Certificate Of Completion Of Training Research Articles

Upper gastrointestinal training in the UK and Ireland: a Roux Group Study.

Surgical training programmes in the United Kingdom and Ireland (UK&I) are in a state of flux. This study aims to report the contemporary opinions of trainee and consultant surgeons on the current upper gastrointestinal (UGI) training model in the UK&I. A questionnaire was developed and distributed via national UGI societies. Questions pertained to demographics, current training evaluation, perceived requirements and availability. A total of 241 responses were received with representation from all UK&I postgraduate training regions. The biggest discrepancies between rotation demand and national availability related to advanced/therapeutic endoscopy and robotic surgery, with 91.7% of respondents stating they would welcome greater geographical flexibility in training. The median suggested academic targets were 3-5 publications (trainee vs consultant <3 vs 3-5, p<0.001); <3 presentations (<3 vs 3-5, p=0.002); and 3-5 audits/quality improvement projects (<3 vs 3-5, p<0.001). Current operative requirements were considered achievable (87.6%) but inadequate for day one consultant practice (74.7%). Reassuringly, 76.3% deemed there was role for on-the-job operative training following consultant appointment. Proficiency in diagnostic endoscopy was considered a minimum requirement for Certificate of Completion of Training (CCT) yet the majority regarded therapeutic endoscopy competency as non-essential. The median numbers of index UGI operations suggested were comparable with the current curriculum requirements. Post-CCT fellowships were not considered necessary; however, the majority (73.6%) recognised their advantage. Current CCT requirements are largely consistent with the opinions of the UGI community. Areas for improvement include flexibility in geographical working and increasing national provisions for high-quality endoscopy training.

UK-wide survey of gastroenterology and hepatology trainees in 2022: endoscopy, workforce planning and the Shape of things to come

ObjectiveShape of Training has shortened the gastroenterology curriculum in the UK from a 5 to 4-year programme. There are ongoing concerns that this will negatively impact training and the attainment...

OGBN O04 Upper Gastrointestinal Training in the UK &amp; Ireland – a Roux Group Study

Abstract Background Surgical training programmes in the United Kingdom and Ireland (UK&amp;I) are in a transition period evidenced by new surgical curricula. This study is the first to collate the opinions of UK&amp;I trainee and consultant surgeons regarding the current Upper Gastrointestinal (UGI) training model. Methods A questionnaire was developed and distributed via national UGI societies and the social media platform, Twitter. A total of 241 responses were received with all UK&amp;I regions represented. Results The median time to Certificate of Completion of Training (CCT) of 13 years was considered reasonable (50.2%), however the majority (67.2%) found training to be unfocused. The suggested targets for publications, presentations and audits were 3–5 (trainee vs consultant &amp;lt;3 vs 3–5, p&amp;lt;0.001), &amp;lt;3 (&amp;lt;3 vs 3–5, p=0.002) and 3–5 (&amp;lt;3 vs 3–5, p&amp;lt;0.001) respectively. The majority (61.9%) considered a higher academic degree advantageous but felt it should not be compulsory. Interestingly, most respondents (63.5%) had or planned to undertake one. Crucially, there were geographical discrepancies in access to training, particularly in bariatrics, robotic surgery, and endoscopy. Proficiency in diagnostic endoscopy was deemed essential for CCT and consultant practice (81.7% and 67.6% respectively). The current index UGI operative requirements were felt to be achievable (87.6%) but inadequate for day one consultant practice (74.7%), an opinion shared by both the trainee and consultant groups (p=0.662). Reassuringly, most respondents (76.3%) deemed there to be a role for on-the-job operative training following consultant appointment. Post-CCT fellowships were not considered necessary for consultant appointment, however the majority (73.6%) again recognised its advantage. Conclusions While variations were seen in the opinions of trainee and consultant surgeons, the current CCT requirements as outlined by the Joint Committee on Surgical Training are consistent with the overall perspective of the UGI community. Areas for improvement include flexibility in geographical working and provisions for endoscopy training, to ensure equal access.

