Guideline New Surgical Training ST2 – ST3 Progression Pathway January 2015 v4to ST3 Progression ST2 26th May 2014 Date: To Appear Here Introduction A key feature of the new surgical training pathway is the principle that career progression is linked to trainee performance. Performance, in turn, is measured by a robust and comprehensive assessment process. A critical point for career progression is the transition from ST2 (i.e. end of Core Surgical Training) to ST3 (start of Specialty Training). This transition from ST2 to ST3 is a competitive process which is based on: a) Performance during Core Surgical Training; b) Specialty interview. This document outlines the principles and practice of the ST2 to ST3 transition process. A prerequisite for transition to ST3 is passing all parts of the MRCS examination. This is an intercollegiate examination which is based on the Intercollegiate Surgical Curriculum Programme and tests the knowledge and clinical skills required of trainees at the end of Core Surgical Training. Trainees must have passed all parts of the MRCS before the date of interview for ST3 selection. The ST3 selection process is based on a clearly defined marking scheme. A total of 1000 marks are awarded in the selection process (650 marks for performance in Core Surgical Training and 350 for the Specialty Interview (table 1)). The marks for performance in Core Surgical Training are awarded on the basis of assessments which take place on a regular, recurrent basis during Core Surgical Training. These assessments take place a) In the workplace; b) In RCSI. a) Workplace assessments: there are 4 types of workplace assessments: i. Supervised Structured Assessment of Operative Performance (SSAOP): this is an assessment of the operative performance of the trainee undertaken by the consultant trainer. This assessment is performed on 3 occasions in each 6 month period during Core Surgical Training. A maximum of 45 marks may be awarded in each six month period for the SSAOPs (15 marks for each assessment). ii. The SSAOP and the SCA must be completed by one of your designated Consultant Trainers. Assessments will not be accepted if completed by an SPR or a Locum Consultant. You are strongly encouraged to involve different trainers in your various SSAOP and SCA assessments. You will not be scored for more than 2 SSAOP’s or 2 SCA’s from any 1 trainer – i.e. in order to achieve maximum scores, you must have at least 1 SSAOP and at least 1 SCA completed by a different member on your team. Furthermore, the assessments must all be completed on different dates. It is your responsibility to ensure that you make arrangements to complete your assessments with your Consultant Trainers in good time and that they are submitted to RCSI before the designated closing date. Subject to change under ISPTC review criteria. 003/STP/ISPTC/2015/v4 1 iii. Structured Clinical Assessment (SCA): this is an assessment of the surgical trainee’s ability to assess a clinical situation. The assessment may be performed on the ward, in the outpatient clinic, in the Emergency Department or Intensive Care Unit. iv. Three SCAs are performed in each six month period during Core Surgical Training and a maximum of 30 marks are awarded for each six month period. (10 marks for each assessment) v. E-Logbook: a score is generated electronically for the logbook activity in each six month period and a maximum of 30 marks is awarded for each six month period. vi. Trainer Reports: a consolidated trainer report is filed at the end of each six month period in consultation with the Hospital based Programme Director for Core Surgical Training. A total of 25 marks are awarded for the Trainer Report in each six month period. For the purpose of selection to ST3 the marks for the first 3 CAPA assessments during CST are considered (i.e. total 390 marks). b) RCSI Assessments: There are 3 RCSI assessments: i. Case Based Discussions on SCHOOL for Surgeons: a maximum of 20 marks may be awarded for each six month period (60 in total) based on assignments on SCHOOL for Surgeons. ii. Technical Skills Assessment: a formal assessment of technical and operative skills is performed towards the end of ST1 (May) and just over mid-way during ST2 (February). A total of 100 marks are awarded for the two technical skills assessments. iii. Human Factors Assessment: a formal assessment of human factors is performed using an OSCE format towards the end of ST1 (May) and just over mid-way through ST2 (February). A total of 100 marks are awarded for the combined Human Factors assessments. For the purpose of selection to ST3 the marks for all RCSI Assessments considered are 260 marks in total. A total mark of 650 can be achieved from CAPA 1, 2 & 3. Specialty ST3 Interview The specialty interview is an integral part of the selection process for ST3 and counts for 350 marks in total. The interview will follow a Multiple Mini Interview (MMI) format. The overall purpose of the interview is to assess the general suitability of each candidate for progression to Specialty Training. The interview process is designed to capture elements of suitability which have not previously been assessed in Performance during Core Surgical Training or in the MRCS examination. The MMI format will be used to give a comprehensive assessment of a wider range of general suitability characteristics. Subject to change under ISPTC review criteria. 