Minutes of the Surgery Specialty Training Board meeting held at 10.30 am on Thursday 24 April 2014 in Meeting Room 5, 2 Central Quay, 89 Hydepark Street, Glasgow

Present: Dominique Byrne (DB) Chair, John Anderson (JA), Helen Biggins (HB), Jon Dearing (JD), Ian Holland (IH), Brian Howieson (BH), Ewen Kemp (EK), Audrey McPetrie (AMcP), Anas Naasan (AN), Douglas Orr (DO), Mike Palmer (MP), Bill Reid (WR), Hamish Simpson (HS), Satheesh Yalamarthi (SY).

By videoconference: Aberdeen – Chris Driver (CD); Edinburgh – James Hutchison (JH), Ian Ritchie (IR), Rachel Thomas (RT).

Apologies: Angus Cain (AC), Anne Dickson (AD), Laurence Dunn (LD), James Garden (JG), Alison Graham (AG), Gareth Griffiths (GG), Anthea Lints (AL), Graham Mackay (GMcK), Lorna Marson (LM), Jen MacKenzie (JMcK), Rowan Parks (RP), Sai Prasad (SP), Andrew Renwick (ARW), Angela Riddell (AR), Jackie Sutherland (JS), Ken Walker (KW).

In attendance: Helen McIntosh (HM).

