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JAG forms for DOPS, MSF and Mini-CEX (required for RITAs) can be found
at:
http://www.jrcptb.org.uk/forms/Pages/default.aspx
Update: November 2, 2011 (Alenka Brooks)
These notes are an interpretation of what took place and do not reflect SAC or training committee position or policy.
Advanced Training Programmes (ATPs) were discussed in detail. Discussions centred around the practicalities of these ‘elite modules’ which will be open to either local or national competition for trainee’s on the 2010 gastroenterology curriculum. It is anticipated these posts will start in Aug 2013 with applications earlier that year. The IBD and endoscopy modules will be recruited to locally. ATPs are designed to be for a period of 12 months and to include general medicine and to be part of the training programme (i.e. not out of programme experience). Some centres may offer posts without general medicine, but this will be a local decision.
It is anticipated that the numbers of ATPs for hepatology will increase from 16 to 25. This is as a result of the anticipated expansion in hepatology consultants numbers required in the future. In order to reduce some of the problems with recruitment it was suggested that recruitment for all of the ATP’s be coordinated at the same time of the year. This would be further helped by all deaneries having the same rotation date for gastroenterology. This was to be discussed further by the training committee. Lack of recruitment has in part been due to the lack of hepatology consultant posts being advertised. It was emphasised that having a CCT in hepatology is not a requirement to being employed as a hepatologist. BASL will be leading the definition and availability of new hepatology posts, and they are currently trying to define which centres can provide adequate training and how much transplant centre experience is required. This is currently 6 months but may decrease to 3. If such a change was agreed this would have to be passed through the GMC as an amendment to the curriculum. It was felt that the ATPs need a national lead and this was felt to be the role of the national lead for the RCP for gastroenterology; Dr David Graham.
Nutrition ATPs would be open to national competition and will be part of existing rotations. It is anticipated that these posts will be provided by the national intestinal failure units and in addition the small bowel transplant units. This may give initially 4 posts. There are anxieties from existing providers of similar posts e.g. pay issues when changing a clinical fellow post to a training number post. These concerns will be addressed by Dr P Neild, the Training Committee chair.
Other training issues such as work placed based assessments (WPBAs) were discussed and trainee’s are advised not to leave these to the last two weeks prior to an ARCP. Prof Bill Burr is trying to make it compulsory for these to be done throughout the year. The GMC will be driving forward the revalidation process via ARCP process for trainees. The usefulness of penultimate year assessments (PYA’s) was discussed as this has been brought up by the RCP. The SAC committee felt that PYA’s were of great use and provided a final check of completion of training/safety net. It may be that in the future when trainees have all their training record on an eportfolio and the ARCP process is robust it may be that this issue could be revisited.
Recruitment in 2011 has been very successful with gastroenterology being oversubscribed (2nd most popular speciality after cardiology). The top 50% of candidates were interviewed. This meant that some trainees who were appointable did not get interviews. In addition some candidates who may have not been appointable had 1 or more interviews. In order to try and reduce this problem it was felt that giving every applicant 1 interview to be the fairest way of ensuring the best trainees were selected. This means that trainees would be interviewing for speciality rather than deanery. They may still be interviewed in their 1st choice deanery, but if all interview capacity was booked then they could be interviewed at any other centre.
Dr H Gordon presented the 6 monthly report on workforce planning. Consultant expansion has fallen from 6-7% to 2.4% in the last 6 months. Although there appears to be no unemployed gastroenterologists it is unclear what posts post CCT holders are currently doing. Dr H Gordon and Chris Romaya from the BSG intend to investigate this in further detail shortly. Gastroenterology will loose 4 training numbers over the next 4 year. This is in line with recommendations from the Centre for Workforce Intelligence who recommend the loss of 6 posts.
It is looking increasingly likely that the SCE will be taken up the European Board and Section in Gastroenterology and Hepatology (EBGH). Although still in the negotiation stages it would be seem that the plan would be to produce a Europeanised version of the SCE, with the 1st exam being planned for 2013.
Update: June 8, 2011
Alenka Brooks: SAC meeting
Alenka Brooks & Philip Smith: BSG Training Committee meeting
These notes are our own interpretation of what took place and do not reflect SAC or BSG Training Committee position or policy. As there was significant overlap between the 2 meetings the combined notes are a summary of both meetings.
The recent round of ST3 recruitment was presented by Dr B Oates. Of 441 applicants, 270 obtained 1 or more interviews. The majority of applicants (74%) had full membership at the time of application. In most regions 100% of posts were filled. In addition most regions filled LAT posts in gastroenterology. It was felt that this first round had been successful and that gastroenterology had filled more vacancies than other specialties.
Late clearing from the 1st round will occur on the 22nd of July which will depend on PACES results. As this will not leave adequate time for Trusts to fill any vacant posts that might arise as a result of this, ways in which this could be avoided next year were discussed. One way in which this might be done in the future is to ensure that PACES results are released earlier. It was noted that only a small number of appointments were made to people without membership (a proleptic offer) for later in the year once full membership obtained. It was felt by TPDs that most candidates without PACES did not apply and are waiting for the 2nd round.
Applications for round 2 will start begin on the 26th of August and run until the 12th of September, interviews will be held between the 19th of September and the 5th of October for appointments from the 1st January to the 31st of March 2012, with clearing from the 31st October. Centres can choose whether to enter the process with training numbers or LATs. However, if they do not declare any numbered posts they will be unable to change this later on in the national recruitment process. Recruitment from 2012 (May) will require applicants to have full membership to be eligible to apply.
The SAC discussed the robustness of the selection process and felt that the least discriminating station was the clinical scenario. After much discussion around how this station could be improved e.g. 2 part questions, probes, it was decided that this station should stay in its current format; 2 clinical scenarios (1luminal and 1 hepatology). It was noted that short listing contributes to 20% of the total mark.