003/STP/ISPTC/2015/v4 2 The specialty interview will take place in the third or fourth week in March of each year (i.e. after the results of the MRCS examination are announced). The MMI interviews for all of the Surgical Specialties will be conducted over a 2/3 day period and will be held in conjunction with the interviews for existing gap-year trainees. At the start of the interview process, a briefing session will be given by the Chairman of ISPTC along with the Director of Human Resources at RCSI. The purpose of this session is to give interviewers guidelines on the legal and good-practice aspects of the interview process. A total of 350 marks are available for the interview. There are five stations in the interview centre, each focussing on a different theme. Prior to the commencement of the interviews, the interview panel for each station will spend 10-15 minutes deciding on questions to be asked, and engaging in a standard-setting exercise. Multiple Mini Interview Topics 1. Quality and safety in surgical healthcare Purpose: The purpose of this station is to assess the candidate’s awareness and commitment to quality and safety issues in the provision of surgical care. Indicative Content: Audit. Incident reporting systems. Risk registers / risk management systems. Medical and surgical error. Clinical governance. Continuous Quality Improvement. MDT meetings. Surgical “handovers”. 2. Commitment to academic advancement and lifelong learning Purpose: The purpose of this station is to assess the candidate’s commitment to maintaining up to date knowledge and professional competence. Indicative Content: Review of surgical portfolio. Attendance at relevant meetings and courses. Presentations and publications. Teaching activities. Involvement in clinical research. 3. Knowledge of current issues relevant to surgical practice Purpose: The purpose of this station is to assess the candidate’s knowledge and awareness of issues (other than surgical knowledge and technical skill) which may impact on delivery of good surgical care. Indicative Content: The Clinical Programmes (Acute Surgery Programme / Elective Surgery Programme). Hospital networks. Universal Health Insurance. European Working Time Directive / shift working. 4. Decision making in surgery Purpose: The purpose of this station is to assess the candidate’s ability to utilise knowledge and skills in making sound clinical judgements for patient management relevant to the specialty in question. Indicative Content: 2 Clinical Scenarios, 3-4 minutes each. Please note this is subject to change under the ISPTC review criteria. 3 5. Professionalism and probity in surgical practice Purpose: The purpose of this station is to assess the candidate’s awareness and commitment to professional and ethical behaviour in surgical practice. Indicative Content: Regulation of the medical profession (Medical Council / Fitness to Practice process). Ethical behaviour for doctors. Patient advocacy. Disclosure of error. Clinical research ethics. Introduction of new technology to surgical practice. Data protection. Each station will be manned by a minimum of two interviewers, at least one of whom is from the specialty concerned. Each hospital which is recognised for Higher Surgical Training will be asked to nominate one interviewer for the selection panel. Each interview lasts for twelve minutes and there is then two minutes for marking. Each interviewer will mark independently without discussion. There will be topics and questions decided in advance by the interviewers and each trainee should cover 2-3 topics during the twelve minute interview. The Chairman of each interview panel is nominated by the President of RCSI. The role of the Chairman is to protect the interests of the College and to ensure that all interviews are conducted in accordance with the regulations defined by ISPTC and the Department of Human Resources. The Chairman should rotate around the 5 different interview stations and ideally should follow one candidate through all five stations. The Chairman should not mark individual candidates but will have a “casting vote” in the event of a tie between two candidates. The extern assessor is selected by the specialty. The role of the extern assessor is to ensure impartiality and objectivity in the selection