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Implementation note 8

Advice for ST6, ST7 and post-CCT doctors undertaking ATMSs and subspecialty training – Moving to the new curriculum 2019

Further to Implementation Note 3 ARCP Guidance, this Note provides detailed guidance for ST6, ST5 and post-CCT doctors undertaking advanced training in terms of their options for moving to the new core curriculum or remaining on the old core curriculum.

On 31 October 2019, the NES NHS ePortfolio for obstetrics and gynaecology will be ‘closed’ and the new ePortfolio will be in used for all doctors training in obstetrics and gynaecology. All information from the old ePortfolio will migrated over to the new ePortfolio in the form of a PDF file, and no data will be permanently erased or lost.

The 2019 curriculum like the previous one consists of a core curriculum (basic, intermediate and advanced skills), and advanced training in the form of ATSMs and subspecialty training. Advanced training is also undertaken by some doctors who have already achieved a CCT in obstetrics and gynaecology.

 

Pre-CCT doctors

Doctors who have already entered ST6 by 31 October 2019 must use the newly reformatted ATSMs or subspecialty curricula but have the option of:

  • moving to the new core curriculum (see Appendix 1 Training Matrix below – this will also be available on the website)

OR

  • staying on the 2013 (old) core curriculum and completing the 30 advanced competencies (see Appendix 2 Training Matrix – this will also be available on the website)

The newly reformatted ATSM and SST curricula have no new competencies added (indeed a few have been removed) but are now made up of a number of clinical capabilities in practice (CIPs) which follow the format of the core CIPs. It is expected that a doctor who has almost completed a pre-2019 curricula ATSM, or subspecialty training, will have accumulated sufficient evidence to mean that they will be in a very similar position with the new curriculum and its sign-off.

There is a much stronger focus on generic, non-technical, skills in the 2019 core curriculum. Indeed, 10 of the 14 core CIPs are ‘non-technical’. In light of this, the generic competency component of ATSM and subspecialty training has been removed because, going forward, most ATSM and subspecialty trainees will be pre-CCT and using the new core curriculum where their acquisition of advanced level generic non-technical skills will be assessed through these 10 core CIPs. They will be expected to show evidence of these generic competencies, specific to their chosen field of special interest, to meet the statements of expectation of an ST6-7, in these generic core CIPs.

Current ST6 and ST7 trainees choosing to transfer to the 2019 core curriculum (as well as moving onto the newly reformatted ATSM and SST curricula, which is mandatory by October 31st 2019) will be expected to provide evidence of the various generic skills in the 10 core non-technical CIPs, meeting the ‘statements of expectation’ for each of these CIPs at ST6-7 level, using evidence accumulated in their area of special interest (i.e. linked with their ATSMs/subspecialty training). They will be assessed using the new matrix.

However, for those current ST6 and 7 trainees choosing to remain on the 2013 core curriculum, but moving onto the 2019 ATSM/SST curricula (as all trainees MUST do by 31 October), their progress through their ATSMs/SST will be judged against the newly reformatted ATSM and SST curricula, which no longer contain these generic competency requirements. These trainees must accumulate evidence from their special area of interest which satisfies the 2018-2019 training matrix for ST6 and ST7. Specifically they will need evidence to support the following generic skills:

  1. Clinical governance (patient safety, audit, risk management and quality improvement). The trainee will be expected to complete at least one project per ATSM or per year in SST. This might be designing and implementing an audit or QI project, perhaps supervising one or more junior staff. The project will need to be presented and an impact demonstrable arising from this work. Other examples include writing or substantially revising a new clinical guideline and demonstrating how this new guidance is disseminated and embedded within a department/Trust or region, or leading a clinical risk review with subsequent dissemination of learning.
  2. Teaching experience. Evidence will be needed of formal teaching provided by the trainee at regional or higher level, with feedback and reflection. The trainee should be ready to be a clinical supervisor by the completion of ST7.
  3. Leadership and management experience. The trainee will need to have completed a leadership and management course.
  4. Presentations and publications. The trainee must be able to provide evidence that they have presented original audit or research work outside of the local department and that they have contributed at least to the writing of an article, book chapter or research paper.
  5. NOTSS.It is expected that trainees remaining on the 2013 curriculum will complete at least 1 NOTSS in each ATSM as evidence of training and assessment of the non-technical skills associated with each ATSM.

