Transcript Tristram Lesser Brian Bingham - UEMS

Tristram Lesser
Brian Bingham
ENT.UK
British Association of Otorhinolarymgology Head and Neck Surgery
And
British Academic Conferences in Otolaryngology
SAC in ORL
JCST
ISCP
Presentation to UEMS-ORL Section
•
•
•
•
Numbers of ENT doctors
Career of ENT doctors
Selection of ENT doctors
Training of ENT doctors
SAC/ENT.UK
Training
Workforce
Numbers for training are national
Numbers for workforce are local
ENT Workforce in England 2014
Robert Hone & Jeremy Davis
With thanks to Lyndy Pullan and the ENT UK Office
Previous Surveys / Other Sources of
Information
• The results of this survey have been compared to
the 2010 workforce survey undertaken by Tristram
Lesser and Jeremy Davis which just looked at
Consultant and SpR numbers.
• The results have been ‘sense checked’ against the
Workforce Plan for England (2014/15) published
by HEE which is based on employment records
– HEE underestimates Locum Consultants as it does not
always pick up agency employees
– HEE more accurately reflects StR’s as it includes many of
those on OOP
ENT services in England
• 153 Trusts surveyed
• 34 do not employ
ENT surgeons
• 119 trusts provide
ENT services
• 703 consultant posts
including 6 Vacant
Posts and 59 Locums
700
600
500
400
300
200
100
0
Number of Consultants 2010
= 569
Number of Consultants 2014
= 703
Total Number of Clinicians – Q1 & Q2
Permanent
Posts
Locums
Consultants
Male
537 (84.2%)
Female
101 (15.8%)
FT
537 (84.2%)
PT
101 (15.8%)
Male
56 (95%)
Female
3 (5%)
FT
45 (76.3%)
PT
14 (23.7%)
638
(91.5%)
697
59
(8.5%)
Junior Clinicians – Q4
Middle Grades & Juniors
FT
Vacant
Total
Fellows & HST’s
263
3
266
Staff Grades
189
15
204
Core Trainees
GPVTS
F2
Other SHO's
F1
Clinical Assistants
60
82
116
143
42
3
2
0
4
6
0
0
62
82
120
149
42
3
• Total of 892 of which 470 are “middle grade”
Number of Higher Surgical Trainees
2010 vs 2014 vs HEE data
300
250
200
150
100
50
0
Number of ST3+
Trainees (2010) =
264
Number of ST3+
Trainees (2014) =
223
HEE Trainee
Numbers = 295
LETB’s
Ratio of HSTs to Consultants per LETB
0.60
0.50
0.40
0.30
Ratio Trainees
to consultants
(2010)
0.20
0.10
0.00
• Averages: 0.46 in 2010 to 0.31 in 2014
Ratio of
Trainees to
Consultants
(2014)
Previously Underestimated Projections
• Higher population growth
Current England Population 54 million
Projected England Population 2030 61 million
Previous Underestimated Projections
• Underestimated Emigration
– Anecdotal reports of between 57 CCT holders in ENT emigrating
per year
– Is this set to increase?
Doctors working in NHS
PMQ country
United Kingdom
India
Pakistan
South Africa
Nigeria
Ireland
Greece
Italy
Egypt
Germany
Romania
Sri Lanka
Iraq
Poland
Australia
Sudan
Spain
Hungary
Czech Republic
Bulgaria
Total
No. of doctors
179,527
25,503
10,503
5,127
4,513
4,227
3,757
3,740
3,587
3,166
2,504
2,479
2,408
2,206
1,985
1,792
1,724
1,521
1,308
1,006
262,583
%
63.9%
8.9%
3.7%
1.8%
1.6%
1.5%
1.3%
1.3%
1.3%
1.1%
0.9%
0.9%
0.9%
0.8%
0.7%
0.6%
0.6%
0.5%
0.5%
0.4%
93.2%
Doctors added to the LRMP by World Region of
PMQ for 2006 - 2015
Doctors by gender
from 2006 - 2015
Future Projections for ENT training
numbers
• Increase in workforce
– HEE forecast a 20% increase in ENT consultants by 2020
– Between 2000 and 2012 all staff groups in the NHS grew
• over 50% more consultants
• 13% more nurses (32,000)
– ~140 new posts - ~28 per year to meet increased
demands
• Workforce requirements equate to approximately
60 posts per annum
– (28 replacement, 10 associate specialist replacements plus 28 new (growth) posts = 66)
Future Projections
National Selection for Higher Surgical
Training
• Once a year
• 1 venue
• Fixed number of places
for England Scotland
and Wales
• Northern Ireland
separate.
