accredited training in vascular surgery: the uk perspective

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Accredited Training in Vascular Surgery: the UK Perspective Gareth Griffiths Department of Vascular Surgery, Ninewells Hospital, Dundee, UK Chairman of the Specialty Advisory Committee in General Surgery

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Accredited Training in Vascular Surgery: the UK Perspective. Gareth Griffiths Department of Vascular Surgery, Ninewells Hospital, Dundee, UK Chairman of the Specialty Advisory Committee in General Surgery. History of UK Vascular Training. 1960s – 1980’s - PowerPoint PPT Presentation

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Page 1: Accredited Training  in Vascular Surgery:  the UK Perspective

Accredited Training in Vascular Surgery: the UK Perspective

Gareth Griffiths

Department of Vascular Surgery, Ninewells Hospital, Dundee, UK

Chairman of the Specialty Advisory Committee in General Surgery

Page 2: Accredited Training  in Vascular Surgery:  the UK Perspective

History of UK Vascular Training• 1960s – 1980’s– Small numbers of general surgeons doing

occasional cases– Some vascular surgery in most hospitals – Special interest development within general surgery

• 1990s – 2000’s– Increasingly a functional monospecialty– Officially still an interest within general surgery– Issues

• Improved specialist outcomes• Increasing difficulty of training in general and vascular

Page 3: Accredited Training  in Vascular Surgery:  the UK Perspective

Vascular Surgery – A New UK Specialty

• 2012– Officially recognised as a monospecialty

– End result of much work by many within the Vascular Society

– Training structures established • Within UK specialty training system• Meeting regulator’s requirements• Newly designed within these limits

– First UK vascular training programmes start in August 2013

Page 4: Accredited Training  in Vascular Surgery:  the UK Perspective

UK Accreditation Process

• General Medical Council Standards– Stages of training– Trainee selection– Curriculum – Requirements for training units– Trainee assessment– Quality assurance– Life long learning

Page 5: Accredited Training  in Vascular Surgery:  the UK Perspective

Stages of Training

• Foundation Years 1 and 2• Core Surgical Training– 2 years, 4 specialties (vascular surgery desirable)

• Specialty Training– 2 years Intermediate

• Breadth of elective and emergency vascular surgery• 1 year general surgery - open abdominal

– 4 years Final• Open and endovascular• Generic Professional Behaviour and Leadership Skills

Page 6: Accredited Training  in Vascular Surgery:  the UK Perspective

Trainee Selection

• National, annual, single centre model• 8 component, 2 hour interview – tests all aspects of the person specifications

• 11 assessors• Single national ranking• Ranking and applicant preference determine

placement• Quality assured by professional and lay

assessors

Page 7: Accredited Training  in Vascular Surgery:  the UK Perspective

National Selection ResultsGeneral Surgery

2011 2012

Internal Consistency(Cronbach’s ) 0.79 0.77

Inter-rater reliability(Intra-class correlation) >/= 0.8 >/= 0.85

Agreement over awarded scores 96% 97%

Page 8: Accredited Training  in Vascular Surgery:  the UK Perspective

Curriculum

• Aim– Independent practice in “everyday”

vascular surgery

– Manage unselected vascular emergencies

– Opportunity to develop a special interest

– Referral to colleagues when appropriate

– Excludes uncommon complex procedures

Page 9: Accredited Training  in Vascular Surgery:  the UK Perspective

CurriculumKey Topics

Limb ischaemia – acute and chronic, upper and lower limb Renovascular disease

Aneurysm disease – aortic and peripheral Mesenteric artery disease

Carotid artery disease Thoracic outlet syndrome

Endovascular surgery Vascular anomalies

Vascular trauma Vasospastic disorders and vasculitis

Diabetic foot Venous disease – superficial and deep

Vascular access Hyperhidrosis

Vascular infections – native and prosthetic Lymphoedema

Page 10: Accredited Training  in Vascular Surgery:  the UK Perspective

Curriculum

Index ProceduresAAA repair – elective open: tube and bifurcated (infrarenal) EVAR