 

Trainees choosing to remain on the 2013 core curriculum will be judged at their ARCPs against the 2018-2019 training matrix. They must satisfy all the requirements of this matrix, including the minimum number of work place based assessments detailed on it, and the OSATs showing ongoing competency. They will need to complete the 30 advanced competencies (dark pink boxes on the old curriculum logbook) which will be available on the new ePortfolio as a single page.

Supervisors should follow the below steps once they have accessed the new Training ePortfolio:

  1. Click on the Profile icon in the top-right of the page:
    Implementation note 8 How-to image 1
  2. Under “Profile”, select “Additional forms”
  3. Under “Create supervisor forms”, select “Create Pre-2019 advanced competencies form”
  4. Under “Trainee name (autocomplete)”, begin typing the trainee’s name then select them
  5. Select the level next to the relevant competency/competencies as appropriate:
    Implementation note 8 How-to image 2
  6. Once completed, at the foot of the page, select “Submit” or, if you wish to come back to complete further competencies later, select “Save Draft”
  7. Draft forms can be accessed at a later point by repeating steps 1 and 2, clicking “View” next to the relevant entry, then “Edit”

 

Doctors undertaking ATSMs or subspecialty training who already have a CCT, or who are in non-training positions

There will always be a small number of doctors who undertake training in ATSMs following the acquisition of their CCT, or even outside of a formal training career (e.g. Trust doctors). This number may increase as credentialing becomes more common. These doctors will follow the newly reformatted 2019 curricula for the ATSMs and subspecialty training, and they too will be expected to accumulate evidence of generic competencies specific to their field of interest. However, they will not be using the core curriculum and these generic skills will not be evidenced through the core generic CIPs. Specifically therefore, they will need to provide evidence in the following domains;

  1. Clinical governance (patient safety, audit, risk management and quality improvement). The trainee will be expected to complete at least one project per ATSM or per year in SST. This might be designing and implementing an audit or QI project, perhaps supervising one or more junior staff. The project will need to be presented and an impact demonstrable arising from this work. Other examples include writing or substantially revising a new clinical guideline and demonstrating how this new guidance is disseminated and embedded within a department/Trust or region, or leading a clinical risk review with subsequent dissemination of learning.
  2. Teaching experience. Evidence will be needed of formal teaching provided by the trainee at regional or higher level, with feedback and reflection. The trainee should be ready to be a clinical supervisor by the completion of ST7.
  3. Leadership and management experience. The trainee will need to demonstrate evidence of these skills at senior level and reference is made to the ST6-7 ‘statements of expectation’ in the core curriculum of core CIPs 2,3, 5 and 14 for examples of how a trainee might evidence these non-technical skills.
  4. Presentations and Publications. The trainee must be able to provide evidence that they have presented original audit or research work outside of the local department and that they have contributed at least to the writing of an article, book chapter or research paper.

 

Appendix 1. Advanced Training Matrix for ST6/7 moving to 2019 Core Curriculum

Core Curriculum:

 

ST6 (or first year of SST training)

ST7 (second and subsequent years of SST training)

Curriculum progression

CiP progress appropriate to ST6 as per the CiP guides and matrix of entrustability levels.

CiP progress appropriate to ST7 as per the CiP guides and matrix of entrustability levels.

