‘Assessment drives learning’ was a key message at the Faculty of Surgical Trainers’ conference ‘Who Makes the Cut? Assessment in Surgical Training’, held in Edinburgh on 22 October
The Surgical Trainers’ meeting was opened by RCSEd president Ian Ritchie, who introduced Professor John Norcini as the first keynote speaker of the well-attended event. Professor Norcini is president and CEO of the Foundation for Advancement of International Medical Education and Research and is one of the world’s leading experts in workplace-based assessment (WBA).
Formative assessment in postgraduate medical education is vital and depends on the quality of feedback given to the trainee, said Professor Norcini. He addressed the issue of whether national training programmes improve the quality of care; reassuringly, the evidence suggests that they do.
Chair of the Intercollegiate Surgical Curriculum Programme (ISCP) Professor Bill Allum discussed the state of trainee assessment in the UK, concentrating on data from the ISCP website. This provided an insight into the current usage of the ISCP and highlighted that, although engagement with the ISCP portfolio has increased over time, the quality of assessments and reports remains variable.
fst3The evidence behind WBA tools and how they have become more valid was picked up by Jonathan Beard, RCSEng professor of surgical education. Professor Beard highlighted the difference between formative and summative assessment, stressing that surgeons tend to see all assessment as a ‘test’, emphasising the need to improve the use of WBAs as assessments for learning rather than as a test of learning.
The trainee perspective was provided by Mr Steve Hornby, an ST8 in upper GI surgery and past-president of the Association of Surgeons in Training. Mr Hornby highlighted that WBAs are like any other tool; it doesn’t matter how good a tool is – if it is used incorrectly it won’t work, and he hoped to see better trainer engagement with the process.
Captain Gordon Graham, Royal Navy, enthralled and captivated the audience with a high-tech presentation on training in the military. He drew many parallels with training in surgery and put forward several interesting concepts that could be applied to surgical training and, in particular, how trainers are selected and trained. In the Navy, an officer’s aptitude for being a trainer is assessed from the moment they enter the service and those with skills in this area are selected and trained as trainers from the start. As a trainer himself, Captain Graham also said he could expect at any point that “someone with a clipboard” could turn up to any of his training events and assess his performance as a trainer. Both these points certainly gave the audience pause for thought when compared with our current system of selecting and assessing surgical trainers.
fst2Our primary care colleagues have had a rigorous system in place for many years when it comes to selecting and assessing medical trainers. Professor Moya Kelly, director of postgraduate general practice education, gave an insight into this system and how it helps maintain the quality of GP education and training. Although the system of trainer selection in general practice could be seen as onerous and being a GP trainer involves a significant workload, Professor Kelly pointed out that this was not seen as a barrier to GPs wishing to train – an important point to remember as surgeons move towards a system of trainer recognition and approval by the GMC.
The meeting moved back into the surgical domain with an examination of what impending GMC trainer recognition and approval might mean for surgical trainers. Mr David Pitts, senior education adviser to RCSEd, illustrated what the process of assessing a surgical trainer could look like and previewed the FST’s Standards for Surgical Trainers.
The differences between the primary care system and surgical training were highlighted by consultant colorectal surgeon Mr Humphrey Scott, who concluded with a plea for a system where all trainers are adequately trained and assessed to ensure that they can be properly accredited and rewarded.
The second keynote lecture came from Harvard’s Dr Steven Yule, who explained that surgeons are gaining increasing awareness of the importance of non-technical skills in ensuring good outcomes, but that they are rarely formally taught or assessed in the UK.
At Boston’s Brigham and Women’s Hospital, Dr Yule and his team have embedded non-technical skills training and assessment into the surgical curriculum. His key message that we are most likely to underperform as surgeons in areas in which we do not formally train or assess was a powerful argument for more explicit incorporation of non-technical skills training and assessment into UK surgical curricula.
Congratulations to Vairavan Narayanan, winner of the oral presentation prize, for his presentation ‘Standardised operative skills assessment with custom printed 3D models’ and to Aphrodite Lacovidou, who took the best poster prize for ‘A novel tonsillectomy simulator: using silicone to train future surgeons’.
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