Minutes of the Surgery Specialty Training Board Meeting Held at 10

Minutes of the Surgery Specialty Training Board Meeting Held at 10

NHS Education for Scotland

Minutes of the Surgery Specialty Training Board meeting held at 10.30 am on Wednesday 2 July 2014 in Meeting Room 1, Westport, Edinburgh

Present: Dominique Byrne (DB) Chair, John Anderson (JA), Helen Biggins (HB), James Garden (JG), Audrey McPetrie (AMcP),Rowan Parks (RP), Bill Reid (WR),Ian Ritchie (IR), Hamish Simpson (HS), Ken Stewart (KS), Rachel Thomas (RT), Ken Walker (KW).

By videoconference: Inverness –Angus Cain (AC); Glasgow – Ewen Kemp (EK),Mike Palmer (MP).

Apologies: Jon Dearing (JD),Anne Dickson (AD),Chris Driver (CD),Laurence Dunn (LD)Alison Graham (AG), Gareth Griffiths (GG), Ian Holland (IH), Brian Howieson (BH), James Hutchison (JH), Anthea Lints (AL), Graham Mackay (GMcK), Lorna Marson (LM),Jen MacKenzie (JMcK), Anas Naasan (AN),Douglas Orr (DO), Sai Prasad (SP), Andrew Renwick (ARW), Angela Riddell (AR), Jackie Sutherland (JS),Satheesh Yalamarthi (SY).

In attendance: Helen McIntosh (HM) and John Sheppard (JS).

1. / Welcome, apologies and introductions
The Chair welcomed Mr Ken Stewart, TPD in Plastic Surgery to his first meeting as Plastic Surgery Specialty Representative replacing Mr Anas Naasan. He thanked Mr Naasan for his work on the STB over several years.
The Chair welcomed John Sheppard, newly appointed Administrative Assistant in the Medical Directorate, as an observer at the meeting.
Apologies were noted.
2. / Minutes of meeting held on 24 April 2014
One amendment was noted:
Page 5, Item 6.2, General Surgery, second bullet point to read ‘Log books have been analysed.’
With this amendment the minutes were accepted as a correct record of the meeting and will be posted on the NES website.
3. / Matters arising
3.1 / General Surgery of Childhood
The item will be discussed at a future meeting
Action:
  • Future agenda item.

