BSG TRAINING COMMITTE
TIG representatives: Adam Haycock/Ana Ignjatovic


UPDATES:

These notes are taken by the trainee rep on the committee and are not an accurate verbatim minutes of the meeting.

Update: February 10, 2010 (Adam Haycock)

Medical manpower

5.2% increase in consultant posts over the last year – 1,,041 total (1 per 60,000 pop, but wide disparity). Need 850 more to meet target 1,700 (expansion of 7% per annum) but issues re NHS budget. Retirement age 62 – stable.

Approx 800 trainees – increase in 4% over the last year. Approx 7.2 years to reach CCT. Predicted CCT dates – 100 per year over the next 4 years, but only 20 retirements per year. If consultant expansion continues at 7%, then there will only be 20 CCT holders without a job. Acute medicine posts are likely to dry up as Acute Medicine CCT holders come through.

Best employment option over the next few years is in hepatology.

JAG

1. DOPS now validated as an assessment tool. Can now change format. Need 4 assessed cases within a month, but no longer 2 assessors.  Your primary endoscopic trainer shouldn’t be an assessor.

If you fail one of the four, do you have do re-do all 4 cases? Not stated yet, but will check!

Do the assessors have to have TTT? Not stated yet, but will come out with guidelines.

2. New JAG website now live and very different.

3. Will be advertising for new JAG Chair. Will be open to all comers and interview appointment.

Hepatology

There is now an official hepatology training lead, who will be representative on the training committee. Centres will now be graded into 3 grades depending on what level of liver training is available there. There is likely to be more need for supervisors to confirm that trainees have actually done specific aspects of hepatology. BSG liver committee and BASL are joining to form one committee to give a single voice in hepatology.

National recruitment

Now with 5 specialities nationally. Can apply to 2 deaneries per speciality, but should state 4 deaneries to have a choice for cascade 2nd round. If selected, candidates will book their own interviews (within 48h). There will be 3 interview stations of 10-15mins each. They can accept an offer, reject it, or hold one offer until final date. Then local clearing round, followed by national clearing process.

Adverts 15 Feb. Opens 26 Feb-26 Mar. Shortlisting 29 March, then invitations 19 April. Interviews 29 April – 17 May. Offers 18-26 May. 1st June holding period ends.

SAC

New curriculum 2010 in progress. Curriculum and methods of assessment should be approved by PMETB. Need to ensure deliverability, esp in hepatology and nutrition.

Penny Nield said that training in nutrition should be deliverable. Minimum standards of centre are trying to be determined (e.g. nutrition team).

KBA

108 took part in second round. 61% passed. It was clear a lot of trainees had done very little preparation. Seemed like most trainees who were
expected to pass did. Lots of pictures e.g. histology, radiology. Next date registration 26 June - 26 July.

Should the BSG run training courses on the KBA? Perhaps… but realistically trainees should be adult learners and find the information for themselves. Charlie Murray has been put in charge of a project looking at the possibility of an e-learning module specifically for the KBA.

Trainee issues:

1) Compulsory endoscopy courses

We were reassured that trainees who started before 2007 and have already demonstrated competence in endoscopy will not have to do ‘mandatory’ JAG courses. They can invoke the unofficial ‘Grandfather’ clause! Advice is to talk to their programme director first and then any further queries should be directed to the BSG secretary. Ian Forgacs has said they will not make anyone do a course who is already clearly competent.

2) Sengstaken survey

This was raised as Edwin Swarbrick wanted to do a survey looking at experience in this. The 2010 curriculum will now state:

Can place safely and manage a Sengstaken tube in refractory variceal bleeding" This skill is assessed by DOPS and is in the core curriculum for all trainees.”

The training committee thought that it was inappropriate to DOPS such emergency procedures, but that training should be done using simulation on a model, with DOPS to confirm competency. However, they would expect trainees to have experience in real life, but not to have DOPS on them.

BSG Training Committee, June 10, 2009 (Ana Ignjatovic)

Workforce report: manpower numbers were depressing as usual. Currently there are 847 consultant gastroenterologists and 515 trainees. The consultant expansion has been 2.7% this year, which is lowest for a number of years and the predictions are that the trusts are going to put a freeze on further recruitment in the current economic crisis. However, as Dr McIntyre pointed out, BSG and the RCP have been trying to predict numbers for years and have failed to do so and the dreaded situation of many CCTholders without a job has not materialised (yet).

JAG report (Prof Barton): JAG is currently trying to establish financial independence and is undergoing qa in the private sector as a part of its revenue-generating stream. Three sections within JAG have recently been formed – qa, trainee and independent endoscopists.

