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  1. 1. MERSEY DEANERY SPECIALTY TRAINING PROGRAMME STARTING AT ST3 in GASTROENTEROLOGY PROGRAMME DESCRIPTIONThis training programme starts at ST3 Level after the completion of Core Medical Trainingand is aimed at doctors who can demonstrate the essential competencies from the personspecification to enter this level of training. The programme is designed to provide theopportunities for the postholder to achieve the Level 2 medical competencies as describedin the General Internal Medicine (Acute Medicine) Curriculum and the Generic Curriculumfor the Medical Specialities and the competencies described in the Gastroenterologyspecialty curriculum.All the Mersey Deanery Medical training posts come under the organisational frameworkof the Mersey Deanery School of Medicine and includes the Core Medical Training (CMT)Scheme which was established in August 2005 and has been the RCP pilot site for manyaspects of CMT including the development of the e portfolio and use of the curricula as aguide for learning in CMT.It will be necessary throughout specialty training to demonstrate satisfactory progress inworkplace assessments of competence when these are reviewed at the Annual Review ofCompetence Progression (ARCP). The milestones to be achieved are described in latestversion of the specialty specific ARCP decision aid on the JRCPTB website.This is a Deanery Wide run through programme which includes all the hospitals listed inthe deanery. All the ST3 and subsequent ST4 – ST7 placements will be allocated by thespecialty programme director on behalf of the School of Medicine.All posts will provide general medicine training and experience with acute unselectedtakes. In some hospitals the ST3 posts may be part of a rota including ST1 and ST2posts. + + +Specialty Training in GastroenterologyThis is a ST3 entry training programme in Gastroenterology aimed at doctors who candemonstrate the essential competencies to enter this level of training. The programme isdesigned to support training for a CCT in Gastroenterology.The programme incorporates ST3 –ST7 providing training to CCT in Gastroenterology and HSTto Level 2 in Acute Medicine. Training is currently based in hospitals in the Mersey Deaneryincluding:♦ University Hospital Aintree♦ Royal Liverpool and Broadgreen University Hospital♦ Arrowe Park Hospital♦ Countess of Chester Hospital♦ Leighton Hospital♦ Macclesfield District General Hospital
  2. 2. ♦ Warrington and Halton Hospitals♦ Southport and Ormskirk Hospitals♦ Whiston HospitalCurriculumA new national gastroenterology curriculum is currently being ratified by PMETB. This is acompetency based and defines the knowledge, skills and attitudes needed to achieve CCT as wellas the necessary assessments (e.g. MinI CEX, DOPS, MSF’s etc) which are mapped to thedifferent elements of the curriculum (see JCHMT web site for further details).Mersey Deanery Gastroenterology Training ProgrammeThe training programme is identical to that described in the job description for a recent SpRrecruitment.See appendixStudy and TrainingThe Deanery is committed to developing postgraduate training programmes as laid down byPMETB, Colleges and Faculties and by the Postgraduate Dean’s Network. At local level, theProgramme director/college/specialty tutors work with the Deanery and individual Trust’sPostgraduate Education Departments to develop and supervise these programmes. ForRespiratory Medicine there is a day release programme (10 sessions per year) which is combinedwith the North West Deanery. The programmes cover all the topics for structured teaching that arein the curriculum. The general medicine Programme Director also provides a day releasestructured programme. Trainees will be expected to take part in these programmes and mustattend at least 70% of the sessions. Study leave will form part of these education programmesand will be arranged in conjunction with the appropriate Trust’s Clinical Tutor. Out-of-programmeexperience is possible depending upon discussions with the Programme Director and adherenceto the Deanery application and review processes.All posts are recognised for postgraduate training.Study leave is granted in accordance with Deanery policy and is subject to the maintenance of theservice.Main Conditions of ServiceThe posts are whole-time and the appointments are subject to:-a) The Terms and Conditions of Service for Hospital Medical and Dental Staff (England and Wales)b) Satisfactory registration with the General Medical Council (London)c) Medical Fitness – You may be required to undergo a medical examination and chest x-ray. Potential applicants should be aware of the Department of Health and GMC/GDC requirements with regards to HIV/AIDS and Hepatitis viruses. Candidates must be immune to Hepatitis B. You will be required to provide, in advance of appointment, evidence of immunity or have a local blood test (as deemed necessary by the Occupational Health Department)Salary ScaleThe current nationally agreed pay scale for this grade is payable. 2