146. ‘Fellowship of the Ring’ – My Waikato Experience – Hamilton, New Zealand

The conventional route to being a Maxillofacial surgeon is a training programme of five years, undertaking the ‘exit’ exam and being awarded a certificate of completion of training (CCT). Whilst for many the next stage would be attaining and undertaking a consultant post immediately or whilst utilising their grace period, some trainees consider the opportunities afforded by a fellowship. This can be both a formal and informal opportunity to address training deficiencies or to consolidate and acquire new skills prior to a definitive consultant post.

A national survey investigating the impact of the COVID-19 pandemic on core and higher breast radiology training in the UK

AIMTo investigate the impact of the COVID-19 pandemic on core and higher breast radiology training in the UK from the perspective of trainees and new consultants.MATERIALS AND METHODSA survey comprising 25 questions was distributed to UK radiology trainees via the regional Junior Radiologists Forum representatives under the auspices of the British Society of Breast Radiology (BSBR).RESULTSSixty-nine eligible responses were received representing all UK training regions. Fifty-five per cent of respondents completing either a core or higher breast rotation felt that the pandemic had a negative effect on their breast training. There was an overall reduction in exposure to the key breast imaging methods when rotations took place during the pandemic. Completing a core breast rotation during the pandemic was less likely to attract trainees to higher breast training. Three out of four breast radiology consultants in their first year after receiving their Certificate of Completion of Training (CCT) felt the pandemic reduced their preparedness for becoming consultants. Positive outcomes included the increased use of online educational resources and remote multidisciplinary meetings.CONCLUSIONSAs well as having a negative impact on breast radiology training overall, the pandemic has had a detrimental effect on attracting trainees to breast radiology as a future career. It is of key importance that trainees have a positive core breast rotation as this experience appears central to many trainees' decisions to pursue higher breast training. Increased use of online learning resources has also been positively received and is a valuable approach to learning that can be maintained in the longer term.

Ethnic differences in success at application for consultant posts among United Kingdom physicians from 2011 to 2019: a retrospective cross-sectional observational study.

To identify associations between success following application for consultant physician posts and demographic factors. Logistic regression analysis of nationwide survey data. United Kingdom (UK) physicians with a recent certificate of completion of training (CCT). All UK trainee physicians who received a CCT between 2010 and 2019 were surveyed. Respondents were excluded if they had not applied for a consultant post or if application data were incomplete. The primary outcome measure was success over the entire consultant application process, i.e. shortlisted and offered the post following the first application. Secondary outcomes were: shortlisted following first application and offered a consultant post at first interview. From 7037 CCT holders surveyed, 50.7% responded. While 1198 (59.7%) respondents were white, 760 (37.9%) were from minority ethnic groups and 50 (3.5%) were of unknown ethnicity. Primary medical qualification (PMQ) country was the UK in 75.3% (n = 1512). On multivariable logistic regression analysis the independent negative associations with success were: minority ethnicity (odds ratio [OR] 0.55, 95% confidence interval [CI] 0.43-0.71); p < 0.001) vs. white; PMQ from Europe (OR 0.47, 95% CI 0.28-0.79; p = 0.004) or Asia (OR 0.68, 95% CI 0.49-0.96; p = 0.027) vs. UK PMQ; year of CCT 2012 (OR 0.40, 95% CI 0.24-0.68; p = 0.001), 2013 (OR 0.39, 95% CI 0.23-0.65; p < 0.001), and 2014 (OR 0.26, 95% CI 0.15-0.43; p < 0.001) vs. 2019. Specialties associated with lower success rates included Cardiology, Endocrinology, Genitourinary medicine, Palliative care, Renal and Respiratory, compared to Acute medicine. Minority ethnic group candidates for consultant physician posts had lower success rates compared to white candidates after correction for important variables including specialty, time from and country of PMQ. This finding requires further evaluation to identify the causes for this variation.