ruptured

False aneurysm repair / exclusion

Carotid Endarterectomy Redo surgery – removal of infected graft

Infra-inguinal bypass – AK, BK, crural Vascular Access

Popliteal aneurysm exclusion and bypass SFJ and SPJ ligation

Embolectomy - femoral and brachial Endovenous LSV and SSV ablation

Four compartment fasciotomy Foam sclerotherapy

Page 11: Accredited Training  in Vascular Surgery:  the UK Perspective

CurriculumSelected Clinical and Technical Skills

Most index procedures 4 Thoracic outlet / cervical rib 3

Non standard open AAA repair 3 Diagnostic angiogram 3

Infrarenal EVAR 3 Angioplasty / stenting 2

TAAA open / endovascular 2 CTA and MRA assessment 3

Renal artery bypassnephrectomy / renal transplant 3

Pre-op cardio-respiratory assessment 4

Mesenteric embolectomy / bypass 3

Risk factor modification 3

Vascular access – primary 4 secondary 3

Ultrasound - superficial venous, intraoperativeAAA size, guided cannulation 4

Axillary botox treatment andthoracoscopic sympathectomy 3

Page 12: Accredited Training  in Vascular Surgery:  the UK Perspective

CurriculumGeneral Surgery

Groin / incisional hernia repair 3Emergency laparotomy 3

adhesolysissmall bowel resection

Colonic resection 3Laparotomy for bleeding 3Splenectomy 3

Page 13: Accredited Training  in Vascular Surgery:  the UK Perspective

Requirements for Training Units• Supervised operating lists – 4 half days per week• Supervised out patient clinic – 1 per per week• Supervised ward round – 1 per week• Supervised angiography meeting – 1 per week • Formal teaching – 2 hours per week• Morbidity and Mortality meetings• Regular simulation practice • Time for study and Workplace Based Assessment• Educational facilities, study leave and expenses• Assigned Educational Supervisor (AES)• Initial, interim and final review for each placement

Page 14: Accredited Training  in Vascular Surgery:  the UK Perspective

Training Programme Approval

• Programme applications assessed against:– Requirements for training units– Operative numbers– Case mix– Population covered

• Most approved, some required to merge

• Rolling assessment and approval of Training Programmes

Page 15: Accredited Training  in Vascular Surgery:  the UK Perspective

Trainee Assessments

• Workplace Based Assessments (WBA – 40 per year)– Clinical Evaluation Exercise

• Originally designed by American Board of Internal Medicine• Assessor observation of trainee:patient interaction

– Case Based Discussion• Detailed discussion of trainee’s management of a case

– Procedure Based Assessment• Derived from OSATS - University of Toronto• Assesses all aspects of an operative procedure

– Multi-source feedback• 360o assessment of performance in the work place• 8-12 assessors - different grades and professions• Includes self assessment

Formative

Page 16: Accredited Training  in Vascular Surgery:  the UK Perspective

Trainee Assessments

• Assigned Educational Supervisor (AES) report– Achievement of objectives – Knowledge, clinical and technical skills

• Annual Review of Competence Progression– Deanery and Specialty Advisory Committee input– Informed by WBA’s and AES report

• FRCS (Vascular) Examination– Section one: written – Section two: clinical and oral

• Programme Director and Deanery support• Specialty Advisory Committee (SAC) support

Summative

Page 17: Accredited Training  in Vascular Surgery:  the UK Perspective

Quality Assurance• Trainee surveys

– General Medical Council (GMC) - generic, high level– Joint Committee for Surgical Training – surgically relevant

• Annual reports– Programme Director – Deanery– Specialty Advisory Committee (SAC) – Joint Committee for Surgical Training

• Visits– Deanery visits to programmes– GMC visits to Deaneries– Triggered visits– Externality provided by Specialty Advisory Committee (SAC)

Page 18: Accredited Training  in Vascular Surgery:  the UK Perspective

Quality AssuranceGeneral Surgery 2012

• Very good:– Achievement of 40 WBAs per year– Clinical experience and exposure– Clinical and operative teaching– Feedback

• Good:– Number of operating sessions per week– Number of out patient clinics per week

• Poor:– Formal teaching

• Vascular training can improve on these figures

Page 19: Accredited Training  in Vascular Surgery:  the UK Perspective

Life Long Learning

• Mentoring• Team working• Continued professional development• Annual appraisal• Revalidation• Skill development– Local need– Technological advancement

Page 20: Accredited Training  in Vascular Surgery:  the UK Perspective

Summary

• Newly developing specialty

• Well structured accreditation system

• Learning from general surgical experience

• Accreditation is a life long process