Head of School Newsletter January 2017

Trainee News 

Apologies for the lateness of this newsletter, but it has a busy few months since August and I have lacked the normal administrative support to keep me in check! The Severn School of O&G extends a warm, belated welcome to the 10 ST1 trainees who started in August 2016 (and 1 to commence in February 2017). The interviews were highly competitive, as Severn has one of the highest application/place ratios in the UK. We are therefore confident we have recruited 11 of the best trainees in the country.

At the other end of the training programme, 10 trainees have gained their CCT in 2016. Of these, 8 have already secured substantive or locum consultant posts, others want to gain post CCT experience in special interests such as paediatric & adolescent gynaecology, and labour ward management.

It has been yet another good year for Severn in the 2016 GMC Trainee survey. Your scores meant that the South West (Severn and Peninsula are a single LETB), came 2nd in the UK for trainee satisfaction. We are immensely proud of this result, as this is an indication that you, as trainees, are generally happy with your training programme.

Congratulations to the trainees who passed part 1, part 2 and part 3 MRCOG this year. There are also trainees to be congratulated for achieving a PhD, MDs, PGCME, research presentation awards, grants and fellowships.

New TPD Education
Rebecca Swingler, Consultant Obstetrician and Gynaecologist, Gloucester has been appointed as Training Programme Director (TPD) for Education. This TPD role is in addition to Mark Denbow’s role as TPD for Operations (organising the training programme, recruitment, quality and assessment etc). Amongst other things, Rebecca will be responsible for overseeing the Regional Teaching Programme and is also the ATSM Director, responsible for the ATSM programme.

New Workplace Behaviour Champion
Rachna Bahl has been promoted to National RCOG Advisor on Workplace Behaviours. We have appointed Christina Edwards, Consultant Obstetrician and Gynaecologist in Gloucester, to the post of Severn Workplace Behaviour Champion. We asked the trainees’ committee to nominate their preferred choice of consultants for this role and then selected Christine from her personal supporting statement. Christine has vast global experience and understanding of workplace behavior and is an excellent choice as your Champion.

I’m sure you will join me in thanking Rachna for all her hard work and in particular her strive to promote zero tolerance to unacceptable behaviours in the workplace.

ARCPs 2016
The ARCP panels were as ever, impressed by the ability of the vast majority of Severn trainees to attain the RCOG Matrix requirements and then to exceed these requirements, both clinically and academically. Severn O&G has one of the highest outcome 1 rates, which is an indication of the caliber of our trainees and the training programme our Trusts provide.

The panel enjoyed seeing the majority of our trainees. Many LETBs only see trainees with outcome 2s and 3s for face-to-face meetings, but in Severn, we find it beneficial to get to know you, to hear what you have to say about your training and your plans for the future. We believe you, as trainees, also benefit from discussion with the panel. We will therefore continue to offer everyone face-to-face ARCPs (otherwise there would be no-one to see!).

Regional Teaching
Last year’s programme of regional teaching through SWOT (trainee specific) and SWAT (advanced level training) days was impressively generous and varied, despite the inevitable cancellations due to the strike action. The RCOG StratOG programme maps the curriculum, covering the basics, allowing Severn regional teaching to have a more interesting, high quality, motivating and highly educational agenda, which has the fluidity to adapt to current topics and fulfill the professional needs of the trainees.

With the reduction in the Deanery administration support, the organisation of these days has become more challenging. An electronic booking and payment system was introduced last year. This has been successful and trainees are slowly getting used to it. May we remind all trainees that they do need to book in advance! The bookings will be closed 1 week prior to the SWOT day to allow the organisers to book catering etc. It is not possible to just turn up on the day!
A new system has been introduced to obtain feedback from each trainee (unfortunately last year this unable to be collected). Just to remind you, the system is:

On-line registration and payment = Feedback form issued and completed = Certificate of attendance Issued

The converse is also true, therefore no registration or no feedback, means no certificate of attendance!

Other schools “top-slice” the trainees’ study leave budget to fund regional training. We have elected not to do this, as we believe it is unfair to the more senior trainees for whom SWOT days may be less relevant. The majority of SWOT days are capped at £20. ST1-4 trainees are required to attend 5 SWOT days per year and ST5s, 5 SWOT/SWAT days. This costs about £100 of your study leave budget, which is considerably less than other schools top-slice and from the quality of the SWOT days, represents very good value for money.

