Joint Committee On Surgical Training Research Articles

Defining quality assessment in vascular surgery training: an expert Delphi process.

A robust and reproducible way of assessing training should optimise and standardise vascular surgical training. This study describes the methodology supporting the Vascular Surgery Specialty Advisory Committee regional quality assurance reports for vascular surgery training programmes in the UK. A Delphi consensus exercise was performed to establish the domains of training that most appropriately assess the quality of a vascular surgery training programme. A total of 54 stakeholders were invited to participate, including trainees, training programme directors and members of the vascular speciality advisory committee (SAC), vascular society executive and education committees. A total of 39 stakeholders successfully completed the three-stage Delphi process over 15 weeks. The domains identified as most appropriate to assess the quality of a vascular training programme were: Joint Committee on Surgical Training (JCST) survey results, clinical experience, regional education programmes, radiology support, timetable, regional support for trainees, trainer support for trainees, opportunities for professional development, trainee-rated quality of consultant teaching and training, and trainee recommendation of the post. This study describes a method to identify and prioritise domains that are appropriate to assess the quality of a vascular training programme. The domains that were identified as appropriate to assess quality are transferable internationally and the Delphi methodology could be used by other training schemes to 'fine-tune' their own domains to review and optimise the quality of their own training programmes.

ANALYSIS OF TRAUMA AND ORTHOPAEDICS SPECIALIST TRAINEES’ EDUCATIONAL EXPERIENCE DURING THE COVID-19 PANDEMIC

Since the emergence of the COVID-19 pandemic, the NHS has been under unprecedentedpressure. Elective surgery had ceased, and trauma surgery has decreased dramatically. Surgical training is multi-faceted and requires a specialist trainee to have a timetable which includes regular elective non-emergency operating, trauma operating and training in outpatient clinics. Consequently, training in theatre and the achievement of operative numbers and index procedures had not been possible for Trauma and Orthopaedic (T&O) specialist trainees.The Joint Committee on Surgical Training (JCST) has clear training index requirements for all T&O specialist trainees. In this study, we surveyed specialist trainees in the North West London deanery against the annual requirements set by the JCST guidelines. In addition, we retrospectively assessed the total number of trauma referrals and operations scheduled in our unit during the COVID-19 outbreak compared to that one year previously. The aim of this study is to objectively assess the effect the pandemic has on T&O specialist training.A total of 24 responses were collected from specialist trainees. The results of the survey showed 87% of trainees believed that their training had been affected. 75% of trainees felt they were not on track to meet operative numbers for the year, and 71% felt index number achievement had been affected. Trauma case numbers dropped by 20% compared to that one year previously.We recommend timely, planned and conscientious remediation for specialist trainees’ educational requirements. Specialist trainees must take responsibility for their training and use of additional educational opportunities. Clinical supervisors and training programme directors must provide additional support and guidance to achieve ARCP outcomes however in some scenarios extension of training may be necessary.

939 Enhancing Core Surgical Training with the Implementation of Key Performance Indicators: A Closed Loop Quality Improvement Project

Abstract Aim The COVID-19 pandemic has brought innumerable challenges to surgical training, especially with regard to theatre opportunities for core surgical trainees. This study aims to evaluate the implementation of training-oriented key performance indicators (KPIs) in supporting trainees to meet the Joint Committee on Surgical Training (JCST) quality indicators for core surgical training. Method A six-month long closed-loop quality improvement project. Two KPIs were developed following discussion with trainees and departmental leads, evaluation of the rota, and review of the JCST quality indicators: theatre/normal-working-day-attendance (T/A) ratio and missed-theatre-sessions/normal-working-day-attendance (M/A) ratio. Our calculations projected a T/A ratio of 1.00 and M/A ratio of 0.20 to be fully compliant with the JCST quality indicators. Data were collected prospectively from eight trainees, who provided feedback on training opportunities and allocation equitability. Results Following implementation of the KPIs, there was a significant increase in the mean T/A ratio from 0.70 (range=0.55–0.82) to 1.00 (range=0.95–1.17) (p=0.03), and a significant decrease in the mean M/A ratio from 0.55 (range=0.45–0.70) to 0.20 (range=0.11–0.22) (p=0.01). There were significant improvements in trainee satisfaction with training opportunities from 50% to 85% (p=0.02) and allocation equitability from 66% to 95% (p=0.01). Conclusions The development and implementation of training oriented KPIs led to increased allocation and fewer missed theatre sessions, enabling trainees to meet the JCST quality indicators. Furthermore, our data demonstrate smaller variances between trainees, thus, highlighting greater equitability of training opportunities. These findings are supported by the improved trainee satisfaction with training opportunities and allocation equitability reported.