• 6 stations
•
•
•
•
•
•
Portfolio Assessment
Clinical Scenario
Communication Skills
Managerial Scenario
Skills Assessment
Structured Interview
The Training in ENT
•
•
•
•
Governed by the General Medical Council (GMC)
Paid for by the Medical Programs Board (MPB)
Commissioned by Local Education Training Boards (LETB)
Delivered by Hospital Departments and Deans (including
courses)
• Over seen and recorded by ISCP
• Syllabus, Competencies, Assessments and Recording
training (log book etc) requirements (Intercollegiate
Surgical Curriculum Programme. (ISCP) Part of JCST/SAC
• Exams
– iMRCS-ENT (European Board equivalent)
– iFRCS ORL-HNS (HST completed)
1-2 years post CCT
Fellowship
SAC CCT check
list
Specialist Register
GMC
6 years of Higher
Specialist
Training
Can include some Pre CCT Specialist
Fellowships in UK or Abroad
Apply for HST
at National Selection
2 years Core Surgical Training
Take MRCS(ENT)
year
8
7
6
5
4
3
Sub- specialist
ENT consultant
ENT Consultant in
Independent Practice
FRCS(ENT)
Part 1 and Part 2
MRCS-ENT
12 months of ENT
2 12 months of related
1 Specialities.
2 years foundation in
medicine and surgery
Take MRCS part A
Undergraduate Medical School MBBS 5-6 years.
EU-Diploma
EU-Board
Speciality ENT
Doctor in
supervised
practice
Undergraduate
Medical School
5-6 years MBBS
Foundation 2
years medicine
and surgery Part
A MRCS
Core Surgical
Training 2 years Part
B MRCS
(MRCS(ENT))
DOHNS Part 1 and 2
or EU Diploma
General Practice
Medicine With a
Specialist interest
Post CCT
Fellowships 12 years
Higher Surgical
Training 6 years Part I
and Part 2 FRCS ENT
May include some
fellowships
Working as Specialty
Doctor in ENT (not
independent practice)
C
C
T
CESR
After
FRCS
and
Article
14
applicat
ion
General
ENT
Consultant
Or Super
Specialist
ENT
Consultant
CT1
CT2
Run through to ST3 in
future
Early Years
12 months ENT early in CT (6 months minimum 18 months maximum)
Additionally 2 or 3 placements over 12 months in a range of related
specialties:
Plastic Surgery
Oral and Maxillofacial Surgery
General Upper GI Surgery
Neurosurgery
Paediatric Surgery
Paediatrics
Cardiothoracic Surgery
Ophthalmology need to check this one
Accident and Emergency Medicine
ITU
General Practice
The common surgical components are covered in Otolaryngology
placements and complementary placements. The ENT components are
covered in ENT.
A CT2 extension in ENT may be available for trainees who have chosen to
change to ENT from generic CST. CT2 extension in generic surgery may
also be available for themed ENT trainees who chose to change to another
surgical speciality or for trainees who require additional time to pass
exams or need a second attempt applying through National Selection.
The minimum ENT experience for ST3 application is 6 months and the
maximum is 18 months.
MRCS(ENT) required for National Selection
Training to Consultant/CCT
National Selection
Uncoupled/Themed Programmes
Final Stage
(Special Interest)
(Fellowships/Interface)
ST3
ST4
ST5
ST6
ST7
The trainee will undergo a period of specialty training of 6
indicative years in the broad specialty as defined by the final stage
(including special interest) syllabus
General ENT and Emergency Safe Training with or without
subspecilaist training/fellowships. iFRCS
ORL-HNS
Working as Speciality Doctor and possible
CESR
Undertake LATs and Trust Grades or straight into Speciality
Otolaryngologist grade
Trust
grade
ST8
LAT
Fellowshi
p
SD
SD
SD
The decision to become a Speciality doctor; DO-HNS exam required
Working in General ENT and some sub specialisation as required by the
service needs. FRCS
or other qualifications will only be
required if applying for CESR.
