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COVID-19 RTC Newsletter June 2020

COVID-19 RTC Newsletter June 2020

03/06/2020

Dear South West Higher Surgical Trainees,

Miss Olsen and Miss Burt recognise the huge upheaval to training that has affected everyone in the region. As we begin to recover, the impact to training and how we proceed in the next 12-18 months is under considerable review.

The TPDs would like to invite all ST trainees in the Southwest to a Q&A virtual forum on Wednesday 23rd of June (time TBC) to discuss key issues and concerns. There will be questions taken on the night but it would be helpful to have an idea of common concerns so an agenda can be formulated so that all queries can be covered.

Questions can be submitted via this survey link and we would be grateful for your opinion on the ARCP process and regional teaching.

Please find an up-to-date Regional Trainee Committee newsletter with important links to key documents.

Rotations – Trusts/Specialties

Rotations between hospitals did not take place as planned in April. Rotations within hospital between different departments should now be taking place if they were due to take place in April and have not yet. Normal rotations are planned to occur from August as per this update from Health Education England. At present, the plan is for rotations to happen in October and preferences have been requested in the usual way.

Cross-covering specialties and medico-legal advice

We may well have been re-deployed into unfamiliar working environments. In line with GMC basic principles of being a good doctor, we must support patients and colleagues in this difficult time. However, trainees should act within their capabilities and with appropriate supervision.

The local postgraduate Dean should be made aware of any trainees being deployed to clinical areas outside of their daily practice or grade.

Please contact and liaise with your local unit to ensure if you cross cover you are acting within your capabilities and have appropriate supervision.

GMC guidance on cross covering and training can be found here. Guidance on recording COVID-related experience is referenced within the ARCP section.

Training days

Regional training days

The training day due to take place in Exeter on 10th June is CANCELLED. As per the email sent on behalf of Richard Bamford on 21/05/20: “The regional training committee are currently looking at ways that these training days can be delivered virtually so that the impact to your training is as limited as possible.”

Bootcamp inductions

ST5/6 Bootcamp – POSTPONED. New dates are 3rd-4th June 2021

CT Bootcamp – 13th, 14th, 28th August 2020 TBC

ST3 Bootcamp – 8th, 9th, 16th October 2020 TBC

Pre-CCT Bootcamp – 9th, 10th February 2021

National trainee associations

              ASiT has an extensive COVID-related resource list on their website and has been running regular topical webinars. The Dukes’ club has a similar list with other resources specific to colorectal surgery and is in the early launch of their virtual education strategy. Please contact other trainee and subspecialty associations for further information. The national royal colleges including RCSEng and RCSEd have also been running regular webinars and have COVID resources sections on their website.

              The Association of Breast Surgery has regular webinars and you can register here for attendance.

Exams

The Joint Committee on Intercollegiate Examinations latest update from 13th May is here.

“While the JCIE had been hoping to stage Section 2 Examinations scheduled to take place from the beginning of September onwards, it has become increasingly apparent that this will not be possible in the face of the ongoing implications of the coronavirus pandemic. …. it was concluded that November 2020 was realistically the earliest that the JCIE should plan to resume examination activity but even then the likelihood is that there will need to be significant modifications to staging to allow for social distancing. This will impact on both Sections of JCIE examinations and will limit the number of candidates that can be accommodated.”

Section 1 Examinations

The timetable as currently published on the JCIE website from November 2020 remains in force. Capacity will be determined in due course.

Section 2 Examinations

These pose additional difficulties due to possible ongoing restrictions on gatherings and travel. Added to that COVID-19 has significant implications for the clinical component which is an integral part of all Section 2 Examinations bar one specialty. The JCIE therefore cannot plan to stage any of the 2020 Section 2 Examinations as originally advertised and has agreed with the four Royal College Presidents the following course of action:

  • ALL Section 2 Examinations that were previously advertised to take place in September, October and November 2020 have been CANCELLED.
  • The JCIE plans to replace these with revised Section 2 examinations at consolidated venues i.e. the examinations will not take place at the locations previously intimated. It is intended that examination formats remain the same, but necessity may dictate some changes to delivery. It is anticipated that these consolidated examinations will be held in November 2020.
  • Examination staging will be modified to allow for social distancing and the lack of access to hospital environments.
  • Contingency plans for remote delivery may be developed in the hope that these can be implemented if face-to-face examinations cannot proceed.

