Plastic Surgery (2016)

Intermediate

Intermediate Stage

Entry into ST3 will usually involve a competitive selection process. The current person specifications for entry into ST3 in Plastic Surgery are shown on the Modernising Medical Careers website. The essential components here are completion of the common component of the core surgical training programme (as evidenced by successful ARCP, WPBA and completion of the MRCS examination) and completion of the Plastic Surgery specific components of the early years training as evidenced by a successful ARCP and completion of the appropriate WPBA.

Plastic Surgery trainees entering ST3 must follow the 2013 curriculum. Trainees entering ST4 will need to transfer before December 2015. Trainees entering ST5 and ST6 do not have to transfer before this deadline but must use the latest version of the modular Final Stage at ST7.

How is the 2013 syllabus different from the 2010 version?

Click here to see mapping of 2010 / 2013 Intermediate syllabuses

Overview of model

The Intermediate Years Plastic Surgery Curriculum proposal represents the second phase of providing a detailed description of the range of practice within our specialty. This is a continuation of the work begun with submission and GMC approval of our Final Years Curriculum (August 2012 version). We had stated in the Final Years submission that we would progress on to similar exercise for Intermediate Years.

In line with the Final Years Curriculum we will adopt the same modular structure of study that encompasses the various topic areas specifying the competency requirements of Knowledge, Clinical Skills and Technical Skills. The adoption of the modular curriculum structure has facilitated a much clearer expression of our specialty. The modular format is widely used on other educational platforms including our professional associations’ instructional courses and the E-Learning for Health project.

The subject matter of each module is presented in a hierarchical manner; namely Basic, Intermediate or Advanced Levels of complexity. The definition of levels applies to the entirety of the programme and does not vary between Early, Intermediate and Final Years. Thus an advanced competency is the same whether or not it is retained as an item under Intermediate Years or is solely applicable to Final Years.

The means used to determine allocation of content at Intermediate Years level is as follows. The Final Years syllabus was taken as the complete expression of our specialty with the exception of some ‘orphan’ content that exists on the original intermediate Years syllabus but was not suitable for special interest development at Final Years level. These additional modules have been written and are flagged in the Summary of Modules list that follows. The curriculum development group along with a number of experts within the profession have removed items from the Final Years syllabus including more advanced operative competences etc. to reflect that which we judge all plastic surgeons should know and be able to perform. This is in line with our stated aim to have a curriculum that starts with the competences we required of our consultants that we then map backwards and is in line with the methodology followed to date.

It is an important part of this process that we define the level of what should be achieved within Intermediate Years. We believe that this is the body of knowledge and clinical skills that are tested at the Intercollegiate Specialty Examination in Plastic Surgery; FRCS(Plast). All trainees learn the same things and acquire similar skill sets up to this point. The current level of the examination is defined as the ‘Level of the Day 1 Consultant in the generality of the specialty.’ One of our major reference points in the current exercise is not to alter what is being expected of trainees at the examination. The key difference between Intermediate Years and Final Years Curriculum is that there is no element of choice for Intermediate Years Curriculum – this is the body of knowledge and skills that we expect all plastic surgeons to acquire during training. We are not planning to change the content of what is examined at the Intercollegiate Specialty Examination.

As part of the Final Years curriculum development a large number of Procedure Based Assessments have been written and uploaded onto ISCP (about 150) and these are now available for use by all trainees (including those on the CESR CP route). The blueprint of PBAs is detailed. No further work needs to be done here but there are some navigability issues that we need to address through ISCP. In addition we have developed the Reflective Case Based Discussion as a tool for use in the Final Years programme. While we do not think this tool is quite right for Intermediate Years, there will be development of reflective learning from an early stage through a reflective diary.

A further need has been identified for development of the Leadership skill set somewhat more clearly in the Intermediate Years. Specifically there is a need to develop all trainees in their ability to work within the multidisciplinary environment as this has become such an important part of the way plastic surgery is now working with other disciplines. The Professional skills themselves are generic and already on ISCP.

The topic areas specified in this syllabus proposal are the same as those in our approved Final Years Curriculum with several single module additions for topics that are currently part of our Intermediate Years syllabus but were not thought to constitute substantive areas of special interest study at Final Years level. These new modules are flagged with *. The sharing of curriculum with other surgical disciplines through the Training Interface Groups (TIGs) has been addressed in the Final Years Curriculum and is not considered further in this submission for the Intermediate Years Curriculum. It is important, however, that the Intermediate Years Curriculum prepared the foundation for trainees to be able to progress careers in their chosen special interests. The topics appear in alphabetical order within the document.