MRCS(ENT)or Equivalent
e.g. European Board Exams
Part A MRCS is normally taken in Foundation Year 2.
Otolaryngology trainees will be required to complete
the MRCS(ENT) examination or the MRCS and the DOHNS examinations and should do so as early as
possible in the initial stage.
Those not progressing through national selection at
the first attempt should either decide to become SDs
and can then move into the LAT/Trust Fellowship
grades. Or re-submit the next year for national
selection but do non-ENT jobs in the meantime. This
will enhance the chances of a career change to another
specialty if unsuccessful again.
Trainee
ISCP Step by Step Guide
List of contents
• Introduction
• Add a workplace assessment
• General navigation
• Add other evidence
• Key terms
• View portfolio areas
• System steps diagram
• Multisource Feedback MSF
• Assessment diagram
• Send message
• Dashboard
• Rate others
• Add a placement
• Add a journal entry
• Training History
• Add to eLogbook
• Learning Agreement
• Other menu items
DASHBOARD
Logging in will take you to your personalised Dashboard showing information you
need to act on, including links to interactive areas.
The first time you login you’ll be asked to agree a new set of terms and conditions
of the v10 website.
Clicking on Dashboard in the main menu also shows you the numbers of items
against each dashboard area.
Alerts under the pink band indicate important tasks that require an action. They do
not disappear until you have taken the action.
Notices under the blue band, are for information and may also require an action.
Warnings under a yellow band, indicate actions reaching their due time.
Work in Progress - colour codes items that are currently incomplete either in grey
(saved by you in draft form) or green (submitted by you to another user who has not
yet completed).
Progress in my current placement – allows you to filter your placements and see
the status of your Learning Agreements.
WORK IN PROGRESS
From your Dashboard / Work in Progress, you can click on each row to see
further information.
The resulting page will list all your work in progress. Click on a row to open
the item and complete from there.
ADD A PLACEMENT
Click Add in the main menu, then Placement.
Fill in one form for each placement.
The first set of information general.
• Use the drop down boxes to make your selections and complete all the
fields.
• The fields are filtered according to your choices as you go e.g. choosing
Core StR as an appointment type will only display Core Surgical Training
as a Parent Specialty.
• Select the TPD. If you are not in a training post, choose TPD, Demo.
• Click Confirm to move to the next stage of adding placement details and
supervisors.
ADD A PLACEMENT
• Supervisors: Type a name or choose from recently selected users (1).
• You can choose multiple people as AES or CS. If a single person fulfils
both roles you will need to choose another person for one of the roles in
order to satisfy the conditions of the Learning Agreement for the
placement.
• Tick to agree the Statements of Health & Probity and Educational
Contract.
• To amend a placement go to Dashboard / Training History from the main
menu. Be careful if deleting a placement as this will also delete that
placement’s Learning Agreement.
• Your TPD will be able to validate your placement.
1
TRAINING HISTORY
Click Dashboard in the main menu, then Training History.
• All your placements will appear here in chronological order, with the latest
at the top.
• You can add placements from here too (1).
• You will see a button to complete the JCST survey (2). We value your
views so please complete this at the end of each placement. An alert
about this will also appear on your dashboard at the end of the placement.
1
• Click in the placement area to open it.
2
TRAINING HISTORY
• If your TPD has not yet validated the placement you can delete it or
amend the details then save as draft or re-submit.
• If your TPD has validated the placement you will need to click to Retract
at the bottom of the page then Press to Confirm Retraction (otherwise
click the down arrow and cancel). The fields can then be amended or the
placement can be deleted.
• Be careful if deleting a placement as this will also delete that placement’s
Learning Agreement.
• To delete the placement, take the step above then scroll to the bottom of
the retracted placement and click Delete and Press to Confirm Deletion
(otherwise click the down arrow and cancel).
