A pathway to colorectal surgery subspecialty and consultant post in the UK Richard G. Ward MA, FRCS Raimundas Lunevicius MD, FRCS Simone Slawik MD, FRCS, 31 May 2013
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1. Respondents to census were able to select more than one area of special interest so the total number of responses across all areas of special interest may be higher than the total number of respondents. 2. Specialty recommendations for England, Wales and Northern Ireland. In 2010 The Association of Surgeons of Great Britain and Ireland (ASGBI) recommended a consultant workforce ratio of 1:25,000 population and an overall maintenance of consultant surgeon numbers. These recommendations will vary depending on each sub-specialty.
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A pathway to colorectal surgery subspecialty and consultant post in the UK Richard G. Ward MA, FRCS Raimundas Lunevicius MD, FRCS Simone Slawik MD, FRCS, 31 May 2013
- 1. Richard G. Ward MA, FRCS Raimundas Lunevicius MD, FRCS Simone Slawik MD, FRCS Aintree University Hospitals NHS Foundation Trust, Liverpool, UK Postgraduate School of Surgery, Mersey Deanery, NHS England International Society of University Colon and Rectal Surgeons Interim Meeting 2013 in Vilnius: World Congress On Colon and Rectal Surgery, Lithuania, 31 May 2013
- 2. General Surgery = Sum of Subspecialties.. Goal of trainee Post of Consultant Surgeon The aim of general surgery training To function effectively in Emergency General Surgery and as a consultant in a team with a special interest: CRS.. Colorectal Surgery is popular (50% of trainees) Aim: to describe a pathway to CRS Consultant Post 2 A pathway to colorectal surgery subspecialty and consultant post in the UK
- 3. Medical School Foundation Programme, FY1/2 Core Surgical Training, CT 1-2 Higher Surgical Training, ST 3-8 4-6 years 2 years in NHS Trust Hospital 2 year surgical rotation, NHS 5 – 6 year surgical rotation, NHS ◦ Years 1&2 breast, UGI, vascular, CRS ◦ Speciality thereafter 3 A pathway to colorectal surgery subspecialty and consultant post in the UK
- 4. HM Government [Department of Health / DH] General Medical Council [GMC] Royal Colleges of Surgeons [RCS] Health Education England, NHS [HEE] Universities 4 A pathway to colorectal surgery subspecialty and consultant post in the UK
- 5. Supports GMC General Medical Council Empowers HEE Health Education England Workforce Planning How to save money ◦ Training costs ◦ Trainee numbers 5 A pathway to colorectal surgery subspecialty and consultant post in the UK
- 6. Medical Registration of Doctors ◦ Doctors Register (pre-CCT; figure below] ◦ Specialist Register (post-CCT: general surgeons..) Quality Assurance ◦ Medical Schools & Curricula ◦ Foundation Training ◦ Recruitment ◦ Speciality Training ◦ Individual Doctors 6 A pathway to colorectal surgery subspecialty and consultant post in the UK
- 7. Local Education and Training Boards [LETB] ◦ 14 DEANERIES: Eng & W Ensure local delivery of Education Quality assurance of Hospital Trusts Training Post Recognition ◦ SCHOOL OF SURGERY Delivery of Education Programmes Trainee Assessment 7 Mersey Deanery, Liverpool A pathway to colorectal surgery subspecialty and consultant post in the UK
- 8. Examinations ◦ MRCS [Membership of the Royal College of Surgeons] ◦ Intercollegiate Speciality Examination SAC [Speciality Advisory Committee] ◦ Write Curriculum for speciality JCST (Joint Committee of Surgical Training) ◦ Intercollegiate overview of SAC’s ◦ Liaise with GMC re Curriculum ◦ Set standards for training recognition ISCP [Intercollegiate Surgical Curriculum Project] 8 A pathway to colorectal surgery subspecialty and consultant post in the UK
- 9. Limited role Research opportunities / only 9 A pathway to colorectal surgery subspecialty and consultant post in the UK
- 10. CORE TRAINING ◦ National application process Local interview [1 only] Candidates rank available posts Competition ratio 3 : 1 HIGHER SURGICAL TRAINING ◦ Speciality specific national selection Single selection centre Candidates rank available posts Competition ratio 4 : 1 [in general surgery] 10 A pathway to colorectal surgery subspecialty and consultant post in the UK
