JCST Quality Indicators for Surgical Training

JCST
Quality Indicators for Surgical Training
Core Surgical Training

Quality Indicator

1.

Trainees in surgery should be allocated to approved posts commensurate with their level of training and appropriate to the educational opportunities available in that post (particular consideration should be given to the needs of less than fulltime trainees). Due consideration should be given to individual training requirements to minimise competition for educational opportunities.

2.

Trainees in surgery should have at least 2 hours of facilitated formal teaching each week (on average). (For example, locally provided teaching, regional meetings, annual specialty meetings, journal clubs and x-ray meetings).

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3.

Trainees in surgery should have the opportunity and study time to complete and present one audit project in every twelve months. (The requirements for audit vary for each surgical specialty. Please refer to the designated specialty for details).

4.

Trainees in surgery should have easy access to educational facilities, including library and IT resources, for personal study, audit and research.

5.

Trainees in surgery should be able to access study leave with expenses or funding appropriate to their specialty and level of training.

6.

Trainees in surgery should complete a minimum of 40 WPBAs per year, with an appropriate degree of reflection and feedback, the mix of which will depend upon their specialty and level of training.

7.

Trainees in surgery will be assigned an educational supervisor and will have negotiated a learning agreement within six weeks of commencing each post.

8.

Trainees in surgery should participate in operative briefings with use of the WHO checklist or equivalent.

9.

Trainees in surgery should have the opportunity to receive simulation training where it supports curriculum delivery.

Quality Indicators for Surgical Training All Core Surgical Trainees

Quality Indicator

10.

All trainees in Core Surgery should attend five consultant supervised sessions of 4 hours each week: for variations in this QI for different specialties, see appendix 1.

11.

All trainees in Core Surgery should attend at least one consultant ward round each week.

12.

All trainees in Core Surgery should be involved with the management of patients presenting as an emergency at least once each week (on average), under supervision and appropriate to their level of training.

13.

All trainees in Core Surgery should complete the following mix of WPBAs per year to achieve QI 6 above:

A minimum of 12 x CEX
A minimum of 12 x CBD
A minimum of 12 x DOPS / PBA 1 x MSF

Total of at least 40 WBAs

The remaining WPBA’s should be agreed between the AES and the trainee based on individual trainee need.

Quality Indicators for Surgical Training Core Surgical Trainees in Cardiothoracic Surgery Placements

Quality Indicator

14.

Core trainees in Cardiothoracic Surgery should be given the opportunity to perform the supervised taking of long saphenous vein to a safe standard and should be capable of opening the chest by sternotomy or thoracotomy by end of 6 months.

15.

Core Trainees on a six month Cardiothoracic Surgery placement should either attend the annual meeting of the Society of Cardiothoracic Surgeons or the Core Skills Course in Cardiothoracic Surgery.

Quality Indicators for Surgical Training Core Surgical Trainees in General Surgery Placements

Quality Indicator

14.

Core trainees in General Surgery should be given the opportunity to perform the following procedures to a specified level as defined by the curriculum:

Primary abdominal wall hernia; appendicectomy; laparoscopic port placement; abdominal incision/closure for laparotomy; removal of skin lesions; and cutaneous abscess drainage.

15.

Core trainees in General Surgery, when on call for emergencies, should be free of routine ward work.

Quality Indicators for Surgical Training Core Surgical Trainees in Neurosurgery Placements

Quality Indicator

14.

Core trainees rotating to Neurosurgery should acquire the ability to insert intracranial pressure monitor devices and to perform burrholes for insertion of external ventricular drains or evacuate chronic subdural haematomas under supervision.

15.

Core trainees rotating to Neurosurgery should participate in daily emergency handover meetings.

Quality Indicators for Surgical Training Core Surgical Trainees in Oral & Maxillofacial Surgery Placements

Quality Indicator

14.

Core trainees in OMFS should be given the opportunity to perform the following procedures to a specified level as defined by the curriculum:

Extraction of teeth; removal of retained roots; biopsy of intra-oral lesions; removal of impacted teeth; debridement of contaminated wound/infected wound/wound with skin loss; and primary closure of skin lacerations of the face and oral tissues where there is no tissue loss or nerve injury.

15.

Trainees in core OMFS placements should have the opportunity to undertake a basic fracture plating course.

Quality Indicators for Surgical Training Core Surgical Trainees in Otolaryngology Placements

Quality Indicator

14.

