3.5 million population 9 Acute Trusts Coast to Coast /Yorkshire to Scotland 315 (77+238) trainees...
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Transcript of 3.5 million population 9 Acute Trusts Coast to Coast /Yorkshire to Scotland 315 (77+238) trainees...
3.5 million population9 Acute TrustsCoast to Coast /Yorkshire to Scotland315 (77+238) trainees 379 Consultants
Lester Sher Northern Academy of Postgraduate Surgery NAPS
The Paradigm shiftThe view from a surgical school;
past, present and future
Tutors and Advisors RCSEng May 2009
Overview
The Context The paradigm shift Future direction QM and the development of the
TPA QM in action / NAPS in action Aspirations and challenges
Deanery & Hospitals
Hexham
Carlisle
Durham
Whitehaven
Bishop Auckland
Darlington
Friarage
Wansbeck
Freeman/ RVI/General
Queen Elizabeth
South Tyneside
Sunderland
Hartlepool
North Tees
James Cook
Manpower context
0.0
5.0
10.0
15.0
20.0
25.0
North E
ast
North W
est
Yorksh
ire a
nd the
Humber
East M
idla
nds
Wes
t Mid
lands
East
London
South E
ast
South W
est
Wal
es
ON
S E
xces
s W
inte
r D
eath
Ind
ex (
%)
Performance context
a paradigm shift
PMETB Training Standards
A curriculum is a statement of
Educational principles Syllabus Waypoints Mode of assessment Standards to be achieved
“implicit becoming explicit”
Future direction
expectations are becoming increasingly explicit
MMC PROGRAMME BOARD TASK & FINISHGROUP ON QUALITY Jan 2009
Maintaining Quality of Training in a Reduced Training Opportunity Environment
MMC PROGRAMME BOARD TASK & FINISHGROUP ON QUALITY Jan 2009
Maintaining Quality of Training in a Reduced Training Opportunity Environment
The DH should make the measurement of the quality of training provided by Local Education Providers part of the remit of the Care Quality Commission.
The DH must consider mechanisms specifically to incentivise high quality training provision.
MMC PROGRAMME BOARD TASK & FINISHGROUP ON QUALITY Jan 2009
Maintaining Quality of Training in a Reduced Training Opportunity Environment
Deaneries/SHAs should be proactive in assuring themselves of “value for money” for their
investment in training
NAPS Annual Salary bill for surgical trainees=£12.5 M
precise information is the key
Can we specify
“quality surgical education”
“value for money” ?
PMETB Domain 2Quality Assurance Review
and Evaluation
Mandatory and annual Owned by local faculty Programme evaluation Driver for improvement with the
development of an “action plan” Centre to provide externality
Action planning is an “empowering”
activity
if owned by local faculty
NAPS QM 2007 Domain 5: Delivery of Curriculum incl
Assessment
Early Years
General
T & O ENT Neuro Plastics PaedsCardiac
MaxFax
Urology
5.1 Enough practicalexperience
5.2Must show how posts combine
5.3Access to training days & materials
5.4Assessment system must be applied
5.5Regular feedback to trainee
Training Post Assessment(TPA)
Quality monitoring of posts
Providing feedback to trainers (faculty development) ?accreditation tool
Over arching strategy
Training Post Assessment(TPA)
Unique to NAPS
Resonates with PMETB domains
Mandatory Web based
Work started Sept 06, continuous refinement
currently 641 returns.
2 reporting formats, specialty and hospital
Domain 1 Patient SafetySPECIALTY REPORT
Domain 1 Patient SafetyTRUST REPORT
Domain 5 Delivering the curriculum
Domain 6 Support and development of trainees
Domain 6 Support and development of trainees
Domain 6 Support and development of trainees
Level of supervision appropriate to
the trainee=ability to give constructive feedback on performance
Suitable job plan with appropriate workload and time to develop trainees
PMETB STANDARDS FOR TRAINERS
Domain 6 Support and development of trainers
Never too late to learnPaul Streets CEO PMETB
Unlike GP trainers, the majority of trainers inhospital medicine are not trained to train, andthey work in an environment characterised byincreasing service pressures and the demandsof the consultant contract and the job plan.
GP trainers are selected, trained, and paid for the job.
bmj.39491.559815.7D
Sent to 379 Consultants; 146 returned (39% return rate)
NAPS Consultant Survey “Counting the cost of surgical training”
Sent out Returned
Cardiothoracic 18 5
ENT 37 18
General Surgery 119 49
Neurosurgery 17 6
OMFS 14 3
Paediatric Surgery
7 1
Plastic Surgery 21 10
T & O 115 47
Urology 31 7
379 146
Do you supervise?
Educational Supervision 81%
62% 1 – 2 trainees49% more than 3 meetings required
Clinical Supervision 92%
68% 1 - 2 trainees82% having a trainee extends
lists/clinics
51% had received no formal training to prepare them for roles.
Level of concern re trainees undertaking procedures
63% Moderate/High concerns 48% patient safety 33% quality of procedure /standards of
care 12% extended time taken
Clinical supervision is major task
Job planning
Time in Job Plan for Education 66% 0 or don’t know 16% Less than 1 SPA 6% 1 SPA or more
Feedback
0
10
20
30
40
50
60
70
80
90
100
1 2 3 4 5 6 7 8 9 10 11 12
Rank
Sc
ore
(%
)
Domain 6 Support and development of trainers: faculty
development
Feedback
0
10
20
30
40
50
60
70
80
90
100
1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37
Rank
Sc
ore
(%
)Domain 6 Support and
development of trainers: faculty development
Domain 7 Management of Education and Training
Clear Roles and responsibilities across the school Integrated Induction Conduct of programmes• “themed” ST1/ST2 with single educational
supervisor of parent specialty setting objectives including out of specialty placements
• assessment strategy specified at induction• rationalisation of early years jobs
Strategic role of school: achievements
Domain 7 Management of Education and Training
Structures and Resources STC structure/representation PDs (all now remunerated) 0.8 WTE to 3.8 support workers “Faculty Development” strategy for school “School identity” STC, Trust and CEO presentations faculty survey, “NAPS” newsletters
Strategic role of School: achievements
aspirations for the future
expectations are becoming increasingly explicit
For the trainee Ethos of self reliance
Take control of learning agenda, objectives reflective activity collection and maintenance of
evidencePrepare for assessment understand the requirements
For the trainer
Understand your responsibilities and become actively involved in developing your expertise to
discharge these
Recognize that Quality Monitoring ensures healthy critique and consequent “action planning”
For the employer
Education and Training are to be valued and regarded as equally fundamental to health as good clinical care and shorter waiting
times
For the RCSs and SACs
Provide standards
• that define surgical trainers capable of providing quality feedback
• that define a working environment conducive to surgical education and training
• that define a surgical job plan that adequately recognizes these issues.
Training Standards?
Trauma experience in the UK and Ireland: An analysis using the FHI elogbook. Jameson, Lamb, Wallace, Sher, Marx, Reed. Injury 2008. 39. 844-852
apprentice
training
structured education
service
Perennial Tensions
The Role of the Surgeon Educator: Tutors and Advisors RCS Nov 2001
Manpower planning
Education and training
Service configuration
The holistic challenge; can we reconcile?
MMC PROGRAMME BOARD TASK & FINISHGROUP ON QUALITY Jan 2009
Maintaining Quality of Training in a Reduced Training Opportunity Environment
Local Education Providers must ensure that trainers and trainees have sufficient, accessible time in their job plans for training and education