In fact the quality of the SWOT days is so good that we have had requests from consultants that they should be able to attend! Whilst this is highly complimentary, the SWOT days are specifically trainee centered and limited in capacity, and we would not wish to detract from this. The SWAT days however fulfill the needs of both more senior trainees/ consultant CPD and full participation is encouraged.

It has been increasingly difficult to recruit trainees to take on SWOT day organisation. The School Board asked the Trainees’ Committee to consider a proposal that the RCOG Matrix “Teaching” requirement should be to help organise one SWOT day in the whole of ST 3 to 5, and to organise one SWOT day in the whole of ST6-7. The committee members were divided on this proposal and deferred consideration to the AGM in March 2017. This means that the requirements, as set out in the RCOG Matrix, stand for this training year (2016-17). ST 5 & 6 are required to contribute to regional training each year. This can be by teaching, facilitating or helping to organise a SWOT or SWAT day, or other aspect of regional training each year.

The teaching programme in Severn has always been trainee-run. This year (Aug 2016-17), it is in the very capable hands of Marie O’Sullivan. Rebecca Swingler, as TPD Education will now be overseeing the Severn programme.

Training Matrix changes 2016-17
Thankfully there is only a single RCOG change this academic year. The following will affect ST1s:

  • All trainees entering ST1 from August 2016 must undertake 1 assessment in laraposcopic simulation via (Formative) OSAT before entering ST3. Ideally this should be achieved in ST1

    The school has ordered box trainers to be available to every unit in order that trainees can achieve this matrix requirement. The Simulation team are also making plans to roll out lap sim teaching to all ST1-2s

We have also amended the Severn Matrix (which qualifies the RCOG matrix when necessary for local amendments) to include:

  • For all trainees entering ST6 from August 2016:

    By the end of ST7, trainees should have undertaken not just Clinical Supervisor Training, but Educational Supervisor Training as well.

    This is so that by CCT our trainees will be, not just trained Clinical Supervisors, but also trained Educational Supervisors. As most of our trainees secure consultant posts in region, this will confer an advantage to the training programme. Educational Supervisor training consists of Clinical Supervisor training plus an extra ½ day training on “Supporting Trainees” and online modules for “Equality and Diversity Training” and “Interviewing”, so this is nor arduous.

  • Curriculum Logbook signoffs have prompted debate within the school and at the RCOG. The RCOG have delegated to the individual schools to decide who should sign the logbooks. Whilst all of us think it is reasonable for more senior trainees to supervise less senior trainees, we had not been prepared, as was revealed at the ARCPS, for some ST1s and 2s to have all of their logbook basic competencies signed off by another trainee, who may not have achieved level 3 competencies themselves!

    The curriculum logbook is a document required by the GMC to prove that an obstetrician and gynaecologist has reached the level of competency required to be on the specialist register. There is also the issue of training in clinical supervision.

    The RCOG guidance is that trainees who hold MRCOG are level 2 Educators and capable of supervision of ST 1-2 trainees for basic logbook competencies.

    However to ensure quality of supervision for the GMC, we can only accept logbook signoffs from post-MRCOG trainee supervisors in conjunction with a countersignature from a clinical supervisor, or the educational supervisor responsible for the ST1-2 trainee.

    Signatures can be obtained (without the need for Educational Supervisor countersignatures), from all consultants (including locum consultants, associate specialists and staff grades, who have clinical supervisor accreditation).

    The Educational Supervisor will be responsible for checking these signatures prior to signing off modules.

    For OSATs there is clear guidance in the footnotes of the RCOG Matrix. A consultant must undertake at least one of the 3 summative OSATS required for demonstrating acquisition of competency, and for all of the single confirming continuing competency OSATS.

Quality Panel Review 2016
This important review of your training programme took place on 7th November. Trainee volunteers represented each trust and presented the Deanery Matrix, Trainee Evaluation Form and GMC survey results to the rest of the panel. This data was supplemented by data from ARCPs, Educational Supervision training and contribution to Regional Teaching. Each Trust was graded on Training, Education and Working Environment. A summary report has been published and sent to you all. Whilst this was mostly complimentary and positive, Trusts are expected to respond, with an action plan to any negative issues.

