The Secretary of State for Health's response to Aspiring to Excellence: Final report of the Independent Inquiry into Modernising Medical Careers- Feb 2008

8th to 11th July 2008. Download registration forms from here.
For further information please contact:
Mr Azad Najmaldin
Consultant Paediatric Surgeon
St James's University Hospital
Leeds LS9 7TF

Tel: 0113 2064014
E-mail: parmjit.jajuha@leedsth.nhs.uk

There has been much confusion about this issue recently with the changes to immigration regulations and the court cases that have followed. Our understanding is that those from within the UK and EEA and those from outside these areas who do not need a work permit to work in the UK can apply freely for training posts. Those who do need a work permit to work here can apply but will only be considered if no suitable UK or EEA candidates apply, this is extremely unlikely to apply to any paediatric surgery posts. The matter is currently still in the appeal stages and may change so we strongly recommend that all those who may be affected consider this as advice only and check carefully on the MMC and other websites before making any final decisions.

SAC Meeting in Paediatric Surgery 7th February 2008
Trainee Report

There was a meeting of the SAC at the Royal College of Surgeons on 7th February which Iain and I attended on your behalf. In the afternoon was a further meeting of the SAC with programme directors. Key issues from both meetings are summarised below.

1. ISCP – the JCST is responsible for the ISCP. It was noted that many trainees are signed up to the site, but not enough trainers are signed up. There was discussion about how the ISCP is funded – it has been funded by the DoH but it is likely that trainees will have to fund it in the future. A cost of £125 per trainee per year was suggested. Whether this would apply to SpRs as well as StRs was not known.

2. Subspecialty training posts in Scotland – there are plans for 2 Laparoscopic fellow jobs and one urology job. These would not need further PMETB approval and would be open to applicants from England and Wales as well as Scotland. Trainees would have to have the first part of their exam before applying for these jobs, and would need to be eligible for CCT by the time they finished them. Concerns were expressed about the lack of manpower planning in the NHS – the target of 4 paediatric surgeons per 1,000,000 has already been met in Scotland, but not in England.

3. Tooke Report – an official government response is not expected before the end of February. It is likely that FY1 will be uncoupled from ‘Core training’ which will last 3 years and end with competitive entry into specialist raining. Post CCT training is likely to be required in Paediatric Surgery. Recent news from the Home Office blocks entry to training jobs by non-EU trainees.

4. ST3 expansion – there was a delay in advertising London ST3 jobs (have now been advertised)

5. Post CCT fellowships – advantages are that they are forward looking and will be very attractive for trainees. The disadvantage is that training may be diluted. Specific fellowships were not discussed.

6. Urology – there was a long discussion about the plans for Urology to apply for subspecialty recognition. The process involves support from a Royal College (RCS(Eng)), application via the SAC to the JCST which would then put the proposal to college council. If approved, the council would apply to PMETB, and approval in principle would be granted. PMETB would then check specific training programmes. The SAC in Urology has agreed to this in principle. However, after discussion about the practicalities of this plan, Mr Malone decided that BAPU would have to have further discussions about whether they wished to proceed with the process.

7. SAC Liaison members – training programme directors are not necessarily on the SAC, but there is a proposal that they should become members to provide external quality assurance for consortia. The concept of a Penultimate Year review – at the RITA 1yr before CCT to check all paperwork is in order – was supported. This would be undertaken by the external training programme director on the RITA/ARCP panel.

8. Chairman’s report – the chairman reported that there were currently 90 trainees, 40% female, with 12 expecting to achieve CCT in the coming year. It is not known how many people who are currently ST1s will be ST3s in 2009. The challenge is to develop a coordinated strategy with deaneries and the NHS workforce review team to ensure that the right numbers of trainees are trained.

9. National selection for training – has been chosen as a model by Plastic Surgery, Neurosurgery and Cardiac Surgery already. Currently Paediatric surgery in England has not gone down this route, but may consider it in 2009. There is already national selection in Scotland.

10. JCST/PMETB – various issues were discussed including the definitions of
a. OOPT – out of programme training (PMETB involved)
b. OOPR - out of programme research (PMETB may be involved)
c. OOPE - out of programme experience (PMETB not involved, will not count towards CCT)
d. OOPC - out of programme career break (PMETB not involved)
For OOPT/R the deanery seeks prospective approval and must have the support of the SAC. Posts in the EU/EAA are excluded if the posts are approved by the relevant competent authority (but PMETB does not have a list of who these are!). The SAC checks afterwards that educational objectives were met. OOPT counts towards CCT. Jobs done outside of this do NOT count towards CCT and may require that the trainee gets a CESR (Article 14) not a CCT. We will seek clarification on whether this applies to old style SHOs who did jobs that were not prospectively approved by PMETB because it didn’t exist at the time. (Since the meeting PMETB have replied and indicated that SHO jobs which had educational approval will count, see message on mailing list). OOPR can only be recognised towards CCT if the curriculum includes research as an optional element of training – in practice it is unlikely to be recognised for trainees who are not on an approved academic track already. Further information may be available at www.pmetb.org.uk/trainees .

