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Post CCT Fellowships
RCSEng New Fellows Conference - 2016	
Mr Nikhil Vasdev
MBBS MRCS MCh(Urol) FRCS(Urol)
RCSEng/BAUS Rob...
Introduction	
•  The model of apprenticeship for surgical training is changing
nationally
•  The number of general surgery...
Post CCT Fellowships	
CCT 	
CESR	
Post CCT
Fellowship 	
NTN	
Independent
Consultant Practice
Post CCT Fellowships	
CCT 	
CESR	
Post CCT
Fellowship 	
NTN	
Independent
Consultant Practice
Post CCT Fellowships	
CCT 	
CESR	
Post CCT
Fellowship 	
NTN	
Independent
Consultant Practice
Post CCT Fellowships	
CCT 	
CESR	
Post CCT
Fellowship 	
NTN	
Independent
Consultant Practice	
1 – 2 years of subspecialist...
Post CCT Fellowships	
CCT 	
CESR	
Post CCT
Fellowship 	
NTN	
Independent
Consultant Practice	
1 – 2 years of subspecialist...
Post CCT Fellowships	
CCT 	
CESR	
Post CCT
Fellowship 	
NTN	
Independent
Consultant Practice	
1 – 2 years of subspecialist...
RCS Senior Clinical Fellowship Scheme	
•  The Royal College of Surgeons of
England and the Surgical Specialty
Associations...
RCS Senior Clinical Fellowship Scheme	
•  The Royal College of Surgeons of
England and the Surgical Specialty
Associations...
hFps://www.rcseng.ac.uk/surgeons/training/accreditation/fellowships/
national-fellowship-register
What is a Fellowship Post?	
•  The College and Specialty Associations define a
fellowship post as a period of additional m...
What is a Fellowship Post?	
•  The College and Specialty Associations define a fellowship
post as a period of additional m...
What is a Fellowship Post?	
•  Does not impinge on the training of pre CCT trainees
•  Is allied to workforce opportunitie...
What is a Fellowship Post?	
•  Has a single programme director assigned, with authority and
accountability for the fellows...
What are the benefits of fellowship training	
•  Fellowship approved will demonstrate that the post meets the
standards as ...
My urology career pathway	
• Research – National University of Singapore (2001 – 2002)	
• Basic Surgical training – NUS / ...
2009 - 2013	
2014 to current
RCSEng / BAUS Lister Robotic Urological Fellowship
RCSEng / BAUS Lister Robotic Urological Fellowship
RCSEng / BAUS Lister Robotic Urological Fellowship
RCSEng / BAUS Lister Robotic Urological Fellowship
RCSEng / BAUS Lister Robotic Urological Fellowship	
Highlights
•  Structured curriculum
•  3 monthly meetings with feedbac...
Thesis during RCSEng / BAUS Lister Robotic
Urological Fellowship
Book published
RCSEng / BAUS Lister Robotic Urological Fellowship
Robotic Prostatectomy fellowship data	
•  Total Number of Robotic Prostatectomy = 200
•  Total Number as first surgeon dur...
Positive Surgical Margins – During Fellowship	
Total cases (200)	 First Surgeon (73)	
T2 + PSM	 14.2 %	 15 %	
T3 + PSM	 47...
Positive Surgical Margins - Consultant data	
Fellowship
cases first
surgeon(73)	
Consultant
cases (119)	
P value	
T2 + PSM	...
(6.3% for 119 cases)
Advanced Robotic Techniques – Robotic Neo-Bladder reconstruction
Appointments of RCSEng / BAUS Lister
Robotic Urological Fellows	
Fellow	 Year of completion	 Current Appointment	
Mr Nikhi...
Conclusion
	•  The Lister Robotic Urological Fellowship is a great training
opportunity in the UK for trainees to be expos...
Conclusion
	•  A Post CCT fellowship regulated by the RCSEng ensures
o  Structured educational experience
o  The developme...
Acknowledgment
Acknowledgment	
•  Mr Jim Adshead , Consultant Robotic Surgeon, Lister Hospital
•  Mr Gregory Boustead, Consultant Robotic...