WORKPLACE ASSESSMENT (WBA) 1/4
1
2
4
3
From the main menu, click Add then, under Evidence, select the WBA from
the list. Although each WBA is designed for a different training situation the
forms all work similarly (MSF is covered elsewhere):
(1)
• Click in the date field to add the assessment date from the date picker.
• Type your rater’s name and click on the name when it appears.
• Your most recent hospital may automatically appear, otherwise type and
click as above.
(2) Rater feedback – your rater’s written comments are the most important
component and are, therefore, mandatory in at least one text box.
(3) Trainee feedback - add your own comments.
(4) Trainee reflections – are optional. Choose to make this public (viewable
by those who can see your portfolio) or private*.
* Ensure reflections are fully anonymised e.g. say ‘patient x’ instead of names or numbers.
Like all training records, reflections may be subject to scrutiny by other parties for legal
reasons. Formal guidance on this area will be forthcoming from the Academy of Medical
Royal Colleges.
WORKPLACE ASSESSMENT (WBA) 2/4
(1) Ratings are normally assessed against the stage of training and
comprise:
N = Not assessed/observed
D = Development required
S = Satisfactory
O = Outstanding
1
2
(2) Details of the event.
(3) Global summary– is an overall rating from four levels that map to the
stage of training.
3
VIEWING TOPICS AND PROGRESS IN THE PORTFOLIO 3/4
• Only the syllabuses within which there are topics which you have linked
with evidence during the time period selected will be displayed.
2
• Each syllabus will be displayed with topics and evidence underneath (1).
3
1
• Click on the number to see a list of the evidence in a new window. Click
again on the down arrow to open up each piece of evidence.
• For each syllabus the default view is the topics against which there is
evidence.
• Alternatively, tick the checkbox to see all topics in that syllabus whether
with or without evidence against them (2).
• Note that only your AES for the evidence completed in that placement can
award outcomes in the left hand box (3). Grey – not started; Yellow – in
progress; Green – Satisfactory and Red - Unsatisfactory.
VIEWING THE LOGBOOK IN THE PORTFOLIO 4/4
From the main menu click Portfolio, then Other forms, eLogbook.
• For the period selected you will be able to see the procedures logged in
each surgical specialty with numbers at different supervision levels.
Those under E for emergency are coloured red.
• Use the scroll button at the side to move up and down the page.
MULTISOURCE FEEDBACK (MSF) ASSESSMENT 1/4
Click Add from the main menu then under Evidence, select the MSF.
As the trainee, you will be responsible for initiating the MSF.
1
•
Enter the date – click in the field for the date picker.
•
Enter your training level (year).
•
Click the green Create MSF button.
•
Click on the red Start button on the next page to begin your selfassessment. The competencies are mapped to the GMC’s Good Medical
Practice framework. The form and ratings are the same as the versions
your raters will receive.
•
Rate yourself as N = Not assessed/observed (i.e. no experience of an
area) / D = Development required / S = Satisfactory / O = Outstanding.
•
Providing examples of your D and O ratings in Other Information (1) is a
good opportunity to demonstrate reflective insight, self-awareness and
empathy and ability to make some suggestions for future improvement.
•
You will be able to save your assessment as draft or submit.
MULTISOURCE FEEDBACK (MSF) ASSESSMENT 2/4
1
• Once submitted you will be able to view it or retract and amend until the
MSF is submitted to your AES.
2
• Once your self-assessment is done, click Save.
• Use the back arrow to return to the Raters page.
• Nominate your raters by clicking and type in the Choose field (1) or using
the user picker tool (2). You must click Save MSF at the bottom of the
form.
• Rater names will appear in the right-hand space and indicate whether an
evaluation is awaited (3) or received (4).
3
• You can remove a rater by clicking on the red
and nominating another
person providing the original rater’s evaluation has not been received.
Remember to click to Save your changes.
• Only when you have enough evaluations will you see a button to submit
your MSF to your AES (5). Unlike v9, your AES will not be able to see
evaluations until you submit them.
