Royal College of Surgeons of Edinburgh calls for changes to outdated surgical training system
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The Royal College of Surgeons of Edinburgh (RCSEd) warns today that many aspects of the surgical training system are outdated and must change to safeguard standards and ensure patient safety as the first surgical training standards for trainers are launched.
For the first time trainee surgeons across the UK will be taught by accredited consultants using surgical standards developed specifically by the RCSEd’s Faculty of Surgical Trainers (FST), a move endorsed by NHS England Medical Director Sir Bruce Keogh speaking today at the College’s Birmingham Centre.
RCSEd President Ian Ritchie said the initiative would focus on the quality rather than the quantity of training: “This can only help to address concerns around the effects of the European Working Time Directive, which has capped the number of hours a surgeon can work.”
He added that the old style apprenticeship model of training no longer met the needs of a changing NHS: “Training has to be delivered in a more structured, consistent and educationally sound way, focused on patient care. The end product of training, after all, must be a surgeon who provides first class, safe patient care.”
Michael Moran, a specialty surgical trainee speaking on behalf of the RCSEd’s Trainees’ Committee, the elected group that represents trainees across the UK, welcomed the introduction of standards for consultant trainers. He said some consultants did not take their teaching role seriously, and used trainees as patient managers and assistants: “There are many exceptional trainers across all surgical specialties, but there are also consultants who only allow their trainees to do operations they already know and rarely take the time to train them on an operation from start to finish. This limits the development of a trainee’s skills and knowledge. In some cases we are being trained by excellent surgeons, but far from excellent surgical trainers.”
Earlier this year, an RCSEd survey found that trainees suffered extremely high levels of bullying and undermining. When asked, 60% of trainees admitted they had been a bullying victim, while 90% said they had witnessed it.
Speaking at the RCSEd’s new Birmingham Centre, Sir Bruce Keogh commended the FST for the development of the Standards: “They provide evidence that the profession can adapt in the right way, at the right time, driven by the right people – those who deliver our health service,” he said, adding: “If it was not obvious before, this makes clear the importance of consultants who can provide training to the same standard.”
The Standards for Surgical Trainers, launched by the FST, are an entirely new initiative to support the accreditation of trainers across the UK by demonstrating their effectiveness and excellence in training surgeons to the highest standards. FST is the first of its kind in the UK, set up by the RCSEd in 2013 to support and develop surgical trainers.
The Standards form the basis for appraisal and accreditation linked to a detailed list of appropriate evidence. They are divided into seven framework areas, each with a number of key elements. Five of the areas apply to a named clinical supervisor, and all seven to a named educational supervisor. The FST has designed them to be aspirational, and to act as a focus for what an effective and excellent surgical trainer should achieve in practice.
The Standards, which have the backing of the General Medical Council (GMC), will ensure that consultants that provide training should be able to:
• Prioritise patient care while delivering high quality training
• Challenge poor practice and promote improvements
• Give support to underperforming trainees
• Plan the best training opportunities for trainees at all levels.
Mr Craig McIlhenny, FST Surgical Director, led the development of the Standards. He believes that a more professional surgical landscape is vital to provide high quality patient care, and a service that is able to respond and adapt to seven-day working.
“Learning to be a surgeon can only be done on the job, and this is often in an emergency setting. It’s a challenging area of medical training carried out in a high pressure environment where the life of a patient is at stake. The Standards will give trainers a framework of excellence that will ensure tomorrow’s surgeons have the practical skills and technical knowledge they need – and importantly, a professional attitude,” he explained.
“As a Faculty of Surgical Trainers we want to champion not only continuing excellence in surgical training, but also the personal journey towards excellence as a trainer. The standards not only support this ongoing development, but also provide formal recognition for the many trainers who are already teaching and inspiring the next generation of surgeons.”
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