The process of JAG certification was brought up. Currently in order to obtain a certificate, trainees need to submit formative and summative dops (double dops) in addition to evidence of course attendance and personal audit data. Once JAG is satisfied with the documentation, a certificate of competence is issued. However it has come to the attention, that even trainees who have a certificate are asked to repeat their summative assessment, i.e. double dops in the new hospital. This made no sense to some in the committee, including me.

It is clear that to be able to practice independently (which is mostly for service provision rather than our benefit) JAG recommends (not sure if anything stronger) summative assessment to be completed. According to most training directors, this needs to be repeated in each hospital trainee rotates through (trust medico-legal issues mainly), which I agreed was not unreasonable. However once the certificate of competency is achieved it seems a bit odd to carry on with the same process, devaluing the certificate. I suggested that the certificate should be given at CCT, as SpRs/ST3s are not ever independent practioners. Ihave raised this point with Siwan Thomas-Gibson, who is the chair of the trainee section of JAG and responsible for signing off our forms.

The second two issues I have sought clarification on are:

- one of the assessors doing the double dops shouldn’t be a trainee’s supervisor/ trainer – difficult to achieve especially in small DGHs.

- Prof Barton is keen for assessments to be performed by two assessors as that is more valid, but is exploring the options of having those trainers assess the trainee at different times (that is not simultaneously)

Report from SAC: the new (edited old curriculum) was circulated. It includes new sections on basic and applied science (irrelevant gastric secretion tests have been taken out!) as there is a move to introduce modules in gastroenterology training, drafts of hepatology and nutrition modules have been produced. Advanced endoscopy and IBD module curricula are to follow shortly (I think it is still unclear how and where these will be delivered).

SCE: we are encouraged to sit this exam. For those sitting in 2009-2010, a first re-sit will be free. It is unclear what happens if trainees don’t pass SCE by their PYA (RITA Dhas been mentioned).

EWTD: specialties with procedural component like gastroenterology will suffer as the working week decreases to 48hrs. There is good evidence that as the working hours decrease, the training component decreases disproportionately more compared to service delivery. It was felt that this would continue as long as gastroenterology is coupled to general medicine, which is unlikely to change any time soon.

Other business: David Thompson is keen for an academic trainee to be co-opted onto TS (like paediatric gastro). We should discuss it but Iagree that we probably aren’t able to adequately represent their interests.

Next meeting 24th sept 2009

BSG Training Committee, February 24, 2009 (Adam Haycock)

Matters arising

Nutrition – Penny Nield
Penny Nield presented the results of her brief survey regarding nutrition training. This gives preliminary results as to what is available (nutrition support team, lead etc). This is in anticipation of the implementation of more structured nutrition training in the new curriculum. She was of the opinion that current expertise may be able to deliver advanced modules, but she is looking to get more info prior to curriculum meeting next week.

JRCPTB and academic careers
The academic committee has sent a report to JRCPTB regarding academic careers in gastroenterology, which they hope will be acted on. There is an editorial in the journal of the RCP regarding academic training. A comment was made that this paper considers that MD programme is regarded as unacceptable for an academic career (training academics rather than OOPE). Robert Logan to talk to David Thompson regarding this.

Run-through training and dual CCT
Now abandoned in England, but continues in Scotland. Trainees in 2007/08 - dual accreditation now recognised by allowing trainees to swap to new curriculum and qualify for dual CCT.

Workplace assessment
All the workplace assessments (current and new e.g. outpatient surveys) are being investigated for feasability in a few regions. The deadline is now March for the assessments to be handed in. Analysis aims to assess whether the data is valid and reliable. The first comment is that they are time consuming and disruptive for clinics etc. Comment made re dual hit of speciality and general medicine i.e. that trainees dual accrediting will have to spend twice as long doing these assessments. Further data is awaited once the pilots are completed

KBA/SCE
Peter Mills was not present to give a full report. There is to be another exam in June, and the committee have banked 1000 questions which is minimum for reliable exam. There will continue to be 1 diet per year. I reported only 77% of SpR’s intend to sit it – this was taken as encouraging as 25% did plan on doing it. Point made that dates need to be specified a long time in advanced (i.e. the June exam dates haven’t been advertised yet). Exam costs do not cover expense of running the exam– it looks like it will continue to make a loss for the next 5 years unless the exam picks up internationally. Sample questions will be provided sometime soon, but it is anticipated that anyone currently working in gastroenterology should pass (despite 30% failure rate this year with N=8).

Workforce report – Nick Thompson
Last year 990 consultants in UK. Currently 999 Feb 09!! The increase was 5.5% 2008. In the last 4 months Oct-Feb – 3% growth. 5% are part time. 9.4% academics.
53 (5.4%) report 2 or more days per week in acute medicine (assumed 0.6 time in gastro).
Trainee numbers have increased by 11%. More research registrars and academic trainees. 41 (5%) flexible trainees – this is static. 30% are female.
Increases in nurses in gastroenterology – 15% in last year.