SP2.2.6An audit on core surgical trainees’ operating theatre experience to improve compliance against JCST training quality indicators

Abstract Aims The primary aim of this study was to audit the experience of core surgical trainees in operating theatres with a view to devise some interventions to improve the quality of theatre experience. Methods This study was a prospective audit that involved filling out a set proforma by all core surgical trainees working in a busy surgical department of a tertiary care university hospital. The proforma included a breakdown of questions to signpost indicators of quality experience and check compliance with the Joint Committee on Surgical Training (JCST) guidelines. It was completed with particular consideration given to the experience while trainees were on their CEPOD week to facilitate accuracy and relevance of feedback. Results 8 core surgical trainees filled out the proforma. 75% of trainees had the opportunity to reflect the case with the senior surgeon. Lowest compliance was shown for pre-operative discussion of crucial learning points with the senior surgeon. Only 50% of trainees had a chance to do a briefing pre-operatively which is one of the JCST quality indicator for core surgical trainees. Conclusion This audit demonstrates the potential for improvement in the operating theatre experience of junior surgical trainees considering JCST Quality Improvement indicators. A checklist may be introduced to achieve maximum utilisation of the finite training opportunities available to current junior surgical trainees. A loop closing audit after the checklist will be able to assess the change in practice and theatre experience.

1276 Is There Enough Time to Train? An Audit of Core Surgical Training Rotas

Abstract Aim This audit aims to compare Core Surgical Training (CST) rotas in our region against the Joint Committee on Surgical Training (JCST) Quality Indicator (QI) 10’s minimum standard of 5 consultant supervised training sessions per week. Method Core surgical trainees in one training region were contacted requesting their on-call rotas from rotations undertaken during the 2019/20 academic year. Rotas were analysed in a protocolised manner, with the number of potential training sessions available calculated and compared against the JCST QI 10 minimum recommendation. Results Twenty-four rotas were assessed across 17 hospitals. Only six (25%) rotas achieved the JCST QI 10 recommended minimum 5 training sessions per week. There was a mean deficit of 18.5 (+/-29.5) training sessions per 6-month rotation. Rotas compliant with JCST QI 10 used a mean rota pattern of 1 in 11 compared to 1 in 9 for those failing to meet the target. Sub-analysis, comprising of the addition of expected consultant supervised training whilst on call, led to an improvement in compliance. 9 (38%) rotas met JCST QI 10's minimum standard when 0.5 hours of consultant supervised training time per on-call session was included, and 13 (54%) rotas met the standard when 1 hour was included. Conclusions Core surgical trainee rotas in the region are failing to provide the minimum number of consultant supervised training sessions set out by JCST QI 10. A move to reduced on-call commitment, increased use of supporting medical practitioners and regular perceived consultant supervised training whilst on call should be considered to improve this.

How to Implement a Simulation-Based Education Programme: Lessons from the UK Urology Simulation Boot Camp.

The operative and non-technical skills exposure of urology trainees has reduced due to a number of factors, including the European Working Time Directive, and the COVID-19 pandemic. Simulation-based education (SBE) is an innovative addition to clinical experience which can begin to address the skills-based learning deficiency in order to help trainees meet their curriculum requirements and optimise the exposure required for a trainee to become a competent general urology consultant. Surgical simulation is an effective training tool but has a complex implementation process, requiring considerable planning tailored to specific educational targets, to ensure it is sustainable and reproducible. Methodology from the field of implementation science offers an invaluable approach to design an effective simulation-based training adjunct, as exemplified by the example of the UK Urology Simulation Boot Camp (USBC), a comprehensive training course which incorporates core technical and non-technical skills based on the current Joint Committee on Surgical Training (JCST) urological training curriculum to equip newly appointed urology trainees to work as competent junior registrars. Delivered annually in Leeds since 2015, the course has had excellent feedback and results in improving the urological knowledge of trainees, as well as increases in trainees’ confidence. This paper will provide a summary of how the course was designed, delivered, reproduced, sustained and evaluated. Its success is demonstrated by its incorporation into the UK urology training programme, and since 2018, it is now recommended to all new urology residents in the UK. The course implementation model would be applicable to other surgical specialties.

