The Future of Cardiology

Training and the EEGC

Russell Smith

Disclosures

• Speaker fee from Bayer

Education and

Training Structure

Russell Smith

• Consultant Cardiologist

• Chair Cardiology SAC

• Vice President (Training), BCS

• Postgraduate Dean

• Co-Chair UKFPO

• National School of Healthcare Science

• UK Medical Education Reference Group

• Curriculum Oversight Group

Agenda

• EEGC

• Future Training – Trainers of the future

• Current and Future Training Issues

– Recruitment

– Trainers – Supervision

– Leadership

– Multi-Professional Colleagues

– Simulation

– Resilience

– Reflection

Team working

EEGC

• European Examination in General Cardiology

– KBA - Knowledge Based Assessment

– SCE - Specialty Specific Examination

• 14th June 2018 (Pearson Vue)

• 1st UK specific exam (6 questions exchanged)

• 120 Questions, 3 Hours

• Single Best Answer MCQ

• Breadth of Core Cardiology

• Lots of Images (Video loops, ECGs etc)

EEGC Preparation

• Clinical Practice!

• Today!

• BCS Annual Conference 4th June 13.45

• UK Curriculum

• ESC Core Curriculum

• ESC Textbook

• Guidelines

• BCS website

EEGC Example

A 46-year-old man attended the Emergency Department with recurrent chest

pain. He had attended 2 weeks earlier with a short history of fevers,

generalised muscle aches including chest discomfort, shivers and mild

diarrhoea. His ECG at that time had shown widespread concave upwards ST

elevation and PR segment depression and he had been treated with ibuprofen

400 mg every 6 hours. His symptoms had settled and he had been discharged

after 2 days feeling well and pain-free. Ibuprofen was stopped after 7 days. His

chest pain had recurred on the day of his attendance. On examination he had

a pericardial rub. His ECG was unchanged.

What is the most appropriate treatment?

A azathioprine

B ciclosporin

C colchicine

D ibuprofen

E prednisolone

EEGC

• Mandated for CCT

• Not an Exit Exam

• Not Assessment of

Competence

• ‘Hurdle not a Barrier’

• NTN holders only

“Staff treated patients and those close to them with what

appeared to be callous indifference.”

“The culture at the Trust was not conducive to providing good

care for patients.”

“The system of regulation and oversight of medical training and

education in place between 2005 and 2009 failed to detect

any concerns about the Trust other than matters regarded

as of no exceptional significance.”

Future (Cardiology) Training

Drivers for Change

David Greenaway…..

19 Recommendations

‘Generalism’

Shape of Training Steering Group

• 4 Nations Departments of Health

• Patient / Health Delivery focussed

• Royal College Proposals

• COPMeD endorsed

HEE Mandate ………our workforce has the right

numbers, with the right skills, values and behaviours,

at the right time and place.

Investing in our current and future workforce is the only way

to ‘future proof’ the NHS. The healthcare workforce is the

means by which the ambitions of the NHS are realised.

Gen-gagement: exploring

essential conditions for

developing the future workforce

Generational Issues

Self reliant

Extremely hard-working

Adaptable and resourceful

Idealistic and competitive

Rebellious tendency –not afraid to challenge

Motivated and driven by career progression

Define self-worth by work and accomplishments

Imbalance between work and family

Technology influences everything

Education is more self-directed

Thrive on instant gratification and prefer information to be delivered in

rapid sound-bites

Ambitious but want more flexibility

Pragmatic and individualist

Open-minded and more tolerant of others – expect diversity around them

Technological multi-taskers, everything should be interconnected

HEE Improving Junior Doctors’ Working

Lives (ARCP Review)

• Flexibility

– Career changes (transferable competencies)

– LTFTT

• Non-Training Grade posts

• Study Leave

• Assessment process

7 Day ServiceClinical Standards

7 day Services Clinical

Standards

Clinical Standard 1Patient ExperienceHealth professionals and social care workers actively involve patients, real time data collection and feedback

Clinical Standard 2Time to 1st Consultant ReviewClinical assessment by Consultant within 14 hours of arrival

Clinical Standard 3Multi-Disciplinary Teams (MDTs)MDT review within 14 hours of emergency inpatient and establish Management plan and Estimated Date of Discharge with 24 hours

Clinical Standard 4Shift HandoverHandovers between incoming and outgoing and led by a key decision-maker

Clinical Standard 5Diagnostics7 day access to Consultant diagnostic tests and reporting within 1 hour for critical, 12 for emergency and 24 for non-urgent