Post CCT Fellowships
Post CCT Fellowships
Post CCT Fellowships
Post CCT Fellowships
Post CCT Fellowships
Post CCT Fellowships
Post CCT Fellowships
Post CCT Fellowships
Post CCT Fellowships
Post CCT Fellowships
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Post CCT Fellowships

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Invited talk at the 'New Fellows' conference organised by the Royal College of Surgeons of England, Bristol, June 2016. Mr Vasdev shares his fellowship experience being the first accredited Post CCT Fellow in the UK in Robotic Urology by the Royal College of Surgeons of England and British Association of Urological Surgeons

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Post CCT Fellowships

  1. 1. Post CCT Fellowships RCSEng New Fellows Conference - 2016 Mr Nikhil Vasdev MBBS MRCS MCh(Urol) FRCS(Urol) RCSEng/BAUS Robotic Fellowship Accredited and Trained Consultant Urological and Robotic Surgeon Hertfordshire and South Bedfordshire Urological Cancer Centre Department of Urology Lister Hospital UK Associate Lecturer in Urology University of Cambridge Honorary Senior Clinical Lecturer in Urology University of Hertfordshire www.nvasdevurology.com
  2. 2. Introduction •  The model of apprenticeship for surgical training is changing nationally •  The number of general surgery trainees (surgeons in specialty training) applying to enter subspecialist fellowship training and then commence independent practice is increasing •  Research in this area has tended to focus on how surgical trainees are affected by fellowship training programmes •  The extra training provided to surgeons during fellowship programmes will increase experience and procedural volume, but whether this translates to improved outcomes remains to be seen Systematic review with meta-analysis of the impact of surgical fellowship training on patient outcomes. Br J Surg. 2015 Sep;102(10):1156-66 hFp://www.ncbi.nlm.nih.gov/pubmed/26122269
  3. 3. Post CCT Fellowships CCT CESR Post CCT Fellowship NTN Independent Consultant Practice
  4. 4. Post CCT Fellowships CCT CESR Post CCT Fellowship NTN Independent Consultant Practice
  5. 5. Post CCT Fellowships CCT CESR Post CCT Fellowship NTN Independent Consultant Practice
  6. 6. Post CCT Fellowships CCT CESR Post CCT Fellowship NTN Independent Consultant Practice 1 – 2 years of subspecialist Fellowship training
  7. 7. Post CCT Fellowships CCT CESR Post CCT Fellowship NTN Independent Consultant Practice 1 – 2 years of subspecialist Fellowship training UK Trainees International Medical Graduates
  8. 8. Post CCT Fellowships CCT CESR Post CCT Fellowship NTN Independent Consultant Practice 1 – 2 years of subspecialist Fellowship training UK Trainees International Medical Graduates Structured fellowship training
  9. 9. RCS Senior Clinical Fellowship Scheme •  The Royal College of Surgeons of England and the Surgical Specialty Associations have established the RCS Senior Clinical Fellowship Scheme to :- o  Manage, o  Quality assure o  Publically recognise fellowship posts in England, Wales and Northern Ireland All fellowship comply with standards of educational quality as set out by the RCSEng
  10. 10. RCS Senior Clinical Fellowship Scheme •  The Royal College of Surgeons of England and the Surgical Specialty Associations have established the RCS Senior Clinical Fellowship Scheme to :- o  Manage, o  Quality assure o  Publically recognise fellowship posts in England, Wales and Northern Ireland All fellowship comply with standards of educational quality as set out by the RCSEng
  11. 11. hFps://www.rcseng.ac.uk/surgeons/training/accreditation/fellowships/ national-fellowship-register
  12. 12. What is a Fellowship Post? •  The College and Specialty Associations define a fellowship post as a period of additional medical training, beyond that available in a usual CCT training programme, which: o  Provides a structured educational experience prior to [Eg. ST5 or above] or immediately following CCT, designed to deliver the requirements of a particular sub-specialty which are not readily available within the CCT training programme o  Has an established curriculum (which includes levels of patient care, medical knowledge, practice-based learning and improvement, communication skills, and professionalism) where the subject matter relates to one of the following o  Acquisition of sub-specialist skills – eg. where specialist surgery has been centralised in line with commissioning decisions.