- 11. Curriculum ◦ programme are based on outcome educational model Workplace Based Assessments Electronic Portfolio Logbook ARCP [Annual Review of Competency progression] Comparison tool between individuals, trusts & national 11 A pathway to colorectal surgery subspecialty and consultant post in the UK
- 12. Academic surgery fellowship:1-2 y M.S. programme: 2 y Ph.D. programme: 3 y Public / global health programmes: MPH degree Volunteering in Africa / Asia For whom who do not enter ISCP programme: ◦ Clinical Fellowship (Fixed-Term Post) ◦ Research Fellowships ◦ LAS (Locum Post) ◦ Locum SpR posts Yes Yes Yes Not encouraged Not allowed – experience not training Article 14 / GMC application for CCT ◦ Complex ◦ Difficult to prove equivalence ◦ Must take InterCollegiate FRCS exam Pass rate <10% 12 A pathway to colorectal surgery subspecialty and consultant post in the UK
- 13. Satisfactory ARCP completion Intercollegiate Examination Success: FRCS certificate Application through SAC for award of CCT [SAC = Certificate of Completion of Training] [CCT = Specialist Advisory Committee] GMC – entry onto Specialist Register (Gen Surg) Eligible to apply for Consultant Post 13 A pathway to colorectal surgery subspecialty and consultant post in the UK
- 14. General – all trainees CRS subspeciality (ST) Inguinal hernia 60 Cholecystectomy 50 Appendicectomy 80 Emergency laparotomy 100 To include :- Colonic resection 20 Hartman’s op 5 Anterior resection 30 Segmental colonic resection 50 Fistula surgery 20 Haems 15 Prolapse surgery 4 Colonoscopies 300 ◦ With 90% rate of cecum intubation 14 A pathway to colorectal surgery subspecialty and consultant post in the UK
- 15. One Consultant CRS vacancy El. Application ◦ Qualifications ◦ Registration ◦ Clinical Experience ◦ Teaching & training Experience ◦ Clinical Governance experience ◦ Management Experience ◦ Audit Experience ◦ Research ◦ IT skills ◦ Motivation ◦ Personal attributes Short-listing Interview date: 27th Jun 2013 15 A pathway to colorectal surgery subspecialty and consultant post in the UK
- 16. Specialty England (52, 7 MM) Wales (3 MM) N. Ireland (1.8 MM) Total (57.5 MM) Trauma & Orthopedic 2089 142 55 2286 General Surgery 2052 133 18 2273 Urology 733 44 22 799 Otorhinolaringology 583 44 31 658 Plastic Surgery 357 14 10 381 OMFS 336 31 9 376 Cardiothoracic Surgery 322 13 9 344 Neurosurgery 246 11 8 265 Paediatric Surgery 146 6 6 158 16 Surgeons classified as retired, temporarily not in practice, surgeons in training and nonconsultant surgeons are not included A pathway to colorectal surgery subspecialty and consultant post in the UK
- 17. Schroeder TV. Commentary 7. Newsletter ASGBI 2010;31: 11. Country Consultants General Surgeons per 100,000 in 2007 Sweden 18 Denmark 16 USA 8 England 4.5 17 A pathway to colorectal surgery subspecialty and consultant post in the UK
- 18. 18 2% 2.50% 2.70% 2.90% 3.50% 4.70% 5.50% 6.60% 12.30% 15.40% 17.30% 24.60% Specialist esophageal/gastric Hepatobiliary General paediatric Transplant (abdominal) Bariatric Non-specialist elective Endocrine Emergency general Upper gastrointestinal Vascular Breast Colorectal 559 CRS Consultants in Engl, Wales, N. Ireland 1 CRS Consultant : 100,000 population Responsible for all elective major and minor colorectal and anorectal procedures including all outpatients and (partly) flex. sigmoidoscopies and colonoscopies A pathway to colorectal surgery subspecialty and consultant post in the UK
- 19. 19 Thank you A pathway to colorectal surgery subspecialty and consultant post in the UK
Editor's Notes
- I am pleased to present a .ppt presentation about a pathway to colorectal surgery subspecialty and consultant post in the UK.
- A consultant position and practise is the legitimate goal of every specialist trainee, despite the fact that UK has significantly less consultants as compared to many Eu countries and even in comparison with the USA.
