THE

RCoA Trainee Committee NewsletterIssue 6 / July 2013

NEWSDr Sumit Gulati (Co-Chairman) / Dr Peeyush Kumar (Co-Chairman) / Dr Jennie Kerr / Dr Katy Nicholson / Dr Natasha Joshi

Dr Caroline Hawe / Dr Jeremy Langton / Dr Gethin Pugh (WAB) / Dr Prit Anand Singh (SAB) / Dr Sarah Gibb & Dr Kate O’Connor (GAT)

Annual CongressThis year’s Annual Congress was held for the first time outside London, in Birmingham. It was well attended with many trainees presenting their posters. There was an interesting two day programme containing many topics of interest to trainees. During lunch time trainees were invited to interact with the Council members. We hope to make this a regular feature at future conferences.

65 years of the NHSThe NHS celebrated its 65th birthday on July 5th 2013. In honour of this the RCoA commissioned a short documentary “Anaesthesia: Art & Science. 65 years in the NHS” to explore the evolution of anaesthesia. It is available to watch on the college website andmakes fascinating viewing.

Keen to do some research? Don’t know where to start… Start here! The National Institute for Academic Anaesthesia (NIAA) are very keen to get trainee anaesthetists involved in research. Dr Ramani Moonesinghe, the Academic Trainee Coordinator, gave an extremely well received talk at the GAT ASM in April 2013 highlighting how/ where trainees can get involved. If you weren’t fortunate enough to be there you can watch it via the AAGBI’s online video platform.

The NIAA are also hosting a research themed week starting on September 30th at the RCoA. There will be seminars on research methodology and peer review followed by the Anaesthetic Research Societies Winter Meeting. It is possible to attend individual components of the week long programme. Further details are available on the RCoA website.

In addition, there is FREE two day meeting entitled Introduction to Academic Anaesthesia organized by the NIAA & London Deanery on September 9th/10th. Register here.

Logbook 9 UpdateThe latest version of the Royal College of Anaesthetists Logbook is now available. In addition to PC and Mac systems; this latest version will also run on iOS devices such as iPhone, iPad and iPod Touch. The new version now allows the user to generate the required logbook portfolio reports on the iOS device; these can then be saved on the device or sent via e-mail.

In order to start using this new feature, you will need to install a free app called Filemaker Go 12, from the App store. For the latest version of the logbook and details of installation please visit http://www.logbook.org.uk

New primary exam resourcesThe RCoA have just released a comprehensive range of exam resources on the college website. The new resources comprise a series of videos designed to show the difference between borderline and pass candidates in the SOE. Can you spot anyone you know in amongst the candidates? Yes, they are real anaesthetic trainees. The videos join existing college provided resources including the primary FRCA book, examples of SBA questions and OSCE information.

Save money – claim for your tax allowable feesFollowing negotiations by Royal College of Surgeons of Edinburgh’s Trainee Council member, HMRC has agreed that all mandatory training fees payable by all medical trainees will become tax deductible. The fee paid to Colleges to recommend for CCT to the GMC will also now be tax deductible. Further information can be found on the RCSEd website and the HMRC website. We would also like to remind trainees that membership fees of professional bodies eg. GMC, RCoA and specialist societies are also tax allowable. Information on how to claim these tax allowances in on the HMRC website and it is possible to backdate your claim by several years.

The trainee committee structure is changing. Details will be available soon but the committee still exists to represent trainee opinion within the college and promote trainee engagement.

committeeupdate

FFICM EXAMINATIONSGet your voice heard as a trainee

The new FICM Examination forms a fundamental part of assessment for trainees completing the new standalone CCT in Intensive Care Medicine.

FFICM Primary ExaminationThere is currently no separate FFICM Primary Examination; this situation may be reviewed in future years but at present, a pass in one of the partner specialty exams: Primary FRCA; MCEM or MRCP (UK) is considered acceptable. Trainees must pass the Primary examination related to their specific Core training programme: ACCS, Anaesthesia or Medicine.

FFICM Final ExaminationThis examination consists of 3 sections: Multiple Choice Question (MCQ) examination, Objective Structured Clinical Examination (OSCE) and the Structured Oral Examination (SOE). Both components of the examination (MCQ, OSCE/SOE) are scheduled twice each year. The next MCQ is on 8th January 2014 and the next OSCE/SOE sitting is in October 2013.