process. The extern assessor should participate in one of the five interview stations but may rotate around the stations during the day. A total of 70 marks are awarded for each of the five stations (i.e. 350 marks total for specialty interview). At the beginning of the interview process the interviewers at each station should spend some time defining which questions to ask and also defining the standards required for answers. There should be a standard setting exercise prior to the commencement of the interviews. At the end of the specialty interview, the total marks for each candidate should be collated (i.e. Performance during Core Surgical Training and Specialty Interview) and the interview panel should then sign off on the candidates selected. Candidates who have not been selected for ST3 will be provided with feedback from the specialty Programme Director. Candidates who have reached a predefined standard in Performance during Core Surgical Training may be offered an opportunity to re-apply for ST3 the following year. In order to be eligible to re-apply the following year, a candidate must have achieved a score in Performance during Core Surgical Training which is at least equal to the mean score achieved in this section by the candidate to be appointed successfully in the selection process. Candidates who are eligible to re-apply will be determined by the Specialty Programme Director in consultation with the Specialty Training Committee. These decisions must be approved by the ISPTC in order to ensure consistency across all specialties. A candidate who is eligible to re-apply the following year will carry the same score for Performance during Core Surgical Training. A Trainee will only be given one opportunity to re-apply for ST3. Please note this is subject to change under the ISPTC review criteria. 4 Table 1 SELECTION PROCESS FOR ST3 A. Performance during Core Surgical Training: 1. Workplace Assessments: 650 marks 130 marks x 3 = 390 marks The following assessments are performed in each of the first 3 rotations during Core Surgical Training: SSAOP x3 (15 marks each): SCA x 3 (10 marks each): E logbook: Trainer reports: 45 marks 30 marks 30 marks 25 marks Total: 130 marks (x 3 rotations) 2. RCSI Assessments: 260 marks Case Based Discussions (SCHOOL for Surgeons): Technical Skills Assessments (ST1/ ST2): Human Factors OSCEs (ST1/ ST2: 60 marks 100 marks 100 marks Must have passed all parts of MRCS examination in order to participate in Interview. B. Specialty Interview: 1. 2. 3. 4. 5. (5 x 70 marks) 350 marks Quality and Safety in Surgical Healthcare Commitment to Academic Advancement and Lifelong Learning Knowledge of Current Issues Relevant to Surgical Practice Decision Making in Surgery Professionalism and Probity in Surgical Practice Grand Total: 1000 marks Please note: Minimum appointable standard required for appointment is 600 marks. Please note this is subject to change under the ISPTC review criteria. 5 NATIONAL SURGICAL TRAINING CENTRE Structured Clinical Assessment (SCA) Trainee Name: Trainer Name: Hospital: Specialty: Programme Year: Rotation: Start Date: End Date: Clinical Problem: ______________________________________________________________________________________ New Patient Follow – Up Patient Case Complexity: Low Medium High Please mark all sections by checking the box in the appropriate category. A maximum of 10 points is awarded per assessment. The form is scored out of 100 for ease of calculation. Very poor. Unacceptable for level of training 1.History taking (20) Misses important information, inefficient, disorganised; fails to check findings. 4 Very poor. Unacceptable for level of training. 2.Physical Examination (20) 3.Clinical Judgement (30) Below expectations for level of training 8 Below expectations for level of training. Poor technique, inefficient, omits many key elements & signs. 4 8 Very poor. Unacceptable for level of training. Below expectations for level of training. Fails to recognise obvious clinical conditions, or misjudges severity. Information gathering to make/ confirm diagnosis is inefficient. 6 12 Meets expectations for level of training Misses some minor facts but relatively precise, logical, purposeful & efficient. 12 Meets expectations for level of training. Good technique, reasonably efficient; omits some key elements & signs. 12 Meets expectations for level of training. Recognises obvious symptom patterns. Reasonably efficient in gathering information to make / confirm a diagnosis. 18 Above expectations for level of training Exceptional. Capable of performing independently Precise, logical, purposeful & efficient; skilful at checking findings. 16 20 Above expectations for level of training. Exceptional. Capable of performing independently. Excellent technique, thorough, efficient; picks up key elements & signs. 