Speciality training in paediatric anaesthesia an update Thames

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Speciality training in paediatric anaesthesia: an update Thames PAG 15 th May 2008 Nargis

Speciality training in paediatric anaesthesia: an update Thames PAG 15 th May 2008 Nargis Ahmad

The changing picture l Modernising Medical Careers l Implications for training in anaesthesia l

The changing picture l Modernising Medical Careers l Implications for training in anaesthesia l St. R training in paediatric anaesthesia l Competence revolution in post graduate medical education

The way we were 1993 - Hospital Doctors—Training for the Future EU legislation on

The way we were 1993 - Hospital Doctors—Training for the Future EU legislation on specialist medical training

MMC l l l l August 2002 - Unfinished business February 2003 - Modernising

MMC l l l l August 2002 - Unfinished business February 2003 - Modernising Medical Careers - initial plans April 2004 - MMC: The next steps details of the new structures June 2005 - Curriculum and operational framework for Foundation Training published. August 2005 - Start of new 2 -year Foundation programme January 2007 - Start of recruitment to Specialty Training jobs June 2007 - Gold Guide to Postgraduate Specialty training August 2007 - Start of Specialty Training jobs.

Influences on training reform l NHS PLAN – Need fully trained doctors – UK

Influences on training reform l NHS PLAN – Need fully trained doctors – UK self sufficient l EWTD l DH removed ring fence around training budgets 2006 l PMETB – “with the introduction of competence-based, assessed, PMETB- approved curricula, explicit standards will underpin the new programmes”

Postgraduate Medical Education And Training Board (PMETB) PMETB is the independent regulatory body. l

Postgraduate Medical Education And Training Board (PMETB) PMETB is the independent regulatory body. l Established by statute in 2003 took over the responsibilities of the STA l is accountable to Parliament l acts independently of government as the UK competent authority l Unlike the STA, PMETB is independent of the Royal Colleges. PMETB commissions services from the Royal Medical Colleges.

17 th March 2007

17 th March 2007

MTAS 2007 l 24 April - Sir John Tooke asked to lead independent inquiry

MTAS 2007 l 24 April - Sir John Tooke asked to lead independent inquiry into implementation of MMC and MTAS. l 12 July - The final report of the Douglas Review is published, describing ST selection as "the biggest crisis within the medical profession in a generation".

Response to the Tooke Review l Stakeholders in PG medicine – agreement l DH

Response to the Tooke Review l Stakeholders in PG medicine – agreement l DH – Formal response published Feb 2008 – 24/47 accepted l ‘in principle’ - most are qualitative with no timetable or mechanism for measuring progress – GMC to merge with PMETB 2010 – 23/47 deferred (NHS MEE) next stage review

The Health Committee Report on MMC 8 May 2008 l l l DH and

The Health Committee Report on MMC 8 May 2008 l l l DH and CMO criticised NHS MEE MMC programme board Royal colleges to work with PMETB and deaneries Greater differentiation within consultant grade Lord Darzi's nationwide vision for next decade June 2008 ‘clinically led-locally driven’

So where are we now? 2 years core training l Uncoupled l l Recruitment

So where are we now? 2 years core training l Uncoupled l l Recruitment – Staged – Managed by PG deaneries

New Curricula Developed by the medical Royal Colleges and approved by PMETB l PMETB

New Curricula Developed by the medical Royal Colleges and approved by PMETB l PMETB with the medical Royal Colleges, faculties and the speciality associations: curricula for all 57 medical specialties, plus 30 subspecialties. l Common standards, clarity and transparency to training & promoting the continuous development of doctors’ skills in order to meet patient need. l

New Curricula

New Curricula

Training the trainers 2010

Training the trainers 2010

Generic standards for training Patient safety Quality Assurance, Review and Evaluation Equality, Diversity and

Generic standards for training Patient safety Quality Assurance, Review and Evaluation Equality, Diversity and Opportunity Recruitment, selection and appointment Delivery of curriculum including assessment Support and development of trainees, trainers and local faculty 7. Management of Education and Training 8. Educational resources and capacity 9. Outcomes 1. 2. 3. 4. 5. 6.

Paediatric Anaesthesia: Intermediate Level ST 3 And ST 4 KEY UNIT OF TRAINING l

Paediatric Anaesthesia: Intermediate Level ST 3 And ST 4 KEY UNIT OF TRAINING l 1 -3 months l Competencies relate to knowledge more than to skills l l Child protection

Paediatric Anaesthesia: Higher And Advanced Level (ST Years 5, 6 And 7) l Preparation

Paediatric Anaesthesia: Higher And Advanced Level (ST Years 5, 6 And 7) l Preparation for independent professional practice in their consultant post of choice Higher training for those pursuing a generalist career l Advanced training to become an expert in a special interest area -. at least 6 months & up to a year l

Higher Training In Paediatric Anaesthesia Objectives To develop competence in meeting the anaesthetic needs

Higher Training In Paediatric Anaesthesia Objectives To develop competence in meeting the anaesthetic needs of infants and children for common surgical conditions l To be able to organise and manage safely a list of paediatric cases, with consultant supervision for neonates and infants under 1 year l To be able to manage hazards and complications of paediatric anaesthesia l To be able to resuscitate and stabilise a sick child for transfer l

Higher Training In Paediatric Anaesthesia l Skills to acquire l Skills to enhance l

Higher Training In Paediatric Anaesthesia l Skills to acquire l Skills to enhance l Training in child protection

Advanced Training In Paediatric Anaesthesia l Training objectives l Indicative clinical experience l Professional

Advanced Training In Paediatric Anaesthesia l Training objectives l Indicative clinical experience l Professional qualities l Skills l Minimum case load l Training environment l Child protection