3.2 / Short Life Working Group – Remote and Rural Surgery
KW noted that 2 AMTF posts in Rural Surgery had previously beeneducationally approved but not funded, and would be difficult to fund on a supernumerary basis. Non-recurrent funding from NES for one post for one year has been sourced and the post is currently being advertised with interviews for a proleptic Consultant appointment in Orkney scheduled for 20th August. DB noted that proleptic appointments could generally be made only up to 6 months in advance of CCT dates although regulations suggested that exceptions could be made to this rule if a trainee was identified for a post but had specific training needs particular to that post which required a longer period. KW felt it would be helpful if a precedent could be set in this regard; the worst case scenario would be if the post was not subsequently taken up although this would also depend on where the trainee was located. Meanwhile the current advert gets round this as it is a post-CCT appointment on Consultant terms and conditions with secondment to the fellowship.
There were a variety of groups looking at Remote and Rural Surgical services and training; the RCSEd has a short-life working group chaired by Mr Gordon MacFarlane, and Professor Ian Finlay at the Scottish Government was also speaking of working with some of the Rural General Hospitals.
3.3 / Recruitment report from specialties (excluding Core): reapplying to same specialty
This was a matter for national agreement. JCST was also working on producing a generic person specification for entry to ST3.
3.4 / TIG Fellowships
Noted: a letter was submitted to MDET.
3.5 / To include discussion of response by Forum of Surgical Colleges and Specialty Associations to the Shape of Training Report
The response was agreed in a meeting held at the EdinburghCollege in April involving all 4 Colleges and all specialties as a regular Forum meeting. This was a consensus document and while there were still areas of disagreement, on the whole the Surgical specialties were happy they could work with Shape of Training. The biggest concern was the proposal to move registration to the point of graduation. DB noted that the report mirrored the Surgery STB’s discussion.
The next steps will be for the Forum to publish the report and engage in the discussion on implementation. Trainee concern around tiered consultant roles was noted; however IR said the ASGBI presentation at the Forum meeting made it clear that while job titles were important, functions were more important. Additionally surgeons’ careers will change over time as people move into management/research etc and link to credentialing.
In terms of broad-based training, the meeting had not discussed this in depth. MP reported there was concern around the proposal and especially in smaller specialties however discussion was at an early stage and ultimately the curriculum would be key.
RT recorded she was unhappy that feminisation of the workforce was seen as an issue and stressed that more people were now seeking to train and work flexibly. IR agreed that the need to encourage more women into the workplace was the real issue. WR stressed that feminisation of the workforce per se was not the issue but rather the need to ensure that feminisation continued within the framework suggested by the report.
WR felt that it would be challenging to get people together to discuss curriculum. There was an overall need to recognise change especially in craft specialties with increased emphasis on front-loading and interpersonal skills and the importance of ensuring people were trained in safe practice via simulation. He felt encouraged by the Forum’s response and was pleased LTFT was being addressed and acknowledged a wider group were seeking LTFT training. A series of workshops have been arranged in September across the UK by the UK Implementation Group to consider different workstreams. He felt the delay to implementation has been useful as it has provided an opportunity for discussion and to correct misconceptions. The workshops could provide Scotland with the opportunity to make a case to the 4 nations group to do things differently eg Remote and Rural.
RP said Surgical specialties have given much thought to Shape of Training. NES saw the value of STBs taking this work forward and influencing the rest of the UK and some were setting up working groups to consider training programmes. He felt broad based training was a key development and they had to consider whether current Core Surgery training for 2 years followed by higher specialty training for 5-6 years had the correct balance; what elements of training should lead to the CST and which part(s) of the curriculum should be addressed in credentialing. The General Surgery SAC has already started considering the latter. The Scottish Government saw broad based training as a mechanism for solving current issues eg Surgery of Childhood and Urology provision. Foundation training was seen to work well and although it may undergo some adjustment, possibly with a move towards more theming, it was agreed that two years was required especially if the point of registration were moved. There was some support for extending Core Surgical training to 3 years, potentially with the inclusion of an optional 3rd year although this would lengthen training programmes. This was favoured by some trainees as they felt it would increase competitiveness for entry to ST3 by building up experience and portfolio. JA felt the first step should be to define the consultant job description then design training otherwise the two would not match. RP said that Health Boards were working on this; however this could not be left to service and NES must work with service and the Scottish Government to agree what was deliverable. Without service buy-in, this would not work.
DB confirmed the STB will wait until the College’s Remote and Rural Short Life working group reported before considering further detailed work.
4. / Scottish Medical Training Careers Fair: 20 September 2014 in Glasgow
DB noted several specialty representatives have already requested space and planned to attend on the day. HS will confirm T & O volunteers and he will be present on the day; AC planned to attend and will confirm attendance by ENT colleagues; EK will represent Ophthalmology and confirm arrangements. The STB discussed and agreed stand sharing arrangements in the allocated space. Specialty representatives will discuss the use of their allocated facilities with colleagues and develop their ‘sales pitch’ as well as ensuring the support of their specialty colleagues on the day. Training Ambassadors will be a visible presence on the day and various seminars on generic themes will take place as well as ‘speed-dating sessions’ using Trainee Ambassadors. Colleges and other bodies have been invited to participate in the event.
DB will email specialty representatives outlining the distribution of stands and floor space information for each to develop their plans in consultation with colleagues and to liaise directly with Jenny Gilmour who was co-ordinating the event.
Actions:
  • DB to email specialty representatives outline distribution/floorspace information for representatives to discuss and develop with colleagues. Specialty leads to email Jenny Gilmour with details.

5. / The Scottish Medical and Scientific Advisory Committee (SMASAC)
JG reported he has been appointed a specialty advisor on the Committee by CMO and was working to understand the group and its influence. There was a real desire for the Committee to have greater influence and a more direct route to CMO and the DCMO was keen to ensure it had a higher profile. An annual report was produced by each adviser and was sent to CMO. Not all specialties were thought to be represented on the Committee (eg T & O and Vascular), and he will seek accurate membership information. Additionally STB members were not always aware their specialty was represented on the Committee, although discussion by the STB members in fact revealed that all specialties did appear to be represented although it was not always recognised as such by all.
JG was keen to provide STB feedback for the Committee’s information and has already flagged up a number of areas – recruitment and retention and workforce issues; remote and rural; Surgery of Childhood; Core training; Emergency and Trauma Care and welcomed other suggestions from STB members for the next Committee. A few were highlighted – simulation, anatomy training and facilities, and how to provide these in Scotland. DB confirmed the STB’s specialty representatives were the best people to approach for advice on training issues.
Action:
  • JG to confirm Committee membership.
  • STB members to send suggestions for the Committee to consider at its next meeting.

6. / Update on Academic Surgery in Scotland
JG had already received some feedback which he had added to his database and was happy to redraft it. WR reported that as well as collecting SCREDS data, NES was in the process of surveying all academic activities and will produce definitive training data; this however would not include information for StirlingUniversity to which some academic trainees in the North of Scotland are linked. JG will update his document using NES data and feedback from colleagues and amend for the next STB meeting.
Action:
  • JG to amend document for next STB meeting.

