ISCPAims, principles and benefits

Overview

• Background, Aims, Key principles• Curriculum components• Benefits for patients, training, trainees• The syllabus• Skill levels• Stages of training, stages diagram• Curriculum standards• Assessment system• Learning opportunities• Summary of curriculum competences

Background

Project 2003-2007• Impetus for change created by the realisation that major changes

were needed in surgical training• Project funded by the UK and Irish Departments of Health and Royal

Surgical Colleges• The JCST and SACs led the process for curriculum development• Produced on an intercollegiate basis• In partnership with OCAP• In collaboration with those charged with delivering health services• Launched in 2007• Under the umbrella of the JCST

Aims

• Provision of excellent care for the surgical patient, delivered safely

• Highest standards of UK surgical practice through high quality surgical training

• Programme of surgical training from core to certification

• At completion of training, able to provide common, elective and emergency service and defined level of specialised service

Key principles

• Common format across all surgical specialties • Systematic progression through stages of training • Curriculum and assessment system that meet GMC standards • Competence-based (time points are indicative)• Professional and leadership skills • Delivery by skilled clinicians, appropriately trained • Learning partnership between trainee and trainer • Involvement of qualified members of the multidisciplinary team • Promotion of equal opportunities and diversity in training• Collects data to evaluate and enhance training & assessment

Curriculum

Standards

AssessmentSystem & methods

Learning portfolio

Training structure

Syllabus

SAC development

& review

Stages oftraining

Educational programmeAppraisal &

Learning Agreement

Training roles for supervision

Reflectivepractice

QA

Regulatorapproval

Curriculum components

Benefits for patients

• Designed to produce surgeons who are able to provide excellent care for the surgical patient, safely

• Promotes effective working practices and service delivery• Provides supervision and accountability through key roles• Provides transparency through an explicit assessment

system and portfolio• Ensures lay and patient involvement in curriculum

development and review

Benefits for training

• Provides a structured and supervised framework with a definable endpoint

• Promotes high-quality teaching and learning• Based on clear standards covering all surgical specialties• Reviewed and maintained by surgical SACs• Promotes patient safety• Affirms professional and educational values• Rigorous and fully integrated assessment • Meets GMC standards

Benefits for trainees

• Promotes consistent training experience in the UK• Mandates the interaction between trainer and trainee• Mandates the training of trainers• Provides a clearly defined syllabus• Provides explicit feedback on practice• Provides a portable portfolio of conduct and practice• Provides guidance for professional development• Provides web-based access including Apps

Benefits for trainers

• Maps to standards for trainers• Provides recognisable educational roles and training

structure • Provides guidance for trainers, assessors & supervisors• Provides tools for recording discussions with trainees • Helps to provide evidence of trainer engagement for

appraisal and revalidation

Training Structure

School of Surgery

Postgraduate Dean

Programme Director

Assigned Educational Supervisor

Trainee

Clinical Supervisor

The PD role

• Organise, manage and direct the training programme• Appoint local faculty as AESs and CSs• Organise faculty development, trainee induction and training for MPT• Oversee progress of individual trainees• Ensure appropriate levels of supervision, training and support• Identify remedial training and resources where required• Work closely with Colleges SACs on curriculum delivery• Administer and chair the ARCP

The AES role

• Overall educational and supervisory responsibility for the trainee • Ensures induction of the trainee to the unit• Ensures trainee works to the curriculum and assessment system• Ensures patient safety in relation to trainee performance • Acts as a mentor to the trainee • Provides appraisal and a placement learning agreement• Monitors the trainee’s portfolio to ensure educational progress• Presents formative feedback to the trainee• Keeps the PD informed of any issues that may affect training• Involves senior faculty in the formal report to the annual review• Provides an AES report for the ARCP

The CS role

• Under the delegated authority of the AES• Ensure appropriate day-to-day supervision of the trainee• Carries out WBA and delivers feedback• Ensures patient safety in relation to trainee performance• Liaises with the AES and faculty about trainee progress • Keeps the AES informed of any issues about training• Contributes to the AES report for the ARCP

The trainee role

• Takes responsibility for own learning• Triggers WBA frequently• Exploits learning opportunities• Attends educational programme• Agrees the learning agreement with the AES• Raises issues and difficulties promptly• Conducts self-directed learning

e.g. peer and self-assessment and reflective practice• Keeps an accurate and up to date portfolio

The syllabus

4 Domains:

• Specialty-based knowledge • Clinical skills and judgement • Technical and operative skills • Professional and leadership skills

The syllabus

• Defines what trainees should know and be able to do• Informs assessment • Specialty overview of the scope of practice• Key topics that all trainees must be able to manage• Index procedures, indicative of all specialty procedures • Topics can be used as learning objectives • Skill levels indicate the required level of performance

