Transcript Document

ISCP
Aims, principles and benefits
Overview
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Background, Aims, Key principles
Curriculum components
Benefits for patients, training, trainees
The syllabus
Skill levels
Stages of training, stages diagram
Curriculum standards
Assessment system
Learning opportunities
Summary of curriculum competences
Background
Project 2003-2007
• Impetus for change created by the realisation that major changes
were needed in surgical training
• Project funded by the UK and Irish Departments of Health and Royal
Surgical Colleges
• The JCST and SACs led the process for curriculum development
• Produced on an intercollegiate basis
• In partnership with OCAP
• In collaboration with those charged with delivering health services
• Launched in 2007
• Under the umbrella of the JCST
Aims
• Provision of excellent care for the surgical patient,
delivered safely
• Highest standards of UK surgical practice through high
quality surgical training
• Programme of surgical training from core to certification
• At completion of training, able to provide common,
elective and emergency service and defined level of
specialised service
Key principles
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Common format across all surgical specialties
Systematic progression through stages of training
Curriculum and assessment system that meet GMC standards
Competence-based (time points are indicative)
Professional and leadership skills
Delivery by skilled clinicians, appropriately trained
Learning partnership between trainee and trainer
Involvement of qualified members of the multidisciplinary team
Promotion of equal opportunities and diversity in training
Collects data to evaluate and enhance training & assessment
Curriculum components
SAC
development
& review
Standards
Syllabus
QA
Assessment
System &
methods
Regulator
approval
Curriculum
Stages of
training
Learning
portfolio
Training
structure
Reflective
practice
Training roles
for supervision
Appraisal &
Learning
Agreement
Educational
programme
Benefits for patients
• Designed to produce surgeons who are able to provide
excellent care for the surgical patient, safely
• Promotes effective working practices and service delivery
• Provides supervision and accountability through key
roles
• Provides transparency through an explicit assessment
system and portfolio
• Ensures lay and patient involvement in curriculum
development and review
Benefits for training
• Provides a structured and supervised framework with a
definable endpoint
• Promotes high-quality teaching and learning
• Based on clear standards covering all surgical specialties
• Reviewed and maintained by surgical SACs
• Promotes patient safety
• Affirms professional and educational values
• Rigorous and fully integrated assessment
• Meets GMC standards
Benefits for trainees
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Promotes consistent training experience in the UK
Mandates the interaction between trainer and trainee
Mandates the training of trainers
Provides a clearly defined syllabus
Provides explicit feedback on practice
Provides a portable portfolio of conduct and practice
Provides guidance for professional development
Provides web-based access including Apps
Benefits for trainers
• Maps to standards for trainers
• Provides recognisable educational roles and training
structure
• Provides guidance for trainers, assessors & supervisors
• Provides tools for recording discussions with trainees
• Helps to provide evidence of trainer engagement for
appraisal and revalidation
Training Structure
School of
Surgery
Postgraduate
Dean
Programme
Director
Assigned
Educational
Supervisor
Trainee
Clinical
Supervisor
The PD role
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Organise, manage and direct the training programme
Appoint local faculty as AESs and CSs
Organise faculty development, trainee induction and training for MPT
Oversee progress of individual trainees
Ensure appropriate levels of supervision, training and support
Identify remedial training and resources where required
Work closely with Colleges SACs on curriculum delivery
Administer and chair the ARCP
The AES role
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Overall educational and supervisory responsibility for the trainee
Ensures induction of the trainee to the unit
Ensures trainee works to the curriculum and assessment system
Ensures patient safety in relation to trainee performance
Acts as a mentor to the trainee
Provides appraisal and a placement learning agreement
Monitors the trainee’s portfolio to ensure educational progress
Presents formative feedback to the trainee
Keeps the PD informed of any issues that may affect training
Involves senior faculty in the formal report to the annual review
Provides an AES report for the ARCP
The CS role
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Under the delegated authority of the AES
Ensure appropriate day-to-day supervision of the trainee
Carries out WBA and delivers feedback
Ensures patient safety in relation to trainee performance
Liaises with the AES and faculty about trainee progress
Keeps the AES informed of any issues about training
Contributes to the AES report for the ARCP
The trainee role
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Takes responsibility for own learning
Triggers WBA frequently
Exploits learning opportunities
Attends educational programme
Agrees the learning agreement with the AES
Raises issues and difficulties promptly
Conducts self-directed learning
e.g. peer and self-assessment and reflective practice
• Keeps an accurate and up to date portfolio
The syllabus
4 Domains:
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Specialty-based knowledge
Clinical skills and judgement
Technical and operative skills
Professional and leadership skills
The syllabus
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Defines what trainees should know and be able to do
Informs assessment
Specialty overview of the scope of practice
Key topics that all trainees must be able to manage
Index procedures, indicative of all specialty procedures
Topics can be used as learning objectives
Skill levels indicate the required level of performance
Skill levels
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Indicate the level of competence to be achieved
Ensure learning is based on progression
Increase with depth and complexity of practice
Increase as the need for supervision decreases and
trainees become more proficient
• Correspond with logbook supervision levels
Knowledge skill levels
4. Knows specifically &
broadly
CORE
3. Knows generally
2. Knows basic
concepts
1. Knows of
e.g. Can:
• List
• Name
e.g. Can:
• Define
• Discuss
• Describe
e.g. Can:
• Explain
• Identify
• Locate
e.g. Can:
• Interpret
• Distinguish
• Compare/contrast
Knowledge skill levels
4. Knows specifically
& broadly
Intermediate/Final
3. Knows generally
2. Knows basic
concepts
1. Knows of
e.g. Can:
• Recall
• Discuss
• Describe
e.g. Can:
• Explain
• Identify
• Locate
e.g. Can:
• Interpret
• Distinguish
• Compare/contrast
e.g. Can:
• Manage
• Judge
• Rate / Estimate
Clinical / Technical skill levels
4. Competent to do without assistance,
including complications
3. Can do whole
but may need
assistance
2. Can do with
assistance
1.Has observed
Knows steps;
Handles instruments;
Performs some parts.
