Minutes of the meeting of the Scottish Board for Training in Medical Specialties held at 1:30pm Monday, 13 February 2012 in the Timbury Room, 2 Central Quay, 89 Hydepark Street, Glasgow

Present: Alastair McLellan (AMcL) Chair, Philip Cachia (PC), Anne Holmes (AH), John Lowe (JL), Susan Nichol (SN), Colin Perry (CP), David Reid (DR), Liz Sinclair (LS), Hazel Stone (HS), Janice Walker (JW)

Video-conference:

·  Aberdeen: Ken McHardy (KM)

·  Ayr Hospital: Robert Masterton (RM)

·  Dundee: Ian Longair (IL), Graham Leese (GL)

·  Edinburgh: Nicki Colledge (NC), Mike Jones (MJ)

·  Kirkcaldy: Morwenna Wood (MW)

Apologies: Gordon Birnie (GB), Donald Farquhar (DF), David Marshall (DM), Lewis Morrison (LM), Donald Smith (DS)

In attendance: Paola Solar (PS)

1.  / Welcome and apologies
Noted as above.
Alastair McLellan chaired the meeting in Donald Farquhar’s absence. He noted that Patricia Leiser would be replaced by Derek Philips as representative on this Board and a letter will be sent to her to thank her for her contribution.
Action:
·  DF/PS.
2.  / Quality review presentations:
§  Geriatric Medicine
Dr Jennifer Burns could not attend the meeting so it was agreed to reschedule this presentation.
§  Infectious Diseases
Noted as a separate document.
Action:
§  PS
3.  / Minutes/notes of previous meetings
3.1 / Medicine Specialty Board meeting held on 10 January 2012
The following amendments were requested:
4.3 ACCS (AM) – GMC letter (p3, para 2)
NC requested that the “+1” to be deleted from the line: “…difficult to demonstrate how ACCS 2+1 was equivalent to 24 months of CMT.” It should say ACCS 2.
5.2 Progress with increased CMT numbers (p4, para 6)
Where it says “…had then granted each sub-specialty an additional post…” the “sub-“ is to be deleted as the sentence is referring to specialties.
10. JRCPTB matters (p7, para5)
The fourth bullet point related to Exceptional Leave, to indicate “it is under discussion”.
Subject to the above amendments, the minutes of the Medicine Specialty Board meeting held on 10 January 2012 were accepted as a correct record of the meeting.
3.2 / Notes of QM discussion: Acute Medicine
The notes of the QM discussion of Acute Medicine were accepted and can be forwarded to Dr Stewart Irvine.
4.  / Matters arising
4.1 / ACCS(AM) and GMC
The concern that was expressed by the group at the last meeting regarding practicalities & challenges of implementing the proposed ACCS-AM 2+1 plan had been raised at MDET – thus far without formal response.
MJ indicated that 2+1 came about to get funding for 3 years and reflected the perception that inevitably ACCS-AM trainees appointed to the programme from Foundation would in future inevitably require the 3rd year to attain the requisite competencies. It was noted that a number of English Deaneries had adopted a pragmatic approach and were running 3yr ACCS-AM programmes. The possibility of adopting a policy of 3 years for NES was discussed, but the possibility that the trainees would challenge this was raised.
It was agreed that although there is broad support for a 3 year programme, this Board needs to hear from COPMeD, MDET and the GMC.
KM observed that as things stand currently, ACCS-AM trainees who have not attained requisite competencies at the end of year 2 must be recorded as having ARCP outcome 3 to be eligible for the 3rd yr of training.
5.  / CMT / ACCS
5.1.  / CMT expansion – 6 posts across Scotland
AMcL reported that although the initial agreement had been expansion of CMT by 10 additional posts across Scotland, in reality only 6 additional had become available, as follows:
3 in the West – disestablished posts 2 Cardiology and 1 Rheumatology
1 in the Southeast – disestablished 1 Cardiology
1 in the East – disestablished 1 Cardiology
1 in the North – disestablished 1 Rheumatology
4 other ST3+ posts had been disestablished without incorporation into CMT – 3 from GUM, and one Cardiology post in North (funding from which had been converted to a Staff Grade appointment).
5.2.  / Recruitment 2012 – progress