Skill levels

• Indicate the level of competence to be achieved • Ensure learning is based on progression• Increase with depth and complexity of practice• Increase as the need for supervision decreases and

trainees become more proficient• Correspond with logbook supervision levels

Knowledge skill levels

1. Knows of

2. Knows basicconcepts

3. Knows generally

4. Knows specifically & broadly

e.g. Can:• Define• Discuss• Describe

e.g. Can:• List• Name

e.g. Can:• Explain• Identify• Locate

e.g. Can:• Interpret• Distinguish• Compare/contrast

CORE

Knowledge skill levels

Intermediate/Final

1. Knows of

2. Knows basicconcepts

3. Knows generally

4. Knows specifically& broadly

e.g. Can:• Explain• Identify• Locate

e.g. Can:• Recall• Discuss• Describe

e.g. Can:• Interpret• Distinguish• Compare/contrast

e.g. Can:• Manage• Judge• Rate / Estimate

Clinical / Technical skill levels

Knows of

3. Can do wholebut may needassistance

2. Can do with assistance

1.Has observed

Knows steps;Handles instruments;Performs some parts.

Knows rationale;Straightforward procedures; Knows when to ask for assistance.

Deals with common problems, variations;Requires advice rather than help.

Manages common and difficult cases;UK consultant level;Can supervise.

4. Competent to do without assistance, including complications

Stages of training

• Defined to reflect the training pathway of the specialty• Provides a means of charting progress against domains

of knowledge, skills and behaviours• Allows benchmarking of progress• Core component is common to all specialties

supplemented by a small specialty-specific component • Intermediate and final stages reflects the increasing

scope of specialty practice

Stages diagram

Curriculum standards

• Each training stage is underpinned by explicit outcome standards in 4 domains

• Standards form the basis for specifying syllabus content• Organise workplace training in terms of case mix and

case load• Basis for identifying relevant teaching and learning

opportunities

Assessment system

Learning Agreement

Assigned Educational Supervisor (AES) Report

Workplace-Based Assessment + LogbookAoA CEX / CBD / DOPS / MSF / OoT / PBA

Courses: ATLS / APLS

Annual Review of Competence Progression (ARCP)

MRCS Examination FRCS Examination

Determines whether trainees are meeting the standards of competence

WBA methods

WBA• Clinical Evaluation Exercise - CEX• Case Based Discussion – CBD• Direct Observation of Procedural Skills – DOPS• Multisource Feedback - MSF• Procedure Based Assessment – PBA• Observation of Teaching – OoT• Assessment of Audit – AoA

Learning Agreement

Comprises• PD Global Objective• Syllabus topics for the stage of training• Agreed learning opportunities and resources• Agreed evidence required - WBA, Exams, Audit etc.• AES Comments• Trainee Comments• Link to portfolio of progress• CS Report• AES Report

Learning opportunities

3 broad areas:

1. Learning from practice

2. Learning from formal situations

3. Self-directed learning

Learning opportunities

Learning from practice

• Any workplace interaction has the potential to become a learning episode

• Workplace assessment• Shadow peers and consultants• On-going systematic feedback, both formal and informal• Reflection on practice

Learning opportunities

Learning from practice - settings

• Theatre• Operative units• Clinic• Ward • Multi-disciplinary meetings• Community

Learning opportunities

Learning from formal situations

• Educational programme arranged locally • Local, national and international level

e.g. courses, seminars, meetings, simulation (technical and human factors)

Learning opportunities

Self-directed learning

• Trainee-led• Vital component of continuing professional development• Study groups, journal clubs and peer review• Learning with peers at teaching sessions• Personal study• Written reflections on practice• Research, projects and audits

Learning portfolio

• Repository of evidence of the trainee’s practice• Audit trail of training• Web-based and password protected• Fitness to practise• Planning personal development• Appraisal and the learning agreement• Workplace-based assessment (WBA) and reflective

practice• Record of educational achievement• Annual review• Foundation for continuing professional development

Reflective practice

Purposeful use of experience/feedback to improve practice

• Requirement of the curriculum and part of CPD• Appended to WBA• MSF Self-assessment• Linked to Case-Based Discussion (CBD)• Personal Development Plan• Journal• Entries must respect confidentiality of colleagues and

patients

Summary of curriculum competences

Clinical Care• History taking, examination skills• Taking consent• Relevant knowledge and diagnostic skills• Ability to formulate appropriate

management plans• Procedural (technical) skills• Record keeping

Maintaining good medical practice• Ability to manage time and work under

pressure• Decision making and implementation

skills• Reflective practice and awareness of own

limitations• Initiative and leadership skills• Focus on patient safety

Learning and teaching• Willingness to ask for feedback and to

learn from it• Teaching

Relationships with patients & colleagues• Communication with patients and their

relatives• Communication with colleagues• Active involvement with your team• Accessibility and reliability