Is there enough time to train? An audit of core surgical training rotas

BackgroundThe Joint Committee on Surgical Training (JCST) have published a series of quality indicators (QIs) which act as a benchmark against which the quality of surgical training can be assessed. This audit aims to compare core surgical training (CST) rotas in our region against the JCST QI 10's minimum standard of 5 consultant supervised training sessions per week. MethodsCore surgical trainees in one training region were contacted requesting their on-call rotas from rotations undertaken during the 2019/20 academic year. Rotas were analysed in a protocolised manner, with the number of potential training sessions available calculated and compared against the JCST QI 10 minimum recommendation. ResultsTwenty-four rotas were assessed across 17 hospitals. Only six (25%) of rotas achieved the JCST QI 10 standard. There was a mean deficit of 18.5 (±29.5) training sessions per 6-month rotation. Rotas compliant with JCST QI 10 used a mean rota pattern of 1 in 11 compared to 1 in 9 for those failing to meet the target.Further analysis, comprising of the addition of expected consultant led training whilst on call, led to an improvement in compliance to 9 (38%) and 13 (54%) of rotas when there was an addition of 0.5 h and 1 h of consultant supervised training time per on-call session respectively. ConclusionMany core surgical trainee rotas in the region are non-compliant with JCST QI 10, indicating a lack of regular consultant-led training opportunities. A move to a reduced on-call commitment with the use of supporting medical practitioners could be considered to improve this.

Quantifying the impact of the COVID-19 pandemic on orthopaedic trainees: a national perspective.

AimsWe aim to objectively assess the impact of COVID-19 on mean total operative cases for all indicative procedures (as outlined by the Joint Committee on Surgical Training (JCST)) experienced by orthopaedic trainees in the deanery of the Republic of Ireland. Subjective experiences were reported for each trainee using questionnaires.MethodsDuring the first four weeks of the nationwide lockdown due to COVID-19, the objective impact of the pandemic on each trainee’s surgical caseload exposure was assessed using data from individual trainee logbook profiles in the deanery of the Republic of Ireland. Independent predictor variables included the trainee grade (ST 3 to 8), the individual trainee, the unit that the logbook was reported from, and the year in which the logbook was recorded. We used the analysis of variance (ANOVA) test to assess for any statistically significant predictor variables. The subjective experience of each trainee was captured using an electronic questionnaire.ResultsThe mean number of total procedures per trainee over four weeks was 36.8 (7 to 99; standard deviation (SD) 19.67) in 2018, 40.6 (6 to 81; SD 17.90) in 2019, and 18.3 (3 to 65; SD 11.70) during the pandemic of 2020 (p = 0.043). Significant reductions were noted for all elective indicative procedures, including arthroplasty (p = 0.019), osteotomy (p = 0.045), nerve decompression (p = 0.024) and arthroscopy (p = 0.024). In contrast, none of the nine indicative procedures for trauma were reduced. There was a significant inter-unit difference in the mean number of total cases (p = 0.029) and indicative cases (p = 0.0005) per trainee. We noted that 7.69% (n = 3) of trainees contracted COVID-19.ConclusionDuring the COVID-19 pandemic, the mean number of operative cases per trainee has been significantly reduced for four of the 13 indicative procedures, as outlined by the JCST. Reassignment of trainees to high-volume institutions in the future may be a plausible approach to mitigate significant training deficits in those trainees worst impacted by the reduction in operative exposure.