  3. 3. Unforeseen CircumstancesIn accordance with the Terms and Conditions of Service of Hospital Medical and Dental Staff(England and Wales) paragraph 110, Junior Doctors shall be expected in the run of their dutiesand within their contact and job description, to cover for the occasional and brief absence ofcolleagues as far as is practicable.European Working Time Directive (EWTD)All posts on the rotation comply with European Working Time Directive regulations.Junior Doctors’ MonitoringFrom 1 December 2000 there is a contractual obligation to monitor junior doctors’ New Dealcompliance. In accordance with Health Service Circular 2000/031 junior doctors have acontractual obligation to monitor hours on request; this will include participation in local monitoringexercises.Removal expensesThe removal expenses applicable to this post will be the policies issued by the AdministrativeTrust. You should not commit yourself to any expenditure in connection with relocation before firstobtaining advice and approval from the Personnel Department at your Administrative Trust,otherwise you may incur costs, which you will be unable to claim.Use of Information TechnologyUnder the Computer Misuse Act 1990, any individual who knowingly attempts to gain unauthorisedaccess to any programme or data held on a computer can be prosecuted. An individual whomodifies any programme or data in a computer which they are unauthorised so to do, is also liableunder the Act. If found guilty of these offences a person may be given a custodial sentence of upto six months or a fine or both. The person would also be subject to disciplinary action which mayresult is dismissal.Similarly, in accordance with copyright law, any person involved in the illegal reproduction ofsoftware or who makes, acquires or uses unauthorised copies of computer software, will besubject to disciplinary action, which may lead to dismissal.Notification of Termination of Employment3 monthsPerson SpecificationFor a detailed person specification for these posts see MMC website at: of PostsFor detailed information about the number of posts currently available please see the jobadvertisement.Further information about the Mersey Deanery and the Mersey Deanery School of Medicine isposted on the Mersey Deanery website 3
  4. 4. Appendix NHS NORTH WEST (MERSEY DEANERY) Specialty training programme starting at ST3 In Gastroenterology and General Internal Medicine ROTATIONAL TRAINING SCHEMECONTENTS1. Person Specification2. Information on The Rotational Training Schemei. Description of the scheme & Rotationsii. Participating hospitalsiii. Duties of postsiv. Supervising consultants & Organisation of STECv Educational & Training programmevi Library facilitiesvii Training Coursesviii Research & Audit Opportunitiesix Study Leave arrangementsx Annual reviews, PYAs & summative assessments3. General Information for Applicants June 2005 4
  5. 5. 1. Person specification:The rotation offers excellent opportunites for education and training in gastroenterology and isdependent for its success on a “partnership” between trainers and trainees.Accordingly, STEC specifies from time to time, a person specification which suits our trainingscheme. This specification is also used by interview panels for purposes of shortlisting. Please now refer to the national person specification. Jan 20072.i. Description of the scheme & RotationsA five-year period of training with dual accreditation in GIM and Gastroenterology is offeredfulfilling the criteria laid down by the JCHMT. The scheme is rotational through nineparticipating hospitals in the Region. The scheme has been approved for five years and describedas excellent, by JCHMT following their visit in October 2001.The scheme has been expanded recently and there are are currently 23 rotational training posts.There are an additional 2 university lecturer posts recognised for training sited at the RoyalLiverpool University Hospital. The 23 posts rotate through 9 hospitals in the Region (Southport-1,Macclesfield-2, Leighton-2, Chester-2, Warrington-2, Whiston-1, Arrowe Park-2, Aintree-6 andRoyal Liverpool-5). Eleven of the rotational posts are sited in the 2 main university teachinghospitals (RLUH and Aintree). Occasionally, non-rotational Fixed Term Training Appointments(FTTA) are made to maintain the balance between DGH and University Hospitals. The trainingprogramme caters for dual accreditation in general internal medicine and gastroenterology. Inorder to be equitable both to the trainees and the hospitals concerned, trainees are rotated on anannual basis usually on the April 1st (periods and rotation dates subject to change). The followingprinciples apply.Most trainees begin their first year in a DGH setting and will also have either the 