Cardiothoracic Surgery Curriculum
2.1 Purpose of the curriculum
The purpose of the curriculum for Cardiothoracic Surgery is to produce, at certification, competent doctors, able to deliver excellent outcomes for patients as consultant surgeons in the UK. Evidence from the last decade indicates a significant improvement in outcomes with surgeons being trained in a special interest (either cardiac or thoracic surgery) rather than Cardiothoracic Surgery. The majority of service needs relate to providing cardiac or thoracic surgeons, rather than Cardiothoracic Surgeons except in a few areas, as indicated by workforce data over the last decade (Specialty Advisory Committee (SAC) / Society for Cardiothoracic Surgery (SCTS) workforce data)
The Cardiothoracic Surgery curriculum will provide consultant surgeons with the generic professional and specialty-specific capabilities needed to manage patients presenting with the full range of acute cardiothoracic conditions up to the point of operation and to manage the full range of acute and elective conditions in the generality of their chosen special interest of cardiac or thoracic surgery, including the operation. Trainees will be entrusted to undertake the role of the general Cardiothoracic Specialty Registrar (StR) during training and will be qualified at certification to apply for consultant posts in Cardiothoracic Surgery in the UK or Republic of Ireland with a special interest in cardiac or thoracic surgery.
Patient safety and competent practice are both essential and the curriculum has been designed so that the learning experience itself should not affect patient safety. Patient safety is the first priority of training demonstrated through safety-critical content, expected levels of performance, critical progression points, required breadth of experience and levels of trainer supervision needed for safe and professional practice. Upon satisfactory completion of training programmes, we expect trainees to be able to work safely and competently in the defined area of practice and to be able to manage or mitigate relevant risks effectively. A feature of the curriculum is that it promotes and encourages excellence through the setting of high-level outcomes, supervision levels for excellence, and tailored assessment and feedback, allowing trainees to progress at their own rate.
This purpose statement has been endorsed by the GMC’s Curriculum Oversight Group and confirmed as meeting the needs of the health services of the countries of the UK.
2.2 Rationale and development of a new curriculum
The Shape of Training (SoT) review
1 and Excellence by design: standards for postgraduate curricula2 provided opportunities to reform postgraduate training. The Cardiothoracic Surgery curriculum will produce a workforce fit for the needs of patients, producing doctors who are more patient-focused, more general and who have more flexibility in their career structure. The GMC’s introduction of updated standards for curricula and assessment processes laid out in Excellence by Design requires all medical curricula to be based on high-level outcomes. The high-level outcomes in this curriculum are called Capabilities in Practice (CiPs) and integrate parts of the syllabus to describe the professional tasks within the scope of specialty practice. At the centre of each of these groups of tasks are Generic Professional Capabilities3 (GPCs), interdependent essential capabilities that underpin professional medical practice and are common to all who practise medicine. The GPCs are in keeping with Good Medical Practice (GMP)4. Equipping all trainees with these transferable capabilities should result in a more flexible, adaptable workforce.
All the shared CiPs are transferable to other surgical specialties and some may be transferable to non-surgical specialties. In addition, core knowledge and skills gained in any surgical specialty training programme are transferable for entry into Cardiothoracic Surgery. Trainees who choose to move from a different speciality training programme having previously gained skills transferable to Cardiothoracic Surgery therefore may be able to have a shorter than usual training pathway in their new training programme. While most of the specialty syllabus is not transferable because the knowledge and detailed technical skills are specific to Cardiothoracic Surgery, some limited areas of the syllabus may be transferable e.g. critical care skills. This flexible approach, with acquisition of transferable capabilities, allows surgical training to adapt to current and future patient and workforce needs and change in the requirements of surgery with the advent of new treatments and technologies.
