Plastic Surgery Curriculum
2.1 Purpose of the curriculum
The purpose of the curriculum for Plastic Surgery is to produce, at certification, competent doctors, able to deliver excellent outcomes for patients as consultant surgeons in the UK. The curriculum will provide consultant surgeons with the generic professional and specialty-specific capabilities needed to manage patients presenting with the full range of acute Plastic Surgery conditions up to the point of operation and to manage the full range of acute and elective conditions in the generality of Plastic Surgery, including the operation and post-operative care. Trainees will be entrusted to undertake the role of the general Plastic Surgery Registrar (StR) during training and will be qualified at certification to apply for consultant posts in Plastic Surgery in the UK and the Republic of Ireland.
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) review1 and Excellence by Design: standards for postgraduate curricula2 provided an opportunity to reform postgraduate training to 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 practice 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.
The curriculum will produce surgeons who are competent in elective and emergency general Plastic Surgery. This will provide clarity to employers / patients regarding the skills a surgeon will have at the time of appointment as a consultant. Plastic Surgery is the general surgery of soft tissue, cancers of the soft tissues and reconstruction. The advanced technical skills required to perform this surgery safely can be acquired through exposure to any of the broad areas of clinical application of these techniques (e.g. Cleft Lip and Palate Surgery, Hand and Upper Limb Surgery, Burns Surgery, Sarcoma Surgery and Head and Neck Surgery) and are transferable between areas of clinical application rather than being specific to an anatomical region. This ensures that the output of the Plastic Surgery curriculum will be general, transferable and flexible; trainees will be appointable to any Plastic Surgery post advertised, with the ability to focus their scope of practice if required by local services after appointment.
The curriculum takes account of and better supports the needs of patients and service providers. It has been developed in consultation with stakeholders, including trainees, trainers, employers, lay representatives and other groups, ensuring the development of a curriculum that is fair, flexible, non-discriminatory, fit for purpose today with the capacity to evolve in future iterations in response to changing needs of patients.
All trainees will develop a full range of emergency skills by certification in order to participate in the unselected adult and Plastic Surgery emergency take and provide continuity of care to this group of patients. They will be entrusted to undertake the role of the general Plastic Surgery StR throughout their training, and as part of that will be expected to look after patients in the pre-, peri-, and post-operative environments during training.
The curriculum allows ease of transfer into other surgical specialties following core surgical training and beyond. Plastic Surgery develops transferable technical skills to a high level: a trainee moving from Plastic Surgery to another specialty will have acquired many technical skills that are of value in any craft specialty destination.
The curriculum describes the clinical CiPs shared with other specialties in surgery supporting flexibility for trainees to move between the specialties in line with the recommendations set out in the GMC’s report to the four UK governments3. The curriculum includes the GPCs common to all medical specialties, facilitating transferability of learning outcomes across other related specialties and disciplines. It will, therefore, be possible for trainees to transfer generic knowledge, clinical and surgical skills to another surgical specialty without restarting at CT1 level. Consequently, trainees will acquire generic skills which can be transferred to other surgical specialties, or to other non-surgical specialties. Trainees who choose a different career route may be able to have a shorter than usual training pathway in their new training programme, in recognition of learning already gained. This flexible approach with acquisition of transferable capabilities will allow training in Plastic Surgery to adapt to current and future patient and workforce needs as well as to changes in surgery with the advent of new treatments and technologies.
2.3 The training pathway and duration of training
Trainees will enter Plastic Surgery training via a national selection process at ST3, or run-through training at ST1 after selection into academic training in Plastic Surgery. Trainees will learn in a variety of settings using a range of methods, including workplace-based experiential learning in a variety of environments, formal postgraduate teaching, simulation-based education and through self-directed learning.
Plastic Surgery training is outcome-based rather than time-based. However, it will normally be completed in an indicative time of six years (four years in phase 2 and two years in phase 3) for those entering training at ST3, and an indicative eight years for those entering via the ST1 academic programme (two years in phase 1 while following the core surgical training curriculum, on successful completion of which they will enter phase 2).
There will be options for those trainees who demonstrate exceptionally rapid development and acquisition of capabilities to complete training more rapidly than the current indicative time. There may also be a small number of trainees who develop more slowly and will require an extension of training in line with the Reference Guide for Postgraduate Specialty Training in the UK (the Gold Guide5).
Trainees who choose less than full time training (LTFT) will have the indicative training time extended pro-rata in accordance with the Gold Guide. LTFT trainees will perform both elective and out of hours duties pro-rata throughout the time of LTFT.
The programme will be divided into 3 phases:
Academic run-though trainees will spend an indicative initial two years of phase 1 following the core surgical training curriculum, with a minimum of a year spent in Plastic Surgery placements. There will then be a critical progression point, at which run-through trainees will have to demonstrate that they have satisfied the requirements of the core surgical training curriculum, passed the Intercollegiate Membership examination of the Royal Colleges of Surgeons (MRCS) and been awarded an outcome 1 at the Annual Review of Competence Progression (ARCP) at the end of the second year of training.
Most trainees will enter training in Plastic Surgery in phase 2 following successful completion of core surgical training or equivalent via a national selection process. Trainees will gain knowledge, clinical, professional and technical skills across the generality of Plastic Surgery. At the end of phase 2 there is a critical progression point at which trainees must be able to demonstrate competencies in knowledge, clinical skills and professional behaviours of a day-one consultant in the specialty and become eligible to sit the Intercollegiate Specialty Board (ISB) examination in Plastic Surgery. Technical skills, whilst well developed by the end of phase 2, will not have developed to the level expected for certification in the emergency and general elective competencies of the curriculum until the end of phase 3.
Trainees will continue to develop technical skills in the elective and emergency aspects of Plastic Surgery to the level of a day-one consultant in the specialty. During phase 3 trainees will continue to be on the general Plastic Surgery on-call rota and will maintain responsibility for in-patients across the breadth of the specialty whilst on call.
During phase 3 it is expected that all of the trainee’s time will be spent developing generic technical skills that are transferrable between special interest areas. Within this, the proportion of time spent within individual areas of special interest will vary according to local requirements of the service, opportunities within the training programme, and interests of the trainee. The Training Programme Director (TPD) would usually determine specialty interest allocations within any given region.
In this outcomes-based curriculum, some trainees may reach the end of phase 3 in less than the indicative time. On completion of phase 3, trainees will be eligible for certification and for recommendation to enter the specialist register. Trainees who do not meet the requirements of phase 3 within the indicative two years may require an extension of training time in accordance with the Gold Guide. The training pathway flowchart is shown below.
Figure 1: The training pathway
The day-one plastic surgeon will need to be able to work closely with the interdependent specialties to deliver whole patient care. The interdependent specialties are:
- Oral and Maxillofacial Surgery
- Trauma and Orthopaedic Surgery
- General Surgery
- Vascular Surgery
- Cardiothoracic Surgery
- Rehabilitation Medicine
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