Final MCQThe examination comprises 90 Multiple True False questions covering the new ICM curriculum. In addition, from Summer 2014, the format will include Single Best Answer(SBA) questions, to assess the application of knowledge in the areas of science applied to clinical practice. A MCQ pass is valid for 3 years.

Final OSCEThis aspect of the exam comprises 13, seven minute stations, each with one minute reading time between stations. All stations must be attempted and one station acts as a ‘test station’ in order to validate new questions; neither the examiner, nor the candidates will be aware of which station this is.Questions are based on the areas of equipment, resuscitation, data and professionalism. Each station is scored out of a maximum of 20, with the individual pass mark for each station being determined by the Examiners before the examination.

Final SOEThis area of the examination will focus on clinical problems. It encompasses four, fourteen minute stations, with two questions being asked at each station. There will also be a two minute waiting period between stations.

Each question is marked independently by two examiners using a three point grading system: Pass = 2, Borderline = 1, Fail = 0

There are eight questions in total, meaning a maximum of 32 marks available. The pass mark is set in the range of 80% - 85% in line with other Medical Colleges and Faculties.The OSCE and SOE components must be attempted together at the first sitting. However if a candidate passes one component but is unsuccessful in another, then only the failed component needs to be retaken.Joint CCT

The FFICM exam is an essential requirement for trainees entering the new standalone ICM CCT programme from August 2012. However, individuals on the Joint CCT programme will be eligible to take the examination, but it will remain optional.For more details on the FFICM examinations, including application form and exam calendar, visit the Faculty of Intensive Care Medicine website.

Dr Gethin Pugh

The Jubilee Current Concepts Meeting is being held on 10-11 October 2013. This special meeting has been organised to celebrate the 25th anniversary of the College. In 1988 the Faculty of Anaesthetists of the Royal College of Surgeons became an independent entity known as the College of Anaesthetists. A Royal charter was granted in 1992 creating the title we use today. The chosen theme is Rising stars of Anaesthesia, Pain Medicine and Critical Care. Trainee members, as the future of the specialty, are warmly invited to come along and hear these influential speakers.

An invitation only trainee event will be hosted by the college alongside the scientific programme on October 10th. Trainee representatives will be invited from each School of Anaesthesia for a tour of the college followed by an opportunity to talk to council members, the trainee committee and attend the evening drinks reception.

As the trainee committee we are really excited to welcome our colleagues from across the country and wish we could invite everyone! We are hoping to use this event to build long term relationships and strengthen this college’s commitment to junior members.

rising starsthe jubilee meeting

Dr Sarah Gibb

GMC POSITION STATEMENT: TIME OUT OF TRAINING

The General Medical Council (GMC) released a position statement on time out of training in November 2012. It was implemented on the 1st April 2013 and provides guidance to Postgraduate Deaneries, Medical Royal Colleges/Faculties, trainees and trainers on the management of absences from training and their effect on a

trainee’s Certificate of Completion of Training (CCT) date.

The GMC has determined that within each 12 month training period where a trainee has been absent for a total of 14 days or more (when they should normally have been at work) a review of whether the trainee needs to have their CCT date extended will be triggered. All leave is included (e.g. maternity, paternity, parental, compassionate paid/unpaid, sickness) except study or annual leave and prospectively approved out of programme training/research (OOPT/R).

The administration of the absence and any extension to training will be undertaken by the relevant Deanery in consultation with the Royal College of Anaesthetists (RCoA). For the full statement and frequently asked questions go to the GMC website.

less than full-time training

Dr Jennie Kerr

The GMC asked trainees questions concerning patient safety for the first time in the 2012 GMC survey. They encourage trainees to speak up when things are not right. This is especially encouraged in light of the recent Francis enquiry. Last year, 5% of trainees reported concerns over patient safety.This year’s survey has now closed and the results are available on the GMC website on June 12th. Have you checked out your school of anaesthesia?

trainees’ concerns about patient safety

the a-z guide updated

GMC survey

This guide for anaesthetic trainees who are currently working LTFT or are considering part time work-ing has been updated to take into account recent changes to training. It includes a list of useful re-sources and it is hoped it will prove a helpful aid to both trainees and trainers alike.