ARCPs

Those who had their ARCPs in May had them performed in absentia and will now have received their outcome letters. All those with an outcome 2 or 3 are offered a telephone or face-to-face conversation with your TPD or alternatively with your AES. It is anticipated that ARCPs in November will continue to run in this same format.

Those who had ARCPs in May will have just received an email from the deanery with an amended Form R part B with a section to self-declare how you have been affected by Covid-19. This will be used alongside the AES report in the future to determine how the Covid-19 pandemic has affected your training and whether a COVID-related outcome is appropriate (see below). This form does not yet seem to be available on the deanery website but is here on the HEE website.

The JCST statement on trainee progression dated 27th April is here. Information on the new COVID-related ARCP outcomes are here. The following is a brief summary of the new outcome 10:

  • Outcome 10 is a “no fault outcome” which recognises that a trainee has been achieving progress and the development of competences/capabilities at the expected rate but acknowledges that the acquisition of some capabilities has been delayed by the impact of COVID-19. The trainee should be awarded either an Outcome 10.1 or Outcome 10.2 depending on whether they are at a critical progression point in their programme.
  • Outcome 10.1 should be used when a trainee is not at a critical progression point in their programme and facilitates a trainee to progress to the next stage of their training.
  • Outcome 10.1 is also appropriate when a trainee is at a critical progression point in their programme where the relevant Medical Royal College or Faculty has amended the curriculum and mandated that the missing competences/capabilities can be acquired at the next stage of training. This includes progressing from ST6 to ST7 without having met all ST6 checklist competencies due to Covid-19 disruption. Trainees in this position who wish to proceed to sitting FRCS would need to have a conversation with their TPD about whether they are ready to do this as JCST advise that many trainees in this position would not be ready having not achieved all ST6 competencies.
  • Outcome 10.2 should be used when a trainee is at a critical progression point in their programme where there has been no derogation to normal curriculum progression requirements given by the relevant Medical Royal College or Faculty (e.g. specific professional examination; mandatory training course). Additional training time is therefore required before the trainee can progress to the next stage in their training.
  • 10.2 should be used when a trainee is at the critical progression point of approaching CCT as additional training will be required before the trainee can complete their training.

Additional to this the JCST released the following statement on surgery-specific management of ARCPs on 1st June. It includes some examples of when certain ARCP outcome codes may be used and also includes a new definition of the minimum evidence requirement for the trainee to present at ARCP when the Covid-19 pandemic has severely impacted on the trainees ability to present the usual “full” evidence. This includes reduced number of validated WBAs (though a suggested number or way of calculating a “pro rata” number is not specified), minimum of one Clinical Supervisor report (desirable number is 3+) and logbook up to date to March (desirable to be fully up to-date). The AES report can provide a holistic assessment and in some cases compensatory evidence where the usual minimum evidence (e.g. MSF) is absent.

A statement has been released about curriculum derogations. This mainly relates to alternative means of demonstrating competencies without specific courses e.g. management, ATLS, that are not currently running prior to CCT.

There is guidance from the JCST on how to record Covid-related experience on ISCP, including a link to ASiT’s Covid experience logbook. Recording this experience is optional.

New curriculum

The new curriculum has been approved by the GMC but will now not be implemented until August 2021. Trainees will start to move to the new curriculum at their first ARCP after this date. All those not in their final 2yrs of training will move to the new curriculum at this point, senior trainees will remain on the old curriculum or have an option to transfer, but these details will be finalised in due course.