Real-world use of workplace based assessments in surgical training: A UK nationwide cross-sectional exploration of trainee perspectives and consensus recommendations from the Association of Surgeons in Training

BackgroundDespite widespread uptake, the utility of Workplace Based Assessments (WBAs) is disputed and evidence underpinning their use is largely based upon their completion in ideal conditions, rather than the real-world setting. AimTo ascertain the real-world usage of WBAs, as perceived by UK surgical trainees. Materials and methodsAn anonymous online questionnaire conducted nationally via the Association of Surgeons in Training (ASiT). Evaluation of 906 completed trainee responses, across all surgical specialties and training levels, employed mixed methods to interpret quantitative and qualitative data. ResultsThe sample permitted a 3.0% confidence level with acceptable internal consistency (Cronbach's alpha 0.755). Formative use was supported by 72.5% and summative use was rejected by almost as many (66.3%). WBA use was perceived to deviate markedly from that recommended by the Joint Committee on Surgical Training (JCST). Significant misuse was identified and elements perceived as inaccurate appear commonplace across the breadth of surgical specialties. Inaccurate completion was acknowledged by 89.6% of respondents and some trainers appear complicit, 147 individuals (16.2%) having reported this to trainers, 40.9% aware of ‘unobserved sign-off’, and 33.6% aware of ‘password disclosure’ by trainers. Furthermore, a majority of trainees felt the Annual Review of Competency Progression (ARCP) respected WBA quantity above quality (55.4%), and a third felt pressure to overstate the number completed (32.0%). Reasons for misuse appeared largely centred upon time restraints, lack of engagement and a will to achieve the required targets for career progression. 1.5 ConclusionsThis study demonstrates that UK surgical trainees perceive that most trainees deviate from guidance in their use of WBAs. This is worrying in both the apparent frequency and nature of misuse and somewhat undermines existing evidence for their role in surgical training. Trainees perceive that required numbers of WBAs are too high, that training programmes fail to encourage their use as formative assessments, and that there is a lack of engagement by many trainees and trainers. We present consensus recommendations from ASiT for the improvement of WBA use in UK surgical training.

Bullying and undermining behaviours in surgery: A qualitative study of surgical trainee experiences in the United Kingdom (UK) & Republic of Ireland (ROI)

BackgroundBullying and undermining (B/U) behaviours are documented in the international surgical workplace. This study is the largest assessment of prevalence of B/U behaviours within UK & ROI surgical training to date. Materials and methodsUK & ROI surgical trainees were electronically surveyed in July 2017. The survey was open for one month and sent to all registered trainees at Core and Specialty level by the Joint Committee on Surgical Training (JCST) along with email and social media dissemination by the Association of Surgeons in Training (ASiT) and the British Orthopaedic Trainees Association (BOTA). A consensus session on the topic was conducted at the ASiT Conference in Edinburgh in March 2018. Standards for reporting of Qualitative Research were followed. Results1412 responses were received (26.6% response rate). All training regions, grades and specialties were represented. 60% of trainees (n = 837) reported witnessing or experiencing B/U behaviours in the surgical workplace. The most common reports related to sexism; 42% (n = 568) reported witnessing or experiencing sexist language/attitudes in the workplace. This was reported more by female respondents (66% compared to 27% male). 21% (n = 291) and 13% (n = 180) reported witnessing or personally experiencing racist and homophobic language or attitudes respectively. Consultants were identified as the most frequent perpetrators. The surgical wards or theatres were the most frequently reported areas that trainees either witnessed or experienced B/U behaviours. Of those trainees who had reported a personal experience of B/U behaviours (n = 344), 20% described their experiences of reporting as negative or very negative. 48.1% of respondents felt that surgery as a whole had a moderate, high or very high degree of a concern about B/U behaviours. ConclusionB/U behaviours are prevalent in the surgical domain. Urgent action is required to eradicate this unacceptable behaviour. A cross-specialty, intercollegiate response is required to tackle this issue and improve the working culture in surgery for all.

An audit of clinical training exposure amongst junior doctors working in Trauma & Orthopaedic Surgery in 101 hospitals in the United Kingdom

