‘Shape of Training’ Report Lacks Detail
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Britain’s oldest Royal College and the only one in the UK to have a Faculty of Surgical Trainers, the Royal College of Surgeons of Edinburgh (RCSEd) dedicated to promoting the highest standards in surgical education, training and clinical practice; today showed broad support for the Shape of Training report, but expressed disappointment in the lack of detail needed for implementation.
Published by the Independent Review and sponsored by bodies such as the General Medical Council (GMC), the four-nation review considers what changes are needed to postgraduate medical training considering the needs of patients and health services in the future. Yet the RCSEd; which has just announced the opening of its first-ever base outside Edinburgh, in Birmingham, to cater to the educational needs of the 80% of its UK membership who live and work in England and Wales; feels the report led by Professor David Greenaway lacks detail and pays only ‘lip service’ to patient safety. Moreover, the RCSEd’s own Trainees’ Committee – the only one of its kind in the UK and which enjoys representation on the College’s Council – feels those most affected by the issues are dangerously underrepresented in the debate at national level.
According to Ian Ritchie, President of the Royal College of Surgeons of Edinburgh;
"The recommendations highlighted in Professor Greenaway’s Review into medical training are long-ranging yet disappointingly light on detail. Despite a thirst for sorely needed change in the culture of training – which we welcome and mirror – more detail on practicalities for implementation is required. The importance of competency and outcome measures across all disciplines cannot be understated, which is why at the Royal College of Surgeons of Edinburgh we’re pleased to have been the first to launch a Faculty of Surgical Trainers, open to the whole surgical workforce regardless of College affiliation. We applaud the support the Report gives to re-establishing an element of apprenticeship to training. We are also proud to give a voice to those who are most affected by these issues, which is why we’re the only surgical college to include an elected trainee member on our Council."
According to Craig McIlhenny, Surgical Director of the Faculty of Surgical Trainers;
"The report shows a disappointing lack of explicit emphasis on measurable training competencies. Decreasing preventable problems is an imminent challenge facing surgeons today, and they need to be provided with the appropriate tools to tackle this. As a Faculty we support a move towards an objective, competency-based system as well as non-technical skills education that are the cornerstones of patient safety. We feel these specific aspects should have been stressed in a more detailed fashion within a document looking at the overall shape of training.”
It was the RCSEd which helped develop one of the internationally-adopted system for evaluating non-technical skills for surgeons (‘NOTSS’), an assessment tool for abilities such as teamwork and communication which are essential for patient safety. NOTSS is officially used in Australia, Japan, around Europe and this month was introduced at Washington D.C. to American surgical residency programmes.
Mr. McIlhenny, who is a consultant urological surgeon, adds;
"The recommendations also seem contradictory, stating ‘we agree that training must continue to be bound by time’, but then suggesting trainees should progress through training at their own rate. The Faculty will continue to stress the importance of robust education delivered by surgeons who have been specifically ‘trained to train’, rather than expecting trainees to simply absorb knowledge just by being apprenticed. Not all doctors should be trainers – only those who can, and are formally assessed, should teach!”
Richard McGregor is the elected Trainee representative on the College’s Council and Chair of the Trainees’ Committee, established in August 2012 to inform the College’s Council of the challenges and issues faced by those undergoing surgical training themselves. He says;
“Earlier this year, Sir Bruce Keogh cited common themes or “barriers” to delivering high quality of care, one of which was the ‘lack of value and support being given to frontline clinicians, particularly junior nurses and doctors’. It is therefore crucial that the way training is developed and delivered ensures that future professionals gain not just knowledge, but objectively-measured competencies and can work together effectively at every stage of a patient’s care as well as throughout their careers. This report touches on these areas but leaves many questions unanswered.”
Richard McGregor, who is an Honorary Specialty Registrar in General Surgery, continues;
“All too frequently, those who are actually going through the process, the trainees, do not have a voice at a national level and are not included in discussions which relate directly to them. Unlike other Royal Surgical Colleges, the RCSEd has an elected surgeon-in-training on Council, advising them of the challenges and issues facing our group. Together with the Trainees’ Committee this allows a range of crucial issues to be raised and debated at the highest level on a frequent basis. My concern is that if we, as frontline staff, have no representation at a UK Government level, future surgeons of the NHS will feel disillusioned and disenfranchised. It is therefore essential that as this, and other debates around the issues which affect trainees most, continue the trainee voice is included and respected.”
Mr. Ritchie, a consultant trauma and orthopaedic surgeon, concludes;
“If the Report ultimately addresses the tensions that exist between service delivery and the provision of high quality training, then it will be seen as a major contribution to healthcare and rejuvenation of the NHS.. We know that one in seven junior doctors regularly feel forced to cope with clinical problems beyond their scope of experience but the continued focus on Working Time Directives is, in our opinion, a red herring – it is not the number of hours but the quality of training that can be undertaken during those (usually unsociable) working hours, that is of importance. Overall, this report generates more questions than answers and we would like to see a greater emphasis on patient safety.”
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