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Speciality training in paediatric anaesthesia: an update

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Higher Training In Paediatric Anaesthesia. Objectives ... To be able to manage hazards and complications of paediatric anaesthesia ... – PowerPoint PPT presentation

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Title: Speciality training in paediatric anaesthesia: an update


1
Speciality training in paediatric anaesthesia
an update
  • Thames PAG 15th May 2008
  • Nargis Ahmad

2
The changing picture
  • Modernising Medical Careers
  • Implications for training in anaesthesia
  • StR training in paediatric anaesthesia
  • Competence revolution in post graduate medical
    education

3
The way we were
1993 - Hospital DoctorsTraining for the Future
EU legislation on specialist medical training
4
MMC
  • 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.

5
Influences 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

6
Postgraduate 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.

7
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8
17th March 2007
9
MTAS 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".

10
Response 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

11
The 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

12
So where are we now?
  • 2 years core training
  • Uncoupled
  • Recruitment
  • Staged
  • Managed by PG deaneries

13
New 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.

14
New Curricula
15
Training the trainers 2010
16
Generic 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

17
Paediatric 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

19
Higher 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

20
Higher Training In Paediatric Anaesthesia
  • Skills to acquire
  • Skills to enhance
  • Training in child protection

21
Advanced Training In Paediatric Anaesthesia
  • Training objectives
  • Indicative clinical experience
  • Professional qualities
  • Skills
  • Minimum case load
  • Training environment
  • Child protection

22
Advanced 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

23
Advanced 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

24
Advanced 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

25
Generic professional skills
  • attitude and behaviour
  • communication
  • presentation
  • audit
  • teaching
  • ethics and law
  • management

26
Clinical 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

27
DOPS
6 EVERY 6 MONTHS
28
Mini-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

29
Mini CEX
30
Case-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

31
Case Based Discussion
2 EVERY 6 MONTHS
32
Case Based Discussion
33
Multi-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)

34
Climbing the pyramid
Does
Shows how
Knows how
Knows
Miller GE. The assessment of clinical
skills/competence/performance. Academic Medicine
(Supplement) 1990 65 S63-S7.
35
Climbing the pyramid
Does
Shows how
Knows how
Knows
Miller GE. The assessment of clinical
skills/competence/performance. Academic Medicine
(Supplement) 1990 65 S63-S7.
36
Managed Integrated Learning
LEARNING
ASSESSMENT Reliable Valid
CURRICULUM define learning objectives
APPRAISAL MENTORING
STANDARD SETTING RECORDING portfolio
37
Challenges
  • 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

38
The 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
39
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40
say nothing and try look like you know what
you are doing?
41
  • ..to be continued
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