BackgroundThere are concerns regarding early years’ training for junior doctors in Trauma & Orthopaedic Surgery (T&O) in the United Kingdom. Our primary objective was to audit the clinical activities undertaken by junior doctors working in Trauma & Orthopaedic (T&O) surgery in the National Health Service (NHS) in a typical workweek. A secondary objective was to audit the clinical exposure of junior surgeons in training to the Joint Committee on Surgical Training (JCST) standards for minimum weekly clinical exposure in T&O surgery.MethodsWe recruited collaborators in 101 T&O surgery departments in NHS hospitals to participate in this study. Clinical activity diaries from 935 doctors working in T&O surgery in the 101 participating NHS hospitals were involved. All junior doctors covering the junior on call tier were included. Collaborators collected clinical activity data from 08:00 18/01/2015 to 20:00 22/01/2015. Clinical activities recorded in sessions (morning, afternoon, evening) depending on what activity that doctor undertook for the majority of that session. Clinical activities were grouped into operating theatre/room, outpatient clinic, on call, “not in work” (i.e. leave, sickness), teaching, and ward cover sessions. The weekly clinical activity of Core Surgical Trainees (CSTs) were analyzed in accordance to two JCST standards for minimum weekly clinical exposure.ResultsOverall, junior doctors working in T&O surgery attended a theatre list session 8.5% of the time, an outpatient clinic 3.2%, were on call 14.8%, a teaching session 1.7%, providing ward cover 34.6%, and on a zero session 20.7% of the time. Only 5% of core surgical trainees (n = 200) met both the JCST standards for minimum weekly clinical exposure in the specialty.ConclusionsJunior surgeons in training, working in Trauma & Orthopaedic surgery in the United Kingdom are not meeting the minimum weekly clinical sessions laid out by the JCST. Further work to develop models allowing for enhanced training experiences and improved clinical exposure to operating lists and outpatient clinics would be beneficial.

JSCT (Joint Committee on Surgical Training) quality indicators for core surgical training in plastic surgery: Are plastic CT trainees getting to theatre and clinics?

JSCT (Joint Committee on Surgical Training) quality indicators for core surgical training in plastic surgery: Are plastic CT trainees getting to theatre and clinics?

Improving core surgical training in a major trauma centre

IntroductionEnglish Major Trauma Centres (MTCs) were established in April 2012. Increased case volume and complexity has influenced trauma and orthopaedic (T&O) core surgical training in these centres. ObjectivesTo determine if T&O core surgical training in MTCs meets Joint Committee on Surgical Training (JCST) quality indicators including performance of T&O operative procedures and consultant supervised session attendance. MethodsAn audit cycle assessing the impact of a weekly departmental core surgical trainee rota. The rota included allocated timetabled sessions that optimised clinical and surgical learning opportunities. Intercollegiate Surgical Curriculum Programme (ISCP) records for T&O core surgical trainees at a single MTC were analysed for 8 months pre and post rota introduction. Outcome measures were electronic surgical logbook evidence of leading T&O operative procedures and consultant validated work-based assessments (WBAs). ResultsNine core surgical trainees completed a 4 month MTC placement pre and post introduction of the core surgical trainee rota. Introduction of core surgical trainee rota significantly increased the mean number of T&O operative procedures led by a core surgical trainee during a 4 month MTC placement from 20.2 to 34.0 (p<0.05).The mean number of hip hemiarthroplasty procedures led by a core surgical trainee during a 4 month MTC placement was significantly increased (0.3 vs 2.4 [p=0.04]). Those of dynamic hip screw fixation (2.3 vs 3.6) and ankle fracture fixation (0.7 vs 1.6) were not. Introduction of a core surgical trainee rota significantly increased the mean number of consultant validated WBAs completed by a core surgical trainee during a 4 month MTC placement from 1.7 to 6.6 (p<0.0001). ConclusionsIntroduction of a departmental core surgical trainee rota utilising a ‘problem-based’ model can significantly improve T&O core surgical training in MTCs.

Indicative operative numbers in urology training in the UK and Ireland

Objectives: In 2011 the Joint Committee on Surgical Training (JCST) issued guidelines for the award of a Certificate of Completed Training (CCT) in urology, including a list of 15 operative procedure groups for which a trainee must have achieved a minimum level of exposure (termed indicative number) and competence. This study evaluated whether the expected exposure correlated with that achieved by UK and Irish trainees. Methods: The operative logbooks of trainees who applied for a CCT in urology from 2010 to 2012 were reviewed. All exposure for each operative group, irrespective of the degree of supervision, was combined to give total operative experience. Results: Data on 154 trainees were available. More than 75% achieved the indicative number for radical prostatectomy, nephrectomy, ureteroscopy, PCNL and inguino-scrotal surgery. Only 70%, 68%, 64%, 25%, 21% and 8% reached the required level for cystectomy, TURBT, TURP, andrology, female and paediatric groin surgery, respectively. There was significant geographical variation in exposure, with the majority of trainees not achieving the minimum level for some procedure groups in certain training regions. Conclusions: There is a disparity between the operative exposure expected by the JCST and that achieved by urology trainees. To prevent large numbers of trainees failing to meet JCST requirements, an urgent and significant change to urology training, or further modification of the current guidelines, is required.