16 20 Above expectations for level of training. Exceptional. Capable of performing independently. Recognises symptom patterns, effectively gathers information & takes appropriate steps to make confirm diagnosis. 24 30 SCA /052014/V1 Very poor. Unacceptable for level of training. 4.Organisation/ Efficiency/ Communication Skills (30) Overall Clinical Care Explanation of diagnosis & management often incorrect or incomprehensible. Poor rapport with patients. Unprofessional at times, answers to patient questions often confusing or incorrect. 6 Very poor. Unacceptable for level of training. Below expectations for level of training. 12 Below expectations for level of training. Meets expectations for level of training. Generally explains diagnosis & management using vocabulary appropriate to patient, Usually professional. Establishes good rapport with patient & answers patient's questions clearly. 18 Meets expectations for level of training. Above expectations for level of training. Exceptional. Capable of performing independently. Explains diagnosis & management using vocabulary appropriate to patient. Establishes excellent rapport with patient. Professional at all times, answers patient's questions clearly & accurately. 24 Above expectations for level of training. 30 Exceptional. Capable of performing independently. Please indicate the weaknesses in this trainee’s performance: Please indicate the strengths in this trainee’s performance: Assessor’s Signature: ___________________________________ Assessor’s Name _______________________________________ (Print) Date: _______________ Office Use Only Score: ______ SCA /052014/V1 NATIONAL SURGICAL TRAINING CENTRE Supervised Structured Assessment of Operative Performance (SSAOP) Trainee Name: Trainer Name: Hospital: Specialty: Programme Year: Rotation Start Date: End Date: Procedure Performed: This is an assessment of operative performance of the surgical trainee. Trainees must complete three SSAOPs in each six month rotation (i.e. 12 in total during CST). Each SSAOP should be for a different surgical procedure. The assessment can be performed on any surgical procedure which the trainer considers appropriate for the specialty and the trainee year of training e.g. appendectomy, or repair of inguinal hernia. Minor operations (e.g. excision of skin lesions) are unacceptable. NB. The completed form will NOT be considered if “N/A” is entered for three or more of the items numbered 1 -15 (i.e. 20% of the items) A maximum of 15 points is awarded per SSAOP. Each SSAOP is scored out of 150 for ease of calculation. N/A = not observed or not done by the trainee Please mark all sections by checking the box in the appropriate category. Case Difficulty (Max 15 marks) Straightforward anatomy, no related prior operation(s) or treatment (e.g. radiation) (5) ☐ Intermediate difficulty (10) ☐ Obesity, abnormal anatomy, complex pathology, related prior operation(s) or treatment (15) ☐ Degree of Prompting or Direction (Max 15 marks) Substantial direction by consultant. Trainee performs all steps but the consultant provides constant direction to the trainee and surgical team. Some direction by consultant. Trainee performs all steps but the consultant provides occasional direction to the trainee and /or the surgical team. (5) (10) ☐ ☐ Minimal direction by consultant. Trainee performs all steps and directs the surgical team independently with little or no direction from the consultant to either the trainee or the surgical team. (15) ☐ SCA /052014/V1 Pre-Operative Preparation (Max 30 marks) Please indicate the degree to which trainee: N/A Very poor. Unacceptable for level of training (1) Below expectations for level of training (2) Meets expectations for level of training (3) Above expectations for level of training (4) Exceptional. Capable of performing independently (5) Below expectations for level of training (4) Meets expectations for level of training (6) Above expectations for level of training (8) Exceptional. Capable of performing independently (10) 1. Demonstrates knowledge of case & relevant investigations. 2. Ensures availability of relevant patient data & x-rays. 3. Ensures patient is appropriately positioned with attention to pressure areas & diathermy pad. 4. Initiates “Time out” in accordance with WHO guidelines 5.Demonstrates effective scrubbing & gowning technique 6. Demonstrates appropriate skin preparation & draping. Operative Procedure (Max 80 marks). Please indicate the degree to which trainee: N/A Very poor. Unacceptable for level of training (2) 7. Plans & makes incision(s) taking into account procedure & prior surgery. 8. Chooses appropriate surgical instruments (including sutures). 9. Uses surgical instruments (includes diathermy, stapler etc.) in a manner that is safe (i.e. visualizes tips) & demonstrates economy of motion. 