• Aesthetics
• Burns
• Chest wall reconstruction *
• Cleft
• Complex wound
• Craniofacial
• Craniomaxillofacial trauma *
• Ear reconstruction
• Genitourinary reconstruction
• Lower Limb Trauma
• Hand
• Head & Neck
• Oncoplastic Breast
• Pelvic floor reconstruction *
• Sarcoma *
• Skin Surgery
• Vascular anomalies *

Standards for Training

Standards for depth of knowledge

The following methodology is used throughout the surgical curricula 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:

1. knows of

2. knows basic concepts

3. knows generally

4. knows specifically and broadly

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.
• The level at which one would expect a UK consultant surgeon to function.
• Is capable of supervising trainees.

• 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.

Competency Levels within each Module

The current system takes each procedure and describes Levels 1- 4 competencies for the same. As the training years proceed the trainee gets to master more complex procedures. There is increasing understanding within ISCP Management Committee that this may not be the best way to demonstrate progression onto more difficult procedures and in line with our Final Years Curriculum we have specified the syllabus content into areas that are typically easier and those that are inherently more difficult. Thus the Intermediate Years Curriculum will be both modular and hierarchical bringing it into line with that currently adopted for Final Years.

A. Basic level competencies

Within each module there are elemental topics that are designed to act as building blocks from which more complex competences can be achieved.

B. Intermediate level competency

These include a list of the more common topics within each module and most of these competencies will have been achieved within Intermediate Years prior to entry into the Final Years programme.

C. Advanced level competency

This third tier of topics includes the most complex topics in each module. Those items that are specified here are for all Intermediate Years trainees.

For the purposes of assessment at Intermediate Years and the Intercollegiate Specialty Examination in Plastic Surgery; FRCS(Plast). the level of competency deemed appropriate for the end of ST6 is Level 3 for the specified Technical Competences and Procedures and Level 4 for Knowledge and Clinical Skills specified on this part of the syllabus.

Assessment of the Intermediate Years Curriculum

It is recognised that trainees will have already gained some competencies during Early Years that can be recognised and taken forward into the Intermediate Years programme. These existing competencies are currently recognised within the ISCP online learning platform and inform the subsequent Intermediate Years Learning Agreement.

The assessment of the curriculum continues to be by workplace-based assessments, including MSF, CEX, CBD, and PBAs. Evidence from these assessments will be used to inform the ARCP that will form the summative assessment of trainees.

Reflective Diary

Trainees will be introduced to formative reflective learning through the use of a reflective diary. It is not thought that reflection at this level of training should be formally assessed but rather it is thought desirable to encourage reflection that then becomes the subject of formal assessment as currently specified under the Final Years Curriculum.

The content of the Intermediate Years Curriculum is that which is formally assessed at the Intercollegiate Specialty Examination in Plastic Surgery; FRCS(Plast). The examination may currently be sat at the end of Intermediate Years when it is judged that the trainee has achieved the necessary competences specified in the generality of the specialty. Progression into Final Years where the trainee can develop special interests as appropriate is not specifically linked to success in the examination but remains under the direction of the Programme Director. Some trainees will need the full programme time to achieve the examination but can nonetheless have tailored an individual Learning Agreement that allows the trainee to progress through Final Years with appropriate placements balancing the requirements of the generality of the specialty with the need to develop some areas of interest with depth and experience appropriate to consultant practice.

The E-logbook (which all surgeons are now recommended to use) has a highly detailed lexicon for plastic surgery. Advanced search facilities have been developed in collaboration with the Curriculum Development Group of the SAC for Plastic Surgery. It is now possible to search on the basis of the WBA blueprint by topic sections / modules (Intermediate Years Curriculum) as well as by the index groupings of operations (Quality Indicators for CCT). All operative experience gained will be visible, enhancing the Learning Agreement and demonstrating both competence development and progression within the programme.

PBA Blueprint

For each special interest area there are work-based assessments corresponding to the module and to the level of attainment within that module. This document lists the available PBAs in black text. PBAs that are highlighted in red text are under preparation. Simulated procedures are indicated in blue text. Some of the PBAs are written by other specialties and this is indicated with the relevant abbreviation i.e. (P) for Plastic Surgery (GS) for General Surgery etc.