Simulation in orthopaedic training: would a national curriculum improve trainees’ surgical skills?

Orthopaedic surgical education is undergoing a transition, requiring trainees to learn a greater number of complex surgical skills but with a reduction in learning opportunities. simulation has been proposed as one way to help solve this dichotomy. The Joint Committee on Surgical Training (JCST) hopes to incorporate simulation into the curriculum for all specialties. Our findings indicate that there is as yet no clear consensus in the literature that simulation in orthopaedic surgery provides a reliable and valid way of improving surgical skills. We therefore urge the JCST to commission a pilot study using its recently published simulation curriculum before making the large investment that would be required to roll it out nationwide.

ICBSE: who are we and where are we going?

The Intercollegiate Committee for Basic Surgical Examinations (ICBSE) is responsible for the continued development, quality assurance and standards of the Intercollegiate MRCS and the Diploma in Otolaryngology – Head and Neck Surgery (DO–HNS). As with the other two intercollegiate committees – namely the Joint Committee for Intercollegiate Examinations (JCIE) and the Joint Committee on Surgical Training (JCST) – the chairperson is appointed following an interview process by the four college presidents. The committees are accountable to all four royal colleges of surgeons in the UK and Ireland and the General Medical Council (GMC).

Procedure-based assessments: an appropriate assessment tool?

The Joint Committee on Surgical Training (JCST), an advisory body to the four surgical royal colleges of the UK and Ireland for all matters relating to surgical training, has identified eight quality indicators specific to orthopaedics and trauma. 1 The sixth indicator is that a minimum of 40 workplace-based assessments (WBAs) be completed per year of training, with some deaneries advocating up to 80 per year.

Surgical trainees survey asks additional questions on patient safety in light of Francis report

The Joint Committee on Surgical Training (JCST) trainee survey will include questions on patient safety in the light of recommendations made by Robert Francis in his report on failings at Mid Staffordshire NHS Foundation Trust.1 Sallie Nicholas, head of the JCST, …

Commentary on: Cosmetic Surgery Training in the United Kingdom: Is It Adequate?

Despite the increased number of training opportunities in cosmetic surgery in the United Kingdom over the past few years, the specialty continues to face some training difficulties. Aesthetic surgery forms an important part of the curriculum for training in plastic surgery; however, exposure to patients with cosmetic problems is limited in the National Health Service. Trainees therefore must seek educational opportunities elsewhere—and this is usually toward the end of training or after a certificate of completion of training (CCT) has been obtained. Traditionally, training in cosmetic surgery entails fellowships, but alternate methods of training have been developed recently. Cosmetic surgery fellowships are available in the United Kingdom, but these are generally short term and places are limited. The Joint Committee on Surgical Training (JCST) offers 12 fellowships per year of a 3-month duration together with the deaneries, which are responsible for the delivery of postgraduate education, in 14 centers in the United Kingdom. The JCST is responsible for setting standards to enable trainees in the interface specialties such as cosmetic surgery to gain the core knowledge and practical abilities they need to conduct safe and competent consultant practice. They are …

Improving Core Surgical Training in Plastic Surgery

Since the introduction of the European Working Time Regulations (EWTR) and Modernising Medical Careers (MMC), concerns have been raised regarding the quality of early surgical training. Recurring issues include the lack of time spent in the operating theatre and outpatient clinic with increased time spent on service provision. As a means of restoring the quality of early surgical training, the Joint Committee on Surgical Training (JCST) has devised a set of SMART (specific, measurable, attainable, relevant, time-framed) standards to be met by core surgical trainees (CSTs). These include the following scheduled weekly activities: four half-day sessions (18 hours) supervised in the operating theatre, one half-day session (4.5 hours) in supervised outpatient clinics and two hours of structured teaching.