benefits

2. Overview • Background, Aims, Key principles • Curriculum components • Benefits for patients, training, trainees • The syllabus • Skill levels • Stages of training, stages diagram • Curriculum standards • Assessment system • Learning opportunities • Summary of curriculum competences

3. Background Project 2003-2007 • Impetus for change created by the realisation that major changes were needed in surgical training • Project funded by the UK and Irish Departments of Health and Royal Surgical Colleges • The JCST and SACs led the process for curriculum development • Produced on an intercollegiate basis • In partnership with OCAP • In collaboration with those charged with delivering health services • Launched in 2007 • Under the umbrella of the JCST

4. Aims • Provision of excellent care for the surgical patient, delivered safely • Highest standards of UK surgical practice through high quality surgical training • Programme of surgical training from core to certification • At completion of training, able to provide common, elective and emergency service and defined level of specialised service

5. Key principles • Common format across all surgical specialties • Systematic progression through stages of training • Curriculum and assessment system that meet GMC standards • Competence-based (time points are indicative) • Professional and leadership skills • Delivery by skilled clinicians, appropriately trained • Learning partnership between trainee and trainer • Involvement of qualified members of the multidisciplinary team • Promotion of equal opportunities and diversity in training • Collects data to evaluate and enhance training & assessment

6. Curriculum components SAC development & review Standards Syllabus Assessment System & methods Curriculum Stages of training Learning portfolio Training structure Reflective practice Educational programme Training roles for supervision Appraisal & Learning Agreement QA Regulator approval

7. Benefits for patients • Designed to produce surgeons who are able to provide excellent care for the surgical patient, safely • Promotes effective working practices and service delivery • Provides supervision and accountability through key roles • Provides transparency through an explicit assessment system and portfolio • Ensures lay and patient involvement in curriculum development and review

8. Benefits for training • Provides a structured and supervised framework with a definable endpoint • Promotes high-quality teaching and learning • Based on clear standards covering all surgical specialties • Reviewed and maintained by surgical SACs • Promotes patient safety • Affirms professional and educational values • Rigorous and fully integrated assessment • Meets GMC standards

9. Benefits for trainees • Promotes consistent training experience in the UK • Mandates the interaction between trainer and trainee • Mandates the training of trainers • Provides a clearly defined syllabus • Provides explicit feedback on practice • Provides a portable portfolio of conduct and practice • Provides guidance for professional development • Provides web-based access including Apps

10. Benefits for trainers • Maps to standards for trainers • Provides recognisable educational roles and training structure • Provides guidance for trainers, assessors & supervisors • Provides tools for recording discussions with trainees • Helps to provide evidence of trainer engagement for appraisal and revalidation

11. Training Structure Multi-professional Team

12. The PD role • Organise, manage and direct the training programme • Appoint local faculty as AESs and CSs • Organise faculty development, trainee induction and training for MPT • Oversee progress of individual trainees • Ensure appropriate levels of supervision, training and support • Identify remedial training and resources where required • Work closely with Colleges SACs on curriculum delivery • Administer and chair the ARCP

13. The AES role • Overall educational and supervisory responsibility for the trainee • Ensures induction of the trainee to the unit • Ensures trainee works to the curriculum and assessment system • Ensures patient safety in relation to trainee performance • Acts as a mentor to the trainee • Provides appraisal and a placement learning agreement • Monitors the trainee’s portfolio to ensure educational progress • Presents formative feedback to the trainee • Keeps the PD informed of any issues that may affect training • Involves senior faculty in the formal report to the annual review • Provides an AES report for the ARCP

14. The CS role • Under the delegated authority of the AES • Ensure appropriate day-to-day supervision of the trainee • Carries out WBA and delivers feedback • Ensures patient safety in relation to trainee performance • Liaises with the AES and faculty about trainee progress • Keeps the AES informed of any issues about training • Contributes to the AES report for the ARCP

15. The trainee role • Takes responsibility for own learning • Triggers WBA frequently • Exploits learning opportunities • Attends educational programme • Agrees the learning agreement with the AES • Raises issues and difficulties promptly • Conducts self-directed learning e.g. peer and self-assessment and reflective practice • Keeps an accurate and up to date portfolio

16. The syllabus 4 Domains: • Specialty-based knowledge • Clinical skills and judgement • Technical and operative skills • Professional and leadership skills

17. The syllabus • Defines what trainees should know and be able to do • Informs assessment • Specialty overview of the scope of practice • Key topics that all trainees must be able to manage • Index procedures, indicative of all specialty procedures • Topics can be used as learning objectives • Skill levels indicate the required level of performance

