Core Surgical Training (2017)

Common content modules

Standards for depth of knowledge during early years surgical training

In the early years of training, the appropriate depth and level of knowledge required can be found in exemplar texts tabulated below. It is expected that trainees will gain knowledge from these or similar sources in the context of surgical practice defined in the core surgical curriculum. 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 below. It is expected that trainees will read beyond the texts below and will be able 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 are not recommended as the sole source within their subject matter and there are alternative textbooks and web information that may better suit an individual's learning needs. The numbers act as a key to knowledge sections of the various module of the syllabus. Some texts are more detailed than others and the more detailed works may be more appropriate to the ST3 preparation modules.

In addition to these standard texts, sample MRCS MCQ examination questions are also available which will demonstrate the level of knowledge required to be able to successfully pass the MRCS examination.

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:

1. Has observed. 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.

2. Can do with assistance. 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).

3. Can do whole but may need assistance. 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.

4. Competent to do without assistance, including complications. 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 level at which one would expect a UK consultant surgeon to function
• is capable of supervising trainees.

These 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
• informing competence-based assessment to provide evidence of what trainees know and can do.

Trainees are required to keep a surgical logbook, using eLogbook, to record their acquisition of procedural experience. Trainees should ensure that they record all cases, those in undertaken in an operating theatre as well as those performed in out-patient clinics, wards, critical care units, emergency departments and procedural suites. The following descriptors of the level of supervision received should be used:

Assisting (A):

• The trainer completes the procedure from start to finish
• The trainee is scrubbed throughout but their role is purely to assist the trainer, who performs all of the key components of the procedure
• The trainee should be sufficiently engaged to learn about the procedure.

Supervised - trainer scrubbed (S-TS):

• The trainee performs components of the procedure (as defined in the relevant PBA) with the trainer scrubbed. In core surgical training, completing the access component or closing the wound under supervision represent a useful training episode and should be distinguished from assisting.
• The trainee should record the component of the procedure for which they were the principle operator in the free text element of the eLogbook entry.

Supervised - trainer unscrubbed (S-TU):

• The trainee completes the procedure from start to finish
• The trainer is unscrubbed and is either in the operating theatre throughout or in the operating theatre suite and regularly enters the operating theatre during the procedure, being present for >70% of the duration of the procedure.

Performed (P):

• The trainee completes the procedure from start to finish
• The trainer is either present for <70% of the duration of the procedure or is not in the operating theatre. The supervising consultant may be scrubbed in the adjacent operating theatre or elsewhere in the hospital
• This level of supervision should be unusual in core surgical training.

Training more junior trainee (T):

• The trainee uses the case to train a junior trainee
• This level of supervision should be unusual in core surgical training.

Observed (O):

• The trainee is unscrubbed and simply observes the procedure.

The common content module is to be completed by all core surgical trainees, for most, in their first year of training. The core specialty modules in eleven specialties (including intensive care medicine) should be included in the learning agreement of all trainees assigned to posts in those specialties with at least 3 to be completed by the majority of trainees over the course of their core surgical training programme. There are 9 ST3 preparation modules (excluding neurosurgery in which a route from CST to ST3 does not exist). Each trainee will complete only one of these in their chosen specialty, largely during their second year of training. The professional behaviour and leadership skills module, required of all surgical trainees at all stages in training, is scheduled for major revision in light of the GMC/AoMRC work developing a framework for generic professional capabilities. Completion of this curriculum has necessitated retaining the existing professional/leadership skills module but it should be noted that on completion of the GMC/AoMRC work cited above, an early revision is likely to be required.