Annual Meeting 2016

Training by Numbers: Competency vs Time in Surgical Training

The Royal College of Surgeons of Edinburgh, Nicolson Street, Edinburgh, 21 October 2016

The conference examined competency-based training in surgery, exploring concepts through state-of-the-art presentations from the world’s leading experts in surgical education and training, and through discussion and Q&A sessions from the audience. It featured a series of practical breakout workshops with topics such as simulation-based training, how to give effective feedback and getting the most from the ISCP.

Conference Review

This Faculty of Surgical Trainers conference explored national and international research into competency based training, focusing on assessment not assumption of capability

Tensions between training and service provision and lack of funding and time support were on the agenda at the fifth annual Faculty of Surgical Trainers (FST) conference, where an international group of surgeons and healthcare professionals shared knowledge on the metrics used and progression pathways available in a competency based training model. The theme, expanding on a lecture given by Professor Richard Reznick at the FST’s inaugural conference on training orthopaedic trainees in Canada using a skills demonstrated rather than time-based model, looked at the progress made since Professor Reznick’s lecture in 2012 and future applications of this system.

Keynote speaker Professor Mary Klingensmith, president of the Association for Surgical Education, shared the new pathways trainers were developing in the USA after the American Board of Surgery unified their commitment to moving towards this training method in 2015. She tackled issues of having two separate bodies that set certification standards and another that oversees the training process and difficulties incentivising additional faculty training without funding, relying on surgeons’ becoming trainers for opportunities for broadening their knowledge and the challenging yet rewarding experiences.

Attendees discussed current issues affecting workplace based assessment including lack of standards, differences between assessor marking metrics and unreliable outcomes due to the inability to reproduce results. The psychology behind marking strategies was also taken into account, with examples of trainers marking trainees well for hard work rather than on their suitability for unsupervised practice.

The originator of Entrustable Professional Activities (EPAs) tools to measure trainee competence Professor Olle ten Cate discussed his assessment system which has successfully been implemented in residencies around the world. During his speech, he outlined a seven item EPA framework which included limitations, required experience and expiration date to incorporate revalidation and skills maintenance. As the Netherlands are leading in EPA training, their experiences and knowledge are being shared globally with the American Board of Surgery meeting Dutch experts in 2017.

Professor Ian Curran tackled the regulators view of competency based training while Mr Craig McIlhenny, Surgical Director of the FST, chaired a panel discussion on whether the UK was ready for this training method. He said: ‘If we are to move to a competency based system we will need robust training programmes, with good metrics and clear way points for progression.’

Professor Nick Sevdalis, who has been investigating team-based care delivery by studying skills and ways to improve them in perioperative settings through simulation based training and debriefing techniques, delivered a lecture on evaluating training interventions. His talk was built on the gaps between research findings being implemented into routine practice, with the average duration being 17 years and how research can be a form of advocacy for patients.

Workshops included a tour of ISCP version 10; improving feedback in ISCP which was run by Gareth Griffiths and Maria Bussey; giving better feedback; and with the advancement of virtual reality technology, an introduction to simulation based education.

The session was closed with awards given for best oral and poster presentations. Lauren Wells won the Medtronic Prize for Best Oral Presentation for her talk on factors influencing the effectiveness of the operating theatre as a learning environment in a medical student population, while Carnjini Yogeswaran won the Ethicon Prize for Best Poster Presentation for their poster – A Stepwise Approach to Urology Training of an International Surgical Training Programme (ISTP) Trainee in a District General Hospital.

Next year’s conference will be held on 4 October 2017 in Birmingham. This is open to all with an interest in surgical training.