Features
The new T&O curriculum Rob Gregory, Lisa Hadfield-Law and Deepa Bose The implementation of any new curriculum is naturally greeted by its users with anxiety and frustration, enthusiasm being a rare initial response. As we recover from the impact of COVID-19, the prospect of having to adapt to the first major curriculum change for seven years may seem daunting, but the changes reflect a desire to improve training advocated by most of us for many years.
O
ur curriculum is a living entity that must evolve in response both to the way in which healthcare delivery changes and to advances in knowledge about how we learn, but must also evolve in a way that raises the standards of the care we deliver.
Rob Gregory is a Consultant T&O surgeon who works in Durham. He has a longstanding interest in surgical training and is currently Chair of the SAC for T&O. He is also a Trustee of the BOA.
So, what can we expect? The principal change relates to the way in which trainees are assessed through the Multiple Consultant Report (MCR). This more holistic approach to assessment is based on the new Generic Professional Capabilities (GPCs), with assessment of these Capabilities in Practice (CiPs) being fundamental. What hasn’t changed is the vast majority of the syllabus – which is why the exam remains unaltered.
“The recent shift towards an outcome based, rather than time based, curriculum continues, but it is envisaged that most trainees will still require six years from ST3 to progress to CCT.”
The recent shift towards an outcome based, rather than time based, curriculum continues, but it is envisaged that most trainees will still require six years from ST3 to progress to CCT. Whilst the outcomes are well defined, the means of achieving those outcomes are less clear and this perhaps represents the major challenge for us. If we take the example of research, the current requirements are easy to list, and everyone knows for example the importance of completing a Research Methodologies Course. Whilst the new requirements are no less difficult to list, the authors of the new curriculum were constrained by the GMC, in
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their ability to influence the means by which evidence of compliance can be demonstrated. The arguments in favour of the continued inclusion of mandatory courses were pressed strongly, but ultimately with little success, and as a result we have been left with ATLS (or the ETC) as the sole mandatory course. This may well be a cause of confusion amongst trainees, trainees and TPDs alike, and may prove to be a source of friction if funding bodies refuse to accept that courses previously held in high esteem and often delivered nationally, fail to deliver ‘value for money’ and their goals must be achieved by other, more nebulous means. We must hope that pragmatism prevails, and that the quality of training is maintained in these areas.
Implementation
Increasing numbers of programmes have started to use the MCR format in shadow form to assess their trainees, and the response appears to be almost universally favourable. The value of the process lies in the constructive nature of the conversations that can potentially involve large numbers of colleagues, not necessarily all doctors, who have contact with the trainee in a wide range of clinical environments. Although the MCR is restricted in terms of who can make entries, contributions from all established clinical team members can help the trainee identify areas of strength and weakness. No longer are we assessing isolated
