Puzzle solver

Jcie

Postgraduate medical education in general, and surgical education in particular, can be confusing. There are many different bodies and acronyms in use across the UK, which can make it difficult to understand who to speak to or who is responsible for an aspect of training.

The Joint Committee on Intercollegiate Examinations oversees the appointment of examiners and assessors, and the regulation and organisation of the FRCS exams for surgical specialties covered by the JCST.

This article outlines the role of each and explains the responsibility of each body and professional in an attempt to simplify the terminology. A useful summary of the roles of the TPD, AES, CS, other assessors and the trainee are outlined at ow.ly/v0i250MBcEL.

RoT

Recognition of Training was introduced by the General Medical Council (GMC) in August 2016. Trainers must be recognised if they are in named educational roles, such as educational and clinical supervisors. In secondary care it is the DoME that gives evidence to the GMC demonstrating that trainers meet the requirements to be recognised for training. The collection of this evidence may be carried out through the appraisal process.

The educational supervisor or assigned educational supervisor (AES) in all JCST documentation is a consultant surgeon responsible for ensuring trainees have clinical supervision, helping them with their professional development and providing induction to a new department. They also need to ensure that trainees maintain their portfolio of evidence in Intercollegiate Surgical Curriculum Programme (ISCP) and document meetings with trainees in ISCP.

The clinical supervisor (CS) will also be a consultant surgeon. They work directly with the trainee to observe clinical practice and to complete work-based assessments (WBAs).

The supervising clinician also has day-to-day contact with a trainee and observes their clinical practice. They are not required to be on the RoT list or to complete formal documents on ISCP, but they may complete WBAs and MSFs. They do not have to be a consultant.

Jcst

Stephen Jones, Consultant ENT Surgeon, Deputy DME, NHS Tayside, FST Committee

Russell

Duncan, Consultant in Emergency Medicine, NHS Tayside, Postgraduate Dean, NES

Haroon Rehman, Consultant Trauma and Orthopaedic Surgeon, Victoria Hospital, Kirkcaldy

The Joint Committee on Surgical Training is the body that makes the strategic decisions on the structure of surgical training in core surgery, general surgery, trauma and orthopaedics, vascular surgery, urology, paediatric surgery, otolaryngology, plastic surgery, neurosurgery, cardiothoracic surgery, and oral and maxillofacial surgery. The JCST is also responsible for the ISCP website and eLogbook.

TPDs

Deaneries

There is a statutory health education authority for each of the four UK countries. They are NHS Education Scotland (NES), Health Education England (HEE), Health Education and Improvement Wales and the Northern Ireland Medical & Dental Training Agency (NIMDTA). These authorities are ultimately accountable for managing the delivery of postgraduate medical training to the standards required by the regulatory body, the GMC. The structure of each differs. As HEE is so large, it is divided into seven regions. Some of them still refer to themselves as deaneries, but the term is no longer used in many. Each one will have a Lead Dean or equivalent for surgical training who is responsible for the day-to-day management of specialty training and quality management of specialty training

SACs

programmes. They are accountable to their Medical Director.

Each Dean is responsible for one or more of the specialty groupings and works with Associate Deans, GP Associate Advisors, Training and Quality Managers and their teams to ensure the delivery of postgraduate medical training.

Within NES, Associate Postgraduate Deans provide a local deputy for the Lead Dean in the relevant deanery workstreams of specialty training, quality assurance, less-than-full-time working, and trainee development, wellbeing and support. They support local training teams, TPDs and trainees. If there are concerns about the quality of training, they are responsible for visiting departments to review them and make recommendations about improvements.

There are specialty advisory committees for each of the surgical specialties covered by the JCST. One member of the SAC will be the liaison member for each region, which is not generally the region they work in, and will attend Annual Review of Competency Progression (ARCP) and Specialty Training Committee meetings in that region. The committee includes members whose responsibilities include quality, curriculum, Certificate of Eligibility for Specialist Registration (CESR) and simulation for the relevant specialty. It will also include representatives from trainees, the intercollegiate exam board for that specialty and national specialty committees.

The principal roles of the SACs include advising trainees and trainers, Surgical Royal Colleges and the JCST, and national selection and assessment of applications for the Certificate of Completion of Training (CCT). Visit www.jcst.org for a more complete summary.

Lep

You may come across this acronym, which means local education provider and refers to organisations offering training. In general it refers to Trusts and Health Boards, depending on the area of the country it is located.

Training Programme Directors are responsible for overseeing the trainees and their progression in a given specialty and region. They are appointed by Deaneries and are usually consultants in that specialty. They may be responsible for trainees in a single LEP or across multiple sites, where trainees rotate within a region. They will chair ARCP and Specialty Training Committee meetings, and are responsible for the outcomes of ARCP, including recommendation for CCT.

DoME

Otherwise known as the Directorate of Medical Education. Every Health Board or Trust is required to have a Director of Medical Education (DME). They will have a team of deputies, associates and administration staff, but the exact structure of the DME varies from one LEP to another. The DME’s role is to oversee the undergraduate and postgraduate learning environment in their LEP. This involves liaison with the deanery and any universities with medical students on placement in the LEP. The DoME is also responsible for the assessment of consultants and SAS doctors’ trainer status and recommendation for recognition of trainer status. The DoME will usually organise induction to the LEP for new members of medical staff. A member of the DoME team will help clinical departments with preparation for scheduled or triggered quality assurance visits to a department from deaneries. The department is also responsible for responses to training surveys on behalf of the LEP. They will investigate and report to the local deanery if any concerns are raised.

In this brief article we have tried to explain the role of the various bodies and people involved in surgical training and some of the confusing terms you may come across. You will find a host of useful information on the following websites:

• www.jcst.org

• www.iscp.ac.uk

• www.hee.nhs.uk

• www.nes.scot.nhs.uk

• www.heiw.nhs.wales

• www.nimdta.gov.uk