Final II

Final II Stage Overview

Final II Stage Overview

The final stages of vascular surgical training include four indicative years from ST5 to ST8 and should involve exposure to the full range of vascular surgical and endovascular elective and emergency procedures, along with training in vascular medicine and vascular ultrasound. Trainees should rotate to different vascular units at one year intervals and work with different consultants for 6 months each during each year. ST7 and ST8 trainees should have the opportunity to work in major specialist vascular units and may develop their own special interest within vascular surgery during this time. The Intercollegiate examination in vascular surgery will be taken after ST6 and is an essential prerequisite for CCT.

Academic trainees will be expected to gain the same competencies as non-academic trainees and will be subject to extension of indicative years by ARCP panels if the panels decide that their research commitment has detracted from their clinical training.

Standards for depth of knowledge during specialist vascular surgical training

The appropriate depth and level of knowledge required can be found in exemplar texts and courses listed below. We expect trainees to have mastery at the depth within the texts and courses and to be able to make use of that knowledge in the context of surgical practice defined in the intermediate and final years syllabus.

The curriculum requires a professional approach from surgical trainees who will be expected to have a deep understanding of the subjects, to the minimum standard laid out in the vascular syllabus. It is expected that trainees will read beyond the texts and to make critical use, where appropriate, of original literature and peer scrutinised review articles in the related scientific and clinical literature such that they can aspire to an excellent standard in surgical practice.

The texts and courses are not recommended as the sole source within their subject matter and there are alternative textbooks, courses and web information which may better suit an individual’s learning style. Over time it will be important for associated curriculum management systems to provide an expanded and critically reviewed list of supporting educational material.

Recommended Reading for the Vascular Curriculum

Final Stage

• Vascular Surgery: 6th Edition. Rutherford R.B. (Ed.), Saunders, 2005
• Comprehensive Vascular and Endovascular Surgery: 2nd Edition. Hallet J.W., Mills J.L., Earnshaw J.J., Reekers J.A., Rooke TM (Eds), Mosby Elsevier, 2009
• Pathways of Care in Vascular Surgery Beard J.D., Murray S. (Eds), TFM Publishing Ltd, 2002
• Rare Vascular Disorders. A Practical Guide For The Vascular Specialist: Parvin S.D., Earnshaw J.J. tfm Publishing Ltd, 2005
• Abrams’ Angiography: Interventional Radiology: 2nd Edition. Baum S. and Pentecost M. J. (Eds.) Lippincott Williams & Wilkins. 2006
• Grainger & Allison's Diagnostic Radiology, 5th Edition. Adam a et al. (Eds.), Churchill Livingstone, 2008
• CT and MR Angiography: Comprehensive Vascular Assessment. Rubin G. D. and Rofsky N. M. (Eds.) Lippincott Williams & Wilkins, 2008
• Introduction to Vascular Sonography: 5th Edition Zweibel W. (Ed.) W.B. Saunders, 2005
• Connective Tissue Diseases. Belch J.J.F. and Zurier R.B. (Eds.) Chapman and Hall, 1995
• Recent Advances in Thrombosis and Haemostasis Tanaka K. and Davie E.W. (Eds.) Springer, 2008
• The Foot in Diabetes (3rd Edition) Boulton A.J.M., Connor H., Cavanagh P.R.C. (Eds.) John Willey, 2000
• Amputation Surgery and Lower Limb Prosthetics. Murdoch G. (Ed.) Blackwell, 1988
• The Vein Book. Bergan J. J. (Ed.) Elsevier, 2007

Recommended Courses

• Royal College of Surgeons of England Raven Department of Education Courses:

Specialty Skills in Vascular Surgery
 Amputations
 Advanced Skills in Vascular Surgery
 Endovascular Aneurysm Repair Planning

• Vascular Ultrasound Course

Recommended Websites

Websites provide up-to-the-minute information on recent trials and technological developments, as well as news of meetings and courses. A few of the more useful websites are listed below.

Intermediate and Final Stage Syllabus Standards

Standards for depth of knowledge during intermediate and final years surgical training

In the intermediate and final stages of surgical training the following methodology is used to define the relevant depth of knowledge required of the surgical trainee. Each topic within a stage has a competence level ascribed to it for knowledge ranging from 1 to 4 which indicates the depth of knowledge required:

Standards for clinical and technical skills

The practical application of knowledge is evidenced through clinical and technical skills. Each topic within a stage has a competence level ascribed to it in the areas of clinical and technical skills ranging from 1 to 4:

Exit descriptor; at this level the trainee:

• Has adequate knowledge of the steps through direct observation.
• Demonstrates that he/she can handle instruments relevant to the procedure appropriately and safely.
• Can perform some parts of the procedure with reasonable fluency.

Exit descriptor; at this level the trainee:

• Knows all the steps - and the reasons that lie behind the methodology.
• Can carry out a straightforward procedure fluently from start to finish.
• Knows and demonstrates when to call for assistance/advice from the supervisor (knows personal limitations).

Exit descriptor; at this level the trainee:

• Can adapt to well known variations in the procedure encountered, without direct input from the trainer.
• Recognises and makes a correct assessment of common problems that are encountered.
• Is able to deal with most of the common problems.
• Knows and demonstrates when he/she needs help.
• Requires advice rather than help that requires the trainer to scrub.

Exit descriptor, at this level the trainee:

• With regard to the common clinical situations in the specialty, can deal with straightforward and difficult cases to a satisfactory level and without the requirement for external input.
• Is at the the level at which one would expect a UK consultant surgeon to function.
• Is capable of supervising trainees.

The explicit standards form the basis for:

• Specifying the syllabus content;
• Organising workplace (on-the-job) training in terms of appropriate case mix and case load;
• Providing the basis for identifying relevant teaching and learning opportunities that are needed to support trainees’ development at each particular stage of progress; and
• Informing competence-based assessment to provide evidence of what trainees know and can do.

The syllabus details knowledge and competence levels expected at the stages in training listed in the right hand columns for ST years 4, 6 and 8. The intermediate syllabus specifies those levels up to ST4 and the final syllabus is indicated in two stages at ST6 and at ST8.

Notes:

1. It should be noted that the syllabus describes minimal standards and that individual training centres may chose to train to higher competency levels as appropriate.

2. For level 2 clinical and technical skills, it should be recognised that procedures should be performed under direct supervision.

3. Work is ongoing to develop programmes for the effective delivery of the physics and radiological knowledge components of the syllabus mapped to effective assessment tools for the new training programmes. These will be delivered locally as the new training programmes are developed.