2.3 The training pathway and duration of training
Trainees will enter Cardiothoracic Surgery training via a national selection process following foundation training for run-through or following core surgical training for uncoupled programmes. Cardiothoracic Surgery training is outcome-based rather than time-based. It will, however, normally be completed in an indicative time of seven years (three years in phase 1, two years in phase 2, and two years in phase 3) for those entering run through training (formerly eight years in the 2015 curriculum). For uncoupled trainees, who will spend two years as a core surgical trainee, it will normally be completed in an indicative time of six years (two years in phase 1, two years in phase 2, and two years in phase 3).
The programme will be divided into 3 phases (figure 1):
Phase 1 will take an indicative time of three years to complete for run-through trainees, during which trainees will gain many of the GPCs and the knowledge, clinical and technical skills in both cardiac and thoracic surgery, as defined in the CiPs and syllabus. Uncoupled trainees will have acquired generic skills, both technical and non-technical, during core surgical training, and it is anticipated that an indicative time of two years will be required to achieve the competencies for completion of phase 1. At the end of phase 1, there is a critical progression point for phase 2 entry, assessed at the Annual Review of Competence Progression (ARCP), where trainees will demonstrate competencies in knowledge, clinical skills and professional behaviours commensurate with the CiPs and GPCs.
By the end of phase 1, trainees will follow a special interest in either cardiac or thoracic surgery after discussion with their Training Programme Director (TPD). The special interest choice will be facilitated based on the needs of the service, the preference of the trainee, the trainee’s skills and the ability of the programme to support the trainee in that special interest. Where a programme cannot facilitate the agreed special interest needs of trainees, Out of Programme Training (OOPT) can be utilised. In exceptional cases, and with specific TPD and Deanery/HEE Local Office support, Cardiothoracic Surgery may be chosen as the special interest. Trainees will need careful counselling before following this route as it is likely to require extra training time. There are few geographical areas within the UK requiring such surgeons and central monitoring of these posts will be undertaken by the SAC and the SCTS to ensure supply matches demand.
Phase 2 will take an indicative time of two years to complete during which trainees will train predominantly in either cardiac or thoracic surgery with the exception of a small number who may train in Cardiothoracic Surgery to fulfil local requirements. During phase 2 of training, it is expected that trainees will continue to be involved in the care of both cardiac and thoracic patients whilst on call to continue gaining the knowledge and clinical skills in the generality of Cardiothoracic Surgery. Trainees will continue to develop GPCs and knowledge, clinical and technical skills in their special interest as described in the CiPs and the syllabus.
To apply for a first sitting of the Intercollegiate Specialty Board (ISB) examination in Cardiothoracic Surgery, a trainee will need to have demonstrated the knowledge and clinical and professional skills equivalent of a day-one consultant in Cardiothoracic Surgery as defined by CiPs and the syllabus. It is anticipated that all trainees will reach this level by the end of phase 2.
Training in the sub-specialty of Congenital Cardiac Surgery will be available after the end of phase 2 for a small number of trainees, who will be able to apply through a national selection process after passing the ISB in Cardiothoracic Surgery. Training in the sub-specialty will take an indicative time of two years.
During phase 3 (indicative time two years) of training, it is expected that rainees will continue to be involved in the care of both cardiac and thoracic patients whilst on call to continue gaining the knowledge and clinical skills in the generality of Cardiothoracic Surgery. Trainees will continue to develop GPCs and knowledge, clinical and technical skills in their special interest as described in the CiPs and the syllabus.
Trainees who demonstrate exceptionally rapid development in knowledge, technical skills and acquisition of capabilities can complete training more rapidly than this indicative time. There may also be a small number of trainees who develop more slowly and require an extension of training in line with A Reference Guide for Postgraduate Foundation and Specialty Training in the UK (The Gold Guide)5. Trainees who opt for training less than full time (LTFT) have their indicative training time extended on a pro-rata basis.
On successful completion of phase 3, including successful completion of the ISB examination, trainees become eligible for certification and for recommendation to enter the specialist register.
Figure 1. Cardiothoracic Surgery training pathway.
Shape of training: Securing the future of excellent patient care
Excellence by design: standards for postgraduate curricula
Generic professional capabilities framework
Good Medical Practice
Gold Guide 8th edition