1. / Welcome, apologies and introductions
The Chair welcomed Mr Jon Dearing, replacing Mr Richard Buckley as BMA consultant representative, to his first meeting.
The Chair recorded the STB’s gratitude to Mr Buckley for his contribution to the work of the STB.
Apologies were noted.
2. / Minutes of meeting held on 17 January 2014
The minutes were accepted as a correct record of the meeting and will be posted on the website.
3. / Matters arising
3.1 / MTI
Following STB support for IR’s paper it was presented to MDET where some reservations were expressed and it noted similar schemes being developed by other Colleges. MDET requested a collaborative and co-ordinated approach with other schemes and in particular RCP which already has a system in place. WR has spoken to IR to begin this work. Professor Finlay at Scottish Government will also be involved in discussion and a meeting will be arranged soon. Meantime ad hoc arrangements will continue.
WR said the chief issue regarding the scheme was the definition of a selection and recruitment process, and discussion would focus on this as control over the quality of applicant and quality of placement was vital. Global health was important and they were keen to maintain a balance in providing experience for a range of countries not merely those with greater wealth.
3.2 / ISCP reports
As no suggestions were received, DB will continue to request the annual report in October and may request an additional report in January each year.
3.3 / Simulation in T&O
HS reported that there had been no opportunity to discuss this at the shortlisting meeting, so no further information was available at present
3.4 / General Surgery of Childhood
JA said that since the last STB meeting he had looked at the provision for training General Surgeons and had identified some opportunities in Children’s Hospitals eg Yorkhill and Aberdeen Children’s Hospital; however there were no such opportunities in SES or EoS. The number of trainees seeking such experience was thought to be low but this will be explored in the summer ARCPs to gain accurate numbers.
DB noted the continued service need. The STB will return to this at a future meeting.
Action:
·  Issue to be discussed at a future meeting.
3.5 / Short Life Working Group – Remote & Rural Surgery
JA noted that training was one element of the group’s remit. There was a shortage of surgeons wishing to pursue a career in Remote and Rural Surgery and, given that different units had different service needs, he suggested that proleptic consultant appointments might be a good way of identifying the trainees requiring specific experience in this area of interest. At present it was difficult to CCT in General Surgery including Remote and Rural as an area of interest, and he proposed to take this to JCST/SAC for discussion. He will report back to the STB once the short life working group has completed its work. SY agreed to send JA information on some themed Core rotations in Remote and Rural Surgery for consideration by the short life working group.
Action:
·  SY to send JA information on themed Core rotations for consideration.
3.6 / Academic Surgery – status report
Item deferred to July STB meeting.
Action:
·  Agenda item at July STB meeting.
3.7 / Shape of Training
The ASGBI response was circulated for information and was similar to the STB’s discussion at the previous meeting (17 Jan 2014). JH noted a comprehensive report produced by the Forum of Surgical Colleges and Specialty Associations; IR indicated that this report was to be discussed next week and may be further modified and then published on the Forum website. The paper will be discussed at the July STB meeting.
Action:
·  Forum report to be discussed at July STB meeting.
4. / Recruitment
4.1 / Reports from Specialties (except Core)
General Surgery
ST3 interviews in London for 119 posts which may increase, plus LATs – 500+ applications have been received.
Vascular Surgery
Twenty posts advertised and interviews will be held in the next 3 weeks.
T & O
All 11 runthrough posts filled. WoS will recruit to 5 ST3 appointments later in the year.
Plastic Surgery
Five posts advertised in early April. Five offers were made however 2 candidates were holding acceptance until 28 May. The SAC has requested information on any other posts due to come up to add to recruitment otherwise they will be put into October recruitment. Ninety candidates have been deemed appointable so reserves were available if people dropped out.
Urology
National UK recruitment held on 24 and 25 March in Leeds. The offers process will begin in May and candidates will be able to hold offers until 28 May. This was a long gap and left little time for HR departments to deal with essential paperwork. They anticipated no difficulty in filling posts. MP and WR will discuss Academic recruitment in Urology at a separate meeting.
OMFS
Three applicants appointed which was a good outcome.
Paediatric Surgery
Interviews will take place on 12 and 13 May in Leeds for one NTN in Scotland and one/two LATs.
Discussion
AN noted the proposal that individuals signed off for ARCP Year 4 in Plastic Surgery would not be allowed to reapply for a different programme within the specialty but could only apply for relocation via IDT. This would be a significant change. DB reported that applicants in General Surgery could apply to the same specialty even if they already held an NTN although they could not do so if they had previously been excluded. This had already been identified as a loophole in the application process. WR said a clear and consistent policy was required across the UK for all specialties and this should be addressed by the Oriel Implementation Team. WR suggested that he and DB would highlight the issue with Jean Allan for discussion at UK level. It would also be helpful to agree a suitable UK recruitment timetable. Posts in England have historically started in October but this may change and staggered changeover will be considered as part of Shape of Training.
Action:
·  DB and WR to highlight need for clear and consistent UK policy with Jean Allan for discussion at UK level.
4.2 / Report from Core Surgery
SY reported there were 48 Scottish posts in national (CSNRO) recruitment; however 12-13 posts remained unfilled after Round 1and will be advertised as LAS posts for one year, with interviews to be held in early June. DB had canvassed the membership of the STB on the preferred approach to fill gaps and the consensus favoured LAS posts via a single national process. This option was not favoured by MDET; however, as no Health Board had accepted to lead recruitment for LATs or Core rotations, it had since been agreed to appoint to LAS posts, the process to be managed by Lanarkshire Health Board and interviews to be held on 4 or 11 June. These LAS posts will return to Core Surgery recruitment next year. Other areas in the UK have already advertised posts aimed at attracting F2s to develop skills required for application to Core Surgery next year. SY had no information on how many Scottish applicants had been interviewed in this year’s Round 1 London.
The failure to fill 25% of posts was disappointing; however this was one of the bigger recruitment groups and appointing to 36 posts was a reasonable performance. There was expansion in the number of CST posts in Scotland this year so the picture was felt not to be as bad as it might appear. At the same stage last year, there remained 10 vacancies, all of which were filled in the 2nd round; this year there was no 2nd recruitment round and it was unlikely that there would be a 2nd round in the future.
The UK rate of progression from Core to ST3 was 38%; however many of those not progressing went into other specialties. There was also a significant attrition rate during Core Surgery and therefore a big drop in number between CST and HST. IR said HEE projections for Core training numbers were for a drop by around 50% in coming years; DB indicated that this was being resisted very strongly by all the Schools of Surgery and that reductions were unlikely to be as significant as suggested.
JA said a significant number of F2s in Scotland sought Core posts but did not meet requirements and he felt that providing information on what was required especially for portfolios at the Scottish Careers Fair would be helpful. It was also noted that a large number of F2s chose to take a gap year before progressing and subsequently returned to seek specialty training starting with Core
5. / Scottish Medical Training Careers Fair
The Fair will be held on 20 September 2014 in the Glasgow Royal Concert Hall. Professor McLellan has asked each STB by email to consider its involvement on the day. DB stressed the need to provide a presence at the Fair which has been timed to fit with recruitment rounds. Commissioned external research showed media influences on career choice against the realities of a medical career. A Careers Fair was one part of the overall effort to make Scotland more attractive to students and trainees. While there was increased tracking of career intentions, it was still not certain what influenced school leavers to enter Medicine. It was important to have visibility at the Fair to help Scotland compete with the rest of the UK in attracting the same cohort. Trainee Ambassadors have been recruited from the current trainee body and have become enthusiastically involved at different levels in the initiative and will be present at the Careers Fair. The Board members were asked to discuss with their colleagues the extent of their specialty’s involvement at the Careers Fair (eg stands/ presentations/ workshops etc) and to inform Professor McLellan as soon as possible of their preferences and requirements either directly or via his PA (). Some transport to the Fair will be provided for students/trainees.
Action:
·  Specialty representatives to discuss/decide with colleagues involvement at the Careers Fair and inform Professor McLellan as soon as possible.
6. / Updates
6.1 / Service
No update report was received.
6.2 / Specialties
General Surgery
JA reported:
·  SAC checklists issued.
· Log books have been analysed.
·  Issues around Endoscopic training courses – DB met Professor Cachia to discuss the provision of funded endoscopy training. Funding was provided by NES and there were opportunities at GRI and Cuschieri Skills Centre; however this was currently under-utilised and so there was pressure to improve the utilisation of the funding in order to avoid losing it. With the existing funding and training capacity, it was felt that the Basci Upper GI Endoscopy needs for all General Surgery trainees could be met at ST3 level, and that the more specialised courses (Therapeutic Upper GI endoscopy, and Colonoscopy) could also be provided later for the trainees declaring a special interest in Upper GI Surgery or Colonoscopy. It was agreed that from August 2014 the 4 General Surgery TPDs should be asked to submit numbers and lists of names of people in these categories for Beverley Beasant (National Project Officer) to allocate to courses.
Vascular Surgery
DO reported:
·  The new General Surgery curriculum is problematic for General Surgery trainees with a Vascular interest: it has been agreed that those trainees with a CCT date before December 2015 would therefore be allowed to stay on the 2010 curriculum; discussions as to which curriculum General Surgery trainees with a Vascular interest who have a CCT date after 2015 should follow are ongoing and involve the GMC and the General Surgery and Vascular SACs. It was proposed that the ARCP process for these trainees should involve General Surgery and Vascular Surgery representation plus a Vascular SAC liaison member in addition to the General Surgery SAC representative. However there were limited numbers of people to do this and also issues around funding multiple SAC representatives’ travel to Scotland for such a small number of trainees. The Vascular Surgery SAC said that representatives should attend where most people were based and that the SAC liaison member need only be involved if there were issues. They were also considering the use of videoconferencing and best use of time to minimise disruption. It has been agreed DO would be involved in the ARCPs for all Vascular trainees including those General Surgery trainees with a Vascular interest except for the North region where there is only 1 trainee and Alison Howd will attend.
·  The FRCS exam in General Surgery with Vascular interest will remain until the final trainee exits.
Trauma & Orthopaedics
HS reported