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Dr Sumit Gulati

All doctors working in the UK require a GMC licence to practise. Revalidation is the process by which a doctor’s licence to practise is renewed and is based on local systems of appraisal and clinical governance. Doctors will be required to revalidate every 5 years but this will be based on the results of yearly appraisal. Thus it is

important that revalidation is viewed as 5-year process not a fifth year event. The GMC officially launched Revalidation on 3 December 2012 and a phased roll out is in process going through to 2018.

The Conference of Postgraduate Medical Deans issued guidance in 2010 that doctors in training should be revalidated through a strengthened ARCP process. The NHS Revalidation Support Team (RST) piloted the new paperwork at the end of 2011. Participating trainees felt that enhancements to the ARCP process were fair and beneficial and that the self-declaration and amended paperwork did not take a significant amount of extra time. 3 new forms have been introduced to support revalidation these are:

Enhanced Form R – This contains trainee information and has more details including a Self Declaration that is over and above what Specialty trainees normally sign on an annual basis.

Educational Supervisor’s Report - This includes existing training report and any fitness to practice issues. Regular discussion about your progress and outstanding learning needs will now include summarising and reflecting on strengths and weaknesses, and significant achievements or difficulties, which will usually encompass information on significant events, and complaints and compliments.

Exit Report from the employer - This is a proposed formal mechanism to provide information on any fitness to practice issues like complaints, serious untoward incidents, conduct or capability issues. This will be requested by the deaneries, on a biannual basis (April and November), from all employers and will be signed by the medical director.

RESPONSIBLE OFFICER (RO)Every doctor registered with GMC will have a RO who will make a revalidation recommendation to GMC periodically. For trainees this recommendation will be based on the outcome of annual ARCP process.

For trainees in England, the responsible officer is postgraduate dean; in Scotland it is the medical director for NHS Education for Scotland; in Wales it is the postgraduate dean of Wales Deanery and in Northern Ireland the postgraduate dean of the Northern Ireland Medical and Dental Training Agency (NIMDTA) will be the responsible officer.

WHEN WILL YOU REVALIDATE?From April 2013 to March 2018 trainees will revalidate at point of eligibility for CCT. Transitional arrangements have been in place for those who gained a CCT between 3 December 2012 and 31 March 2013 who will revalidate between April 2014 and March 2016. In the future trainees will start a five year revalidation cycle upon full registration with the GMC. Doctors who gained full registration after the 3 December 2012, will have a variable date for revalidation depending on how long their training lasts: If training lasts less than five years, the first revalidation will be at the point of eligibility for CCT. If training lasts longer than five years, first revalidation will be five years after full registration, and the trainee will revalidate again at the point of eligibility for CCT.

There is comprehensive guidance on the GMC website about what will happen in the event of CCT date changes/ interruptions to training.

REMEDIATION“The overall process agreed with the practitioner to redress identified aspects of underperformance. Remediation is a broad concept varying from informal agreements to carrying out some re-skilling, to more formal programmes including supervised remediation and/or rehabilitation”The introduction of revalidation is expected to identify doctors with performance issues. The department of health published guidance on remediation in 2011. It indicates that performance issues should be dealt with locally in the first instance. For those in training posts remediation will be provided by the home deanery/ LETB. Many now have information on their websites eg. London, Wales.

Patient multisource feedback for anaesthetists: draft guidance:The GMC considers patient feedback to be fundamental to revalidation and state that it should be obtained at least once in a 5-year revalidation cycle. The RCoA recognises the importance of communication and interpersonal skills in anaesthetic practice and encourages all anaesthetists to obtain patient feedback wherever possible. Families and carers, students, suppliers or customers can all be canvassed depending on an indivuduals field of practice. The College has published a position statement on individualised patient feedback for revalidation.

Non-traditional medical careers:Plans for non-traditional medical careers (such as locums, Military training) are being finalised and will be published in due course. Regardless every trainee will have a RO. Academics will have the employing (or honorary contract) NHS hospital trust as their designated body.