4th or 5th years ina similar location. We aim to offer all trainees two consecutive years in one of the universityteaching hospitals. The arithmetic involved in rotations within the training scheme requires someflexibility as to which hospitals SPRs are rotated and some posts may be allocated by competition. .The rotations are decided following the annual reviews in November each year to give both trainersand trainees sufficient notice of their rotations for the following April. The programme directorconsults widely amongst both supervising trainer colleagues and trainees with particular needsbefore making recommendations and the final decision is made by STEC.At present, all posts rotate on an annual basis so that each trainee would spend approximately oneyear in each of five hospitals (this may change to four 15-month rotations). In the first year, mosttrainees will be placed in a DGH setting where it is expected that up to 80% of their activity will bein GIM with the remainder introducing them to gastroenterology and endoscopy. In each of theUniversity teaching hospitals, at least 20% of their activity should involve GIM but it is expected 5
  6. 6. that there will be intensive exposure to all aspects of Gastroenterology. In the remaining two yearsit is anticipated that GIM and Gastroenterolgy activities would approximately be split 40:60 inorder to satisfy the accreditation requirements of both specialities.In all years, unselected medical take is an essential component both of the posts offered and ofqualifying requirements for accreditation in GIM. All posts in each hospital are offered withcontracts of possible resident on call commitment, increasingly on a shift basis. In the largerhospitals some attempt is made to allow more senior SpRs to be on call from home but this oftendepends on the experience of other staff involved in the rota. Usually the 4th or 5th year will be ina DGH setting in line with JCHMT guidance and is likely to be resident on call.Map of Merseyside showing relationship of Training hospitals and main Access routes: 6
  7. 7. 2.ii. Participating hospitalsA brief description of participating hospitals is given with “vital statistics” to indicate the natureand context of training in Gastroenterology & Medicine.TRAINING NUMBER OF SpR Team personnel STEC REPHOSPITAL GASTROENTER (n=) HO;SHO;Staff OLOGISTS GAintree 6 (incl. 1 Sen Lect) 6 3;3;1 Dr. R. SturgessArrowe Park 4 2 3;1;2 Dr. J.DawsonChester 2 2 1;2 Dr. T.WardleLeighton (Crewe) 2 2 2;1;1 Dr. I. LondonMacclesfield 2 2 2;2 Dr. E. RocheRoyal Liverpool 6 5 4;2 Dr. M. Lombard& University 3 2 Prof. J. RhodesSouthport 2 1 1;1 Dr. G. ButcherWarrington 2 2 2;1 Dr. B. LinakerWhiston 2 (+2) 1 3; 2; 1(+1) Dr. J. McLindonAintree University Hospital, north Liverpool.VS: 350,000 pop; 1300 beds; 12000 endoscopies pa in 4 theatres; 72 GI beds.Affiliated consultants: Four GI surgeons, two GI radiologists, two histopathologists.GI services: special interests in GI: Laser treatment, liver clinic, celiac, HPB, EUSRegional centres for Neuroscience, Maxillo-facial, ENT, Infectious Dis.University of Liverpool Department of Medicine on site (Endocrinology & Respiratory). One of theGastroenterologists is a University Senior Lecturer.GI Training: affiliation with one consultant each & emphasis on one aspect of training within abusy University teaching hospitalEduc. activities: weekly gastro/surgical/radiology & gastro/histopath meeting, Hospital grandround. Involvement in undergraduate teaching is encouraged.Research: opportunities on site are encouraged within new clinical science block.Arrowe Park Hospital, Wirral.VS: 350,000 pop; 920 beds; 9000 endoscopies pa.Affiliated consultants: Three upper GI surgeons, three colorectal surgeons (+1 Ass.Spec).GI services: general services including ERCP to local populationRegional centres for Oncology at Clatterbridge nearbyUniversity of Liverpool Medical students on siteGI Training: ideal opportunity to experience Medicine/Gastroenterology in the context andenvironment of a metropolitan district service.Educ activities: Weekly multidisciplinary X-ray meetings & separate MDT meetings, weeklymedical grand round 7
  8. 8. Countess of Chester Hospital, Chester & West CheshireVS: 250,000 pop; 180 medical beds; n= endoscopies pa in 2 theatres; n= GI beds.Affiliated consultants: Three GI surgeons, two GI radiologists, one histopathologist.GI services: full range expected of a busy DGHGI Training: affiliation with one consultant each & emphasis on one aspect of training.Opportunity to experience Medicine/Gastroenterology in the context and environment of ametropolitan & surrounding rural district service.Educ. activities: weekly gastro/radiology meeting, Hospital grand round & GI journal club.Leighton Hospital CreweVS: 250,000 pop; n= medical beds; n= endoscopies pa in 2 theatres; n= GI beds.Affiliated consultants:.GI services: full rangeGI Training: affiliation with one consultant each & emphasis on one aspect of training.Opportunity to experience Medicine/Gastroenterology in the context and environment of ametropolitan & surrounding rural district serviceEduc. activities: weekly Hospital grand roundMacclesfield, East CheshireVS: 200,000 pop; 112 acute medical beds; approx 4000 endoscopies pa in 2 theatres;Affiliated consultants: 2 GI surgeonsGI services: general gastroenterology services integrated in medical servicesGI Training: affiliation with two consultants, training in general medicine with introduction togastroenterology & endoscopy. Opportunity to experience Medicine/Gastroenterology in thecontext and environment of a rural district service.Educ. activities: weekly gastro/radiology meeting, monthly gastro/histopath meeting and weeklycase presentations/journal club.Royal Liverpool University HospitalsVS: 400,000 pop; 1200 beds; 12000 endoscopies pa in 4 theatres; 54 GI beds.Affiliated consultants: Eight GI surgeons, four GI radiologists, two histopathologists.GI services: special interests in GI therapy, IBD, HPB & Liver clinic, EUS, Genetics.Regional centres for Nephrology, Pancreatic & Liver disease.University of Liverpool Most of the University academic departments on site: research andinvolvement in undergraduate teaching are encouragedGI Training: affiliation with one consultant each & emphasis on one aspect of training.Educ. activities: weekly gastro/surgical/radiology & gastro/histopath meeting, Separte MDTs forUpper GI. Lower GI and HPB cancer; Hospital grand round, MASTER unit for endoscopy video-linked courses; JAG-approved courses in Endoscopy.Southport & Formby district general hospitalVS: 250,000 pop; 180 medical beds; n= endoscopies pa in 2 theatres; n= GI beds.Affiliated consultants: Three GI surgeons, two GI radiologists, one histopathologist.GI services: full rangeGI Training: affiliation with one consultant each & emphasis on one aspect of training.Opportunity to experience Medicine/Gastroenterology in the context and environment of ametropolitan & surrounding rural district service.Educ. activities: weekly gastro/radiology meeting, Hospital grand round & GI journal club. 8
  9. 9. Warrington HospitalVS: 250,000 pop; 644 beds; n= endoscopies pa in 2 theatres; n= GI beds.Affiliated consultants: Two GI surgeons.GI services: full rangeGI Training: affiliation with both consultants & emphasis on one aspect of training. Opportunity toexperience Medicine/Gastroenterology in the context and environment of a metropolitan & “newtown” district service.Educ. activities: weekly gastro/radiology meeting, Hospital grand round & GI journal club.Whiston Hospital KnowlselyVS: 360,000 pop; 800 beds; 10000 endoscopies pa in 3 theatres; 64 GI beds in x3 GI/GIM wards.Affiliated consultants: Two GI surgeons.GI services: full rangeGI Training: affiliation with both consultants & emphasis on one aspect of training. Opportunity toexperience Medicine/Gastroenterology in the context and environment of a metropolitan districtservice.Educ. activities: weekly gastro/radiology meeting, Hospital grand round & GI journal clubAccommodation:All hospitals have limited capacity for accommodation. SpRs within a five-year scheme will berotated between hospitals in the region and a central location is advisable in order to minimisedomestic disruption over the term of the scheme.2.iii: Duties of posts:Indicative timetables are available for each hospital but these are subject to regular changes. Ingeneral, trainees in each post will undertake the following duties: 1. Personal ward rounds with team 2. Supervised consultant ward rounds 3. Endoscopy sessions (usually 2 per week) according to level of training 4. Outpatient clinics (usually 2 per week), some specialised, some general 5. Involvement in acute medical “take” and post take ward round is compulsory. Rotas are variable but conform to current regulations in all hospitals. All posts are offered as resident-on-call but in some hospitals this is not always applied (depends on SpR grades current at the time) 6. Affiliation or cross-cover arrangements with other medical teams operates in some hospitals, and should be regarded as an integral part of training in GIM 7. Protected session for research/audit 8. Protected educational time (usually grand round & other formal activity) 9. A regional day-release programme of education operates (10 days for gastroenterology, 5 days for GIM: see below)Trainees rotating to a particular centre should consult with the appropriate supervising consultant. 9
  10. 10. 2.iv: Supervising consultants & Organisation of STECThere are, at present, 32 consultant gastroenterologists in the Mersey Deanery who participate inthe training scheme as listed below. In addition, the SpRs will have two representatives at STECwho will “hold office” for three years each - it is recommended that these are elected in theirsecond or third year of the scheme. The committee meets twice per year in June and November toreview operational procedures, the education programme and individual trainees if necessary.INSTITUTION CONSULTANTS STEC REP NUMBER SpRsAintree Dr. R. Sturgess Dr. R. Sturgess 6 Dr. N. Kapoor Dr. P.O’Toole Dr. K. Bodger Dr. S. Hood Dr. S. SarkarArrowe Park Dr. J.Dawson Dr. J.Dawson 2 Dr. R. Ferguson Dr. R. Faizallah Dr. B. OatesChester Dr. T. Wardle Dr. T. Wardle 2 Dr. R. Harris Dr. C. FrancesLeighton Dr. J. McKay Dr. J. McKay 2 Dr. I. LondonMacclesfield Dr. P. Foster Dr. P. Foster 2 Dr. E. RocheRoyal Liverpool Dr. M. Lombard Dr. M. Lombard 5 Dr. A. Ellis Dr. H. Smart Dr. K. Leiper Prof. A. Morris Prof. I. Gilmore& University Prof. J. Rhodes Prof. J. Rhodes 2 (Lecturers) Prof. A. Watson Dr. M. PritchardSouthport Dr. G. Butcher Dr. G. Butcher 1 Prof. C. KiireWarrington Dr. B. Linaker Dr. B. Linaker 2 Dr. C. TanWhiston Dr. J. McLindon Dr. J. McLindon 1 Dr. S. Turner Dr. A. BassiSpR reps Dr. S. Ahmed Dr. Collins2.v: Educational & Training programme:The training programme comprises “in-service” training which should be regarded as the mostimportant and significant aspect of training, supplemented by regular guidance, a formal educationprogramme and punctuated by formal assessment and feedback.SpRs have already completed general professional training and are expected to be of a calibre andlevel of experience to manage a proportion of clinical caseload independently under supervision. 10
  11. 11. Opportunity should occur informally (e.g. in ward rounds and clinics) and formally (e.g. inappraisal sessions and instructed endoscopy lists) to give instruction, support and guidance.Individual trainers and trainees on each leg of the rotation should come to a consensus of whattraining is required and can be offered during that particular post. In this way, each year willproduce progress in competence. For further information, trainers and trainees are referred to theRoyal College of Physicians Curricula for GIM & Gastroenterology, the JAG training document,and the recommendations for training in academic medicine published by the JCHMT.A day-release programme operates within the Deanery to ensure formal delivery of a curriculum inGIM (five days per annum) and Gastroenterology (ten days per annum). SpRs must attend over80% of these sessions during a twelve month period to satisfy training requirements. They arecounted as 50% of the study leave entitlement and should be supplemented by enrolment oncourses of endoscopy training, ALS, management, communication skills and academic meetingsduring the 5-year scheme.Active participation of SpRs has been important in ensuring the success of this programme to date.During the programme, each SpR is expected to present a proscribed topic, present the audit theyhave undertaken during the year and present a critical appraisal of published guidelines.The educational programme for 2004 is appended as an Library facilities:Each hospital has a well-stocked postgraduate library and some provide access to electronicinformation. In addition, trainees are encouraged to join the Liverpool Medical Institution (LMI)which also houses specialist journals and provides on-line literature search facilities. Postgraduatemeetings are also held at the LMI on a monthly basis by the Mersey Gastroenterology group andtrainees are encouraged to attend.2.viii: Research & Audit OpportunitiesEach SpR must undertake an audit project during each post on the rotation. The subject matter isnegotiable with the educational supervisors but must be completed within the attachment at thathospital. Each SpR presents his/her audit each year at the educational programme. These shouldbe of a high standard and can often be publishable.Research activity is encouraged, both for purposes of training in this discipline and also to foster anenvironment of scientific enquiry. In terms of building research activity into the programme, fourlevels can be considered: 1. All posts offer at least one session for research & audit purposes. Experience has demonstrated that productivity is poor unless the trainee plans this with his/her educational supervisor in advance. The postgraduate Dean will require evidence (usually publication) of effective use of this opportunity. STEC has appointed a research facilitator (currently Prof. Alastair Watson) to give advice but projects should be supervised by the educational supervisor at each hospital. SpRs are encouraged to make early contact with Prof. Watson. 2. From 2002, most trainees have rotated to one of the two University hospitals for a period of two years (rather than one year at each as was previously the case). This has allowed the trainee to embark upon research activity which can be consolidated during a two-year period and research performance during these posts forms an important part of the annual 11
  12. 12. assessment process. It has been a successful strategy in terms of presentation and publication. In addition, the two-year posting should allow trainees to develop some subspecialist interest at each hospital. It is anticipated that these posts will occur in 2nd/3rd or 3rd/4th year of the programme. 3. There are two University Lecturer posts which are constructed in such a way as to allow half-time clinical training at a single location (RLUH) for up to 3 years and half-time research over that period of time. These posts are appointed by the University in open competition after national advertisement. 4. External funding is available from time to time to conduct research full-time in gastroenterology. Competition for this type of grant is usually intense and interested trainees are encouraged to seek advice at an early stage from the Academic Departments and their supervising consultants. 5. At UHA, there is a post with 60% protected time for research which is offered on a biennial basis to trainees in the scheme on the basis of competition. Appointment is based on the likelihood, given performance and research activity to date, that the SpR will be productive in research. During the term of this post, the incumbents are encouraged to apply for external funding so that they can engage in full time research for an extended period of time with leave of absence from the rotational scheme. 6. A variety of higher degree courses (usually MSc level) are offered by local Universities on a modular basis over 2-3 years. Trainees can utilise their research session for these by prior arrangement with educational supervisors. The Deanery can only contribute part funding towards these and trainees may need to fund the remainder. The courses require a high level of personal commitment but have been used successfully in the past.To date, our scheme has an excellent record with more than 75% trainees acquiring externalfunding for periods of research and more than 90% achieving publication.2.ix: Study Leave arrangementsStudy leave is granted at the discretion of the postgraduate dean. A structured educationalprogramme has been developed within the Deanery in GIM and Gastroenterology and this accountsfor 15 days of study leave entitlement per annum (5 days GIM, 10 days Gastroenterology).A range of courses is available within the Deanery (e.g. endoscopy, ultrasound, ALS, management,interview & communication skills) which SpRs are encouraged to attend.A limited amount of funding is available for trainees to attend courses or meetings outside theDeanery. Only those meetings on STEC approved list will be funded. The following criteria aretaken into account in deciding which trainees have priority for funding: I. Priority is given to trainees presenting a paper or poster II. Local service call & rota arrangements must be reconciled III.Some consideration will be given to egality of access to leave IV.Exceptionally, study leave will be granted for private study or to complete a research project subject to satisfactory progress reports. 12
  13. 13. 2.x: Annual reviews, PYAs & summative assessmentsEvery trainee must undergo an annual review in each enrolled specialty (GIM & Gastroenterology)at which progress is assessed (Record of In-service Training Assessment: RITA). The review panelrepresents the Postgraduate Dean, the programme directors for GIM & Gastroenterology, theresearch facilitator and the supervising consultant. Supervising consultants submit a progressreport which they should have already discussed with the trainee during a formal appraisal session.In the fourth (penultimate) year, an external assessor is present for both reviews which are rigorous.At present, SpRs are asked to give a brief presentation of achievements and training needs to thepanel.A logbook of training must be kept up to date by the trainee and presented to the assessmentcommittee.At each assessment, deficiencies or gaps in training at each stage are noted and plans for furtherprogress agreed. Failure to progress (in all aspects of training, including publication) may result intargeted training objectives and may require more regular reviews or repetition of a period oftraining. Failure to adequately address deficiencies will result in termination of the trainingcontract.The annual review is also an opportunity for trainees to comment on aspects of the trainingprogramme or their current post. A confidential feedback system has been devised within theDeanery to allow trainees to comment on posts. This system has been superseded by theconfidential feedback system administered centrally by JCHMT (which is almost identical to ourown system!). Clearly, it is preferable that this is achieved through regular and open discussionbetween trainees and trainers. So far, our internal regulatory system has worked well and traineeshave taken some ownership of the quality assessment of the training scheme. 13