7. / Updates
7.1 / Service
DB noted that training posts other than those in UK national recruitment were being advertised in Scotland only and the same was true for consultant posts. RP confirmed it was a Health Board HR decision not to advertise in the BMJ; however posts were advertised openly and nationally; AC noted Highland has advertised in the BMJ but as an exception. DB will provide information to RP and he will take this to MDET. It was also agreed a Scotland-wide decision was required regarding advertisements for consultant posts – deferred until MDET responded.
Action:
  • DB to provide RP with information regarding advertising of training posts; RP to take to MDET.

7.2 / Specialties
  • Core Surgery
There was a clear issue in recruiting to core in Scotland, Wales and Northern Ireland. Scotland has filled 12 vacancies with LAS appointments and these will provide individuals with experience for next year’s recruitment. JA said that while there was no shortage of FY2 doctors seeking core posts, portfolios were often inadequate and he hoped this would be addressed by the Careers Fair in September. It was not clear whether this was a function of portfolio or training and it was not specifically a Scottish Foundation issue. He will ask ARW to seek information from the 12 individuals which he will feedback to the next STB meeting. AC noted a similar issue with the apparent weakness of portfolios of Scottish applicants to HST ENT; this was thought to be the result of a lack of a national forum for presentations which they were now seeking to address.
  • General Surgery
JA reported they were working to establish how many trainees aspired to Remote and Rural, Surgery of Childhood etc and will provide feedback information at the October STB meeting. In terms of recruitment, one or two posts remained to be filled.
  • Trauma and Orthopaedics
No additional update information was received.
  • Ophthalmology
EK reported recruitment went well. He noted a simulator was now in place in Glasgowand being used by trainees and consultants who required refresher sessions.
  • ENT
AC reported participation for the second year in UK national recruitment in Leeds and this worked well apart from the portfolio issues already noted.
  • Urology
MP reported all posts have filled. Glasgow was undergoing rapid reorganisation due to its reconfiguration of services which will affect trainees, and placements will have to be changed. This will have a short term effect on training. He also noted that the recent SAC meeting agreed to rewrite the 2010 curriculum although only minor changes minor changes were expected. Some simulation training was due to start in Glasgow and in the Boot Camp for new trainees.
  • Plastic Surgery
KS reported that all posts have filled. He was currently writing a paper on the provision of training in cosmetic surgery for Professor Cachia to take to MDET. He noted there was a lack of clarity on and infrastructure in Training Fellowships in Scotland and the specialty would like to consider and formalise training mirroring the English model of centrally-funded TIG Fellowships. RP said this effectively was a case for an AMTF post, for which a salary is required. The type of specialised training provided in these posts may eventually come under Shape of Training. DB and KS will discuss this outwith the meeting.
  • Paediatric Surgery
  • OMFS
  • Neurology
  • Vascular Surgery
  • Cardiothoracic surgery
No additional update information was received.
Action:
  • JA to ask AR to seek information from the 12 people and feedback information at next STB meeting.
  • JA to provide information on General Surgery trainee aspirations at October meeting.
  • KS and DB to discuss Plastic Surgery AMTF post.

7.3 / SAC update
7.4 / Academic
No additional update information was received.
7.5 / MDET
WR reported much work was taking place to harmonise processes within the now single Scottish Deanery.
7.6 / Colleges
No additional update information was received.
7.7 / Simulation
KW reported on behalf of the Scottish Surgical Simulation Collaborative, that implementation of the Core Surgery strategy starts in August 2014. Courses include Boot Camp at the beginning of Core Surgical Training, followed by CCrISP midway through the Core programme and BASICS at the endThe monthly teaching is to be gradually reformed, with hands-off components shifted into evening webinars to allow more hands on time in the teaching days. The Incentivised Laparoscopy Practice project is also under way – take-home simulators with online targets to achieve before progressing to real laparoscopic tasks in the live theatre. Simulation training remained highly recommended but not mandatory yet. The GMC have stopped short of mandating until satisfied it is available – a “Catch 22”, as only mandating it will ensure availability. KW and WR were working on a paper to make the case for funding and the paper will go to MDET for its approval.
Curriculum changes were available online for Core and others. The JCST Simulation Working Group will meet on 3 July to confirm these and KW will then provide the STB with an update.
The SSSC is also working on proposals for Faculty Development. They were now ready to start building strategies for other Surgical specialties and Vascular Surgery and Urology have volunteered as the next specialties; KW will also approach General Surgery.
The UKsurvey previously conducted into the availability of simulation facilities and to provide evidence to GMC will be repeated. Specialty leads were asked to circulate the questionnaire to TPDs to feedback information for KW to collate. He would then produce Scotland’s response before the deadline for feedback to GMC (31 August. 2014).
Actions:
  • KW to provide STB with an update after JCST Simulation Working Group meeting.
  • Specialty leads to circulate survey questionnaire to TPDs to feedback information to KW for collate.

