Vascular Surgery Curriculum
2.1 Purpose of the curriculum
The purpose of the curriculum for Vascular Surgery is to produce, at certification, competent doctors, able to deliver excellent outcomes for patients as consultant vascular surgeons in the UK. The curriculum will provide consultant vascular surgeons with the generic professional and specialty-specific capabilities needed to manage patients presenting with the full range of acute and elective vascular conditions, inclusive of the operation or procedure. Trainees will be entrusted to undertake the role of the Vascular Surgery Specialty Registrar (StR) during training and will be qualified at certification to apply for consultant posts in Vascular Surgery in the UK. Within these areas the model of consultant Vascular Surgery practice is consistent, in that it follows the creation of vascular networks with a hub and spoke working pattern around an arterial centre. This model is followed throughout the British Isles and Ireland and is consistent with the structure described in the Provision of Vascular Services1 document.
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.
The curriculum covers the three phases of the vascular training pathway. In phase 1 the trainee will achieve core surgical competencies with a view to entering the vascular training pathway through national selection at ST3 or having followed vascular themed run-through training having been appointed at ST1. In phase 2 the trainee will acquire the relevant general surgery skills and so allow introduction to all aspects of Vascular Surgery. The progression of vascular competence is guided, and benchmarked by the respective ST4 and ST6 Annual Review of Competence Progression (ARCP) decision guides. The completion of phase 2 will be marked by the trainee reaching the level of knowledge and clinical and professional skills required to be assessed as a day-one consultant in Vascular Surgery and so be eligible to sit the Intercollegiate Speciality Board examination in Vascular Surgery. In phase 3 trainees will continue to develop the full range of vascular skills required for certification as defined by the syllabus objectives.
It will be possible for trainees to develop further advanced competencies based on patient need in a geographical area or to deliver a specialist service requirement. This technical development may be undertaken as post-certification activity and recognised with a credentialing process beyond the remit of this curriculum.
Whilst the indicative time for vascular surgical training will be six years for uncoupled and eight years for run-through training, the actual length of training may be shorter or longer than the indicative time according to the rate at which competencies are achieved.
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) review2 and Excellence by Design: standards for postgraduate curricula3 provided opportunities to reform postgraduate training. The 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 Capabilities4 (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)5. 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 (see section 2.3.1). In addition, core knowledge and skills gained in any surgical specialty training programme are transferable for entry into Vascular Surgery. Trainees who choose to move from a different speciality training programme having previously gained skills transferable to Vascular Surgery 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 Vascular Surgery, some limited areas of the syllabus may be transferable. 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 Progression through training
Uncoupled trainees will enter phase 2 after completion of core surgical training (phase 1) and successfully gaining a National Training Number (NTN) through the national selection process.
Run-through trainees in the Improving Surgical Training (IST) pilot will enter phase 2 after having achieved an outcome 1 at their ARCP at the end of ST2. These trainees will not be required to attend ST3 national selection interviews.
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.
Vascular Surgery training is outcome-based rather than time-based. However, it will normally be completed in an indicative time of eight years (two years in phase 1, four years in phase 2 and two years in phase 3) for those entering run-through training at ST1 and six years for uncoupled trainees entering at ST3 (four years in phase 2 and two years in phase 3). 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 the Reference Guide for Postgraduate Specialty Training in the UK (the Gold Guide6).
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 three phases:
- Phase 1 will follow the Core Surgical Training curriculum for acquisition of both technical and non-technical generic skills, with a Vascular Surgery theme (of at least six months) to the first two years of training for run-through trainees. Run-through trainees in the IST pilot and trainees on an academic training pathway will progress to phase 2 after the award of an outcome 1 at the ARCP at ST2. Those uncoupled trainees, including the military trainees, completing core surgical training or equivalent would enter phase 2 of vascular training at ST3 via national selection.
- Phase 2 will take an indicative time of four years during which trainees will gain the GPCs and the knowledge, clinical skills and professional behaviours of Vascular Surgery expected of a day-one consultant in the specialty, as defined in the CiPs and the syllabus. At the start of phase 2 the trainee will be placed in General Surgery for one year to gain skills in safe navigation of abdominal contents and peri-operative management in elective and emergency settings. There will be the facility to undertake a further year of general surgery on call, along with vascular progression, to ensure the development of the required competencies. Trainees will then be exposed to all aspects of the generality of emergency and elective Vascular Surgery during the rest of phase 2. There will be a critical progression point at the end of phase 2, satisfaction of which will permit application to sit the ISB examination in Vascular Surgery.
- Phase 3 will take an indicative time of two years during which time trainees will gain all the skills necessary in the generality of Vascular Surgery to deliver all of the open and endovascular emergency, urgent and elective procedures, of the Vascular Surgery curriculum that are necessary to perform safely as a day-one consultant. The further development of certain aspects of the curriculum for a trainee can be facilitated based on the needs of the service (either local or national), the preference of the trainee, trainees skills and the ability of the programme to support the trainee in that development. Where a programme cannot facilitate the additional curriculum development of trainees, Out of Programme Training (OOPT) can be utilised. 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 expected two years may require an extension of training time in accordance with the Gold Guide.
2.3.1 Interdependence with other specialties
Vascular Surgery has several areas of interdependence with other specialties that are variable in their extent based on local service requirements and patient needs. The specialties of Cardiothoracic Surgery, Cardiology, Diabetes Medicine, Interventional Radiology, Renal Medicine, Stroke Medicine and Transplant Surgery all have a degree of interdependence with Vascular Surgery. Some of this interdependence relates to multi-disciplinary team (MDT) working and would be assessed as part of the GPCs and so it would be entirely appropriate for a specialty representative to teach, feedback on or assess a Vascular Surgery trainee and for Vascular Surgery trainers to reciprocate.
With respect to interdependence of technical skills, the variation of delivery will relate to local service requirements and structure. The development of these technical skills may be delivered by another specialty or in partnership to mirror the local pathways and so ensuring that no specialty has any curriculum compliance issues. Where there is the ability to deliver collaborative care / procedures for the patients benefit this is described within the objectives of the syllabus.
In practice the largest collaboration is between Vascular Surgery and Interventional Radiology where the co-operative approach is based on MDT working. This integrated management is based on an inclusive decision-making environment to ensure optimal patient outcomes. The training of endovascular procedures represents an area of common ground between the two curricula and the delivery will be guided by the local service structure. It will be ensured that all trainees obtain the training to allow appropriate practice as a day-one consultant within their specialty. The Vascular Surgery curriculum has identified where collaboration occurs within cases and as such where trainers of either specialty may be delivering the education. By undertaking combined open and endovascular cases, Vascular Surgery will relieve some of the burden of providing the endovascular education to Vascular Surgery trainees as well as reciprocating to Interventional Radiology trainees. This common ground of training can ensure appropriate exposure and integrated decision making.
Figure 1. Vascular Surgery Training Pathway. Trainees can enter Vascular Surgery training at phase 1, following the curriculum for core training in surgery and running through without further selection onto phase 2 of the Vascular Surgery curriculum, or trainees can enter at phase 2, having successfully completed the curriculum for core surgical training and been successful at a national selection process into Vascular Surgery training. Core surgical training is uncoupled from specialty training for the majority of trainees. The availability of posts is at the discretion of the statutory postgraduate medical education bodies.
The Provision of Services for Patients with Vascular Disease 2018
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