10. Handles tissue carefully, demonstrates meticulous dissection technique & appropriate use of tissue planes. 11. Anticipates needs, thinks ahead & sets up operative field by effective use of retraction & assistants, with efficient forward progression & flow. 12. Demonstrates a calm demeanor, is not distracted, slows down when appropriate & accepts feedback. 13. Is able to SCA /052014/V1 problem solve, recognised, avoid & recover from errors & unexpected events (includes abnormal anatomy & bleeding). 14. Communicates effectively with team, provides leadership & appropriately monitors changes outside immediate operative field. Postoperative Care (10) Please indicate the degree to which the trainee: N/A Very poor. Unacceptable for level of training (2) Below expectations for level of training (4) Meets expectations for level of training (6) Above expectations for level of training (8) Exceptional. Capable of performing independently (10) 15. Completes the operation note & writes postoperative orders. Please indicate the weaknesses in this trainee’s performance: Please indicate the strengths in this trainee’s performance: Please rate this trainee’s overall performance in this procedure. Exceptional rating indicates technically proficient performance (i.e., trainee is ready to perform THIS operation independently assuming he/she consistently performs at this level). Unable to perform basic operative steps without direction ☐ Fair performance but needed considerable direction to complete steps. ☐ Good performance but needed some direction Excellent performance but needed some direction ☐ ☐ Exceptional performance. Could operate independently. ☐ Assessor’s Signature: ________________________________________ Assessor’s Name ___________________________________________ (Print) Date ___________________________ Office Use Only Score: ______ SCA /052014/V1 NATIONAL SURGICAL TRAINING CENTRE Trainee Assessment Report Trainee Name: Trainer Name: Hospital: Specialty: Programme Year: Rotation Start Date: End Date: Guidelines for Hospital Based Programme Director (HBPD) Where more than one trainer is involved with the trainee, a consensus opinion should be expressed on the form which should be signed by all trainers Complete the main assessment by placing an X in the box below the descriptor N.B. The completed form will NOT be considered if “N/A” is entered for three or more of the items numbered 1 -15 (i.e. 20% of the items) A maximum of 25 points is awarded for each trainee assessment form. The form is scored out of 250 for ease of calculation. N/A = not observed or not done by the trainee Please mark all sections by checking the box in the appropriate category. N/A A. Clinical Skills (150) 1.History Taking (20) Very poor. Unacceptable for level of training Misses important information, inefficient, disorganised; fails to check findings. 4 2.Physical Examination (20) 3.Diagnostic skills (25) 4 (30) 5.Operative Skills 8 Above expectations for level of training 12 8 12 16 10 15 16 Lacks decision making, technical & forward planning skills. 18 20 5 Requires constant oversight to ensure completion of operation notes & 24 15 Requires some direction to complete operation notes & post- 30 Demonstrates exceptional decision making, technical & forward planning skills. Demonstrates decision making, technical, & forward planning skills. 10 25 Recognises symptom patterns, effectively gathers information & takes an evidence based approach to make or confirm a diagnosis. (25) 6.Postoperative Management 20 Consistently orders most appropriate lab & imaging investigations. Demonstrates a logical approach to diagnosing common surgical conditions & complications. Recognises obvious symptom patterns & generally uses an evidence based approach to make or confirm a diagnosis. 12 20 Excellent technique, thorough, efficient; picks up key signs. Requires some direction to order appropriate lab & imaging investigations & to diagnose common surgical conditions & complications. Fails to recognise obvious clinical conditions or misjudges severity. Does not use an evidence based approach to make or confirm a diagnosis. Exceptional. Capable of performing independently Precise, logical, purposeful & efficient; skilful at checking findings. Good technique, reasonably efficient; omits some key elements & signs. Haphazard or inappropriate ordering of diagnostic tests. Frequently fails to diagnose common surgical conditions & complications. 6 Meets expectations for level of training Misses some minor facts but relatively precise, logical, purposeful & efficient. Poor technique, inefficient, omits many key elements & signs. 5 4.Clinical Judgement Below expectations for level of training 20 25 Efficiently completes operation notes & post-operative SCA /052014/V1 (20) post-operative orders as well as appropriate postoperative patient management. 