The Shape of Your Own Training - Time To Get Engaged
created 01 December 2016
The on-going reforms to training and medicine in general reflect society’s changing expectations and demography. In terms of surgical training, it is no longer the case that the only thing that counts is time served and the approval of a consultant supervisor conveyed to future employers by way of a letter of reference. The shift to a system based on demonstrating competency, coupled with an emphasis on developing objective and reproducible methods of assessing knowledge, skills and attitudes has been both positive and necessary. However, as with all major change, the transition has not been easy. Before we embarked on this transformation, there was no blueprint of a successfully implemented comprehensive training system from another country that we could copy.
It is understandable why trainees, when contemplating previous failures of training reform and when faced with the imposing establishments and administrative bodies of surgery, may feel disinclined to get involved. This however is a mistake; apathy and disengagement will not lead to progress. It is all too easy to drive in the slow lane and think that given time, things will just get better, or that someone else will do something about it.
It is clear that many juniors perceive their training, and the people and institutions that run their training, as sometimes being insensitive to their needs, blind to their difficulties and run centrally with political necessities trumping other considerations. The reality is different. There are hundreds of people working hard, often in their own time, doing their utmost to try to ensure that the quality of our training is world class; good training is a goal that everyone is agreed upon. The structures that we take for granted (the curricula, JCST, ISCP website, etc.) are in a continual cycle of implementation, assessment and revision. Our place in this process is central.
By getting involved and working together with our trainers, training program directors, deans and the overarching training bodies, we as trainees can make a real difference to how our training and the training of future generations of surgeons is shaped.
I have been fortunate, through ASiT, to be invited to contribute to several Joint College ventures. I have been a member of the Joint Surgical Data Governance, ISCP Management and ISCP Data Analysis committees for over two years and have deputised on others. My experiences, to use a tired cliché, have been eye opening. I believe that many trainees do not perhaps realise that our opinions are actively sought, always listened to and usually implemented. My career in surgery started during the events of MMC/MTAS and it is clear that if we are to avoid such difficulties again, it behoves us as trainees to get involved and make sure that our opinion is made clear and that we don't let good intentions pave the way to unhappy careers.
A concrete example of the value of our input recently has been the ISCP review.1 Trainees made a major contribution to this process. This review fed into version 10 of the website which is currently being Alpha tested. Increasing trainer engagement by making ISCP a key part of their professional feedback and revalidation will be a central theme; this is real progress and was one of our principal demands. Work-based assessments are also being significantly reformed. They will now rightly be referred to and used as purely formative tools, thereby restoring their validity and original purpose as well as going at least some way to addressing our concerns about gaming.2 Procedure Based Assessments (PBAs) in particular will be recommended as formative assessments with progress from a series of PBAs being reviewed at ARCP. An emphasis on free-text feedback will be made and trainers will themselves be judged on how much written feedback they provide; an “economic” nudge for trainers to do the right thing. Generic PBAs are also to be introduced so that procedures that aren’t catered for can nevertheless be logged as training events. There is still a lot to do; the eLogbook in particular requires major surgery itself and should be better integrated with healthcare datasets as well as with the ISCP – these problems are being addressed right now.
The message is therefore, please get engaged. Getting involved with ASiT and attending committees is certainly worthwhile if you feel that it’s for you, but the really important engagement is more about doing the apparently mundane day to day stuff like contacting ASiT and the JCST with your concerns and suggestions as well as completing all the annoying surveys you get in your inbox – these are the best way for us to find out what you think and feed this back. Engagement is also about reflecting on the ISCP assessment you’ve just done or on-line tool that you’ve just used and then feeding back how you think it might be improved. All feedback provided is looked at and considered.
Soon we will be the consultants and not the juniors. We all want to be as well prepared for the job as we can be, and it's our clear duty to play a central role in ensuring that this happens.
Alex Vesey, General Surgery trainee and Member of ASiT Council
References
1. Vesey AT, Bekdash B, Sinclair P, Radford P, Hornby S, Beamish A. Response to the ISCP Review. 2013; : 1–32.
2. Shalhoub J, Vesey AT, Fitzgerald JEF. What Evidence is There for the Use of Workplace-Based Assessment in Surgical Training? Journal of Surgical Education 2014; : 1–10.
Lewis Ashman
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