4
5
JOURNAL ENTRY
Click Add in the main menu, then Journal Entry to record notes reflections on
your practice.
•
Add a title.
•
Type in your entry*.
•
Using the drop down box, select either Save as draft or commit to your
portfolio (the date is automatically recorded).
•
When you click to commit, you can choose, under Portfolio Access, to
make the journal entry private. This means that only you can see it.
Otherwise it is visible to anyone who can view your portfolio (see
Dashboard / Who can see my account).
•
Click Commit to Portfolio.
* Note that reflections are a formal educational requirement. They are better done after some
consideration. Good reflection will include a brief description of the event, the outcome and
what went well. You should expand on what you learnt and what steps you will take to
improve practice. Ensure it is fully anonymised e.g. say ‘patient x’ instead of names or
patient numbers. Like all training records, reflections may be subject to scrutiny by other
parties for legal reasons. Take advice from a senior experienced colleague on cases that
may be contentious or may result in an investigation. Formal guidance on this area will be
forthcoming from the Academy of Medical Royal Colleges.
ADD AN OPERATION TO THE LOGBOOK
Click Add in the main menu, then, in Other Forms, click on eLogbook.
• The first time you do this through the ISCP website you will need to log in
to the eLogbook using the username and password with which you
registered on eLogbook. Thereafter the link will be remembered and you
will be signed on automatically through this route.
• To add an operation, click Add Operations in the left-hand menu of
eLogbook and complete the details.
• As these are separate systems, there may occasionally be a break in the
linkage. In the rare event that you do experience any issues, please
contact the ISCP Helpdesk team in the first instance - by phoning 020
7869 6299 or emailing [email protected].
Training Programme Director
ISCP Step by Step Guide
MY TRAINEES
•
My Trainees is the area that you will use most frequently as
TPD. From here you can access all your trainees and carry
out TPD functions.
1
The number in the menu next to your role indicates the
number of trainees you manage within that role (1).
•
Click on As Training Programme Director.
Three tabs divide your trainees by a time period and indicate
the number of trainees within that area (2).
Current includes trainees whose placements are in progress.
2
Historic includes trainees whose placements have expired
but by not more than 12 months after which you will no longer
be able to view them.
3
Future includes trainees you will be managing in the next 6
months.
Colour-coding (3) indicates the status of their portfolio for
last login (LOG), last workplace assessment recorded,
placement set up, Learning Agreement status and last ARCP
outcome. Red indicates that an area requires attention by the
trainee.
Your trainees are listed within each tab and you can filter them
by specialty and name.
•
Click on the area showing the trainee details.
This leads you to a trainee summary page. If the trainee has
uploaded a CV you can view it by clicking on the orange link
(4).
•
Click on the tabs at the top of the summary page to use
Global Objectives, view the Portfolio, manage ARCPs,
delegate access to this trainee to other TPDs and send this
trainee a message.
4
VIEWING THE PORTFOLIO 4/4
2
Viewing the eLogbook
• Choose eLogbook from the Viewing list (1).
• Select a Custom or Specified time period (2).
The report displays the procedures recorded by the trainee
in each specialty with numbers at different supervision levels.
1
Those under E for emergency are coloured red. Use the
scroll button at the side to move up and down the page (3).
3
WORKPLACE ASSESSMENT (WBA) 2/2
You should complete the following fields:
Rater feedback (1) – your written comments are the most
important component and are, therefore, mandatory in at least
one text box.
Ratings (2) – the trainee is normally assessed against the stage
of training (except in PBAs). Click the relevant square for: N =
Not assessed/observed / D = Development required / S =
Satisfactory / O = Outstanding.
1
2
Global summary (3)– the overall rating is selected from four
levels that map to the trainee’s stage of training. Early in the
training stage the trainee may be at or below the level for the
stage, towards the middle and end they may be at their level or
above. For example, a core trainee may achieve level 2 in most
areas by the middle or end of CT2.
Sign off (4) Note that you can sign off here or at the same time
as the trainee. The trainee can retract a WBA to amend it. If it’s
been validated you will be notified of a retraction via your
dashboard.
3
4
ARCP / MANAGE 2/6
Trainee Progress tab
The first section shows summary information.
