Minutes of the meeting of the Scottish Board for Training in Medical Specialties held at 1.30 pm on Tuesday 3 September 2013 in the Calman Room, 2 Central Quay, 89 Hydepark Street, Glasgow (with VC links)
Present: Donald Farquhar (DLF) Chair, NickiColledge (NC), Moya Kelly (MK), Alastair McLellan (AMcL), RakNandwani (RN), Susan Nicol (SN), Liz Sinclair (LS), Janice Walker (JW), Cathy Watkins (CW).
By video-conference: Kirkcaldy –Morwenna Wood (MW).
Apologies: Gordon Birnie (GB), Graham Leese (GL), David Marshall (DM), Ken McHardy (KM), Lewis Morrison (LM), Rowan Parks (RP), Colin Perry (CP), David Reid (DR), Rhona Waugh (RW), Morwenna Wood (MW).
In attendance: Ellon McGregor (EM), Graeme Williams (GW) for quality review presentations; Brian Neilly (BN) for item 3; Helen McIntosh (HM).
1. / Welcome and apologiesDLF welcomed all to the meeting and apologies were noted.
Noted:
- Colin Perry has demitted office;
- John Lowe has taken up a post in Fife and left the STB;
- Jackie Sutherland has left the STB due to the re-allocation of recruitment HR support;
- Stephen Glen has been appointed Associate PG Dean for CMT taking up post in mid September and will also chair the CMT sub group. The CMT sub group will meet on 2 October;
- Angela Riddell from NHS Lothian was the new HR representative on the STB.
2. / QM presentations
- Renal Medicine – Dr Ellon McGregor
- Medical Ophthalmology – Dr Graeme Williams
The presentations were received by the STB.
3. / Nuclear Medicine: outline proposal for revised training
HEE and JRCPTB were both supportive of the proposal. The GMC has asked each of the devolved nations for its view and the Scottish Government has asked NES to give it consideration. There were 25 trainees in the UK but only one trainee in Scotland at present.
Current entry was at CMT2 with 4 years training followed by a summative KBA and then placement on the specialist register. Training in the West of Scotland was allied with Internal Medicine and after 5 years individuals emerged with a dual CCT.
There were a number of drivers for change – the advent of hybrid imaging, availability of PACS, trends in employment and changes in workload.
Options for the future were embedded training or integrated training and there has been wide consultation over a long period of time with RCP, JRCPTB, RCR, Deaneries, trainers, trainees and patient groups. The specialty’s own 2012 trainee survey showed that increased diagnostic image training would be welcomed and many individuals trained in Radiology after Nuclear Medicine to increase their chances of gaining consultant posts. This was a global issue.
The new model was – Foundation - to CMT- to Core Radiology FRCR for 3 years - then to Higher Nuclear Medicine for 2 years and then Advanced Nuclear Medicine for one year; overall the length of training would extend from 4 to 6 years. The advantages of the new model would be high quality of patient safety, the development of Nuclear Medicine and improved training and job prospects.
Dr Neilly said the 2012 survey showed that the proposed change for CCT and CESR was very marketable despite the extended programme length. As Nuclear Medicine was a Medical specialty and not a Radiological one CMT was an essential component of training and trainees also needed to develop patient management skills. He confirmed that under the proposed change some very complex cases would still have to be sent to England for diagnosis/treatment.
DLF said that 22 of the 25 specialty posts were based in England which has already approved the curriculum change. The STB accepted this was the direction of travel and accepted the proposed curriculum change.
3. / Minutes of Medicine STB meeting held on 21 June 2013
The minutes were accepted as a correct record of the meeting and will be posted on the website.
- Notes of joint Medicine STB/National Leads meeting held on 21 June 2013
Page 2, item 4, second paragraph, second sentence to read ‘…four Quality Improvement Managers (QIMs).’
- Notes of Quality Review presentations on 21 June 2013: Clinical Neurophysiology and Palliative Medicine
4.
4.1 / Matters arising
CCT dates in August/recruitment
Jean Allan’s response to DLF’s letter highlighted that 40 trainees per day would be on their ‘period of grace‘ between 4 and 7 August. If replacements were recruited in that same period the cost would be very high and hence posed a risk to NES. For that reason, the CCT date will remain at 5 August.
4.2 / Replacement of Bob Masterton
The Chair of SAMD has confirmed the group was seeking a replacement representative.
4.3 / Speciality Training Issues
The item has been overtaken by the Shape of Training review.
4.4 / Statement on Practical Procedures
MW noted that DMEs were unsighted on this issue and as a result the group requested greater two way communication between CMT TPDs and their local DMEs. Stephen Glen and the CMT sub group will discuss the issue at its meeting on 2 October and to report back on discussion to the Medicine STB meeting on 22 October.