Education and Training: Flexible portfolio training: a novel approach to future physician training

Flexible portfolio training (FPT) is a novel Royal College of Physicians' training scheme developed in 2019 to tackle issues of burnout, retention and recruitment among medical registrars. Awareness of the FPT scheme may be lacking and this article intends to inform potential future FPT trainees and their supervisors. Open to applicants at the time of appointment to higher specialty training, the FPT scheme protects up to 20% of total training time for trainees to pursue an area of interest in one of four pathways (medical education, quality improvement, clinical informatics and research) without extending time to achieve their certificate of completion of training (CCT). Training numbers remain limited and are only available in certain areas across England and Wales. This article explores the benefits of FPT including medical scholarship, flexibility of time and flexible development of personal learning outcomes and objectives and, crucially, improved wellbeing. The experience of FPT trainees and example projects from those on the medical education pathway in the East Midlands suggest that the scheme can address some of the concerns identified in the future doctor report, potentially sustaining trainees through specialty training, preventing stress and burnout as well as propelling individuals towards lifelong and rewarding careers.

All roads can lead to surgery

Pursuing a career in surgery is a rigorous process that demands commitment and hard work. Surgeons in the United Kingdom must go overcome a myriad of competitive stages prior to becoming a consultant. In the United Kingdom, the most common pathway to become a surgeon is via the ‘direct route’ which encompasses completing multiple training programs, namely, the Foundation Program, followed by Core Surgical Training, and then onto Higher Speciality Training, with the aim of obtaining the Certificate of Completion of Training (CCT). More recently, certain specialities have introduced the ‘Improving Surgical Training’ (IST) pathway. IST is a competence-based, run through surgical program that was introduced by the Royal College of Surgeons of England (RCS) and Health Education England (HEE). “The pilot trials improvements in the quality of training, a better balance between service and training for trainees, and professionalisation of the role of the surgical trainers” [1]. However, there are alternative pathways that have been designed for those who prefer a different route to training or have been unsuccessful during the selection stages. These pathways are not well-advertised, but with the competitive rates now higher than before, it is becoming a more attractive pathway for junior doctors, hence the increasing the demand for clearer instructions on potential routes for aspiring surgeons.

1492 The Age of Trainees When Joining the Specialist List – What Are the Differences Across Specialties?

Abstract Introduction Those wishing to pursue a career in surgery will be aware of stereotypes that exist within each specialty, including how long it takes to attain a certificate of completion of training (CCT). These perceptions are often historic, and whilst may be based on elements of truth, are rarely backed by robust data. Oral &amp; maxillofacial surgery (OMFS) for example is plagued by the stigma of necessitating a second degree which gives the assumption the age of being appointed a consultant is somewhat above average. We aim to dispel (or prove, depending on one’s predisposition) such myths by analysing the age of surgeons when appointed to the General Medical Council’s specialist list. Method Information on the age of entry onto the surgical specialist lists between 1997 and 2018 was obtained from the General Medical Council (GMC). Data was suitably statistically analysed. Results 19,135 surgeons joined surgical specialist lists during the study period. General and trauma and orthopaedic surgery accounted for 60% of all surgeons (n = 11,444). The age on joining surgical specialist lists ranged from 27–83 years, with a mean of 41.4 years. Neurosurgeons most frequently joined the specialist list in the youngest age bracket. OMF surgeons, along with their cardiothoracic and vascular colleagues, are joint eldest by 1.3 years. Conclusions Since the creation of the specialist list, training has seen several upheavals. This data shows that despite each specialty’s specific requirements and individuals’ varying paths, there is little difference in the age when the consultant destination is reached.