At least 3 summative OSATS confirming competence by more than one assessor
(can be achieved prior to the specified year)

 

Caesarean section (complex)
Laparoscopic management of ectopic pregnancy
Ovarian cystectomy
Surgical management of PPH
Surgical wound debridement

Mini-CEX
(expected to be undertaken in areas of Advanced Training)

 

 

CBD
(expected to be undertaken in areas of Advanced Training)

 

 

Reflective practice
(expected to be undertaken in areas of Advanced Training)

 

 

NOTSS
(expected to be undertaken in areas of Advanced Training)

TEF

 

Each training year

Each training year

TO2

 

2

2

Recommended courses

(once during Advanced Training)

Leadership and Management course

Leadership and Management course

 

Advanced Curriculum:

 

ST6 (or first year of SST training)

ST7 (second and subsequent years of SST training)

Curriculum progression

ATSM / SST CiP progress appropriate to first year of Advanced Training

ATSM / SST CiP progress appropriate to second and subsequent years of Advanced Training

At least 3 summative OSATS confirming competence by more than one assessor
(can be achieved prior to the specified year)

Fill in as appropriate for each ATSM / SST

Fill in as appropriate for each ATSM / SST

Recommended courses

(once during Advanced Training)

Fill in as appropriate for each ATSM / SST

Fill in as appropriate for each ATSM / SST

 

 

Appendix 2. Advanced Training Matrix for ST6/7 staying on 2013 Core Curriculum

Core Curriculum:

 

ST6 (or first year of SST training)

ST7 (second and subsequent years of SST training)

Curriculum progression

Completion of Advanced Competencies (dark pink boxes)

 

Completion of Advanced Competencies (dark pink boxes)

 

At least 3 summative OSATS confirming competence by more than one assessor
(can be achieved prior to the specified year)

 

Caesarean section (complex)
Laparoscopic management of ectopic pregnancy
Ovarian cystectomy

Mini-CEX
(expected to be undertaken in areas of Advanced Training)

8

 

8

 

CBD
(expected to be undertaken in areas of Advanced Training)

8

 

8

 

Reflective practice
(expected to be undertaken in areas of Advanced Training)

8

 

8

 

NOTSS*
(expected to be undertaken in areas of Advanced Training)

1

1

TEF

 

Each training year

Each training year

TO2

 

2

2

Recommended courses

(once during Advanced Training)

Leadership and Management course

Leadership and Management course

 

Advanced Curriculum:

 

ST6 (or first year of SST training)

ST7 (second and subsequent years of SST training)

Curriculum progression

ATSM / SST CiP progress appropriate to first year of Advanced Training

ATSM / SST CiP progress appropriate to second and subsequent year of Advanced Training

At least 3 summative OSATS confirming competence by more than one assessor
(can be achieved prior to the specified year)

Fill in as appropriate for each ATSM/ SST

Fill in as appropriate for each ATSM/ SST

Recommended courses

(once during Advanced Training)

Fill in as appropriate for each ATSM/ SST

Fill in as appropriate for each ATSM/ SST

Clinical governance (patient safety, audit, risk management and quality improvement)

One completed project per year appropriate to ATSM/ SST

One completed project per year appropriate to ATSM/ SST

Teaching experience

Evidence of formal teaching provided at regional or higher level, with feedback and reflection.

Evidence of formal teaching provided at regional or higher level, with feedback and reflection.
Evidence of ability to be a clinical supervisor

Leadership and management experience

Evidence of departmental responsibility and/or clinical administration and/or involvement in departmental meeting or forum

Evidence of departmental responsibility and/or clinical administration and/or involvement in departmental meeting or forum

Presentations and publications

Evidence of presenting original audit or research work outside local department
Contribution to the writing of an article, book chapter or research paper

Evidence of presenting original audit or research work outside local department
Contribution to the writing of an article, book chapter or research paper

 

*NOTSS: It is expected that trainees remaining on the 2013 curriculum will complete at least 1 NOTSS in each ATSM as evidence of training and assessment of the non technical skills associated with each ATSM