AMcL informed the group that that running SMT CMT recruitment in collaboration with and in near-identical manner to the processes run by RCPL for rest of UK CMT appointments had worked well. Minor differences existed in the online self-scoring system more by accident than by design, but the format and conduct of the interviews was identical. A shared question bank, to which the Scottish CTLeads had contributed, had been used – and provided generally excellent questions – perhaps the best of which were the clinical scenarios and the weakest being the Ethics questions – that had generated the only negative feedback from panellists Useful resources including interviewer guidance, guidance for chairpersons and for evidence-checkers had been adapted for the SMT CMT appointments process. Each day of interviews started with a video presentation based on an RCPL powerpoint presentation, but tailored for the Scottish process to ensure consistency of approach across the 6 days of interviews.
LS reported that 240 candidates had been interviewed and ~22 had been deemed unappointable: the rest were appointable. For the 110 CT1 posts that were available to be appointed (98CMT1 & 12 ACCS-AM (LS observed that the website presented the ACCS-AM posts as 3yr posts!) – over 100 CMT1offers had gone out. So far 31 had accepted, with 3 requesting an upgrade. At present 19 had accepted CMT1 in West, 6 in SE, 2 in East & 4 in N. So far 2 offers for ACCS-AM have been accepted. Overall currently ~77 were holding CMT offers.
The group expressed concern that there were not many immediate acceptances of the CMT offers and that so many were holding – the presumption being that they were holding either for offers in different specialties or for CMT elsewhere in UK.
LS noted that there still were about 100 appointable candidates who had not received an offer. Those with an offer were allowed to hold it until the 19th of March. HR expected to start getting acceptances and releasing offers to other appointable candidates as soon as other specialties start sending out their offers LS advised that HR were beginning to plan provisionally for a 2nd CT1 interview round in case there were posts not filled in this round.
Concern was expressed about the risk that applicants who had not received offers form SMT at this stage might opt to take up offers from elsewhere. DR & LS advised the group that applicants are all aware from the offers system of their ranking and can track the numbers of posts that have been filled and that remain to be filled, and how many are holding – and that this should offer reassurance during this phase of the offers process.
AMcL informed the group that this year an ‘appointability threshold’ of 36 had been predetermined in association with the RCPL process. Applicants who had been deemed unappointable had typically achieved score of ‘2’ or less from more than one panellist in at least one station. This year because of the significance of scores of 2 or less (in signifying potential non-appointability), panellists were encouraged to discuss scores before finalising their marks. Where ‘2’ or less was recorded the chairperson was required to discuss this with the panel members recording these scores to clarify the strength of conviction that candidates were truly unsuitable for appointment. So decisions about unsuitability for appointment were not taken lightly.
RM commended the principle of employing a predetermined threshold of ‘appointability’ but expressed the view that the ability of candidates to hold offers for prolonged periods appeared to weight advantage and benefit too heavily in favour of the candidates.
On behalf of the Medicine Board, the chair thanked LS and her team for their diligence and efficiency during the CT1 recruitment process.
5.3 / HST Recruitment 2012 – progress
The group noted that the posts are now advertised. Portal will open on the 20th of February for 2 weeks, until the 2nd of March. HR is currently working on the panels, setting up interviews, etc.
Although the website initially said “yes” alongside each specialty, it was confirmed that this has now been changed to the number of vacancies.
KM raised again the issue of how to handle the situation where applicants for ST3 posts are offered provisional appointments contingent upon them attaining full MRCP, but who in fact fail to achieve that goal. The HR position is that without the MRCP diploma these trainees are not eligible to take up ST3 posts, and at the discretion of the local PGD/CMTDean, might be considered for a CMTa extension to training. The issue that again stimulated debate was how to handle the situation where the trainee then achieves full MRCP. The most robust response was agreed to be to advertise for the following February an ST3 LAT post and through open competition the trainee is eligible to apply & be appointed. KM & GL favoured a more pragmatic approach and seamless transition from CMTa into ST3LAT without a fresh appointments process, although it was the HR view that the robust process described was preferable to the pragmatic option, albeit it required an appointment process to be put in place.