Surgical Perspective: UWI Graduates Path to a Certificate of Completion of Training (CCT) &amp; Fellowship in the UK

Surgical post graduate training is a rapidly evolving field that has seen major technological shifts in its delivery of care. Our aim in this article is to deliver a viewpoint of a contemporary roadmap for the University of the West Indies (UWI) graduate. The overall path and length of training schemes in the United Kingdom (UK), in respect to general surgery and urology is presented. It is important for the reader to understand that the UWI graduate has many different avenues they can pursue to gain entry onto a UK surgical training programme. The Caribbean should benefit from the connectivity and collaboration with our international colleagues. Keywords: surgery, postgraduate, training, general surgery, urology, fellowship

Access to management and leadership training during COVID-19

COVID-19 has brought several new challenges to education and training, particularly for those close to their certificate of completion of training (CCT). One of the specific requirements for CCT across all specialties, and a specific area of interest in the NHS Long Term Plan, is that of leadership and management.1 Across the UK many courses have been cancelled as a result of COVID-19.2 In order to ensure trainees did not miss out on this opportunity we decided to run our 2-day course virtually via Zoom. The number of trainees was limited to 25 in order …

Urology trainee perceptions of curriculum checkpoints and challenges to achieving a Certificate of Completion of Training: Results of a national survey

Objective: To determine the views of urology trainees regarding training checkpoints/waypoints, and challenges to achieving a Certificate of Completion of Training (CCT). Methods: A novel survey was devised and distributed to evaluate urology trainee perceptions of the challenges in achieving the current CCT requirements as well as their views on the ST4 waypoint, indicative numbers (INs), workplace-based assessments (WBAs) and critical condition case-based discussions. Results: Of 347 trainees, 59 (17.0%) returned completed surveys from 13 of 19 training regions. The most significant challenges in achieving CCT as perceived by all trainees were, from highest to lowest: publication requirements, paediatric urology experience, achieving FRCS (Urol), INs and WBAs. All questions relating to ST4 waypoints were answered positively by a majority of respondents. Conclusions: The findings of this survey suggest that trainees will approve of the forthcoming changes in training assessment and outcomes embedded within the 2021 curriculum. The ST5 checkpoint, in particular, is an opportunity to better match trainees and placements and will underpin successful ‘phasing’ of training. A future study will inform the success of ‘embedding’ the 2021 curriculum and subsequently play a crucial part in the continuous improvement of urological training. Level of evidence: Not applicable for this multicentre audit.

Fellowship opportunities

Background: The training pathway in maxillofacial surgery results in a certificate of completion of training (CCT). Whilst for many the next stage would be attaining and undertaking a consultant post, some trainees consider the opportunities afforded by fellowships, which can be both formal and informal opportunities, to address issues of deficiency or to consolidate and acquire new skills prior to a definitive consultant post.

European OMFS in the time of Brexit – where did the UK fit and how might the future look?

The specialty of OMFS in the UK is a dual degree specialty which was recognised in Europe within Annex V of Directive 2005/36/EU. Currently UK law matches that of the EU. Brexit may change this. DIRECTIVE 2005/36/EU: Defines two specialties within European nations, Dental, Oro-Maxillo-Facial Training DOMFS (Basic dental & medical training) and Maxillofacial Surgery (basic medical training). The UK sat within DOMFS and so specialists from DOMFS nations could travel and work in the UK. Specialists from all other nations were required to use the Certificate of Eligibility for Specialist Registration (CESR) route. DIRECTIVE 2013/55/EU: This directive updated 2005/36/EU regarding Mutually Recognised Professional Qualifications (MRPQ) including creating an international alert system for doctors in difficult Entry onto the UK OMFS Specialist List by CESR Route CESR application is a large and complex portfolio of evidence to demonstrate knowledge, skills and experience are equivalent to a Certificate of Completion of Training (CCT) holder. To date, no EU applicants have successfully completed a CESR application. Even after Brexit, the UK will remain a full member of UEMS. The OMFS Section of UEMS is a source of information and support for specialists wishing to work in other nations and for nations wishing to develop an OMFS specialty in their nation. Applicants meeting the person specifications for approved OMFS specialty training (ST) posts in the UK are welcome to apply to the national selection process for OMFS specialty training in the UK. Many have done so successfully. Fixed term appointments and Fellowships are advertised and represent a useful route to gain support for application for training or through the CESR Route. The UK remains part of the diverse OMFS community in Europe. There is support from within the UK and from UEMS for trainees and specialists interested in coming to the UK to train or to work.

