Trends in training progression: response to the study by Silkens et al

Recruitment and retention are of major concern to all in medicine. Improvement in recruitment to UK speciality training programmes does not directly translate into senior workforce capacity, which remains dependent on trainee progression. In 2021, Silkens et al undertook a mixed-methods study to investigate this and described a trainee-driven shift away from conventional training pathways and expectations. These findings suggest a need for a broad change in approach to careers, underpinned by commitment to reducing differential attainment, acknowledgment that trainees may have a range of unique needs, and development of a culture of equality, diversity and inclusion.

Specialty-Training Program During COVID-19 Pandemic: A Single Center Survey on over 300 Trainees and Trainers (Preprint)

BACKGROUND COVID-19 pandemic caused significant modifications such as limiting the number of residents in the clinics, cancelling elective surgical procedures, stopping face to face practical education, and transforming theoretical education into distance learning platforms resulted in alterations in the curriculum. OBJECTIVE We addressed to assess the situation of trainees’ education using an online questionnaire from the trainees’ and directors’ perspective during the pandemic. METHODS The survey platform SurveyMonkey® was used to distribute the survey and to collect responses. We generated a list of multiple-choice questions about how social distancing affected the delivery of medical education, potential compromise in core training and difficulties in conducting clinical research for the thesis. RESULTS A total of 364 trainees among 552 (65.9%) under training at our university hospital and 90% of the directors (37 of 41) responded the survey. Almost 78 percent of the trainees claimed that they have been negatively affected during the pandemic. Although majority of the trainees (60,3%) reported that extension of their education program is not necessary, most of the program directors were in tendency of extending the duration of the speciality training period. The participants predominantly considered that online training would keep on being a part of the training program after the pandemic. CONCLUSIONS Education programs are negatively affected during pandemics. However, authorities should manage this deficiency by a new perspective since present trainees are familiar to use technology-driven virtual sources for their education. After the pandemic, computer-assisted online learning and web-based programs should be integrated into educational curriculum. CLINICALTRIAL The study was approved from the institutional review board of Gazi University Ethics Committee (Approval Number: 2021-276).

Developing psychiatric resources for the new foundation programme curriculum

AimsOur aim was to develop an easily accessible, relevant and deliverable resource to meet the training requirements of the new foundation curriculum for Foundation Trainees in the West Midlands. The virtual resource needed to provide information at the correct knowledge depth, whilst also being flexible enough to allow trainees to access the materials despite the challenges of remote working. The West Midlands currently holds approximately 1,300 places for foundation training with an increase in numbers planned for 2023 and 2024.MethodThe United Kingdom Foundation Programme (FP) is a two-year structured, supervised training programme of learning in the workplace developed to prepare medical graduates for speciality training. The Foundation Curriculum is currently being updated in line with the GMC Standards for Post Graduate Curricula to reflect the developing and contemporaneous training needs of doctors and is expected to go live in August 2021.Though the foundation curriculum is broad and does not usually include specific diseases, it is recognised that mental health disorders are common and are frequently missed. The new curriculum makes a specific statement regarding the importance of mental health and specifies a syllabus covering this important area of medical practiceAround 80% of doctors are expected to have exposure to a community medicine placement, with around 40% expected to have placement within a specific mental health setting. Though other community placements may provide some exposure to the acute challenges of mental health, this is not guaranteed.To assist in meeting the FP requirement for training in mental health we developed an online resource for all West Midlands trainees, with lectures and information available that covers all of the core curriculum requirements for the FP. These resources can be accessed at any time of the day, at any point of foundation training, with each module certificated to show evidence of the attainment of foundation competencies ready for students ARCP (Annual Review of Competency Progression).ResultA programme of evaluation and effectiveness will be undertaken when the new curriculum goes live.ConclusionThere is an expected expansion in the number of training Foundation doctors within the next 5 years; therefore the demand for this training is expected to increase over time. As the understanding and awareness of the interaction between physical health and mental health continues to develop, we expected the use of this resource grow into the future.

Special Interest- what are trainees doing in the West Midlands?

AimsThe aim of this survey was to find out how Speciality trainees used their special interest sessions, using multiple choice and open questionsBackgroundThe ST (Speciality Training) curriculum recognises that it is desirable that all higher trainees gain additional experiences that may not be available in their clinical placement. Two sessions every week must be devoted during each year of Speciality training for such personal development, which includes research or to pursue special interests. Special interest sessions are defined as “a clinical or clinically related area of service which cannot be provided within the training post but which is of direct relevance to the prospective career pathway of the trainee”. This experience must be appropriately managed, supervised and assessed.MethodWe conducted a survey of Speciality trainees in the West Midlands region across all psychiatric specialities using an online survey. The survey was open for one month period in January 2021 and reminders were sent intermittently. Following survey closure, quantitative data were analysed using Google Forms and Excel. Qualitative data were collated and reviewed to identify relevant themes.Result47 of the total 82 Speciality trainees in all psychiatric specialities including dual trainees responded. Maximum response rate was from General adult/Dual trainees who form the bulk of Speciality trainees. Most trainees discussed their special interest with their supervisors and included this in learning plans. 79% were able to have a weekly session. Most sessions were devoted to gaining additional clinical experience, medical education, gaining leadership competencies and completion of further post graduate qualifications. The majority of trainees chose special interest sessions in their own trust, however 45% had difficulty getting released from their clinical commitments. Trainees demonstrated evidence in their portfolio by reflection, WPBA and reflective notes. Trainees were positive about their experiences and requested more support to access sessions locally.ConclusionThe Future Doctor report (HEE 2020) recognised that our Future Doctors must have a broad range of generalist skills to meet the population needs, therefore it is essential that doctors in training are supported by trainers and trusts to access special interest sessions to ensure that they achieve a broad range of competencies. To signpost trainees we have developed a booklet advertising available opportunities for ST trainees and other services may wish to consider this.