Nick Thomson thought that it was worth a new piece of work to estimate future expansion needs and disease load to improve the accuracy of manpower planning for the future.
There is not much allowance in these numbers for general medicine – assume all are working in gastroenterology. This may be more accurate as time goes by and acute medics take up acute medicine leaving gastroenterologists to do gastroenterology.

Dr Forgacs brought up the issue of Temporary NTN’s: if a programme has a trainee as OOPE, can they fill that with a ‘temporary’ NTN? This is supported by JRCPTB and RCP. The BSG has tried to set a limit of 10 per year to avoid NTN ‘creep’. Numbers should level off now the EWTD and run-throughs are completed. There are difficulties filling LATs etc to plug gaps for OOPE. There is strong pressure to ‘plug the gaps’ with extra numbers. LATS may come back now that training is uncoupled, but probably not to the previous degree.

The mismatch from numbers of trainees and posts may have to be done by extending training e.g. nutrition in order to keep Trusts happy. Or consultants will be delivering out of hours work alongside the trainee. Watch this space!

Trainee survey
Ana Ignjatovic and I reported the findings of the National Training survey. This was well received, with programme directors keen to get the information. A full report of the data will be made at the Trainees section symposium at the BSG meeting in Glasgow next month.

National Clinical Research Strategy
The issue was raised as to whether the Trainees section should be involved in developing the BSG research strategy, in particular relating to how research fits into training. This clearly overlaps with both the training committee and the Academic Development committee, but Prof Hull thought that this was an important issue and should be included in the BSG response. Dr Logan asked whether there was an enthusiastic programme director who would like to be involved in this, and we will await any responses.

JAG Trainers accreditation
Roland Valori has suggested trainer accreditation and an assessment structure to improve the quality of training in endoscopy, to be organised by JAG. If JAG go ahead with this, it does increase emphasis on endoscopy training, perhaps to the exclusion of other types of training. The training committee was urged to think about assessing trainers in non-endoscopic aspects of training. A point was made that JAG can’t go out on it’s own regarding revalidation, and that this will need to be part of an overall revalidation strategy. A comment was made that the focus should be on the end-result – well trained trainees and NOT the process behind it, which will sort itself out. There was some disquiet regarding what was seen as JAG’s over-enthusiasm, and this will be fed back to JAG.

Report from SAC – Ian Forgacs
The curriculum hasn’t undergone a major revision since Calman. Now is perhaps a good time to consider it in view of reduction in time for training, the desire for ‘subspecialisation’ or specialist interest development (Hepatology, Nutrition, IBD and interventional endoscopy). Academia is well represented if you are at F1 and F2, but it was felt that we should try to develop this along the way as well by recognising research as training.

There seems to be consensus of developing ‘core’ training, but also the need to provide specialist interest training within a training programme rather than afterwards. A suggestion was that there would be core training for 3 years (including general medicine) then competitive application for sub-specialist training e.g. 5 half-days doing the sub-speciality per week. The number of places for this training would likely be small, with the remainder of trainees developing specialist interests as they can within the usual training programme (as currently occurs).
There is a full curriculum development meeting next week to discuss all these issues.

Recruitment round 2009 – Bev Oats
The ST job specification has been approved by PMETB. Bev Oates is now compiling a dataset for the last round of applications to try to identify good shortlisting and interview questions, but the data needs to be fully analysed. Best match may be qualification scoring and then re-shortlisting on leadership and aptitude questions? However, this may prove practically difficult.
There is no national selection this year – only regional matching which closes in May, then round 2 in June. There is a need to consider whether there will be a national selection in 2010, and plan for that.

AOB
Mel Lockett
Paul Dunkley is developing web-based tool for endoscopy DOPS, which should enable programme directors to look at trainees’ progress in endoscopy. This may be automated in JETS.

BSG Training Committee, September 25, 2008 (Adam Haycock)


1. Workforce report:

There have been a number of consultant posts advertised in the last few weeks, bringing this year’s expansion of numbers to 6%, which is significantly better than the previous two years. It was thought that this has been driven by the 8 week waits for endoscopy and the provision of out-of-hours endoscopy. Some posts have been specifically created to deal with these points. What will happen to them once the backlog has gone may become an issue.

Current numbers are attached below.

2. National Recruitment: selection criteria

A national job specification for appointment to ST3 needs to be produced to standardise the way in which applicants are shortlisted and selected. This was felt to be an urgent issue as several committee members had very differing experiences during last year’s national selection process to their local one. A draft is to be produced by the end of October 08 for approval by the SAC.