Major Lower Limb Amputation: A Review of Current Standards in One Vascular Centre

Introduction: There is a need to improve outcomes and care in the perioperative period amongst patients who are having major lower limb amputations. The aim of this audit was to determine adherence to the National Confidential Enquiry into Patient Outcome and Death (NCEPOD) recommended standards for the management of patients undergoing major lower limb amputations. Methods: 50 patients requiring major lower limb amputation in a District General Hospital were audited, with further detailed analysis possible in 19 cases where the full records were available. The age range (median) was 49 – 93 (75). 72% were male and 28% were female. The data was collected and analysed using Microsoft Excel 2013 ™. Results: Of the 50 cases audited, 20% (10) of the amputations were performed on a planned operating list and 88% (37) of patients had their operation within normal working hours. A consultant surgeon or trainee with a Certificate of Completion of Training (CCT) performed the operation in 72% (36) of these cases. On detailed review of 19 cases, 68% (13) were reviewed by a consultant within 14 hours of arrival to hospital and 47% (9) were reviewed by a Vascular Consultant within 24 hours of admission. 68% (13) had the amputation within 48 hours and 5% (1) were elective; it is unknown if a local review took place to determine why the rest, 5 cases and all urgent, were not performed within 48 hours. There was multidisciplinary team (MDT) involvement in the decision to operate in 16% (3) of cases. In 26% (5) of the cases were an MDT was not used, this was due to urgency of the operation. There is evidence of discussion with a consultant vascular surgeon in 4 of these cases. However, we were unable to determine whether these 5 cases were reviewed by a consultant Anaesthetist. Discharge planning and rehabilitation was discussed as soon as the need for amputation was identified in 21% (4) of cases. Only 1 case had a named amputation or discharge coordinator. 21% (4) of cases had physiotherapy from the first day post-amputation. A total of 19 (38%) of patients were known to have diabetes pre-operatively. On detailed review of 10 of these patients whose notes were available, the following results were obtained; 50% (5) had both pre-operative and post-operative review, and 30% (3) only had pre-operative review. 7% (7) of the patients had their insulin prescribed according to the National Patient Safety Agency (NPSA) guidelines. It was unclear whether hospital guidelines had been used to manage uncontrolled blood glucose levels in any of these cases. There was an 80% achievement for each of the following standards; nutritional state assessment within 48 hours of hospital admission, pre-operative screening for Methicillin-resistant Staphylococcus aureus (MRSA), pre- and post-operative falls assessment and risk reduction measures. We noted a 30-day post-amputation survival rate of 80%. Conclusion: There are still improvements that need to be made to help improve outcomes for patients undergoing major lower limb amputation. The key areas are early consultant review, involving an extensive MDT in the decision to operate, perioperative optimisation of patients with diabetes, and proactive discharge-planning facilitated by an amputation coordinator.

