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Roles and Responsibilities

Schools of Surgery/LETBs/deaneries

Schools of Surgery or their equivalent have been created nationally within each Postgraduate Medical Deanery and/or Local Education and Training Board (LETB) and the Scottish Surgical Specialties Training Board (SSSTB) within NHS Education for Scotland (NES). They provide the structure for educational, corporate and financial governance and co-ordinate the educational, organisational and quality management activities of surgical training programmes. The Schools draw together the representatives and resources of deaneries/LETBs/SSTB, JCST, trusts, NHS service providers and other relevant stakeholders in postgraduate medical education and training. They ensure the implementation of curricula and assessment methodologies with associated training requirements for educational supervision. In the Republic of Ireland, these roles are undertaken by the Medical Council, HSE National Doctors Training and Planning (NDTP) and the Royal College of Surgeons in Ireland (RCSI).

Who is involved in training?

The key roles involved in teaching and learning are Training Programme Director, Assigned Educational Supervisor, Clinical Supervisor,Assessor and Trainee.

Training Programme Director

The majority of Training Programme Directors (TPDs) manage specialty programmes; there are, however, a number who manage Core Surgical Training programmes (CST).

TPDs are responsible for:

  • organising, managing and directing the training programmes, ensuring that the programmes meet curriculum requirements
  • identifying, appointing and supporting local faculty (i.e. AES) including training where necessary
  • overseeing progress of individual trainees through the levels of the curriculum, ensuring learning objectives are set, appropriate assessments are being undertaken and that appropriate levels of supervision and support are in place
  • helping the Postgraduate Dean and AES manage trainees who are running into difficulties by identifying remedial placements and resources where required
  • working with delegated Specialty Advisory Committee (SAC) representatives (SAC Liaison Members) and College representatives (e.g. college tutors) to ensure that programmes deliver the specialty curriculum
  • working with delegated Specialty Advisory Committee (SAC) representatives (SAC Liaison Members) and College representatives (e.g. college tutors) to ensure that programmes deliver the specialty curriculum
  • ensuring that deanery/LETB administrative support are knowledgeable about curriculum delivery and are able to work with SACs, trainees and trainers
  • administering and chairing the Annual Review of Competence Progression meetings (ARCP).

Assigned Educational Supervisor

Educational supervision is a fundamental conduit for delivering teaching and training in the NHS. It takes advantage of the experience, knowledge and skills of expert clinicians/consultant trainers and their familiarity with clinical situations. It ensures interaction between an experienced clinician and a trainee. This is the desired link between the past and the future of surgical practice, to guide and steer the learning process of the trainee. Clinical supervision is also vital to ensure patient safety and the high quality service of trainees. The curriculum requires trainees reaching the end of their training to demonstrate competence in clinical supervision before Certification. The Joint Committee on Surgical Training (JCST) also acknowledges that the process of gaining competence in supervision must start at an early stage in training with trainees supervising more junior trainees. The example set by the educational supervisor is the most powerful influence upon the standards of conduct and practice of a trainee.

In the UK, the GMC’s plan for recognition and approval of trainers will take full effect from 31 July 2016. In addition to the GMC’s statutory requirements for approval of GP trainers, postgraduate deans and medical schools will formally recognise medical trainers who are named Assigned Educational Supervisors and named Clinical Supervisors. The Assigned Educational Supervisor (AES) is responsible for between one and four trainees at any time. The number will depend on factors such as the size of the unit and the availability of support such as a Clinical Supervisors (CSs) or Clinical Tutors (CTs). The role of the Assigned Educational Supervisor is to:

  • have overall educational and supervisory responsibility for the trainee in a given placement
  • ensure that an induction to the unit (where appropriate) has been carried out
  • ensure that the trainee is familiar with the curriculum and assessment system relevant to the level/stage of training and undertakes it according to requirements
  • ensure that the trainee has appropriate day-to-day supervision appropriate to their stage of training
  • act as a mentor to the trainee and help with both professional and personal development
  • agree a Learning Agreement, setting, agreeing, recording and monitoring the content and educational objectives of the placement
  • discuss the trainee’s progress with each trainer with whom a trainee spends a period of training and involve them in the formal report to the annual review process
  • undertake regular formative/supportive appraisals with the trainee (typically one at the beginning, middle and end of a placement) and ensure that both parties agree to the outcome of these sessions and keep a written record
  • ensure a record is kept in the portfolio of any serious incidents for concerns and how they have been resolved
  • regularly inspect the trainee’s learning portfolio and ensure that the trainee is making the necessary clinical and educational progress
  • inform trainees of their progress and encourage trainees to discuss any deficiencies in the training programme, ensuring that records of such discussions are kept
  • ensure patient safety in relation to trainee performance by the early recognition and management of those doctors in distress or difficulty
  • keep the Training Programme Director informed of any significant problems that may affect the trainee’s training
  • provide an end of placement AES report for the Annual Review of Competence Progression (ARCP).

In order to become an AES, a trainer must be familiar with the curriculum and have demonstrated an interest and ability in teaching, training, assessing and appraising. They must have appropriate access to teaching resources and time for training allocated to their job plan (approx. 0.25 PA per trainee). AESs must have undertaken training in a relevant Training the Trainers course/programme offered by an appropriate educational institution and must keep up to date with developments in training. They must have access to the support and advice of their senior colleagues regarding any issues related to teaching and training and to keep up to date with their own professional development.

Clinical Supervisor

Clinical Supervisors (CSs) are responsible for delivering teaching and training under the delegated authority of the AES. They:

  • carry out assessments as requested by the AES or the trainee - this will include delivering feedback to the trainee and validating assessments
  • ensure patient safety in relation to trainee performance
  • liaise closely with other colleagues, including the AES, regarding the progress and performance of the trainee with whom they are working during the placement
  • keep the AES informed of any significant problems that may affect the trainee’s training
  • provide regular CS Reports which contribute to the AES’s end of placement report for the ARCP.

The training of CSs should be similar to that of an AES.

Assessor

Assessors will carry out a range of assessments and provide feedback to the trainee and the AES, which will support judgements made about a trainee’s overall performance. Assessments during training will usually be carried out by Clinical Supervisors (consultants) and other members of the surgical team. Those who are not medically qualified may also be tasked with this role. e.g. for the MSF.

Those carrying out assessments must be appropriately qualified in the relevant professional discipline and trained in the methodology of Workplace Based Assessment (WBA). This does not apply to MSF raters.

Trainee

The trainee is required to take responsibility for his/her learning and to be proactive in initiating appointments to plan, undertake and receive feedback on learning opportunities. The trainee is responsible for ensuring that

  • a Learning Agreement is carried out in each placement;
  • opportunities to discuss progress are identified;
  • assessments are undertaken and validated by assessors in good time;
  • evidence is systematically recorded in the learning portfolio.

Teaching

The detail of clinical placements will be determined locally by Training Programme Directors (TPDs). In order to provide sufficient teaching and learning opportunities, the placements need to be in units that:

  • are able to provide sufficient clinical resource,
  • have sufficient trainer capacity.

The JCST has developed a series of Quality Indicators (QIs) to help identify good and poor quality training placements. The QIs are measured through the JCST trainee survey.

The PDs and AESs define the parameters of practice and monitor the delivery of training to ensure that the trainee has exposure to the following:

  • A sufficient range and number of cases in which to develop the necessary technical skills (according to the stage of training) and professional judgement (to know when to carry out the procedure and when to seek assistance)
  • Managing the care of patients in the case of common conditions that are straightforward, patients who display well known variations to common conditions, and patients with ill-defined problems
  • Detailed feedback.

Development of professional practice can be supported by a wide variety of teaching and learning processes, including role modelling, coaching, mentoring, reflection, and the maximising of both formal and informal opportunities for the development of expertise on the job. Learning opportunities need to be related to changing patterns of healthcare delivery.

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