18. Skill levels • Indicate the level of competence to be achieved • Ensure learning is based on progression • Increase with depth and complexity of practice • Increase as the need for supervision decreases and trainees become more proficient • Correspond with logbook supervision levels

19. Knowledge skill levels CORE 4. Knows specifically & broadly • e.g. Can: • Interpret • Distinguish • Compare/contrast 3. Knows generally • e.g. Can: • Explain • Identify • Locate 2. Knows basic concepts • e.g. Can: • Define • Discuss • Describe 1. Knows of • e.g. Can: • List • Name

20. Knowledge skill levels Intermediate/Final 4. Knows specifically & broadly • e.g. Can: • Manage • Judge • Rate / Estimate 3. Knows generally • e.g. Can: • Interpret • Distinguish • Compare/contrast 2. Knows basic concepts • e.g. Can: • Explain • Identify • Locate 1. Knows of • e.g. Can: • Recall • Discuss • Describe

21. Clinical / Technical skill levels 4. Competent to do without assistance, including complications Manages common and difficult cases; UK consultant level; Can supervise. 3. Can do whole but may need assistance Deals with common problems, variations; Requires advice ratherthan help. 2. Can do with assistance Knows rationale; Straightforward procedures; Knows when to ask for assistance. 1.Has observed Knows steps; Handles instruments; Performs some parts. Knows of

22. Stages of training • Defined to reflect the training pathway of the specialty • Provides a means of charting progress against domains of knowledge, skills and behaviours • Allows benchmarking of progress • Core component is common to all specialties supplemented by a small specialty-specific component • Intermediate and final stages reflects the increasing scope of specialty practice

23. Stages diagram

24. Curriculum standards • Each training stage is underpinned by explicit outcome standards in 4 domains • Standards form the basis for specifying syllabus content • Organise workplace training in terms of case mix and case load • Basis for identifying relevant teaching and learning opportunities

25. Assessment system Determines whether trainees are meeting the standards of competence

26. WBA methods WBA • Clinical Evaluation Exercise - CEX • Case Based Discussion – CBD • Direct Observation of Procedural Skills – DOPS • Multisource Feedback - MSF • Procedure Based Assessment – PBA • Observation of Teaching – OoT • Assessment of Audit – AoA

27. Learning Agreement Comprises • PD Global Objective • Syllabus topics for the stage of training • Agreed learning opportunities and resources • Agreed evidence required - WBA, Exams, Audit etc. • AES Comments • Trainee Comments • Link to portfolio of progress • CS Report • AES Report

28. Learning opportunities 3 broad areas: • Learning from practice • Learning from formal situations • Self-directed learning

29. Learning opportunities Learning from practice • Any workplace interaction has the potential to become a learning episode • Workplace assessment • Shadow peers and consultants • On-going systematic feedback, both formal and informal • Reflection on practice

30. Learning opportunities Learning from practice - settings • Theatre • Operative units • Clinic • Ward • Multi-disciplinary meetings • Community

31. Learning opportunities Learning from formal situations • Educational programme arranged locally • Local, national and international level e.g. courses, seminars, meetings, simulation (technical and human factors)

32. Learning opportunities Self-directed learning • Trainee-led • Vital component of continuing professional development • Study groups, journal clubs and peer review • Learning with peers at teaching sessions • Personal study • Written reflections on practice • Research, projects and audits

33. Learning portfolio • Repository of evidence of the trainee’s practice • Audit trail of training • Web-based and password protected • Fitness to practise • Planning personal development • Appraisal and the learning agreement • Workplace-based assessment (WBA) and reflective practice • Record of educational achievement • Annual review • Foundation for continuing professional development

34. Reflective practice Purposeful use of experience/feedback to improve practice • Requirement of the curriculum and part of CPD • Appended to WBA • MSF Self-assessment • Linked to Case-Based Discussion (CBD) • Personal Development Plan • Journal • Entries must respect confidentiality of colleagues and patients

35. Summary of curriculum competences Clinical Care • History taking, examination skills • Taking consent • Relevant knowledge and diagnostic skills • Ability to formulate appropriate management plans • Procedural (technical) skills • Record keeping Maintaining good medical practice • Ability to manage time and work under pressure • Decision making and implementation skills • Reflective practice and awareness of own limitations • Initiative and leadership skills • Focus on patient safety Learning and teaching • Willingness to ask for feedback and to learn from it • Teaching Relationships with patients & colleagues • Communication with patients and their relatives • Communication with colleagues • Active involvement with your team • Accessibility and reliability