Fellowships

National TIG fellowships will continue as planned. Due to the postponement of the FRCS exam if this impacts entry requirements for a TIG fellowship then as long as there is AES and TPD support they can continue as planned, with the provision of passing Section 2 during their fellowship year.

The JCST statement is available here.

Independent fellowships are likely to be affected because of global travel and worldwide healthcare implications. Liaise directly with your fellowship contacts and ensure travel advice is followed as per gov.uk.

Individual units within the UK may be currently able to accept fellows at varying times due to outgoing fellows so please contact your preferred unit to discuss. Any further information about this year’s recruitment will follow.

Pregnancy and Surgical trainees

Please contact your local trusts and line manager if you are pregnant to ensure that the necessary risk assessment is being made with regards to your pregnancy and working. RCOG guidelines (below) give advice about pregnancy and COVID exposure. The JCST have issued surgery-specific advice related to pregnancy (unrelated to Covid).

  • RCOG guidelines with specific advice to healthcare workers updated on the 13th May can be found here.  
  • JCST surgery-specific advice dated May 2020 for trainees and trainers here.

Trainee wellbeing

This is an important period within which to stay well both physically and from a mental wellbeing perspective. There are many local resources available.

As a group of trainees we would encourage you to be involved in the facebook group or if you have any queries or concerns a Q&A forum has been set up on the SWHST website which you can find here.

Every unit has a surgical tutor whose role involves trainee welfare – we would encourage you to make contact with them (if they haven’t done so already). If you’re not sure who your trust surgical tutor is – please get in contact with the trainee board via the SWHST website.

The South West also has the Professional and Support Wellbeing (PSW) team for help and support. Additional information and advice can be found on their website:

Peninsula deanery

Severn deanery

Or you can e-mail them directly at psw.sw@hee.nhs.uk

Peer-mentoring scheme

During the last few months of COVID-19 the changes to our normal practice and interaction with each other as trainees has been affected.  Many of us rely on local and regional training days as a way of catching up with each other, networking and having the opportunity to find out what is going on across the region as well as ad-hoc advice on training. It goes without saying that mentoring in surgery is supported by RCSEng and ASiT.

The Regional Training Committee is initially proposing a buddy and peer-mentorship programme to give us an opportunity to regain the valuable time we will miss out on while regional training is on hold but also provide support to those who are more junior or simply seeking a way of improving specific areas of our work and training.  Ultimately, the aim will be to enrol all new ST3 trainees into the programme to be supported by a more senior trainee within their hospital and while at the moment mentor training is not essential, if successful, training in the mentor process can then be introduced.

More information will follow for those who are looking to take part and your help in answering a few short questions on the most recent Survey Monkey will help us to tailor the programme to best fit what we need.  For more details please contact Hannah Wright (wright.hannah26@gmail.com).

Recovery of training

It is recognised by many that training has been difficult during this time and there will continue to be barriers to delivering training during the recovery phase, but that it is essential that training is recovered and trainees continue to progress. This RCSEng document on the recovery of surgical services includes the following about the recovery of training, other statements are due from some trainee and specialty associations in due course:

  • A robust plan should be in place to support the next generation of surgeons. Where possible, additional opportunities for training and for more surgical and clinical exposure should be identified.
  • Delivery of surgical training needs to be matched to the need for increased surgical activity and should be undertaken at all sites involving NHS patients (including independent sector settings).
  • In the recovery phase, decisions surrounding progression based on the modified ARCP process should be flexible to ensure individual trainees progress through the programme at an appropriate pace in line with the change to a competency based curriculum.
  • Earlier appointments to posts with mentoring supervision should be considered, alongside with earlier appointment to mentored consultant posts.
  • Opportunities for simulator training should be identified.
  • Training should also be made available on new ways of delivering healthcare, including virtual clinics.
  • Support the wider use of online resources (continue to increase availability to build on what has already been done well).

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