7.8 / Trainees
RT attended a meeting arranged to discuss the single employer proposal. The concept was acknowledged as a good one as it would streamline administrative and other procedures; however debate continued on which organisation would assume the role.
7.9 / JCST
DB reported the JCST survey of trainees took place each year and he will circulate the survey report to specialty representatives for their information.
A meeting has been arranged on 22 September for QM staff at NES to familiarise themselves with the JCST survey results and discuss access. It is hoped that QIMs will use the survey results in future to enhance NES’s current processes.
He noted that funding has been withdrawn in England for regional ISCP administrators; however an online training resource will be available for NES staff, Educational Supervisors and DMEs to train others as appropriate.
Action:
  • DB to circulate the JCST survey of trainees report to specialty representatives.

7.10 / CSTC
Noted: recruitment issues were the main discussion point.
7.11 / CoPSS
DB reported there was continued anxiety around the drive to reduce core numbers. Craig McIlhenny had been invited to present on the Faculty of Surgical Trainers and its Standards for Trainers; this had been well received by the group. The same presentation was also given to JCST and had been similarly well received. DB will invite him to present to the STB at a future meeting.
Action:
  • DB to invite Craig McIlhenny to present on the Faculty of Surgical Trainers at a future meeting.

7.12 / SCCCSS
No update was received.
8. / AOCB
8.1 / LAS appointments in Core Surgery
HB reported there were 12 appointments which may rise to 14. She was asked to circulate information about the teaching programme for Core Surgical trainees to these LAS appointees as well as to those in LAT appointments; however she noted that no study leave budget was available for LAS appointees. JA confirmed LAS appointees would not have access to study leave or funded courses but would be invited to participate in local teaching and to use logbooks and Health Boards would then decide locally whether they should be released to attend. HB will include this information in the notification of training sent to LAS appointees.
Action:
  • HB to send information regarding local teaching and logbooks to LAS appointees.

8.2 / LAT posts
There appeared to be variation in practice on making LAT appointments across Scotland and specialties. WR reported that Training Management has been made aware that WoS has its own policy and it will produce a revised policy to ensure an overall standard of appointment.
JA confirmed that local interviews currently take place soon after National Recruitment at which time there was generally little change to applicants’ experience and achievements; as a result, it had been deemed appropriate to use the scores obtained in the National Recruitment process to determine applicants’ appointability to training (LAT) posts; it was recognised that trainees who did have extra experience but might not have applied to National Recruitment would be viewed sympathetically. It was difficult to set up a local recruitment process to reproduce the London recruitment process so in the absence of a score from that process these candidates were often appointed to LAS posts and advised to apply to National Recruitment the following year.
Noted: NES was working on establishing a national LAT process.
8.3 / Out of programme experience
There were variations within Scotland between regions and specialties on how these were granted and it was agreed this should be consistently applied. WR confirmed MDET was currently working on a Scotland policy although he stressed the need to build in flexibility for individual circumstances. Three months notice was required and applications such as those for 3 year PhDs or which were associated with funding from major grant-awarding bodies (eg MRC) were prioritised.
8.4 / Recognition of Trainers
RP confirmed this was a GMC requirement for Clinical and Educational Supervisors and NES was gathering names from Health Boards via DMEs – at present more than 3,000 names have been received and this information will be returned to GMC for its 31 July deadline. He confirmed that Clinical and Educational Supervision responsibilities must be included in job plans.
The challenge in taking this work forward will be in fine tuning responses eg some consultants will be deemed Supervising Clinicians and so will not require full Recognition. IR added that the Faculty of Surgical Trainers was working on ways to help Consultants meet criteria for accreditation starting in 2016. WR noted the SOAR team was currently working to establish a page on SOAR to record training/educational information for Consultant appraisal.
8.5 / STB membership
The Chair noted Mr Nick George has stood down as Ophthalmology deputy on the STB.
Mr Anas Naasan has also stood down and been replaced by Mr Ken Stewart as the Plastic Surgery representative (see item 1, above).
The Chair recorded the Board’s thanks to Mr George and Mr Naasan for their contributions.
9. / Date of next meeting
The next meeting will take place at 10.30 am on Thursday, 2 October 2014 in Rooms 1 and 2, 2 Central Quay, 89 Hydepark Street, Glasgow.
10. / Dates of 2015 meetings: doodle poll
A doodle poll will be sent to STB members to agree dates for 2015 meetings.
Action:
  • To conduct a doodle poll for 2015 meetings.

Actions arising from the meeting

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