Common Elective and Acute Problems in the General Surgery of Childhood
13-14 December 2007

Aims
This course aims to update the current management of common paediatric surgical problems.
This two-day course is aimed at:
-STs 1-8 and Consultants in General Surgery
-STs 1-2 in Paediatric Surgery
 
Convenor
Mr Harry Ward
Consultant Paediatric Surgeon, The Royal London Hospital
 
Mr Tony Lander
Consultant Paediatric Surgeon, Diana Princess of Wales Children Hospital
Tutor in Paediatric, The Royal College of Surgeons of England
 
Course Programme
Elective Surgery
-Lumps and bumps
-Neck swelling
-Constipation and rectal bleeding
-Umbilicus and abdominal wall
-Groin and scrotal swelling
 Medico/legal
-Ethics
-Consent
 Acute Surgery
-Acute scrotum
-Incarcerated inguinal hernia
-Vomiting infants/Intussusceptions, congenital, pyloric stenosis
-Acute/recurrent abdominal pain
-Appendicitis
 
Format - Lecture and interactive discussion centred on clinical scenarios.
Fee: £500
For more information please contact:
T: 020 7869 6332 F: 020 7869 6329 E: paediatric@rcseng.ac.uk

In partnership with the Royal College of Surgeons of England, Cancer Research UK invites applications for a Clinician Scientist Fellowship in Surgery. All applicants must be Members or Fellows of the Royal College of Surgeons of England and in good standing.
You must check your eligibility for these awards at:
http://www.fellowships.cancerresearchuk.org/
You will also find the application there. When completing the forms please state clearly that you are applying for the Cancer Research UK / Royal College of Surgeons of England Clinician Scientist Fellowship.
If you would like to discuss your application for any of these fellowships, or have any questions, please contact Dr Matthew Wakelin at: matthew.wakelin@cancer.org.uk or Tel 020 7438 5333.

Following a discussion document and feedback from stakeholders, the new MMC Programme Board, whose members include the BMA, the Academy of Royal Colleges and NHS Employers, has recommended changes to junior doctor training and recruitment for 2008. Download the full report here.

It has been proposed that all appointments to surgical training schemes at ST level 1 or 2 be time limited, meaning that there would be no guaranteed progression to higher levels of training and that an additional competitive selection process would occur prior to ST 3. This would be broadly similar to the previous situation with SHO grades seeking progression to SpR training and has been referred to as “uncoupling”. In the MTAS process, however, there were appointments made at ST2 level in paediatric surgery that were not FTSTAs, with the understanding of the trainee that they had been appointed to “run-through” training. This has left the situation unclear as to how ST3 posts will be appointed next year and may mean that those who were unsuccessful in applying to ST3 level in 2007 are unable to compete for ST3 posts in 2008.

The following is an attempt to present the views of paediatric surgical trainees following an open discussion at our National Training Day on 2nd October. This meeting was attended by a variety of trainees including foundation level doctors, FTSTAs, trainees at ST 1, 2 and 3 level (some of whom had been appointed to “run-through” posts), SpRs and those seeking entry into training posts in MMC.

It should be noted that whilst on some issues opinions were unanimous, on others opinion was divided, reflecting the fact that in order to progress it is not possible to act fairly to all groups of trainees.

Current Situation

Trainees have been appointed to ST2 posts in paediatric surgery with the expectation that this will be a “run-through” appointment and, assuming satisfactory progress and assessments, they will arrive at a CCT without further selection.
There remain trainees committed to the specialty who are seeking ST3 level appointments having failed to secure posts in the MTAS round 1 or 2. It is unclear how many ST3 level posts will be available in future years.

Firstly the situation as exists currently needs to be addressed and then a consideration of how things may be arranged in the future can be undertaken.

Current Selection of ST3 Run-Through posts

We feel that two separate groups of trainees need to be considered and that it is important to try to act fairly to both those seeking ST3 posts and those already appointed to ST2 posts. Regrettably seems it will not be possible to produce a solution that will be satisfactory to all.

Three possible options were considered as a way forward:

The first option was to introduce uncoupling with immediate effect. This would mean that any trainee appointed at ST2 level as a “run-through” would have this appointment retracted and would have to enter an open, competitive selection process in order to obtain an ST3 post in paediatric surgery. This proposition had significant support from those present for several reasons including the manner in which the selection process was carried out and the lack of opportunity for other, more experienced candidates to apply to ST3 posts. Conversely many felt this was unfair to the trainees from whom an offer would be withdrawn who would face further uncertainty and who may have made firm plans for their futures based on the appointment to “run-through” training. Doubts were also expressed as to the legality of withdrawing job offers once made.
A second option was to honour the appointments made to ST2 trainees and allow them to run-through. This met with some support as it was felt to be dishonourable to withdrawn previously made offers and, providing that the competency assessments were robust enough, only good trainees would progress. Opponents to this felt that to allow these trainees to run-through would prevent many high calibre, committed trainees from ever being able to enter higher surgical training in paediatric surgery.
The third option would be to further increase the numbers of training posts at ST3 level in order to accommodate the extra numbers. This was unanimously rejected, even by those seeking ST3 appointments as it was felt that this would lead to problems with training in our numbers sensitive specialty and the prospect of post-CCT unemployment.

It was clear from the lack of consensus at the meeting that there is no possible way forward that will satisfy all groups of trainees. In determining the fairest and most acceptable way forward further information is requires including the actual number of ST3 posts that would be available were all ST2 run-through training offers honoured based on a robust and accountable assessment of capacity. Also the legality of each option needs to be considered, both for those who have received a contract with run-through training, and those who may have been let down by the significantly flawed appointment system over recent months. And It seems inevitable that some high quality candidates will not be able to continue in paediatric surgery, although it was pointed out that this was always the case with the previous system as “Calman numbers” were always limited. A system whereby these trainees could be supported and counselled as to their career options would be valued.

Additional concerns were expressed by trainees in ST3 posts that they had only been given one year contracts and that it was unclear with whom their contract was, either the deanery or the employing trust.

Future Selection of ST3 Run-Through posts

It was felt to be unrealistic to expect that future consultant surgeons could be identified and selected only 2 years post-graduation. Doubts were also expressed as to the robustness of workplace based assessments and it was felt that mediocre trainees would be able to progress leading to a lowering of standards. An additional selection process may help ensure standards remain high. It would also have the additional benefit of introducing more flexibility to the early part of a surgical career with potential to move between specialties. Consequently the meeting unanimously favoured uncoupling of surgical training for all future appointments and introducing competitive selection at ST3 level.

Summary

These are difficult and challenging times for the profession and for trainees in particular. It is unclear who is responsible for the situation we find ourselves in and it seems to trainees that there has been a lack of planning and accountability. There is a widespread lack of confidence in those overseeing these changes. Whatever plans and changes are to be introduced we feel strongly that trainees should be consulted and involved in order to produce a solution that is acceptable to those people who will be most affected..

We particularly despair of the apparent lack of central planning and control of trainee numbers and the absence of any transparent workforce planning. We feel this is essential to ensure adequate employment prospects in the future.


What all trainees would value most highly is clarity and the ability to make long term plans for their future careers.

Iain Yardley, Jonathan Sutcliffe and Clare Rees