11. Academic surgery – the importance of academic surgery was recognised, but the perceived conflict with service delivery was acknowledged. It is not clear how the Tooke report will influence the path of academic surgery. We presented the results of the trainees’ survey into research, and trainees were thanked for their participation in this important study. The survey had a good response with 60 trainees replying in time for the report. Of these, about half had undertaken a period outside of clinical practice and many thought that they might undertake research in the future, Most trainees who had done research commented on what a valuable experience it had been and we encouraged the SAC to continue to support research. The report will be published on the website in the future.

12. Exam – the next exam will be held in Oxford in March 2008. The current pass rate is 2/3 for the written and 75% for the second part (60% overall). The group of question writers has been increased and there is now a bank of >1500 questions to which 200 are added each year.


Clare Rees
Paediatric Surgery Trainee Representative

Trainee Rep Report
4th February 2008

1. Curriculum update - the BAPS E&T committee will be sending a member to the ISCP curriculum meeting next week. Specific points to be raised include the list of DOPs and PBAs for Paediatric surgery which do not reflect the expected competencies of ST3 trainees who will need to use them. It is not clear who wrote them, and the committee does not propose to offer to write new ones, but will suggest appropriate procedures to be assessed including pyloromyotomy, appendicectomy, inguinal herniotomy, orchidopexy and circumcision (not infant). It was also noted that blank PBA forms would be useful so that trainees can adapt them to any operation.

2. RITA/ARCP process – the ARCPs this year will be very similar to RITAs and trainees should complete the green and yellow forms still.

3. E logbook – the logbook continues to be updated and Miss Cusick is happy to register all new trainees. There will be a logbook committee to be convened soon, with Sarah Wood to represent trainees on this committee.

4. Training meetings – the following meetings are all planned for the near future (dates on Trips diary @ www.trainee.baps.org.uk )
• Oncology course – just completed, no official feedback yet
• Trauma course
• EUPSA
• BAPS training day at Chelsea & Westminster – date confirmed as 26-27th June
• BAPS congress Salamanca
• APA meeting
• Simpson Smith Symposium 21st May – programme reviewed, to include sessions on GORD and Management of Complications, Simpson Smith Lecture to be given by Prof Alan Flake (Philadelphia Children’s Hospital).
• General Paediatric Surgery course – a new course which aims to cover gaps in the syllabus not covered on other courses (eg Trauma, Oncology, Neonatology). It was noted that the title does not necessarily make it clear that this course is for Paediatric Surgeons, and a suggestion was made to remove the word ‘general’ from the title to make this clearer. The cost was discussed, and noted to include accommodation. The course is supported and coordinated by the Raven Department of Education at RCS(Eng).
• Oxford Neonatal Course – 14-18th July
• Basic Sciences course - this was run on a 2-yearly basis but not in 2006 during MMC. Mr Jesudason at Liverpool is planning to run the course this year. No dates available but probably winter.
It was agreed that all courses run by BAPS should have a discount for BAPS trainee members. This will not include externally run courses.
Training days will be centred around a theme, as requested by trainees after the Nottingham training day. Centres which have not hosted a training day in the last 5 years will be invited to choose from the list of topics provided by the committee.

5. National Surgical fellowships - it is possible that Paediatric Surgery will be awarded up to 6 of these next year. It is not known whether the Department of Health has an ongoing commitment to fund these posts.

6. CPD/ Revalidation - BAPS is represented on a college steering group which represents all 9 surgical specialties. With the exception of the cardiac surgeons, most specialties do not have mechanisms in place for revalidation yet. It is envisaged that there will be generic advice from the RCS and that this will be based on the ISCP website. It was noted that it is particularly difficult to compare outcomes in a specialty with small volume operations which are expected to have good long term outcomes. The difficulties remain as to how to set the standards and what to assess.

7. Electronic training resources - no progress to report, but a grant may be available from the Dept of Health to provide funding for this area. The committee will investigate this.

8. Pilot of OSCIs at RITA/ARCPs
A proposed pilot of an OSCI examination to be held as part of the RITA process is expected to take place in the London/SE deanery this year. This is intended to provide an objective assessment of trainees’ competencies and to highlight areas which need further input. If a deficiency is noted because of a lack of training in a particular area (e.g. laparoscopy) this could be used to decide future placements. It is envisaged that there will be 10 stations including X-rays/CT scans/ Laparoscopic skills etc. If the pilot is successful then this could form the basis of the decision to select trainees to progress from ST2 to ST3 and even be part of a national ranking system.

Clare Rees