An update on workforce planning was presented by Dr Gordon. Consultant expansion nationally has fallen to 3.5% in the last year. There is likely to be an excess of CCT holders in the forthcoming years. Further discussion about this revolved around some deaneries reducing training numbers, this is likely to occur naturally thorough deaneries making financial cuts locally. There has been a 35% increase in locum appointments and an increase in post CCT fellowships. Other specialties have significantly more difficulties than gastroenterology with the publication of a recent document detailing for the first time CCT holders in other medical specialities without jobs. The centre for workforce intelligence is keen to take geography and workforce planning into account for each speciality. It’s likely that they will recommend to the DoH that gastroenterology numbers stay stable or undergo a modest reduction (0-5%). There is an excess of trainees in the London region and this year they have had to cut 9 posts. The way in which TPDs may decide which posts to consider cutting might be aided by a post training survey. Such a survey has been led by trainees from the Severn Deanery. Trainee’s present to a quality panel and individual comments are fed back anonymously. The training committee felt that this would be a good way to examine the quality of training and should be considered in other regions.
The chair of the neurology SAC has raised concern that trainees on the academic clinical fellowships may not have sufficient time within their 4 year training programme to meet all of the clinical competencies detailed in their speciality curriculum. This was discussed in detail by the SAC and training committee. It was felt likely that trainees are likely to require extra training and that this would be planned via outcomes from the ARCP process. This could be enhanced by having joint academic and clinical ARCPs.
Advanced speciality training in hepatology was discussed in light of a recent case where a trainee wished to obtain specialist transplant experience. This has resulted in a discussion by the hepatology community as to what training is required for specialist hepatology accreditation. It is likely, but yet to be confirmed that working in a transplant centre for 6 months will not be considered essential. Much of what is learnt there can be obtained at a satellite specialist hepatology centre. Although details remain to be finalised it is likely that only 6 weeks experience at a transplant centre will be deemed essential. Further discussion followed regarding only small numbers of trainees (41 in 6 years) accrediting in hepatology, and overall only 8% of CCT holders in gastroeneterology have a CCT in hepatology. This was thought to be due to the fact that trainees have concerns about job opportunities and therefore want to remain as flexible as possible. It appears that most trainees choosing to train in hepatology are doing so via the ‘modular’ route i.e. obtaining evidence of hepatology experience documented on their CVs rather than via ‘certification’. In the future there may be a JAG type accreditation of hepatology training centres.
It is likely that 6-8 advanced nutrition modules which are part of the 2010 curriculum will be available for national competition in 2013. These posts will have >50% of their time allocated to speciality nutrition training, and may still include time of the GIM rota and will not be eligible for OOPE or post CCT.
Concerns were raised at both committees about falling number of trainees interested in ERCP. There are increasing retirements of radiologists, physicians and surgeons with ERCP skills (25 retiring in the next 5 years). In addition only 3 trainees have accredited via the JAG certification process in the last year. It is felt that between 25-30 traine’s need to train in ERCP/year in order to meet the national requirement. There are plans to have a national audit in 2012 looking at ERCP provision and training. Dr R Alcolado highlighted that there are currently no trainees in Wales training in ERCP and the radiologist who provides this service currently is due to work part time with a view to retirement.
Prof Mills is to step down after 5 years of chairing SCE committee. New members and a chair are currently being recruited. Discussions are being held with EU partners as to whether EU member states may use the SCE as their accreditation tool. Prof Mills informed the committee that overseas candidates will be able to sit the SCE without having PACES.
Trainees are advised to keep a log of clinic numbers via a spreadsheet of patient numbers (new and follow-ups) for log books. It was confirmed that trainers do not need to sign off each patient seen. Dr Ellis will consider drafting a document detailing the perceived minimum numbers of patients trainees are expected to see per year in OPD and endoscopy as concerns were raised about the quantity of experience obtained in gastroenterology due to the time trainees spend contributing to G(I)M rota. This led on to discussions about a widespread problem recently presented at the RCP ‘Why don’t I want to be a medical SpR?’ The SAC discussed this in detail and it was felt that several factors contribute to this such as a lack of feeling part of a team, and unclear career progression. In addition the advent of new initiatives such as Hospital at night increasingly blurs the boundaries of what the medical SpR does and increases workload. This may be an area in which the trainees section of the BSG can obtain valuable information via the gastroenterology trainee’s survey.
Dr M Lockett has produced detailed ARCP guide to aid TPDs with summative process at ARCP. However, it was felt that due to the detail required in these they would be best used as a guide for educational supervisors to help trainees identify any areas which require further attention before the ARCP. In the future it was felt that the ARCP guide could be uploaded by trainees onto their e-portfolio. It was noted that patient surveys have now become an essential requirement for trainees on the 2010 curriculum. Discussion also centred on a possible move for more formal CBDs being done in OPD. The practicalities of this were discussed by the committee and it was felt that this should be left to local centres to plan.
Mr J Stebbing (chairman of JAG) gave a detailed update from JAG, with reference to where it sits politically as a multiprofessional quality assurance body for GI endoscopy. Currently there is a political imperative for units in England and Wales to obtain JAG accreditation but this is not mandated. JAG is looking to be financially independent from 2013 (currently underwritten by the RCP). They have recently changed the fee structure for trusts from a 5-yearly payment to an annual one. In addition fees for individual applications have increased from £50 to £75. From 2012 the accreditation process of units will be fully in line with the GRS process and will be annual assessments of units. JAG is focusing efforts on improving the ‘back end’ of the JETS e-portfolio in order to make it more user friendly for trainees and trainers.
The next meeting will be held on the 1st of November 2011.
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