Advanced Training In Paediatric Anaesthesia Training Objectives l. FT either in a specialist paediatric

Advanced Training In Paediatric Anaesthesia Training Objectives l. FT either in a specialist paediatric hospital or a tertiary referral centre, or lead consultant for paediatric anaesthesia in a district general hospital l. To acquire an in-depth knowledge and understanding of the anatomical, physiological, pharmacological and psychological differences between adults and children, and be aware of the changes associated with growth and development, and with co-existing disease l. To be competent in relation to every aspect of the peri- operative management of children of all ages, from the very premature neonates to those children with complex coexisting disease

Advanced Training In Paediatric Anaesthesia Training Objectives l. To become skilled in communicating with

Advanced Training In Paediatric Anaesthesia Training Objectives l. To become skilled in communicating with children, parents and other carers throughout the surgical episode, and also become an effective communicator within the multidisciplinary paediatric team l. To understand the legality of consent in children, in relation to research, restraint and procedures l. To acquire leadership skills when managing both elective and emergency paediatric cases and also when supervising more junior trainees

Advanced Training In Paediatric Anaesthesia Indicative Clinical Experience l. Enhance basic and higher training

Advanced Training In Paediatric Anaesthesia Indicative Clinical Experience l. Enhance basic and higher training l. Minimum 6 months l. Experience in full range of paediatric spectrum l. Direct supervision in first 3 months l. Experience as lead clinician: elective & emergency l 1 -2 months PICU l. Acute pain l. Specialist interest areas l. Wider aspect of paediatric care

Generic professional skills l attitude and behaviour l communication l presentation l audit l

Generic professional skills l attitude and behaviour l communication l presentation l audit l teaching l ethics and law l management

Clinical Assessment Tools. . the RCo. A has decided that common tools and documentation

Clinical Assessment Tools. . the RCo. A has decided that common tools and documentation should be used for workplace based assessment, The tools to be used are: • Multi- Source Feedback • Mini-Clinical Assessment Evaluation Exercise • Direct Observation of Procedural Skills • Case Based Discussion

DOPS 6 EVERY 6 MONTHS

DOPS 6 EVERY 6 MONTHS

Mini-Clinical Assessment Evaluation Exercise (mini-CEX) The key learning event in anaesthetic training is the

Mini-Clinical Assessment Evaluation Exercise (mini-CEX) The key learning event in anaesthetic training is the supervised operating list, where management plans are formulated, problems are discussed, techniques and procedures taught and behaviours learnt. The mini-CEX is intended to evaluate the core skills that trainees employ in many clinical scenarios throughout the curriculum Thought processes and management decisions not knowledge

Mini CEX

Mini CEX

Case-based Discussion (Cb. D) Designed to evaluate decision making, interpretation and application of evidence

Case-based Discussion (Cb. D) Designed to evaluate decision making, interpretation and application of evidence by reviewing a record of anaesthetic practice It is intended to assess the clinical decisionmaking process and the way in which the trainee used medical knowledge when managing a single case

Case Based Discussion 2 EVERY 6 MONTHS

Case Based Discussion 2 EVERY 6 MONTHS

Case Based Discussion

Case Based Discussion

Multi-source Feedback (MSF) Examine behaviour. They mostly rely on feedback ratings obtained from colleagues

Multi-source Feedback (MSF) Examine behaviour. They mostly rely on feedback ratings obtained from colleagues and/or patients. All require a considerable commitment of time and resources if they are to be done fairly and safely. If not done properly, with appropriate collation of evidence and the provision of careful and sensitive feedback, they can be devastating to trainees. In due course central guidance and or direction on this may be given by the PMETB e. g. by the introduction of a nationally validated system of Multisource Feedback (MSF)

Professional authenticity Climbing the pyramid Does Behaviour Shows how Knows Miller GE. The assessment

Professional authenticity Climbing the pyramid Does Behaviour Shows how Knows Miller GE. The assessment of clinical skills/competence/performance. Academic Medicine (Supplement) 1990; 65: S 63 -S 7. Cognition

Professional authenticity Climbing the pyramid Does Performance Shows how Knows Miller GE. The assessment

Professional authenticity Climbing the pyramid Does Performance Shows how Knows Miller GE. The assessment of clinical skills/competence/performance. Academic Medicine (Supplement) 1990; 65: S 63 -S 7. Competence

Managed Integrated Learning ASSESSMENT Reliable Valid LEARNING CURRICULUM define learning objectives APPRAISAL & MENTORING

Managed Integrated Learning ASSESSMENT Reliable Valid LEARNING CURRICULUM define learning objectives APPRAISAL & MENTORING STANDARD SETTING & RECORDING portfolio

Challenges l l l Assessment should be a positive process, must be robust i.

Challenges l l l Assessment should be a positive process, must be robust i. e. objective, reliable and valid as consequences may be serious for any trainee Be careful of what you measure and what you can’t measure The trainee in difficulty Trainees work with each individual consultant infrequently EWTD Time needed to perform assessment

The Northern Ireland Experience Pilot Aug 2005 l Each 3/12 l – 2 DOPS

The Northern Ireland Experience Pilot Aug 2005 l Each 3/12 l – 2 DOPS – 1 Anaes-CEX – 1 CBD l DOPS 25 mins (10 -85) l Anaes CEX 38 mins (10 -100) l CBD 38 mins (2075 mins) l MSF end year 1 “In our experience the new assessment tools are better at identifying weaker trainees than rewarding and motivating those who are excellent”

………say nothing and try look like you know what you are doing?

………say nothing and try look like you know what you are doing?

…. . to be continued

…. . to be continued