Action:
- Stephen Glen and CMT sub group to discuss the issue at its next meeting on 2 October and to report back at the Medicine STB meeting on 22 October.
5. / CMT / ACCS
5.1 / Associate Dean for CMT, WoS / Chair CMT sub-group
Noted: Dr Stephen Glen has been appointed Associate Dean for CMT, WoS and will chair the CMT sub group. There have been a significant number of TPD changes in CMT and HM should be notified of any additional changes.
Action:
- To notify HM of any additional TPD changes.
5.2 / Recruitment 2014
A draft timetable was received from RCP and interview venues booked provisionally at the Hilton Edinburgh Airport Hotel 21-23 January and Glasgow Central Hotel 28-30 January. Organisation of panels will start at the beginning of October and they will approach previous as well as new panellists. DLF will chair one Edinburghinterview day and organise Edinburgh chairs for the other dates. LS has arranged to meet Stephen Glen on 23 September to discuss his input. DLF noted his thanks to LS for her work on the process.
5.3 / Specialty Selection Test pilot
The test will be piloted for CMT applicants in parallel with selection and recruitment but will not affect recruitment and selectors will not have access to any information. MK reported GP National Recruitment Office was asked to administer the process and has been liaising with JRCPTB on questions. The test will be run at various test centres and trainees will be able to book a date/venue that was convenient. The pilot will be assessed by Workforce Psychology and analysis sent to HEE. Foundation will use the test as part of the recruitment process.
AMcL noted some concerns regarding the test and possible unintended outcomes.
5.4 / Simulation paper
JRCPTB proposed to add simulation training to curriculum. However at present only 60% of trainees across all Deaneries have access to simulation training and GMC has sought assurance that this could be delivered. A meeting will be held in Harrogate later in the year to discuss this. The paper circulated for today’s meeting showed what was currently available in Scotland and will be used as background for the meeting. AMcL will revise the paper with some amended WoS information. As well as timetabled training days, there were ad hoc opportunities in all Deaneries eg self directed training and use of mannequins. SES was looking at signing people off as simulator safe.
NC said the work was progressing well and JRCPTB may be looking to expand this to clinical scenarios eg delirium and angry relatives.
Action:
- AMcL to revise paper including amendments for WoS.
6. / HST
6.1 / UK Recruitment - clearing / Round 2 and HR input to Medicine STB
UK recruitment to Round 2 was underway; numbers were small and several specialties decided against participating. Recruitment will be via a single centre and Scotland will host CPT and Infectious Diseases. Those appointed will not take up post until January/February 2014.
HR allocation to each of the STBs will change but will not be confirmed until the SRDB meeting on 6 September.
6.2 / Scottish input to recruitment model for 2014
There were a number of issues eg clustering arrangements were weak and the STB noted the need to improve communication and strengthen Scotland’s voice in whatever model was chosen.
6.4 / MCR – a new WPA
The Multiple Consultant Report (MCR) is a new assessment tool to be completed by several consultants to determine whether or not there were issues with a trainee’s performance. Following the success of a pilot, it was agreed to roll this out more widely. It will be part of the e-portfolio and JRCPTB wanted it to become mandatory. NC said there will be more emphasis on feedback than on assessment and the MCR which will look at day-to-day performance and provide broader evidence and increase the validity of the Educational Supervisors report. The number of consultants required to input to the MCR will depend on individual unit size. NC will check whether the MCR will apply to both CMT1 and ST3, the timetable for rollout and whether it could be completed as a group as well as individually.
Action:
- NC to check MCR applied to both CMT and HST, rollout timetable and whether MCR can be completed individually or by a group of consultants.
7. / JRCPTB update
NC reported:
- Three Deaneries will continue the WPA pilot before JRCPTB makes its decision (the MCR document was already approved).
- JRCPTB are piloting a post-CCT credential scheme – the current document will be amended and re-circulated as in its present form it was very English-centric. She stressed there was nothing to prevent NES participation.
- Joint Infection Training – now likely to be launched in 2015; issues noted in Medical Microbiology and HIV training.
- RCPath seeking establishment of new joint training board for physicians and laboratory specialties eg Haematology. No agreement as yet.
- Core Medicine – surveys among trainees showing unpopularity of CMT and service demands over-riding training needs. JRCPTB has proposed production of core standards for CMT – more information to follow.
- Workforce Planning – HEE created a specialist group to consider this and was looking at increasing core training posts using Trust posts. However there was a lack of confidence in some Deaneries that they will recruit to these posts.
- Shape of Training report.
- Liz Berkin, Deputy Director, has demitted office and been replaced by Alastair Miller. Gillian Dilke-Wing will take responsibility for recruitment.