The experiences of DMS trained GPs and direct entrants in their first 5 years post CCT: a qualitative analysis

BackgroundIn developing the Ministry of Defence (MoD) First5 network, a database of all Tri-Service doctors in their First5 years post receiving their certificate of completion of training (CCT). However, on building the database, up to 23% of doctors, trained by the MoD were no longer regular service military personal within 5 years of completing their GP training.AimTo explore the experience of Defence Medical Services (DMS) trained GPs and direct entrants in in their First5 years post CCT.MethodAn invitation was extended to all GPs currently in the DMS and all those that trained in the Defence Deanery, who gained their CCT between 2011 and 2018. An initial focus group of was conducted, the themes then contributed to the semi-structured interview questions.ResultsFive themes were identified from the focus groups and interviews: Is the apprenticeship model dead? What is my role again? ‘I just don’t think they got the best care they could’ve’. The importance of autonomy and innovation. Should I stay or should I go now?ConclusionDMS should work to establish an environment in which all military First5s have autonomy over their practice; the ability innovate; and a forum in which they can share. This must go hand-in-hand with newly qualified military GPs being supported in their management and administrative learning, while being mentored by an engaged colleague to help understand ‘what’s next’ in their portfolio career.

An analysis of the cosmetic surgery experience acquired through UK plastic surgery training

Cosmetic surgery is an essential component of Plastic Surgery training. Our study demonstrates the average cosmetic surgery experience of UK Plastic Surgery registrars over their 6-year training scheme. Comparison is made with the operative requirements for the Certificate of Completion of Training (CCT) and the Royal College of Surgeons (RCS) Cosmetic Certification scheme. By using the web-based eLogbook, we analysed all the cosmetic surgery operations recorded by Plastic Surgery registrars during their specialist training. The weighted mean average number of procedures was calculated for different areas of cosmetic surgery practice, according to the level of supervision. The number of RCS cosmetic credits acquired for eight domains of cosmetic surgery was calculated, thus enabling comparison with the operative requirements for certification. eLogbook data were collated for 454 registrars from 2010 to 2016 inclusive. Trainees participated in a mean of 122 cosmetic operations during their training (50% as an assistant), which satisfies the requirement of 100 procedures for CCT. The majority of trainee involvement (66%) was with cosmetic breast and body contouring cases. Comparison with the criteria for cosmetic certification reveals that on average, trainees could certify in cosmetic breast and body contouring surgery but would be unable to accredit in other areas of practice. Current UK training affords sufficient cosmetic surgery exposure for CCT but offers a limited breadth of exposure. Trainees who wish to certify in cosmetic surgery of the head and neck region will likely be required to seek additional experience outside their deanery training programme.

Global lessons: developing military trauma care and lessons for civilian practice

The wars in Iraq and Afghanistan have helped to shape the modern Defence Medical Services. Many lessons were learnt including the need for rapid haemorrhage control, senior decision-making and the evolution of deployed transfusion support. These changes were implemented simultaneously with a coherent, end-to-end medical plan from point of wounding through to rehabilitation. Implementation of the medical plan is harmonious with the NHS trauma pathway, and is key to ensuring effective delivery. Military anaesthetists have a long pre-deployment training pathway starting with a Certificate of Completion of Training (CCT) in anaesthesia and/or critical care, and with an emphasis on military skills related to their specific role. Pre-deployment training includes additional skill training, team training and finally whole hospital collective training. This pathway ensures ongoing and continuing competence on an individual basis, and assurance that hospital management systems and clinical staff can function effectively as a deploying unit.

Changes in UK ophthalmology surgical training: analysis of cumulative surgical experience 2009–2015

ObjectiveTo investigate changes in the patterns of cumulative surgical experience for ophthalmologists in the UK following the introduction of a new national training scheme.DesignRetrospective review of all surgical training records...

Commencing an StR-led on call MR spinal imaging service in a tertiary neuroscience centre

Background to the audit: In our tertiary neurosciences centre, on-call spinal magnetic resonance imaging (MRI) (OCSM) has traditionally been a consultant-led service. However, interpreting lumbar spine MRI is included in the core competences in The Royal College of Radiologists’ (RCR) curriculum and trainees were reporting inadequate exposure to such imaging when approaching their Certificate of Completion of Training (CCT). In July 2016 we introduced an StR-led service with specialist neuroradiologist support available off site. Here we review the implications of this change.