Trainee progress works in the same way as portfolio viewing
and allows systematic consideration of the trainee’s portfolio
evidence. You will see a series of filters.
• In Viewing – Use the drop down box to select the areas you
want to view; these include (1):
ARCPs
Global Objectives
Learning Agreements
Topics and Progress
Evidence (by WBA method)
Evidence / Other Evidence
eLogbook
Journals
PDPs
Rotas
• Use the Custom Date Range – Click the checkbox and
select a custom from and to period (2 / 3). OR
• Select a Time period – Click the drop down box to choose a
pre-established period by placement, level, ARCP or
Everything (default) (4).
• Your selections determine the evidence that is displayed in
the area below. For example, you may wish to select to view
the eLogbook by the current ARCP period (5).
Note: If you have any queries during an ARCP the ISCP
Helpdesk would be happy to help. You can call us on 020
7869 6299.
1
2
3
5
4
RATE OTHERS / MULTISOURCE FEEDBACK (MSF)
The MSF is created by the trainee who conducts a selfassessment and chooses raters from a range of grades, one of
whom must be her/his current AES:
Requirements for nominating rater:
• AES
• 2 Consultants
• 2 Senior nurses
• 2 Other doctors
• 2 Other healthcare professionals
If you are chosen as a rater, you will see an alert/link on your
dashboard. Alternatively click My Trainees from the main menu
then under Rate Others, select Validate WBAs / MSFs (1).
1
2
3
The form includes links to guidance notes (2).
• Click the boxes to complete your ratings:
N = Not assessed/observed / D = Development required
/ S = Satisfactory / O = Outstanding (3).
• Provide written comments; for the trainee this is the most
helpful component of formative assessment (4).
• You can save as draft to come back to later.
• Sign off.
4
STANDARDS FOR HST in ENT
•
Ten Standards separated into three groups
Experience standards: Experience over the last 6 years of training
Exposure standards: Training and the standards and exposure for
each job.
Programme standards: Support for subspecialist, generic and
academic exposure.
Experience Standards
• Undertaking a minimum of 2000 operations during the last 6 years
of training as principal surgeon or main assistant.
• Undertaking, as principal surgeon, a broad spectrum of operations
that are allied to emergency work, these being 10 mastoid
operations, 40 tympanoplasties, 10 major head and neck
operations, 10 tracheostomies, 10 paediatric endoscopies (including
flexible), 5 vocal cord palsy procedures, 10 septorhinoplasties, 30
FESS, 10 removal of foreign bodies from airway including nasal and
fish-bones.
• Exposure to the management of emergencies as manifested by 300
nights on call and/or having managed 1000 emergencies in higher
surgical training.
Exposure Standards
• Clinics: 3 or more a week, including emergencies
– Conform to ENT guidelines (Numbers, Facilities)
– ST3 to include weekly special interest clinics (paediatric, vertigo,
audiological, otology, tinnitus, head and neck, voice, rhinological and
others)
• Operating Lists:
– 3 a week in CT/ST1 and 2,
– 4 a week in ST3 to ST8
• Hospital Throughput: 500 ENT operations per annum per
higher surgical trainee in that unit
Programme Standards
• Rotate through sub-specialities otology, neuro-otology,
paediatrics, benign head and neck, head and neck oncology,
rhinology, sinus surgery, facial plastics, voice and balance.
• Generic skills training in management skills, teaching,
education, leadership and team working.
• Support provided for extra curricular activities; for example to
the level that would support for 3 papers per year, 2 audits
per year and 1 presentation per year, or a higher degree )eg
MS, Mphil, MBA, Educational or other diploma) or leadership
skills training or similar.
• Facilities for sub special interest training within the
programme.
“Training The Trainers”
TRACE Course
•
•
•
•
•
•
•
Education Theory
Practical Skills
Equality and Diversity
Structure of Training
Assessments
Work Based Assessments
GMC requirement
Web Sites
e-log 2016
• The updated Otolaryngology curriculum
came into effect in August 2016.
• https://www.iscp.ac.uk/curriculum
• http://www.e-lefent.org.uk