3. Report from SAC:

Ian Forgacs eloquently pointed out the “Byzantine complexity” of the SAC with a good example of the newly formed Medical Education England (MEE) that has been set up post-Darzi to advise the DOH regarding training, workforce planning, currriculum development etc - all of which is already done by other committees! There may even be subspecialist committees (already nicknamed mini-MEE’s).

The main discussion was regarding the revision of the whole GI curriculum that will be undertaken in the next 18 months (delivery 2010). This will take into account all the new changes to training (e.g. EWTD implementation) and assesments (DOPS, MiniCex etc) and will be revised every 3 years.

4. Work-based assessment pilots: feedback from Joe Booth, Education Projects RCP. This was very interesting! All the groups piloting these assessments felt that although it is a good idea in principle, actually implementing them was turning out to be unworkable. This may counter-balance some of the extremely positive responses coming back from some other specialities (e.g. sports medicine).

One key point that came out in the discussion was that decisions on advancement for trainees at RITA’s will now be made SOLELY on the evidence provided (either paper or e-portfolio) for legal reasons. Some deaneries have therefore been saying that a face-to-face discussion is not necessary if the paperwork is correct. The committee unanamously disagreed and thought that a face-to-face contact was essential to allow a formative element for the trainee and also for the trainee to feed back to someone independent regarding their training. They also thought that the portfolio can often descend into a ticking-boxes exercise, and thought that we needed to emphasise the importance of the trainer’s report as a key means of picking up both superior and deficient trainees.

5. Knowledge Based Assessments (KBA Board progress)

The numbers reported were clarified: 8 candidates took it – 7 who currently hold NTN’s or LATS in the UK, and one overseas. 5 passed. They are pleased that TiG are going to ask a successful candidate to speak at the BSG, and that we are encouraging participation. They also said they would encourage consultants to sit it as well (why, I’m not sure). It was clarified that this the KBA is a clinically related exam, and so should be sat after appointment to ST3, and must be passed by the PYA.

6. Report from TiG

I presented the draft Training Survey, and got a very encouraging level of support. Prof Barton has even agreed to come up with a cash incentive of £500 for a prize draw to encourage trainees to respond. I have written him a very gushing thank-you email!!

The training committee had several suggestions.

1) They thought the subspeciality questions were also important. They particularly wanted to get out info regarding things like nutrition training - what type of training (time spent on a nutrition support team, time spent in an intestinal failure unit etc), how long trainees do it for etc.

2) They suggested some questions about the EWTD - e.g. is your current post EWTD compliant, has it affected your training

3) Robert Logan pointed out that we are currently ignoring all the LAT/ACF's/Walport fellows, so should have some pertinent questions for them e.g. do you think that your current post is affecting your training in a positive, neutral, negative way?

I will liase with Prof Barton to help elucidate these questions and to get the incentive formalised!

7. Report from JAG

Prof Barton presented an encouraging report regarding the competency assessment for colonoscopy, which has now been shown to have excellent validity and reliability, proving the principle. They will now repeat this for OGD.

Prof Barton also presented a vision of the E-learning portfolio, of which GI endoscopy is one of 20 groups participating. This will contain educational material e.g. videos/photos, teaching aids etc, available to all.

Ian Forgacs made the point that the JAG summative DOPS will now be an mandatoryy requirement to pass your PYA. A short discussion ensued regarding exactly who this applied to, and the general opinion was that it should be prospective only. i.e. if you have done your summative DOPS already (in the old system), then you would not have to re-do it again. However, anyone currently in ST3 is likely to be affected.

8. Training for Programme Directors – Manual update. Nothing to report

9. Co-ordinating Academic Training for Physicians - deferred to next meeting

10. BASL – Hepatology training

BASL have produced a report looking at hepatology training. While this was thought to be a good start, and probably necessary, it was a stand-alone document not taking into account any of the other training issues. Most of the committee thought that the suggestions as stated were not deliverable (e.g. trainees should all get 1 year hepatology training in a unit with a 24/7 bleeding rota). Also, there are currently not enough hepatologists currently in post to deliver the trainees. Ian Forgacs will ask BASL to present their plan to the SAC, but thought that this would probably be best dealt with during the curriculum review in 2010.

REVIEW OF MEDICAL MANPOWER IN GASTROENTEROLOGY (ENGLAND)

CONSULTANTS

Consultants in post

Consultant adverts

LOCUM CONSULTANTS (with or without NTN) = 19
SPECIALIST REGISTRARS (time expired) = 2
SPECIALIST REGISTRARS (out of programme) = 7
ACADEMIC REGISTRAR/CLINICAL LECTURER = 12

SPECIALIST REGISTRARS (on SpR contract)

RESEARCH FELLOWS

LATS: 61
VISITING REGISTRARS: 58
Vacant NTNs: 94 (62 SpRs w/o NTN)