Clinical Standard 6Interventions/ Key Services

Timely 24/7 access to Consultant-led interventions

Clinical Standard 7Mental Health

Acute admission patients assessed by psychiatric liaison 24/7

Clinical Standard 8On-going Review

High dependency areas patients to be seen by consultant twice daily, and once moved onto general

wards, at least once daily

Clinical Standard 9Transfer to Primary, Community and Social Care

Support services both onsite and offsite to be available 7 days a week to ensure next steps in pathway can be

taken

Clinical Standard 10Quality Improvement

Review of patient outcomes to drive care and quality improvement

JRCPTB agreed proposal

Group 1 specialties (dual train with Internal Medicine)

Group 2 specialties (single CCT)

Acute Internal Medicine Allergy

Cardiology Audio vestibular Medicine

Clinical Pharmacology and Therapeutics Aviation and Space Medicine

Endocrinology and Diabetes Mellitus Clinical Genetics

Geriatric Medicine Clinical Neurophysiology

Gastroenterology Dermatology **

Genitourinary medicine Haematology

Infectious Diseases* Immunology

Neurology Medical Ophthalmology

Palliative Medicine Nuclear Medicine

Renal Medicine Paediatric Cardiology

Respiratory Medicine Pharmaceutical Medicine

Rheumatology Rehabilitation Medicine

Tropical Medicine* Sport and Exercise Medicine

*Discussion ongoing re dual programmes with MM/MV **Detail of programme to be determinedMedical Oncology not included - ongoing discussion with UKSTSG

New Dual CCT Curriculum

• IM Stage 1 starts 2019

• ST4 selection for 2022

• 2021 uncertain selection (no CMT output)

• Cardiology remains 5 years (as 6 years dual now)

• Curriculum (To Be Confirmed, ?2020 for 2022):– General Professional Capabilities

– Internal Medicine (8 CiPs)

– General Cardiology (5 CiPs)

– Advanced Modular Cardiology (1-2 CiPs, 4-5 points)

• 3+2 or 2+3 years but general throughout

• Some IM in final year

All Cardiology CCT Holders will be

Capable in:

• General (acute) cardiology

• Generic Skills for elderly, multi-morbid patients

• An advanced modular skill

• Acute medicine (for a small proportion)

• Plus have a sound grounding in cardiovascular

research

Credentialing

• Doesn’t exist yet!

• Post CCT probably (SAS, career change)

• Disagreement over whether common or rare

• Non-CCT specialties (cosmetic surgery)

• Advanced curricular components

• Cardiology

– TAVI

– Advanced ICC

Advanced Modules(not sub-specialties)

• PCI (structural)

• EP (Ischaemic)

• Devices (extraction)

• ACHD (1 / 2)

• Pregnancy

• Heart Failure (Transplantation)

• Imaging (multi-modality)

• ICC

2016-17 Census – Cardiology 14% consultants, 28% HSTs female (overall 35% and 54% 3 Colleges)

Tariff

Professionalism

“is not a stable construct that can be defined

in isolation, taught and assessed. It is

something that is socially constructed in

interaction and sustained through

institutional structures.”

Goldie J, Dowie A, Cotton P, Morrison J. Professionalism in: Oxford Textbook of Medical

Education. Ed. Walsh K. Oxford, OUP, 2013.

Derived from Martimiankis MA et al. Med Educ 2009;43:829-837

Resilience

“[Being a doctor] involves taking really difficult and

complex decisions faced with uncertainty about

individuals who are at crisis at that point in their lives.

We’re training people who are going to have to

make…decisions that will be challenged, who will be

complained about, people will be unhappy with the

things that they do, and we need to make sure that we

give people the emotional resources to be able to

cope with that.”Niall Dickson (GMC): BMJ Careers. 30 April 2015

What is resilience?

• Resilience is the process of adapting well in the

face of adversity, trauma, tragedy, threats or

significant sources of stress

• Resilience is not a trait that people either have or

do not have. It involves behaviours, thoughts and

actions that can be learned and developed in

anyone

American Psychological Association

Becoming resilient

• Keep things in perspective

• Maintain a hopeful outlook

• Take care of yourself

• Reflect and plan actionsAmerican Psychological Association

• Make connections (‘real’ ones)

• Avoid seeing crises as insurmountable problems

• Accept that change is a part of living

• Mindfulness, meditation, yoga, Headspace™

Simulation Based EducationST3/IM4 – ‘bootcamp’

Patient Safety & Induction

Work-Training-Leisure

"The Dark Side clouds every thing.

Impossible to see, the future is."