- Next JRCPTB meeting will take place on 4 September.
8. / Reshaping Workforce meeting held on 9 July 2013
This year’s meeting had been more discussion based than in previous years and had included discussion on growth areas. Professor Padfield’s paper proposed some growth via new funding for unscheduled care services to Emergency Medicine/ Acute Medicine/Paediatrics/O& G. It was also proposed to increase CMT by 10 split across Scotland by the standard geographical distribution or to approach service to fund posts for service delivery as a central NES resource. Growth specialties proposals were: Acute Medicine +4; Geriatric Medicine +5; E & D + 1; Gastroenterology + 1; Renal Medicine +1; Respiratory Medicine +1. Those proposed to reduce were Medical Oncology and Neurology. AMcL considered expenditure on LAT/LAS posts could be used to fund substantive posts instead.
The paper was still in draft; It was noted that Dr Ian Finlay has replaced Professor Padfield as Scottish Government liaison.
9. / New National Leads / SAC representatives
- Acute Medicine - Alistair Douglas from Alastair Dorward
- Clinical Neurophysiology - Arup Mallik from AlineRussel
- Rheumatology - Vinod Kumar from Alan McDonald
- Palliative Medicine – Kathleen Sherry from Alison Mitchell
- Paediatric Cardiology - Ben Smith from Trevor Richens.
11. / AOCB
11.1 / StART Alliance
This will be an agenda item for discussion at the joint Medicine STB/National Leads meeting in November and a standing agenda item for the Medicine STB.
Much work was underway. Preliminary work showed that trainees were mostly influenced by their peers in choice of training programme and in response; the Alliance had established trainee ambassadors and was developing a job description for the appointments. At present there were 30 trainee ambassadors and more were sought across all specialties and regions. Each will be provided with a NES email and Twitter account and asked to share information. They will also seek to appoint trainer ambassadors. Webinars were also planned and these will comprise a panel of 2/3 trainees/trainers to introduce the session and participate in Q & As. It was hoped there would good participation in the webinars. DLF confirmed Medicine would welcome involvement – core in October/November and HST later. DLF proposed he and Stephen Glen could be involved.
NES will have a stand at the October BMJ Careers Fair and was considering whether to increase its presence at such events/whether to run a Scottish Careers Fair. DLF will discuss this with Anne Dickson and asked APDs to discuss with their local TPDs. RN noted there could be funding for this via specialty associations/shared funding.
It was planned to disseminate training ambassador information via TPDs. NC noted the College website now contained careers guidance information for Scotland as written by trainees. She will send the link to Anne Dickson for information. She has also spoken to Anne Dickson about taking a stand at the Careers Event. She noted much enthusiasm among trainees for the StART initiative.
AMcL will produce a trainer ambassador job description for circulation.
Actions:
- Agenda item for joint Medicine STB/National Leads meeting in November; standing agenda item for Medicine STB meetings.
- DLF to discuss StART Alliance involvement with Anne Dickson; APDs to discuss with local TPDs.
- NC to send link to College careers guidance information for Scotland to Anne Dickson.
- AMcL to produce a trainer ambassador job description for circulation.
11.2 / Acute Care group
This group has been established by HEE and David Marshall has volunteered to represent Scotland. This will be an agenda item for the next STB meeting.
Action:
- Agenda item for next Medicine STB meeting.
12. / Date of next Medicine STB meeting
The next meeting will take place at 1.30 pm on Tuesday 22 October 2013 in Room 5, Westport, Edinburgh (vc available).
Actions arising from the meeting
Item no / Item name / Action / Who4.4 / Statement on Practical Procedures / Stephen Glen and CMT sub group to discuss the issue at its next meeting on 2 October and to report back at the Medicine STB meeting on 22 October. / SG
5.
5.1 / CMT / ACCS
Associate Dean for CMT, WoS / Chair CMT sub-group / To notify HM of any additional TPD changes. / All
5.4 / Simulation paper / To revise paper including WoS amendments. / AMcL
6.4 / MCR – a new WPA / To check MCR applied to both CMT and HST, rollout timetable and whether MCR can be completed individually or by a group of consultants. / NC
11.
11.1 / AOCB
StART Alliance / Agenda item for joint Medicine STB/National Leads meeting in November; standing agenda item for Medicine STB meetings.
To discuss StART Alliance involvement with Anne Dickson; APDs to discuss with local TPDs.
To send link to College careers guidance information for Scotland to Anne Dickson.
To produce a trainer job ambassador job description for circulation. / DLF/HM
DLF, APDs
NC
AMcL
11.2 / Acute Care Group / Agenda item for next STB / HM
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