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UK HigherSurgicalTraining Pathway GeneralSurgery AshrafunNessa FCPSMRCSPGCert (General Surgery)FRCS 07.12.2024General Surgery trainingisdividedintotwo phases and will takeanindicativetime of sixyears(fouryearsinphase2 and twoyearsinphase3). Uncoupled traineeswill enterphase2 aftercompletion ofcore surgical training (phase 1)and successfully gaining aNationalTraining Number(NTN)throughthe national selection processTrainingroute (common pathway) Foundation year 1 Foundation year 2 Core trainee year 1/Specialty trainee year1 CoreTrainee year2/Specialtytrainee year 2 • National Selection: allocated trainingnumber: HigherSurgicalTraining • Phase1 GeneralSurgery ( 1year of upperGI,1year ofLowerGI, 6 months of other specialty- Peadiatrics surgery/ Breast/ Endocrine/Transplant SpecialtyTraining year 3 SpecialtyTraining year 4 SpecialtyTraining year 5 SpecialtyTraining year 6 • Phase2: UpperGI/ HPB/Colorectal /Breast / Endocrine/Transplant SpecialtyTraining year 7 SpecialtyTraining year 8Capabilities Manages anout-patient clinic in Practice (the high- Manages theunselected emergencytake level Manages ward rounds andtheon-going careof in- outcomes patients of training): Manages anoperatinglist 5 Manages multi-disciplinaryworkingGeneral ProfessionalCapabilities: 9 Domain 2:Professional skillsPractical skills Domain 3:Professional Communicationand interpersonal knowledgeProfessional Domain 1:Professional values and skills requirements behaviours National legislativerequirements Dealing uncertaintyity and The health serviceand healthcare Clinical skills system in thefour countries Domain 4:Capabilities inhealth Domain 5:Capabilitiesin leadership Domain 6:Capabilities inpatient promotion and illnessprevention and team working safety and quality improvement Domain 7:Capabilities in Domain 8:Capabilities ineducation Domain 9:Capabilities inresearch safeguarding vulnerablegroups and training and scholarshipSimplyput, theCiPsandGPCs aretheconstituentpartsoftheroleof a consultant general surgeonTrainingin workplace Ward Formal teaching MDT Courses 12 hours 12 hours hours night Selfdirected dayshift shift reading clinic Theatre Electivework Emergencywork TeachingGeneralSurgery AESMEETING ASSIGNEDEDUCATIONALSUPERVISOR ISCP INTERCOLLEGIATE SURGICALCURRICULUM PROGRAMME ELOGBOOK ARCP ANNUALREVIEW OFCOMPETECE PROGRESSION Level I:Able toobserve only Level II:Ableand trustedto act withdirect supervision: The •b) Supervisor present forpartt supervision levels are: Level III:Ableand trusted to act with indirect supervision Level IV:Able and trusted to act at the level expected ofa day- one consultant LevelV:Able and trusted to actat alevel beyondthat expected ofaday-one consultantT able1:Supervision levels tobeachieved bytheendof eachphaseoftraining Indicative Supervision Level (end of Supervision Level (end of phase 3 and Capabilities in Practice phase 2) certification) Manages an out-patient clinic Level III Level IV Manages the unselected emergency take Level III Level IV Manages ward rounds and the on-going Level III Level IV care of in-patients Manages the operating list Level III Level IV Manages multi-disciplinary working Level III Level IVRecording progress in the ISCP Learning Portfolio Trainees can initiate the learning agreement This and WBAs AESscan curriculum directly complete isavailable TheISCP with Deanery/H trainee through learning supervisor TPDscan EELocal appraisal Other theJCST’s portfolio s. They validate Office through CSscan people Intercolleg canbe canrecord traineesin administra the complete Assessors involvedin used to logbook learning theMCR canrecord training iate builda procedure their torscan agreement atthemid- canaccess Surgical training sand placement support ,monitor pointand feedback trainee Curriculum recordof other s, monitor theTPD, trainee end of and portfolios Programm trainee evidence training JCST portfolios each validate according e(ISCP) conduct usinga and trainee and placement WBAs. totheir training and varietyof manage enrolment provide . roleand managem practiceas forms. theARCP. and ARCP end of function. entsystem follows: Theycan process. placement at ww.iscp.ac.uk alsolink AES cp.ac.uk.ac.uk WBAswith reports. critical conditions and index procedure s.Every 6monthsTraineerotatethrough a placement • Canbe placed inSamehospital different specialty/differenthospitalsinsame Deanary • Traineegetsa 6monthof rotain advance with aplan ofelective work,emergency oncall days • 20daysofAnnual leave and specificdatesofStudyleave • Studybudget oflimited amount to avail courses, conferences • GetsaConsultant