Surgical Training – a Spiral of Learning – Are you ready?
S Vig, H Allan, L Hadfield-Law, A Hollowood , M Deakin

William Halsted was an innovator of surgical training in the early 20th century. Traditionally training was offered to the senior professors and Halsted wished to improve this, not change it and bring it round full circle but to take training and education to a higher level.
Halsted changed the focus of training to the house officer. House officers were given graduated responsibilities including supervised surgery within an apprenticeship model. Dependent on time served and large numbers of patients treated, the programme ensured that the resident surgeon would be skilled and experienced at the end of it.This concept of surgical training has continued to be used successfully but has recently had to evolve again with the implementation of MMC and EWTD.
Trainees no longer have access to a wealth of experience or time. Trainees need to understand the knowledge, skills, judgment and professionalism needed to become the Consultant Surgeon. They also now need to use every opportunity and patient encounter to learn.
Trainees have adapted and have embraced the Foundation Programme. Assessments and reflective practice have been key to developing education and training and are mandatory for the trainees. These trainees have now become the CT1s and 2s registered with Intercollegiate Surgical Curriculum Programme (ISCP). They are keen and enthusiastic and determined to succeed to become the next generation to influence surgery. Trainees are expected to lead their learning and ask for assessments to direct their learning needs. They are ready.
Are the trainers ready? Although some surgeons took part in the ‘Tools of the Trade’ training sessions which introduced the new workplace based assessments used in the Foundation Programme, many didn’t. Some surgeons took part in briefings associated with the implementation of the Intercollegiate Surgical Curriculum Programme (ISCP) which involved an introduction to the assessment methods, as well as the curriculum and the web site but many did not.

ISCP not only specifies a syllabus within a curriculum but also designated educational and mentoring responsibilities of the Assigned Educational Supervisor (AES), Clinical Supervisor, Trainer and Assessor. The College Training the Trainer course was updated to reflect the new curriculum and in particular the needs of the Clinical Supervisors as teacher and trainer, but what of the AES and Assessor?

Training and Assessment in Practice (TAIP) was developed, by surgeons and educators for the Raven Department of Education, to coincide with the implementation of the curriculum. TAIP developed a framework to clarify the usage of the new assessment tools.

From the first pilot, before implementation, participants were feeding back how helpful the course was in developing their understanding of workplace based assessment and where it fits into the process of supporting a trainee’s learning, including using assessments formatively to provide developmental feedback.

‘I particularly valued the video analyses and the scoring and the discussions that followed. Equally, I valued the trainer/trainee case scenario demonstrations – very very powerful.’ (Leeds Participant 2008)

“Assessment tools demystified…” said a participant on a recent Training and Assessment in Practice (TAIP) course held in the West Midlands.

‘the sessions looking at how to incorporate assessment tools into everyday practice and what exactly we are assessing will make the greatest difference to my practice.’ (Reading participant 2008)

The course does not just cover the new assessments but also covers the learning agreement, portfolio assessment and development and how to encourage the trainees learning experience drawing on the ISCP and utilising on-line forms. TAIP also encourages a quality assurance of the assessment process.

The interactive course, with faculty including a surgeon, an educator and trainee has had additional benefits to the consultants attending:
They are able to apply the same systematic approach to learning, recording evidence and building a portfolio for their own practice which is helpful in preparation for revalidation;
The programme provides evidence of the consultant’s continuing professional development (CPD). This is further enhanced if the surgeon becomes faculty on the programme.

From a deanery/Schools of Surgery perspective, the course provides evidence that their surgeons are meeting the ISCP requirements that AESs and Assessors are trained (No5 vol89 ISSN:1473-6357) and the PMETB standard 4 for trainers (http://www.pmetb.org.uk/fileadmin/user/QA/Assessment/PMETB_STANDARDS_FOR_TRAINERS_JAN_2008.pdf).

Recent developments in the programme include:
· greater cooperation between the Education Department and Schools of Surgery to deliver the programme locally. The benefits to surgeons are decreased costs both in terms of fees and travel and accommodation as well as time away from home (and the workplace)
· In response to feedback from participants and Schools of Surgery the programme has been modified so that the College is now able to offer a one day course tailored to the day to day needs of Trainers and Assessors.


For further information on TAIP please contact the Professional Development team: 020 7869 6350 or pdcourses@rcseng.ac.uk