Trainee Awards
We invited applications for the National Trainee awards 2016. This was an initiative set up by the National Trainees Committee with the purpose of recognising excellence. The applications (based on the previous years’ achievements), were scored by the College Tutors and the regional applicant for each group, was selected and put forward for the national awards:

ST1-2 Neil Ryan
ST3-5 Jess Preshaw
ST6-7 Mel Griffin

Unfortunately, it has been announced that the RCOG will not go ahead with the national awards this year, due to lack of national trainee participation. The RCOG will send certificates for regional recognition.

Time Spent Out of Programme (OOP)
The current demand for OOP is unprecedented. As a School, we firmly believe that OOP is beneficial to our trainees for many reasons; for their career prospects, their personal development and sometimes in building their confidence. Many of our trainees in Severn undertake OOPR or OOPE to gain a qualification to further their career. As a consequence most of our trainees to date have had little or no difficulty in securing consultant posts, most of them in the local area.

The downside of OOP is that it leaves a gap on the training programme. We currently have 16 ST3-7 trainees on OOP (28%) and 14 on maternity leave, which leaves 10 gaps in ST3-7 posts around the region. In February the situation is predicted to be significantly worse with 12 gaps at ST3-7 level. There is concern that these gaps might affect the quality of training for the remaining trainees and can impact on patient safety.

I have had a discussion with the Associate Dean, Geoff Wright, who advises no more than 25% of trainees in post can take OOP at any one time.
With this in mind, Geoff and I have issued a statement on OOP, including an order of precedence for granting OOP and the timescale that needs to be adhered to. You have all received details of this.

Academic Training
There are currently 7 trainees engaged in academic training in Severn, 5 at ACF (Academic Clinical Fellow) level and 2 at ACL (Academic Clinical Lecturer) level. The academic team at NBT, led by Professor Draycott have worked tirelessly to enable the creation and supervision of these posts. The School continues to support the academic programme and another (replacement) ACF trainee has been recruited to commence in August 2016. ACFs spend 25% of their time academically and 75% clinically. They are still expected to achieve their RCOG matrix year specific requirements within the shortened clinical time period.

Simulation Training
Simulation training is growing in importance and over the past 2 years has been added as an RCOG matrix requirement. As usual, Severn is paving the way! Dimitrios Siassakos (NBT) is leading an initiative to evaluate the benefits of Robust. He and his team will be inviting the ST2s for Robust training (ST2 matrix requirement). Meanwhile Mark James (Gloucester) and Christy Burden (ACL NBT) will be leading on training in laparoscopic simulation (ST1 matrix requirement). Whilst this is offered via expensive national courses, our aim as a school, is to offer you this mandatory training at a minimal expense to your study leave budget. As part of the implementation of laparoscopic simulation training, a box trainer will be purchased for each unit. It is hoped that ST3-7 trainees will make use of this, for higher level simulation and for development of simulation teaching skills.

Social Media
Every year there are issues with social media. It’s easy to get carried away, but please be aware of professional and social boundaries (and don’t mix the two!), that the nature of posted comments may be interpreted differently to how you intended and potentially cause distress, and that any posted comments are subject to the same laws of defamation as verbal, or written communications.

Deanery Administrative Support
Unfortunately we are still without a Specialty Support Manager. The Deanery are in the process of recruitment, but until then Caroline Stitfall and Jess George are helping with any administrative tasks.

We are about to embark on national recruitment in order to secure our Severn trainees. This will take place in a football stadium in Manchester!

Gloucester are advertising for a subspecialist Training Post in Gynaecology Oncology, so any interested trainees should watch out for this.

There is a varied and exciting programme of regional training developing for 2017, so keep looking at the website for details. The details of the laparoscopic simulation training and PROMPT courses will be posted.

ARCPs will take place in the Summer on 12th and 29th June and 5th July. The academic ARCP date is yet to be arranged. You will be contacted with your date in the next couple of months, and “yes”, you do have to have an ARCP every year!

Finally- I know that you are under the shadow of the new contract and things seem a bit glum at present, but please remember that we have a great training programme, with numerous opportunities, delivered by good training centres Our trainees are generally successful in their choice of consultant posts and end up working alongside good colleagues. So have hope!

With kind regards

Jo Trinder