- Graduates of University Medical Schools of the UK or other EU country have to complete a two year Foundation Programme covering a range of subspecialities, not just surgery. The strongest advocates of 2 year FP are the students who want to improve there doctors skills and for those graduates who have NOT decided their future speciality at the early state. Trusts like them: relatively cheap labor compared to the cost of specialists. Governments often prefer shorter periods in order to reduce the cost of training. UK graduates, therefore, receive full registration in GMC after FY1, however, thet cannot enter specialisation until they have completed FY2 (similar system in Sweden). The main reasoning behind this second year is to unsure as many graduates of British Medical Schools are given the opportunity to be exposed to a wider range of specialties, including General Practise, after the more traditional FY1 year of predominantly medicine and surgery, thereby hopefully encouraging subsequent entrance into such disciplines, many of which were facing serious recruitment difficulties. AND, one big advantage of the FP has been the introduction of a generic National Foundation Curriculum with defined competencies. Candidates then apply by national selection for entry into a two year Core Surgical Training programme in one of the Schools of Surgery run by an NHS Deanery (not based on a University). They rotate through themed programmes of four month posts, two in a chosen subspeciality and two in related surgical disciplines. Achievement of set Curriculum objectives is expected for satisfactory completion of the Core Surgical Training programme, including The Membership of the Royal Colleges of Surgeons examination.
- The deaneries are responsible for the management and delivery of postgraduate medical education in addition to supporting the continuing professional development of all doctors and dentists. This includes ensuring that all training posts provide the necessary opportunities for doctors and dentists in training to realise their full potential and provide high quality patient care. The deaneries are also responsible for trainers, educational supervisors and educational leaders, their training needs and educational development. From April 2013, the Deaneries will be part of a Local Education and Training Board under Health Education England; Health Education England is a Special Health Authority accountable to the Secretary of State for Health. Each Deanery has specialty schools: School of Surgery, ... Each Deanery works with Trusts within the Unit of Application: EXAMPLE: 17 NHS Trusts are within Mersey Deanery
- Medical Schools at Universities: 33. N. Ireland: 1, Wales: 2, Scotland: 5, England: 25.
- The next step is to obtain general surgery trainee status via competitive entry through national selection and complete The Intercollegiate Surgical Curriculum Programme (ISCP) which has been developed on an intercollegiate basis, involving 13 Royal Colleges, Associations, and their Specialist Advisory Committees. Both Core Surgical Training programme and ISCP are based on outcome educational model. That means that within such a model, training is not a matter of hours and years worked in the NHS Trusts within each Deanery but requires demonstration of achievement of competencies set out in the ISCP for each stage of training. The ISCP - an outcome based educational model. That means that within such a model, training is not a matter of hours and years worked. Royal College of Surgeons of England , Royal College of Surgeons of Edinburgh , Royal College of Physicians and Surgeons of Glasgow , Royal College of Surgeons in Ireland , Association of Surgeons of Great Britain & Ireland , British Association of Oral and Maxillofacial Surgeons , British Association of Otorhinolaryngologists -, Head and Neck Surgeons , British Association of Paediatric Surgeons , British Association of Plastic, Reconstructive and Aesthetic Surgeons, British Association of, Urological Surgeons, British Orthopaedic Association, Society of British Neurological Surgeons , Society for Cardiothoracic Surgery in Great Britain and Ireland
- Diagnostic and curative flexible sigmoidoscopies and colonoscopies are mandatory components of colorectal surgeon training. In UK, such training is carried out in conjunction with our gastroenterology colleagues with strict conditions for completion of endoscopy training to enable independent practise. Training in laparoscopic colorectal surgery is mandatory. This was initially delivered in post CCT fellowship posts designated for laparoscopic training but as expertise has developed, this training is increasingly delivered during the six year training programme. A minimum of 20 laparoscopic colorectal resections would be expected of a CCT trainee . UK training in subspeciality colorectal surgery is now highly developed. However, excessive focus on colorectal disease to the detriment of general surgical skills could compromise standards of Emergency General Surgery.
- Why is it difficult to obtain a permanent post? Why do most trainees like CRS subspecialty?
- UK has significantly less consultants as compared to many Eu countries and even in comparison with the USA. General surgery 4.5 gen (GI) surg’s in England 16 in Denmark 18 in Sweden even 8 in the US Urology 1.3 in England 4.8 in Denmark Cardiothoracic surgery 0.6 in England 2.2. in Denmark
- Respondents to census were able to select more than one area of special interest so the total number of responses across all areas of special interest may be higher than the total number of respondents. Specialty recommendations for England, Wales and Northern Ireland In 2010 The Association of Surgeons of Great Britain and Ireland (ASGBI) recommended a consultant workforce ratio of 1:25,000 population and an overall maintenance of consultant surgeon numbers. These recommendations will vary depending on each sub-specialty.