NEED MORE INFORMATION/ HELP?A Revalidation Helpdesk has been established at the College with a team of experienced clinicians to act as specialty advisors to respond to enquiries from anaesthetists and their appraisers and responsible officers. They can be reached at revalidation@rcoa.ac.uk or you can contact the trainee committee directly on trainee@rcoa.ac.uk. The RCoA, GMC and NHS Revalidation Support Team websites contain a wealth of information for further reading.

REVALIDATION

The GMC already receive aggregated examination data from Colleges and Faculties through the Annual Specialty Report (ASR). The ASR is specifically designed to provide assurance to the GMC and the public that Colleges are driving the quality of training and the delivery of curricula in line with the GMC‘s standards.

The present aggregated examination data received by the GMC allows them to analyse the performance of UK trainees by gender, country of origin and Primary Medical Qualifications etc. However, aggregated data is difficult to validate and the analysis of such data is limited.

Therefore in order to improve data quality and completeness, which in turn will allow the GMC greater control in the analysis of progression patterns, they have requested that Colleges and Faculties provide data at ‘trainee level’ which will allow the GMC to establish clean and validated datasets and integrate exam results with ARCP and recruitment data etc.

To achieve this, the GMC have asked that Colleges/Faculties provide individual data fields for all UK trainees, the required fields include: GMC number, First name, Surname, Trainee level and Deanery, exam result, marks, date of success and a marks breakdown. The GMC have confirmed that they will only publish aggregated exam data against GMC number in the form of pass or fail. Other specific data will be retained and may be used for research.The College has been in discussion with the GMC to ensure that the provision of data requested and that data storage/governance is in accordance with The Data Protection Act 1998 (DPA 1998). The College is satisfied that the provision of data for doctors registered with the GMC is permitted under the DPA 1998 Schedule 2. The GMC have recommended the following privacy notice:

“If you are registered or anticipate being registered with the GMC then your personal data, including data about your exam results, will be passed to the GMC for quality assurance and research purposes and to facilitate the awarding of certificates of completion of training (CCTs).”

The privacy notice will be put in place no later than 31st March 2013. The GMC’s privacy notice will be in addition to the College’s ‘Disclosure of Information’ notice which is already reflected on examination application forms and covered in the College’s data protection policy.

Individual candidate data will be published by the GMC using a password protected online reporting tool from September 2014. The report will use data collected over the 2013-2014 academic year.

For further information please see the GMC website.

Graham Clissett, RCoA Examinations Manager

GMC TO COLLECT EXAMINATION DATA

SAFE ANAESTHESIA LIAISON GROUP

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On the 17th December 2012 the Department of Health published a scoping report on the junior doctors’ contract produced by NHS Employers in collaboration with the four health departments. The review took into account the views of many employers within the NHS as well as the British Medical

Association (BMA), British Dental Association (BDA) and the BMA Junior Doctors Committee (JDC).

The current “New Deal” contract was implemented in 2000 with the specific remit of reducing junior doctors’ hours, enforcing minimum rest breaks and working conditions. Between 2004 and 2009 the European Working Time Directive (EWTD) came into force. In “Time for Training”, the report on the impact of the EWTD on medical training in England, Sir John Temple raised concerns over the way the EWTD and New Deal constrained working patterns and that this may have a serious impact on training opportunities.

In addition employers are concerned by the punitive nature of the current contract, the burden of monitoring and the financial risks of the pay banding system. It is felt that this system has led to opposing financial incentives between employers and doctors in training which may lead to strained employment relationships.All stakeholders agreed that contract renegotiations should work towards achieving five key aims; better patient care and outcomes, doctors in training feeling valued and engaged, affordability, producing the next generation of medical professionals, improving relationships (between junior doctors, employers and Deaneries). Employers in England favour a flexible, locally determined approach within an overall national framework, while the BMA JDC advocated comprehensive nationally applied standards to ensure consistency. Employers in the devolved administrations also supported nationally applied standards.

Some other areas which the scoping report has raised for negotiation are; linking pay progression to progress through training and competencies achieved; whether doctors should be paid during rest breaks; more emphasis on basic pay rather than banding; the future of salary protection (pay protection for career grade doctors returning to training) and banding protection; recognition for unsociable hours worked; how much out of hours work is necessary for training; potential for an educational component to be included in contract; lead employer arrangements.