5.4 / CMT equivalence and “local” LAT arrangements
In order to ensure attainment of equivalence to CMT competencies, an issue of relevance mainly among non-UK candidates, it had been agreed that a panel would set up (DF, PC & AMcL) which will look into each of the cases individually. This will be done in early March after the appointment rounds wherever there are potentially appointable candidates with uncertain equivalences – they will be flagged up by JL’s team on a case by case basis.
The ST3 person specification was reviewed and it was clarified that with regard to MRCP, the requirement was for MRCP or equivalent diploma. NC raised the need to share awareness among those involved in shortlisting for ST3 appointments that CMT equivalence and MRCP equivalence were acceptable. It was important that these candidates were not rejected at shortlisting on the basis of having equivalence but also that they are flagged to JL who will note the need for further scrutiny if these candidates are successful in their application.
The need for an analogous process for ST3 LAT appointments was again endorsed by the STB. While such appointments are typically devolved to local panels, it was acknowledged that such appointments carry higher risk at all levels and are at least as deserving as ST3 appointments of scrutiny with regard to equivalence re CMT competencies and MRCP diploma. It was agreed that key learnings from the scrutiny of such cases in the current ST3 round should inform a policy document that should be compiled by DF on behalf of the group.
Action:
·  DF to draft a policy for handling assessment of CMT & MRCP equivalence for l ST3 LAT appointments that incorporates experience gained from this round of ST3 appointments.
5.5 / OOPR – academic arrangements
The chair reported the SRDB’s recent approval of a process permitting appointment of an ST3 rather than an ST3 LAT to ‘backfill’ trainees undertaking OOPR. Prerequisites are that 1) this would only apply when trainees commit to prolonged periods of research that has attracted funding from major grant awarding bodies such as MRC, BHF, Wellcome, CRC etc., 2) would apply prospectively from August 2012 and 2013) cannot apply retrospectively. It was noted that the ‘academic community’ itself is expected to engage in agreeing and writing a policy document to cover this process.
The constraints are that this does not represent additional funding and depends on maintenance of agreed establishment numbers (per specialty per deanery) overall.
SES has recently considered 10 applications and agreed 4 as suitable for bona fide ST3 appointments rather than LAT appointments.
5.6 / Requests for UK recruitment
The National Leads had been asked by DF to declare interest in engagement in UK Recruitment for 2013. Clinical Genetics & Paediatric Cardiology are already committed to this, and Neurology has requested inclusion in UK National recruitment. As the next meeting of the SRDB is in March/April, requests for consideration for this should be received by end of February. It should be noted, however, that in the current political climate, the Scottish Government would only approve this in cases where Scotland would be disadvantaged compared to the rest of the UK if they run recruitment separately within Scotland.
6.  / National Medical Reshaping Workforce meeting of 19/01/12
DF had reflected to AMcL his perceptions of what had been achieved at this fruitful meeting. There was general support to the principle of moving away from target intake to managing output numbers and the need to agree training establishment per specialty and ultimately per deanery. Paul Padfield had been asked to take this forward through an options paper.
While there was no agreement about a process to change overall distribution ratio within Scotland as a whole, it was acknowledged that there might be a case to support weighting of trainees’ allocations nationally on the basis of recognised training resources, as might be argued for Cardiology, Dermatology & Liver transplant.
Action:
·  DF to clarify a date for target of establishment.
7.  / JRCPTB matters
NC had a few points from the last JRCPTB meeting: