Bulletin October.ps - The Royal College of Surgeons of England

DOI: 10.1308/147363505X70856
Defining our priorities
Ann R Coll Surg Engl ( Suppl) 2005; 87:298–299
Two events coincide in September
2005: on 30 September the
Postgraduate Medical Education and
Training Board (PMETB) goes live
and Phase 3 of the intercollegiate
surgical curriculum project (ISCP)
will commence in four of the prepilot
deaneries 1 with programmes of
faculty development. We have also
seen the first stages of Modernising
Medical Careers (MMC) being
implemented with the start of the
first foundation year trainees in
August 2005.
We face a period of change and inevitable
uncertainty and it is therefore vital that
the College maintains a dialogue with its
members and fellows as well as with
other stakeholders (in the jargon) in the
delivery of surgical training and education,
particularly the Trusts and the deaneries.
In his evaluation of the ISCP pre-pilots, 2
Professor Michael Eraut noted that
learning through service was a legitimate
way of acquiring knowledge.The use of
light supervision by consultant trainers
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BERNARD RIBEIRO
PRESIDENT
PRESIDENT’S NEWSLETTER
will allow trainees to progress to become
certified competent surgeons able to
deliver a service.To achieve this, consultants
need time to deliver and assess their
training. The need to establish a dialogue
with Trust management to identify how
this time can be protected by Trusts led
to my meeting with Dame Gill Morgan,
chairman of the NHS Confederation,
in August 2005. We discussed a number
of matters ranging from pressures on
surgical consultants in terms of time
for training and assessing trainees, the
developing surgical curriculum and the
concept of ‘schools of surgery’ 3 within
the deaneries, through to the College’s
ongoing work on the reconfiguration of
services (http://www.rcseng.ac.uk/
service_delivery/reconfig/).
As I mentioned in my last newsletter,an
early priority for my presidency will be to
initiate a debate to determine what the
end point of training should be.That
debate needs to be wide ranging and to
engage employers. We need to recognise
that in the future, particularly with the
growing number of Foundation Trusts
and private sector providers, it is the
employers who will decide what sort
of consultant surgeons they are going
to employ. I will meet regularly with
Dr Morgan and other representatives
of the NHS Confederation and will keep
you updated on our discussions.
In recent years the College has developed
a close working relationship with the
deaneries through the deanery liaison
committee of the College.Professor
Graham Winyard is my co-chairman and
through this committee we have shared
views and responses to the PMETB
consultations. Locally, the appointment of
regional coordinators, funded by your
College,and more recently deanery
advisers (http://www.rcseng.ac.uk/
regional/advisers.html), has been vital in
helping to cement this relationship.We
are grateful for the support many of the
deans are providing to us in developing
the ISCP.One example of our close
collaboration is the emerging concept of
schools of surgery. The surgical
curriculum pre-pilot study 3 found that
medical directors in Trusts were:
> not clear of the roles and
responsibilities of those involved in
training (including surgical trainers,
educational supervisors, College tutors,
regional specialty advisers and to a
lesser extent programme directors);
and
> not clear of the organisational structure
that linked the deanery, royal colleges
and Trusts.
The concept of schools of surgery within
the deaneries, supported by College
representatives, is currently evolving to
help develop roles and responsibilities in
order to professionalise the existing
arrangements and to facilitate a closer
working relationship between the Trusts,
the deans and the College.It is hoped
that schools of surgery will be established
in the five pilot deaneries, thus providing
an effective organisational structure to
manage educational resources and
support the trainer–trainee partnership
during and after curriculum reform. It is
hoped that such a regional organisation
could be sensitive to local needs and
opportunities. We will publish further
information about schools of surgery and

THE ROYAL COLLEGE OF SURGEONS OF ENGLAND BULLETIN
how we plan to further develop and pilot
the idea but it has been encouraging to
see how readily many of the deans have
been to work collaboratively with us in
developing this idea.
In the coming months a series of
stakeholder meetings will be held in a
number of deaneries to introduce the
ISCP locally. If you receive an invitation to
one of these events I urge you to attend.
We will be piloting the curriculum over
the next 18 months and we urgently need
your views and feedback.
To this end we have begun conducting
information sessions to introduce the
project’s faculty development
programmes, which are aimed at enabling
you, the surgical educators, to begin
piloting the new surgical curriculum in
your local deaneries, and we have started
fostering opportunities for open
communications between trainers,
deaneries and Trusts throughout the UK.
Wessex surgical educators’
meeting
I attended this meeting in Salisbury,
organised by Mr Tim Walsh and
Mr Alistair Flowerdew,with
Mr David Rosin (vice-president) and
representatives of the College to
receive feedback on MMC and the ISCP.
A variety of speakers, from senior Trust
management to specialty representatives,
were asked to present their hopes and
concerns for the new surgical curriculum
programme.
On the whole,most speakers were very
positive towards the key aims of the
project. Speakers and delegates generally
felt that the introduction of a curriculum
would make training fairer and more
transparent, and would identify sooner,
rather than later,those gaps in knowledge
and technical skills that would need
development in order to progress
through training, thereby offering
mentoring and work planning
opportunities which would benefit both
trainees and trainers. Speakers and
delegates also welcomed the project’s
findings to date regarding issues such as
the identification of time and funding for
dedicated teaching versus meeting target
and service obligations.
However, many speakers and delegates
voiced concerns about the proposed
programme,raising issues such as
selection and entry into surgical training
for current SHOs as well as those in the
future, obtaining the time and funding
considered necessary to implement the
programme and the value of the
Certificate of Completion of Training
(CCT) in comparison to the Certificate
of Completion of Specialist Training
(CCST). In my opinion, the latter is a nonissue.CCT
defines the end of specialist
training; it does not guarantee consultant
appointment. As a senior registrar with
only three years’ training at that level
I was appointed a consultant surgeon
without being accredited by virtue of
completing four years’ training. Since that
time I have rightly been judged on how
I performed in my post, as others will be
whether they have a CCT or a CCST.
In response to these concerns Mr Frank
Harsent, chief executive of the Salisbury
Health Care NHS Trust, asserted that it is
imperative that the surgical, and medical,
colleges engage with Trusts and hospitals
to ensure that training is focused on
producing those consultant surgeons
needed to meet workforce demands and
societal needs, especially in light of the
increasing prominence of Foundation
Trusts and independent sector treatment
centres. He felt that MMC had not
engaged employers in discussions about
the planned changes which could
potentially have a destabilising effect on
health providers. In an increasingly
competitive environment, Trusts will
determine what care they can provide
and who best to employ to deliver that
care. He predicted that in the foreseeable
future many Trusts will opt to withdraw
from training.
Mr Harsent predicted that workforce
planning would increasingly be a matter
of meeting locally defined service needs.
Dr Clair de Boulay, Wessex Institute’s
dean, warned that service needs must be
identified for the future. Otherwise the
training agenda may not reflect the needs
of patients.
It has become very clear,therefore, that if
we,as a profession, and as a College,do
not set the agenda for the modernisation
and revision of surgical training and define
the end point of training, the Trusts and
hospitals will.
The PMETB
During the summer we have received and
responded to a raft of consultation
documents from the PMETB concerning
draft procedures for interim quality
assurance,quality assurance of
postgraduate medical education and
standards for entry into specialist medical
education. Links to the documents and
the College’s responses are available on
our website at http://www.rcseng.ac.uk/
publications/docs. I will update you in
future newsletters.
Advice to SHOs
By the time this piece appears in the
Bulletin,the College will have published
some preliminary advice to current SHOs,
which will be available on the College
website (http://www.rcseng.ac.uk/) and
will be emailed to all those SHOs
registered with the College as well as to
surgical tutors. I appreciate that current
SHOs face a particularly stressful time as
there are many unanswered questions on
how the changes brought about by the
MMC initiative will affect them. As
previously stated, the problem of the
SHO bulge and the need to allocate
additional national training numbers to
surgery over the next three years will be
at the top of my agenda when I meet the
secretary of state in October 2005.
In my September 2005 newsletter I asked
you to email me your views about what
the end point of training should be.
I would like to remind you of that request
and invite you to let me have your
comments on this or any other issues
raised in my Bulletin newsletters at
prcsviews@rcseng.ac.uk.
References
1 Ribeiro B, Hagan P, Daly B. The intercollegiate surgical
curriculum project: progress to date. Ann R Coll Surg
Engl (Suppl) 2005; 87: 264–266.
2 Eraut M. Mapping the problems facing the new surgical
curriculum. Ann R Coll Surg Engl (Suppl) 2005; 87:
230–234.
3 Canter R, Kelly A, Williams G. Pre-piloting the new
surgical curriculum: first impressions. Ann R Coll Surg
Engl (Suppl) 2005; 87: 190–191.
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