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. History of UK Vascular Training. 1960s – 1980’s - PowerPoint PPT PresentationTRANSCRIPT
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– 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
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
UK Accreditation Process
• General Medical Council Standards– Stages of training– Trainee selection– Curriculum – Requirements for training units– Trainee assessment– Quality assurance– Life long learning
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
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
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%
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
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
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
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
CurriculumGeneral Surgery
Groin / incisional hernia repair 3Emergency laparotomy 3
adhesolysissmall bowel resection
Colonic resection 3Laparotomy for bleeding 3Splenectomy 3
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
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
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
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
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)
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
Life Long Learning
• Mentoring• Team working• Continued professional development• Annual appraisal• Revalidation• Skill development– Local need– Technological advancement
Summary
• Newly developing specialty
• Well structured accreditation system
• Learning from general surgical experience
• Accreditation is a life long process