A deadline for completion of renegotiations has been set for April 2014 by Health Secretary Jeremy Hunt although it is looking increasingly unlikely that this target will be met.

Dr Sarah Gibb

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All RCoA Events can be booked via the RCoA Events webpages. For those of you who are unable to at-tend an event for any reason the RCoA also have an online video streaming platform. For those of you who are unable to attend an event for any reason, the RCoA also have an online webcasting platform. Many of lectures held at the College have been uploaded and can be viewed freely via the college web-site.

ESRA Annual CongressESRA 2013 is a unique opportunity to enhance your practice by partaking in the top caliber scientific programme and discussing the latest advances in anesthesia with leading specialists from across Europe and around the world.When Wednesday 04/09/2013 - Saturday 07/09/2013Location Scottish Exhibition and Conference Centre, GlasgowFee £375

Advanced Airway WorkshopAimed at Consultants and senior trainees wishing to gain advanced airway skills using experienced small group teaching and hands-on practice.When Wednesday 04/09/2013Location Royal College of AnaesthetistsFee £195

After the Final FRCA - making the most of ST5-7At this event explore how best to enhance your learning experiences in years ST5-7. Presentations from experienced anaesthetists who specialise in paediatrics, neuroanaesthesia, regional anaesthesia and cardiothoracics. Workshops focusing on management, teaching and research.When Thursday 05/09/2013Location Royal College of AnaesthetistsFee £165

Leadership & Management: Personal EffectivenessThe RCoA have introduced a series of interactive workshops covering a spectrum of topics designed specifically for Anaesthetists (both senior trainees and Consultants). These are designed to help you answer these questions and give an insight into personal strengths, development needs and the skills necessary to have a real impact as a leader in today’s NHS.When Monday 09/09/2013Location Royal College of AnaesthetistsFee £220

VASGBI Annual Scientific MeetingFor more information and to book please visit the VASGBI Website. When Monday 16/09/2013 - Tuesday 17/09/2013Location Town Hall, ManchesterFee £225

AAGBI Annual CongressFor more information and to book please visit the AAGBI Website. When Wednesday 18/09/2013 - Friday 20/09/2013Location The Conference Centre, DublinFee £340

Introduction to Academic AnaesthesiaFor more information and to book please visit the London Deanery Website. When Monday 09/09/2013 - Tuesday 10/09/2013Location The London Deanery, Stewart HouseFee Free

National Anaesthesia Trainee Research DayA national meeting to establish a foundation for a UK national trainee network for research in anaes-thesia, pain medicine and intensive care medicine. The day will include education about research and existing networks and there will be opportunities for trainees to share experiences and present projects. Open to trainees and interested consultants. Programme to be available shortly from the NIAA website.When Monday 02/12/2013Location Royal College of AnaesthetistsFee Free

CoursesDr Jennie Kerr

Our regular round up of documents that trainees should know about. Don’t approach an interview / exam without checking these out!

AoMRC: Changing care, improving quality: reframing the debate on reconfiguration (June 2013)

MHRA: Statement on the use of codeine in children (June 2013)

BMJ: Day of week of procedure and 30 day mortality for elective surgery: retrospective analysis of hospital episode statistics (Aylin et al. BMJ May 2013; 346)

SALG: Safety Notification for Intravenous Paracetamol (May 2013)

DoH: Quality in New Health System - Maintaining and Improving quality from April 2013 (April 2013)

RCS: Standards for Children’s Surgery (March 2013)

The RCoA trainee committee aims to bridge the gap between trainees and the RCoA. We want to hear about any issues you are experiencing during anaesthetic training so please do not hesitate to contact us: trainee@rcoa.ac.uk.

If you have any suggestions for articles for either “The Gas” or the RCoA bulletin then let us know. We suggest that you contact us prior to writing an in depth article.

If you are moving house it is important that you update the college of this to allow continued delivery of publications. This can be done quickly and easily using the online form.

You can contact us by email or by writing to us at: The Trainee Committee, Royal College of Anaesthetists, Churchill House, 35 Red Lion Square, London, WC1R 4SG.

Dr Katy NicholsonBEDTIME READING

COMMUNIC@TION