Knows of
Knows rationale;
Straightforward
procedures;
Knows when to ask for
assistance.
Deals with common
problems, variations;
Requires advice
rather than help.
Manages common and
difficult cases;
UK consultant level;
Can supervise.
Stages of training
• Defined to reflect the training pathway of the specialty
• Provides a means of charting progress against domains
of knowledge, skills and behaviours
• Allows benchmarking of progress
• Core component is common to all specialties
supplemented by a small specialty-specific component
• Intermediate and final stages reflects the increasing
scope of specialty practice
Stages diagram
Curriculum standards
• Each training stage is underpinned by explicit outcome
standards in 4 domains
• Standards form the basis for specifying syllabus content
• Organise workplace training in terms of case mix and
case load
• Basis for identifying relevant teaching and learning
opportunities
Assessment system
Determines whether trainees are meeting the standards of competence
Learning Agreement
Assigned Educational Supervisor (AES) Report
Workplace-Based Assessment + Logbook
AoA CEX / CBD / DOPS / MSF / OoT / PBA
Courses: ATLS / APLS
Annual Review of Competence Progression (ARCP)
MRCS Examination
FRCS Examination
WBA methods
WBA
• Clinical Evaluation Exercise - CEX
• Case Based Discussion – CBD
• Direct Observation of Procedural Skills – DOPS
• Multisource Feedback - MSF
• Procedure Based Assessment – PBA
• Observation of Teaching – OoT
• Assessment of Audit – AoA
Learning Agreement
Comprises
• PD Global Objective
• Syllabus topics for the stage of training
• Agreed learning opportunities and resources
• Agreed evidence required - WBA, Exams, Audit etc.
• AES Comments
• Trainee Comments
• Link to portfolio of progress
• CS Report
• AES Report
Learning opportunities
3 broad areas:
1. Learning from practice
2. Learning from formal situations
3. Self-directed learning
Learning opportunities
Learning from practice
• Any workplace interaction has the potential to become a
learning episode
• Workplace assessment
• Shadow peers and consultants
• On-going systematic feedback, both formal and informal
• Reflection on practice
Learning opportunities
Learning from practice - settings
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Theatre
Operative units
Clinic
Ward
Multi-disciplinary meetings
Community
Learning opportunities
Learning from formal situations
• Educational programme arranged locally
• Local, national and international level
e.g. courses, seminars, meetings, simulation (technical
and human factors)
Learning opportunities
Self-directed learning
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Trainee-led
Vital component of continuing professional development
Study groups, journal clubs and peer review
Learning with peers at teaching sessions
Personal study
Written reflections on practice
Research, projects and audits
Learning portfolio
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Repository of evidence of the trainee’s practice
Audit trail of training
Web-based and password protected
Fitness to practise
Planning personal development
Appraisal and the learning agreement
Workplace-based assessment (WBA) and reflective
practice
• Record of educational achievement
• Annual review
• Foundation for continuing professional development
Reflective practice
Purposeful use of experience/feedback to improve practice
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Requirement of the curriculum and part of CPD
Appended to WBA
MSF Self-assessment
Linked to Case-Based Discussion (CBD)
Personal Development Plan
Journal
Entries must respect confidentiality of colleagues and
patients
Summary of curriculum
competences
Clinical Care
• History taking, examination skills
• Taking consent
• Relevant knowledge and diagnostic
skills
• Ability to formulate appropriate
management plans
• Procedural (technical) skills
• Record keeping
Maintaining good medical practice
• Ability to manage time and work under
pressure
• Decision making and implementation
skills
• Reflective practice and awareness of
own limitations
• Initiative and leadership skills
• Focus on patient safety
Learning and teaching
• Willingness to ask for feedback and to
learn from it
• Teaching
Relationships with patients &
colleagues
• Communication with patients and their
relatives
• Communication with colleagues
• Active involvement with your team
• Accessibility and reliability