Core trainees in ENT should be given the opportunity to perform all the procedures in the Early Years Curriculum to the specified level as defined in the curriculum. The basic minimum is:

Insertion of grommets; reduction of nasal fracture; adult tonsillectomy; and paediatric adenotonsillectomy.

15.

Core trainees in ENT should regularly attend ward rounds dealing with the management of emergency admissions.

Quality Indicators for Surgical Training Core Surgical Trainees in Plastic Surgery Placements

Quality Indicator

14.

Core trainees in Plastic Surgery should be given the opportunity to perform at least three procedures from each list to the standard stipulated below by the end of Core Surgical Training:

  1. a)Performed operations - exploration, repair of extensor tendon; excision of basal cell carcinoma; split skin graft; full thickness skin graft; repair of full thickness lip or eyelid lacerations (any one); debridement of contaminated wound / infected wound / wound with skin loss (any one).

  2. b)Performed with assistance or Assisted operations / procedure perform exploration, repair of flexor tendon with assistance; perform local flap to reconstruct a defect with assistance; burns resuscitation with assistance; perform microsurgical nerve repair with assistance; assist in free tissue transfer surgery; assist in fasciotomy for compartment syndrome.

15.

Core trainees in Plastic Surgery should be given the opportunity to attend the Emergency Management of Severe Burns Course (EMSB).

Quality Indicators for Surgical Training Core Surgical Trainees in Paediatric Surgery Placements

Quality Indicator

14.

Core trainees in Paediatric Surgery should be given the opportunity to perform procedures in the category General Surgery of Childhood (to include circumcision, non-neonatal inguinal herniotomy, ligation of PPV, umbilical hernia repair, appendicectomy) to a specified level as defined by the curriculum.

15.

Core trainees in Paediatric Surgery should have the opportunity to undertake a level 2 Safeguarding or Child Protection course and attend a Basic Paediatric Life Support course.

Quality Indicators for Surgical Training - Core Surgical Trainees in T&O Placements

Quality Indicator

14.

Core trainees in T&O should be given the opportunity to perform the following procedures to a specified level as defined by the curriculum:

DHS; Hemiarthroplasty; ankle fracture fixation; MUAs with application of plaster; and THRs.

15.

Core trainees in T&O should be allocated to units that ensure supervised attendance at a minimum of 20 fracture/trauma based clinics in 6 months.

Quality Indicators for Surgical Training - Core Surgical Trainees in Urology Placements

Quality Indicator

14.

Core trainees in Urology should be given the opportunity to perform routine cystoscopy with retrograde stent placement and basic inguinoscrotal surgery (hydrocele, epididymal cyst excision, and circumcision) both to level 2 standard as defined by the curriculum.

15.

Core trainees in Urology, trainees should be given the opportunity and time to access web based urology educational media.

Weekly consultant supervised sessions

Core trainees should have the opportunity to attend five consultant supervised sessions each week (only four of which may be named). These can be broken down as follows for each specialty:

Appendix 1

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Specialty

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Specific requirements for QI 10

Cardiothoracic Surgery

Core trainees in Cardiothoracic Surgery should attend three operating sessions and at least one outpatient clinic each week.

General Surgery

Core trainees in General Surgery should undertake 3 supervised operating sessions (one of which should be an emergency session) and 2 supervised outpatient clinics each week.

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Otolaryngology

Core trainees in ENT surgery should attend three operating lists (at least one as the principle trainee) and three clinics (including emergency clinics) each week.

OMFS

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Core trainees in OMFS should attend 3 operating lists and 3 outpatient clinics each week. These should include emergency lists and clinics.

Neurosurgery

Core trainees in Neurosurgery should attend a minimum of two half-day theatre sessions, including emergency surgery, one clinic, one consultant ward round and one MDT session. When attached to Neuro-ICU, they should attend daily consultant teaching ward rounds.

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Paediatric Surgery

Core trainees in Paediatric Surgery should attend three operating sessions (one of which should be an emergency session) and at least one outpatient clinic each week.

Plastic Surgery

Core trainees in Plastic Surgery should attend three operating sessions (one of which should be an emergency session) and at least one outpatient clinic each week.

Trauma & Orthopaedics

Core trainees in Trauma & Orthopaedics should attend three operating sessions (2 x trauma and 1 x elective) and at least one fracture clinic each week.

Urology

Core trainees in Urology should attend at least three operating sessions, (including flexible cystoscopy, but at least two GA operating lists per week) and at least one outpatient clinic each week.