allocated asAssigned EducationalSupervisor(AES) • Rest oftheconsultantscan be Clinicalsupervisorand canfeed backtoAESregarding trainees • GetsanAnnual review of competency progression (ARCP)outcome at the end of placement to progress orto indentifyareas ofimprovement All theassessments in the Learning agreement:appraisal curriculumaredesigned to meetings withtheAESat the WBA:immediateverbal dialogue includeafeedbackelement as beginning, middleand end of after alearning episode well asto identify concerns in each placement multipleways: MCR(mid-point formative): CBD:meeting with aconsultant MSF:meeting withtheAESto meeting with theAESorCSto trainerto discuss the discussthetrainee’s self- discussthetrainee’s self- management ofapatient case assessment and team views assessment andCSs’ views on CiPs ARCP: afeedbackmeetingwith MCR(final formative, theTPD ortheirrepresentative contributing to theAES’s Formal examinations: following anARCP. summativeReport):meeting withtheAESorCSto discussthe summativefeedback on key •Constructivefeedbackisexpected to trainee’s self-assessment and areas ofknowledge and skills includethreeelementsi)a reflectionon CSs’views onCiPs trainee’sachievements, challenges and aspirations and iii)an action plan.CriticalConditionsforGeneralSurgery Assessmentof theacute abdomen Include Includesmall differential Strangulated / Intestinal Intestinal and large bowel Post-operative General diagnosis, obstructed ischaemia obstruction obstructionin haemorrhage operativeand hernia thediscussion conservative Include Includedifferent treatment in the Includeboth physiological operativesites diAcuteion Blunt / responseand (e.g. neck gastrointestinal upper and lower penetrating management of discussion Necrotising surgery)in the haemorrhage GIbleedingin abdominal injury blunt and fasciitis discussion thediscussion penetrating injury in the Includeother Includelarge severesoft Include bowel andsmall tissue infections Sepsis recognition and Anastomotic bowel Colorectal Acutecolitis / inthe discussion management in leak anastomotic toxicmegacolon (e.g. diabetic thediscussion foot infection) leak Biliary sepsis Vascular Faecal Includeall Acute Oesophageal UpperGI peritonitis UGI causesand their pancreatitis perforation anastomotic •Ruptured AAA management in leak •ischaemiab thediscussion •Compartment syndrome By certification there should be documented evidence of performance at the level of a day-one consultant in the portfolio by means of the PBA. The table below sets out the required PBA levels ranging between 2 to 4: • Level2 a: Guidance required for most/all of the procedure (or part performed) b: Guidance or intervention required for key steps only • Level3 a: Procedure performed with minimal guidance or intervention (needed occasionalhelp) b: Procedure performed competently without guidance or intervention but lacked fluency Index procedures • Level4 a: Procedure performed fluently without guidance or intervention b: As 4a and was able to anticipate, avoid and/or deal with common problems/complications In addition, the indicative numbers of index cases help to demonstrate sufficient experience to be able to manage the range of pathology trainees encounter. It is recognised that competence could be achieved with fewer cases, if supported by evidence fromother assessments. Meeting the numbers does not, in itself, imply competence.https://www.iscp.ac.uk/https://www.iscp.ac.uk :subscriptiononlyhttps://www.iscp.ac.uk/https://www.iscp.ac.uk/ OTHER EVIDENCES OUTSIDE CLINICAL WORKSForexample Trainee has managed apatient withAcuteAppendicitis ,itcanbe assessed byanyofthe followingWBAs History,Management -CaseBased Discussions (CBD) Clinicalexamination –Clinical Evaluation Exercise (CEX) Consented patient -Clinical Evaluation Exercise forConsent CEX for consent) PerformedAppendicectomy- Procedure BaseAssessment/ (PBA) DirectObservational Procedure (DOPS)https://www.iscp.ac.uk/https://www.iscp.ac.uk/Nonoperative technical skills(NOTES)https://www.elogbook.org/ . freeaccesshttps://client.elogbook.org/eLogbook/Operations/OperationMaintain/Addhttps://www.jcst.org/cesr/REFERENCES https://www.jcst.org,accessed12.06.23 https://www.iscp.ac.uk/iscp/curriculum/general-surgery-curriculum, accessed 12.06.23 https://client.elogbook.org/eLogbook,accessed 12.06.23Disclaimer Allinformationcopiedand screenshotfrom ISCP website; the curriculumhas been introducedinAugust2021. Data has beenanonimyzed,allidentifiablepersonal information disclosureis avoided,exception is unintentionalThank you https://app.medall.org/feedback/feedbac k- flow?keyword=fcfdb9ef75e73a6abe95e7a e&organisation=ash-nessa