4 7.Follow-Up Planning (10) B. Professional Development (40) 8. Teaching Activities operative orders & to manage postoperative patients. Generally anticipates complications. 8 12 10. Presentations (10) Consistently anticipates patient discharge needs & communicates these in a timely manner. 4 6 8 10 Very poor. Unacceptable for level of training Below expectations for level of training Meets expectations for level of training Above expectations for level of training Exceptional. Capable of performing independently N/A 4 6 Very little participation in clinical audit. 2 Excellent, enthusiastic teacher. Seldom misses an opportunity to teach students or interns. Seldom volunteers to teach but will complete teaching assignments in an effective manner. Avoids teaching, & contributes little to the education of students & interns. 8 4 6 8 6 Does not perform research. 8 Performs research under direction. 4 6 10 Independently performs research using the literature. Appropriate statistical & research methods. (10) 2 10 Presentations are thoroughly researched & presented in an organized & clear manner. Presentations are adequately researched & well presented. 4 10 Participates actively in collection & evaluation of clinical audit data. Participates occasionally in clinical audit. Presentations are inadequately researched & presented in a haphazard manner. 2 11. Research 20 2 2 (10) 16 Usually anticipates patient discharge needs & communicates these needs in a timely manner Seldom anticipates or communicates patient discharge needs without prompting. (10) 9. Clinical Audit orders. Manages post-operative patients in a conscientious manner & anticipates complications, without prompting. 8 10 N/A C. Personal Skills (60) 12. Communication (15) Very poor. Unacceptable for level of training Below expectations for level of training Explanations to patients are often incorrect & confusing. Often treats nurses & colleagues with disdain & has generated a number of complaints 3 Meets expectations for level of training Above expectations for level of training Excellent patient rapport, answers patient's questions clearly & accurately. Treats nursing staff & colleagues with respect & is respected in turn Good rapport with most patients & usually answers questions clearly. Communicates & works well with nursing staff & colleagues. 6 9 Exceptional. Capable of performing independently 12 15 SCA /052014/V1 13. Teamwork & Leadership (15) Poor team player; works alone, does not support or assist colleagues. Very limited leadership ability. 3 14. SelfAwareness & Self – Management (15) 15.Management & Organization (15) Good team player, but average leader. Demonstrates excellence in some leadership skills but not others. 6 6 Constantly disorganised, does not identify priorities, always behind in tasks. Tends to panic in a crisis & is unable to deal with emergencies. Unreliable, frequently forgets significant patient duties / tasks 3 9 12 Demonstrates some insight into strengths & weaknesses & generally responds well to feedback. Does not seek opportunities to learn but accepts these when offered. Generally presents himself/ herself in a professional manner Little or no understanding of own limitations or deficiencies & does not respond to feedback. No inclination to organize work, needs to be pushed constantly, Sloppy in appearance & work manner. 3 Works well with team members; offers support, coaching and/or feedback & resolves conflict. Exceptional ability to direct / team activities. Assesses needs, allocates tasks, motivates, organises, & maintains a positive team environment. 9 Recognises own deficiencies & makes appropriate changes. Responds well to feedback Actively seeks opportunities to advance. Presents himself/ herself in a professional manner at all times 12 9 15 Exceptionally wellorganized. Identifies priorities & remains calm in a crisis. Is able to deal with emergencies. Reliable & seldom forgets significant patient duties / tasks Generally prioritises appropriately & is efficient. Usually calm at time of crises. Occasionally needs to be reminded of duties but generally dependable 6 15 12 15 Please indicate the weaknesses in this trainee’s performance: Please indicate the strengths in this trainee’s performance: Please rate this trainee’s overall performance in this post: Very poor. Unacceptable for level of training Below expectations for level of training Meets expectations for level of training Above expectations for level of training Exceptional trainee. Assessor’s Signature: __________________________________________ Assessor’s Name _____________________ (Print) Date _______________________ Office Use Only Score: ______ SCA /052014/V1 R o y a l C o l l e g e o f S u r g e o n s i n I r e l a n d C o l á i s t e R í o g a n a M á i n l e á i n É i r i n n 1 2 3 S t S t e p SCA /052014/V1
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