M62 Course, 2006

Mike Nelson, Consultant Surgeon, Isle of Wight

M62 Course, 2006

Introduction

M62 Course, 2006

Mike NelsonTrained as SpR in WalesFRCS (Gen Surg) 2005 Colorectal subspecialtyCCT October 2005Locum Consultant Surgeon Charing Cross HospitalConsultant Surgeon – April 2006 Isle of Wight

M62 Course, 2006

Pre-Calman

“Registrar”

19961996

Consultant

Senior Registrar

FRCS

M62 Course, 2006

Calman Principles

Single SpR Grade

19961996

Exit Exam & Consultant

Curriculum, RiTAs

MRCS

M62 Course, 2006

Calman Environment

New Deal = Less Hours

20062006

Consultant Expansion

Subspecialisation

Seamless Training

M62 Course, 2006

Jobs by specialty n=206

Colorectal, 62

Breast, 47

Vascular, 34

Upper GI, 33

Other, 11

Transplant, 10

HPB, 6

Endocrine, 3

0 10 20 30 40 50 60 70

`

2002

M62 Course, 2006

Results: 2002 ICE Passes

0

10

20

30

40

50

60

70

Col Bre Vas UGI/HPB Oth Tran End

115 successful candidates

ICE Passes

M62 Course, 2006

Drivers for Change

2006

EWTD

Service Changes

MMC

Lifestyle

Regulation

Initiatives

ISTCs

Laparoscopic

M62 Course, 2006

0

2

4

6

8

10

12

14

No. T

rain

ees

None 1 to 100 101 to 200 201-300 over 300Endoscopies performed

Median=12.5(range 0-345, n=24)

Endoscopy Experience

M62 Course, 2006

MMC

Specialist and GP trainingprogrammes

(Run-through training)

Medical school – 4-6 years

Career posts

F1F2

Postgraduate Medical Training

Senior Medical Appointments

Fixed termspecialist training

Arrows indicate competitive entry

CCT route

Specialist

M62 Course, 2006

More QuestionsFurther exams post ICE? Not on your life!Why should surgery be different?Why should coloproctology differ?Can we separate emergency and elective work?Will we recreate old bottlenecksIs it necessary?

M62 Course, 2006

Suggested Path ForwardRobust evaluation of Calman Heterogenous group Implement improvements

Any changes universal Are “craft” specialties different?

Evidence based Changes will be inevitable

Colleges & Associations continue to lead

M62 Course, 2006

Trainee’s Role Must be Active

Join Societies ASiT Dukes’ ClubCollect and publish data Electronic logbookIdentify good & bad training unitsEncourage future trainees

M62 Course, 2006

Summary

Current CCT holders probably OKCurrent senior SpRs probably OKCurrent new SpRs less certainCurrent SHOs parallel trainingCurrent F1/2s very uncertainHowever… change is nothing new Extent and pace is unprecedented

M62 Course, 2006