Title: Speciality training in paediatric anaesthesia: an update
1Speciality training in paediatric anaesthesia
an update
- Thames PAG 15th May 2008
- Nargis Ahmad
2The changing picture
- Modernising Medical Careers
- Implications for training in anaesthesia
- StR training in paediatric anaesthesia
- Competence revolution in post graduate medical
education
3The way we were
1993 - Hospital DoctorsTraining for the Future
EU legislation on specialist medical training
4MMC
- 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.
5Influences on training reform
- NHS PLAN
- Need fully trained doctors
- UK self sufficient
- EWTD
- DH removed ring fence around training budgets
2006 - PMETB
- with the introduction of competence-based,
assessed, PMETB-approved curricula, explicit
standards will underpin the new programmes
6Postgraduate Medical Education And Training Board
(PMETB)
- PMETB is the independent regulatory body.
-
- Established by statute in 2003 took over the
responsibilities of the STA - is accountable to Parliament
- acts independently of government as the UK
competent authority - Unlike the STA, PMETB is independent of the Royal
Colleges. PMETB commissions services from the
Royal Medical Colleges.
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817th March 2007
9MTAS 2007
- 24 April - Sir John Tooke asked to lead
independent inquiry into implementation of MMC
and MTAS. - 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".
10Response to the Tooke Review
- Stakeholders in PG medicine
- agreement
- DH
- Formal response published Feb 2008
- 24/47 accepted
- 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
11The Health Committee Report on MMC 8 May 2008
- 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
12So where are we now?
- 2 years core training
- Uncoupled
- Recruitment
- Staged
- Managed by PG deaneries
13New Curricula
- Developed by the medical Royal Colleges and
approved by PMETB - PMETB with the medical Royal Colleges, faculties
and the speciality associations curricula for
all 57 medical specialties, plus 30
sub-specialties. - Common standards, clarity and transparency to
training promoting the continuous development
of doctors skills in order to meet patient need.
14New Curricula
15Training the trainers 2010
16Generic 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 - Management of Education and Training
- Educational resources and capacity
- Outcomes
17Paediatric Anaesthesia Intermediate Level ST3
And ST4
- KEY UNIT OF TRAINING
- 1-3 months
- Competencies relate to knowledge more than to
skills - Child protection
18 Paediatric Anaesthesia Higher And Advanced
Level(ST Years 5, 6 And 7)
- Preparation for independent professional practice
in their consultant post of choice - Higher training for those pursuing a generalist
career - Advanced training to become an expert in a
special interest area -.at least 6 months up to
a year
19Higher Training In Paediatric Anaesthesia
Objectives
- To develop competence in meeting the anaesthetic
needs of infants and children for common surgical
conditions - To be able to organise and manage safely a list
of paediatric cases, with consultant supervision
for neonates and infants under 1 year - To be able to manage hazards and complications of
paediatric anaesthesia - To be able to resuscitate and stabilise a sick
child for transfer
20Higher Training In Paediatric Anaesthesia
- Skills to acquire
- Skills to enhance
- Training in child protection
21Advanced Training In Paediatric Anaesthesia
- Training objectives
- Indicative clinical experience
- Professional qualities
- Skills
- Minimum case load
- Training environment
- Child protection
22Advanced Training In Paediatric Anaesthesia
Training Objectives
- FT either in a specialist paediatric hospital or
a tertiary referral centre, or lead consultant
for paediatric anaesthesia in a district general
hospital - 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 - 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
23Advanced Training In Paediatric Anaesthesia
Training Objectives
- To become skilled in communicating with children,
parents and other carers throughout the surgical
episode, and also become an effective
communicator within the multi-disciplinary
paediatric team - To understand the legality of consent in
children, in relation to research, restraint and
procedures - To acquire leadership skills when managing both
elective and emergency paediatric cases and also
when supervising more junior trainees
24Advanced Training In Paediatric Anaesthesia
Indicative Clinical Experience
- Enhance basic and higher training
- Minimum 6 months
- Experience in full range of paediatric spectrum
- Direct supervision in first 3 months
- Experience as lead clinician elective
emergency - 1-2 months PICU
- Acute pain
- Specialist interest areas
- Wider aspect of paediatric care
25Generic professional skills
- attitude and behaviour
- communication
- presentation
- audit
- teaching
- ethics and law
- management
26Clinical Assessment Tools
- ..the RCoA 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
27DOPS
6 EVERY 6 MONTHS
28Mini-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
29Mini CEX
30Case-based Discussion (CbD)
-
- Designed to evaluate decision making,
interpretation and application of evidence by
reviewing a record of anaesthetic practice -
- It is intended to assess the clinical
decision-making process and the way in which the
trainee used medical knowledge when managing a
single case -
-
31Case Based Discussion
2 EVERY 6 MONTHS
32Case Based Discussion
33Multi-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)
34Climbing the pyramid
Does
Shows how
Knows how
Knows
Miller GE. The assessment of clinical
skills/competence/performance. Academic Medicine
(Supplement) 1990 65 S63-S7.
35Climbing the pyramid
Does
Shows how
Knows how
Knows
Miller GE. The assessment of clinical
skills/competence/performance. Academic Medicine
(Supplement) 1990 65 S63-S7.
36Managed Integrated Learning
LEARNING
ASSESSMENT Reliable Valid
CURRICULUM define learning objectives
APPRAISAL MENTORING
STANDARD SETTING RECORDING portfolio
37Challenges
- 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 cant
measure - The trainee in difficulty
- Trainees work with each individual consultant
infrequently - EWTD
- Time needed to perform assessment
38The Northern Ireland Experience
- Pilot Aug 2005
- Each 3/12
- 2 DOPS
- 1 Anaes-CEX
- 1 CBD
- MSF end year 1
- DOPS 25mins (10-85)
- Anaes CEX 38mins (10-100)
- CBD 38 mins (20-75mins)
-
In our experience the new assessment tools are
better at identifying weaker trainees than
rewarding and motivating those who are excellent
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40say nothing and try look like you know what
you are doing?
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