PERIPAPILLARY RETINAL NERVE FIBER ALTERATIONS IN HEART FAILURE WITH REDUCED EJECTION FRACTION

Objectives: To evaluate the effect of heart failure with reduced ejection fraction (HFrEF) on retinal nerve fiber layer (RNFL) thickness. Methodology: The study included patients who were being followed at Kartal Kosuyolu High Speciality Training and Research Hospital for HFrEF and were referred to the Eye Clinic of the Dr. Lütfi Kırdar Kartal Training and Research Hospital, Istanbul, Turkey between 2017-2019. Study participants were divided into two groups, one comprising HFrEF patients and a control group of patients without HF. Each patient underwent a routine ophthalmologic examination including best corrected visual acuity evaluation, intraocular pressure measurement, slit-lamp biomicroscopy and fundus examination. The RNFL of each patient was measured using spectral domain OCT. Results: A total of eyes of 37 HFrEF patients and 38 controls were evaluated. Superior RNFL thickness was 113.71±17.08 μm in the HFrEF group and 126.22 ± 13.68 μm in the control group (p=0.001). Inferior RNFL thickness was 117.88 ± 14.5 μm in the HFrEF group and 131.69 ± 12.93 μm in the control group (p<0.001). Average RNFL thickness in the HFrEF and control groups was 92.32 ± 10.22 μm and 103.31 ± 8.14 μm, respectively. There were significant differences between the study groups in all five parameters. Conclusion: In this study, RNLF thinning occurs in HFrEF compared to the control group that may be useful for demonstrate tissue perfusion deficiency in HFrEF.

Surveillance of Colorectal Cancer (CRC) in Cystic Fibrosis (CF) Patients

Cystic Fibrosis (CF) is the commonest inherited genetic disorder in Caucasians due to a mutation in the gene CFTR (Cystic Fibrosis Transmembrane Conductance Regulator), and it should be considered as an Inherited Colorectal Cancer (CRC) Syndrome. In the United States, physicians of CF Foundation established the “Developing Innovative Gastroenterology Speciality Training Program” to increase the research on CF in gastrointestinal and hepatobiliary diseases. The risk to develop a CRC is 5–10 times higher in CF patients than in the general population and even greater in CF patients receiving immunosuppressive therapy due to organ transplantation (30-fold increased risk relative to the general population). Colonoscopy should be considered the best screening for CRC in CF patients. The screening colonoscopy should be started at the age of 40 in CF patients and, if negative, a new colonoscopy should be performed every 5 years and every 3 years if adenomas are detected. For transplanted CF patients, the screening colonoscopy could be started at the age of 35, in transplanted patients at the age of 30 and, if before, at the age of 30. CF transplanted patients, between the age of 35 and 55, must repeat colonoscopy every 3 years. Our review draws attention towards the clinically relevant development of CRC in CF patients, and it may pave the way for further screenings and studies.

934 Remote one-to-one virtual surgical skills training: Evolving the delivery of operative skills training in the UK

Introduction COVID-19 has had an unprecedented effect on surgical training, including prerequisite entry-level courses to speciality training. We describe the implementation of a virtual, one-to-one training programme aimed at the acquisition and retention of operative skills. Methods Enrolment commenced 8th May 2020 for wound closure techniques or an extended programme including tendon repairs, delivered by Specialist Registrars in Plastic Surgery using Zoom® (v. 5.0.5) via mobile device. Participant feedback was collected retrospectively using a 5-point scale following course completion. Results 5 participants completed the wound closure programme, and 3 the extended programme, over an average of 5 weeks, with 2 sessions per week. 5 participants were male, 3 female and were of the following grades: 2 CT2, 4 FY2, 1 FY1 and 1 medical student. A total of 103.5 hours of training was recorded to 7 September 2020. Participants reported that all virtual skills taught were readily transferable to the theatre environment. Following the course, all participants felt confident to complete the skills learnt independently, rating the course as excellent. Conclusions The COVID-19 crisis has placed insurmountable obstacles in the face of surgical training. With further validation, we aim to develop surgical skills training with virtual, easily reproducible, cost-effective, trainee centred programmes.

1012 Surgical Trainee Satisfaction Variations with Seniority and Region: An Evaluation of General Medical Council National Training Survey

Aim The General Medical Council (GMC) National Training Survey invites all doctors in training and this study evaluates satisfaction in surgical training and variations with speciality, seniority, and training region. Method All survey results were obtained from the GMC website. Responses of trainees, ranging from foundation training to registrar, were collected and categorised by speciality, training stage and location. Results 9465 surgical trainees completed the study in 2019. The highest indicators were Educational Supervision (97.68), Clinical Supervision (87.42) and Clinical Supervision (out of hours) (87.28). The lowest were Workload (44.60), Rota Design (56.00) and Local Teaching (59.31). Highest and lowest ranking specialities were oral and maxillofacial surgery (84.25) and vascular surgery (73.95). Satisfaction varied significantly across training stages, with speciality trainees highest (82.58) overall and foundation year 1 lowest (70.03). London scored highest (77.95) and Northern Ireland, Scotland and Wales collectively scored 77.13. Within England, South England ranked highest in five specialities but only orthopaedics and neurosurgery showed significant national variations. Conclusions Our data show variations in training satisfaction across many training cohorts. Satisfaction increases with surgeon seniority. Trainers and educational boards should target interventions to improve the quality of training for all grades of trainees and ensure appropriate curriculum coverage and address specific concerns.