  13. 13. What is a Fellowship Post? •  The College and Specialty Associations define a fellowship post as a period of additional medical training, beyond that available in a usual CCT training programme, which: o  Acquisition of super-specialty technical skills – for example, in new technologies and treatments which may not be readily available within a given region or training programme o  Acquisition of multidisciplinary skills in a given clinical area
  14. 14. What is a Fellowship Post? •  Does not impinge on the training of pre CCT trainees •  Is allied to workforce opportunities •  Takes place in an institution that assumes ultimate responsibility for delivery of the programme of training and education; this includes providing sufficient protected time for both trainer(s) and trainees (fellows) and necessary financial support for the programme
  15. 15. What is a Fellowship Post? •  Has a single programme director assigned, with authority and accountability for the fellowship post •  Has identified faculty that will assume educational and supervisory responsibilities throughout the programme •  Has a written agreement in place specifying responsibilities for training, teaching, supervision and evaluation of the programme •  Provides opportunities for audit and research •  Has an external evaluation process
  16. 16. What are the benefits of fellowship training •  Fellowship approved will demonstrate that the post meets the standards as set out by the Royal College of Surgeons and Specialty Associations, •  Offers a high quality learning experience •  Recognition of these factors will assist in attracting high calibre fellows •  The scheme will also benefit patients and the public, protect the interests of trainees and fellows and improve the quality of teaching, research and professional practice
  17. 17. My urology career pathway • Research – National University of Singapore (2001 – 2002) • Basic Surgical training – NUS / Northern Deanery, Newcastle upon Tyne (2003 - 2006) • SpR Rotation (Northern Deanery, Newcastle upon Tyne) (2006 -2012) • RCSEng / BAUS Robotic Fellowship (Lister Hospital, Stevenage) (2012 – 2014) * Including fellowship to City of Hope Medical Centre, LA, USA •  Consultant Urological Surgeon (Lister Hospital, Stevenage) ( 2014 – current)
  18. 18. 2009 - 2013 2014 to current
  19. 19. RCSEng / BAUS Lister Robotic Urological Fellowship
  20. 20. RCSEng / BAUS Lister Robotic Urological Fellowship
  21. 21. RCSEng / BAUS Lister Robotic Urological Fellowship
  22. 22. RCSEng / BAUS Lister Robotic Urological Fellowship
  23. 23. RCSEng / BAUS Lister Robotic Urological Fellowship Highlights •  Structured curriculum •  3 monthly meetings with feedback submitted to the RCSEng •  260 hours of dry lab training •  Exposure to 315 Robotic Cases •  First surgeon on 200 Robotic Cases •  Consultant On Call rota – last 6 months of fellow •  ChM (Urol) – During fellowship (University of Edinburgh) •  Distinction in Thesis •  Research Throughput o  Thesis with distinction o  40 papers, 4 clinical trials, 5 research projects, 38 presentations, 6 book chapters, 1 book and 7 Audits
  24. 24. Thesis during RCSEng / BAUS Lister Robotic Urological Fellowship
  25. 25. Book published RCSEng / BAUS Lister Robotic Urological Fellowship
  26. 26. Robotic Prostatectomy fellowship data •  Total Number of Robotic Prostatectomy = 200 •  Total Number as first surgeon during fellowship = 73
  27. 27. Positive Surgical Margins – During Fellowship Total cases (200) First Surgeon (73) T2 + PSM 14.2 % 15 % T3 + PSM 47 % 45 %
  28. 28. Positive Surgical Margins - Consultant data Fellowship cases first surgeon(73) Consultant cases (119) P value T2 + PSM 15% 4 % < 0.05 T3 + PSM 45% 7 % < 0.05 N = 119 cases (August 2014 – June 2016) Overall PSM = 6.3 % (National average 27%) 35 52 32 2014y 2015y 2016y Number of Robotic cases
  29. 29. (6.3% for 119 cases)
  30. 30. Advanced Robotic Techniques – Robotic Neo-Bladder reconstruction
  31. 31. Appointments of RCSEng / BAUS Lister Robotic Urological Fellows Fellow Year of completion Current Appointment Mr Nikhil Vasdev 2014 Consultant Urological Surgeon, Lister Hospital, Stevenage Mr Greg Shaw 2015 Consultant Urological Surgeon (Locum), UCLH, London Mr Bhavan Rai 2016 Consultant Urological Surgeon, James Cook University Hospital, Middlesbrough
  32. 32. Conclusion •  The Lister Robotic Urological Fellowship is a great training opportunity in the UK for trainees to be exposed to and learn robotic urological surgery in a modular manner •  It is an honour to become the first UK accredited robotic urology fellow by the Royal College of Surgeons of England and BAUS •  Based on my experience as the RCSEng / BAUS Robotic Urological Fellow and now as a Consultant Urological and Robotic Surgeon training our next fellow
  33. 33. Conclusion •  A Post CCT fellowship regulated by the RCSEng ensures o  Structured educational experience o  The development of an established curriculum o  Acquisition of high quality sub-specialist skills without any compromise to patient safety and outcomes as demonstrated during my RCSEng Post CCT Fellowship •  Based on the patient data and outcomes collected during my RCSEng fellowship , the data confirms improved patient outcomes •  We also welcome applications from highly motived trainees to apply for our fellowship (nikhil.vasdev@nhs.net)
  34. 34. Acknowledgment
  35. 35. Acknowledgment •  Mr Jim Adshead , Consultant Robotic Surgeon, Lister Hospital •  Mr Gregory Boustead, Consultant Robotic Surgeon, Lister Hospital •  Mr Tim Lane, Consultant Robotic Surgeon, Lister Hospital •  Dr Gowrie Mohan, Consultant Anesthetist, Lister Hospital •  Dr Tim Wilson, Consultant Urologist, City of Hope, LA, USA •  Dr Clayton Lau, Consultant Urologist, City of Hope, LA , USA •  Mr David Thomas, Consultant Urologist, Freeman Hospital, Newcastle upon Tyne www.nvasdevurology.com

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