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surgiCAl trAining pAthwAy
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urgical training in Ireland enjoys a global
reputation that is based upon a proud tradition of
producing generations of leaders in surgery around
the world as well as a reputation for innovative
approaches to structured training. In 2011, the
programme for training surgeons in Ireland was
externally endorsed and commended on several levels by the Irish
Medical Council. Constant challenge and review are necessary to
sustain this reputation for excellence. In a world that is changing
rapidly, several perceptions need to inform any revised training
pathway:
surgical training in Ireland takes too long;
surgery is not attracting the numbers of trainees that it once was;
the attrition rate (from the Basic Surgical Training Programme) is
unacceptably high; and,
the crisis in surgical service delivery is negatively impacting
training.
Since 2010 the Department of Surgical Affairs at RCSI has engaged
formally and informally with Fellows, Specialties and trainees on
these issues. In late 2011, RCSI's Committee for Surgical Affairs
(CSA) requested the Department of Surgical Affairs to formally
review these issues and bring forward recommendations.
a comPlex challenge
The training of a surgeon is a complex process requiring the
acquisition of knowledge, skills and behaviours involving both
clinical(hospital)-based settings as well as structured learning
and assessment interventions here at RCSI. The process is further
complicated by the complex relationship between training and service
delivery.
This mutual dependency needs careful management in order to meet
critical training requirements as well as supporting a clinical service
delivery model which must underpin training. RCSI is co-operating
with both MET and other postgraduate training bodies in developing
solutions to the service delivery challenge. The key dimensions within
the scope of the new pathway include:
trainee selection;
content and duration of training;
trainee numbers, assessment and progression;
quality assurance; and,
trainee engagement, communication and support.
a way forwarD
RCSI has a primary responsibility to optimise the delivery of training
in surgery. The College's priority is the safeguarding of a high quality,
fit-for-purpose surgical training programme. RCSI will continue
to work through the Clinical Programmes to develop solutions
that address the complex issues in the delivery of surgical services.
Surgical training will always be dependent upon service but it cannot
be subservient to it.
In March of this year, RCSI's Council gave permission to proceed
with a fundamental revision of the structure, content and duration of
surgical training in Ireland. The proposed changes are, in the opinion
of the College, both radical and necessary. They do carry risk but
have support and commitment from RCSI, the ISPTC and across the
surgical specialties. The planning of these changes has also benefitted
from input from the office of HSE MET and the Medical Council.
The major changes anticipated under the new RCSI surgical training
pathway include:
the current `basic' programme will be shortened to two years from
the current three years;
the training pathway will change from three years `basic' training
and six years `higher' training to a continuous 8 years of training,
structured as "Surgical Training 1" (ST1) through ST8;
the so-called `gap years' between the `basic' and `higher' training
years will be eliminated;
progression from ST1 through ST8 will remain competitive and be
based on robust assessment of performance.
this new `core' programme will be modelled around a re-focused
year one and year three of the current programme;
the intake to `core' will be reduced to a number that reflects system
training capacity as well as anticipated higher training places; and,
the current `BST selection' process will be replaced by a
surgical training selection process for a `flow-through' training
programme, the first year of which is a `common stem'.
strategic resPonse
RCSI has a long and proud history of innovative training programmes
that produce high quality surgeons capable of delivering excellent
patient care not just in Ireland, but around the world. There is
currently a convergence of separate but powerful change drivers, all of
which will have a fundamental impact on training.
Such landscape changes require a strategic response to ensure the
totality of the training journey is delivering against the needs of a
changing service and is attracting and retaining the very best medical
graduates.
time for change
the surgical training Journey
eunan friel, mAnAging direCtor surgiCAl AffAirs, rCsi on ChAnges to the surgiCAl
trAining pAthwAy
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