The curriculum is competence-based. It focuses on the trainee’s ability to demonstrate the knowledge, skills and professional behaviours that they have acquired in their training (specified in the syllabus) through observable behaviours. Since it is competence-based, it is not time-defined and accordingly it allows these competences to be acquired in different time frames according to variables such as the structure of the programme and the ability of the trainee. Any time points used are therefore merely indicative.
There are certain milestones or competence points which allow trainees to benchmark their progress:
- Entry to surgical training - CT1 (or ST1 for those specialties or localities with run through programmes).
- Entry to entirely specialised training - ST3*.
- Exit at certification.
* A critical competence point is ST3 at which point, in practice, trainees will make a clear commitment to one of the nine SAC defined disciplines of surgery.
UK only
Within the early years of training (defined as that period which is prior to entry into ST3), much of the content is common across all the surgical specialties. During this period, trainees will acquire the competences that are common to all surgical trainees (defined as common competences) together with a limited range of competences that are relevant to their chosen surgical specialty (defined as specialty-specific competences).
- Those who have made a definitive choice of their desired surgical specialty, and who have been able to enter a 'run-through' training programme, will be able to focus upon achieving the common competences and the specialty-specific competences for their chosen specialty.
- Those who have not yet made a definitive choice of their desired surgical specialty will obtain a range of extra competences in a variety of surgical specialties, while at the same time sampling those specialties, before focussing on the chosen specialty prior to entry into ST3.
For those not in run-through programmes, within the early years, the trainee is not committed to a specific surgical specialty and can enter any of the relevant specialties at ST3 level provided they a) meet their educational milestones in the common surgical component of the curriculum and b) satisfy all the speciality requirements for entry in the specialty of their choice. The different training schemes offered by the postgraduate deaneries meet different educational needs and permit trainees to make earlier or later final career choices based on ability and preference.
It is essential that trainees must achieve both common and specialty-specific competence to be eligible to compete at the ST3 specialist entry competence level. In the early years (initial stage), the common core component reflects the level of competence that all surgeons must demonstrate, while specialty-specific competence reflects the early competences relevant to an individual specialty. In particular the MRCS examination is a mandatory requirement to enter higher specialty training in any discipline, irrespective of candidates reaching all other educational requirements. Otolaryngology trainees are required to pass the MRCS(ENT) examination or the MRCS and the DO-HNS examination.
From August 2013, the MRCS examination became a formal exit requirement from Core Surgical Training. It is also a mandatory requirement to enter higher specialty training in any discipline, irrespective of candidates reaching all other educational requirements. Otolaryngology trainees are required to pass the MRCS(ENT) examination or the MRCS and the DO-HNS examination.
UK and Republic of Ireland
Following entry into higher specialty training (which for those who have undergone training in core programmes will follow on from a second selection process), the trainee will typically undergo a period of training in the broad specialty and at the higher levels begin to develop an area of special interest, to allow some degree of specialisation in his or her subsequent career.
Early years surgical training – UK only
The purposes of early years (i.e. the initial stage) training are:
- To provide a broad-based initial training in surgery with attainment of knowledge, skills and professional behaviours relevant to the practice of surgery in any specialist surgical discipline. This is defined within the common component of the syllabus (which is also the syllabus of the MRCS).
- In addition it will provide early speciality training such that trainees can demonstrate that they have the knowledge, skills and professional behaviours to enter higher specialty training in a surgical specialty. The speciality element in the early years is not tested in the MRCS but through Workplace Based Assessments (WBAs) in the first instance, and subsequently through the Intercollegiate Specialty FRCS examinations, which are taken towards the end of specialty training.
Additionally trainees will be continuously assessed on the contents of the common component and their speciality-specific slots through WBA and structured reports from Assigned Educational Supervisors which in turn contribute to the Annual Review of Competence Progression (ARCP); this includes the level of competence expected of all doctors including surgeons to meet their obligations under Good Medical Practice (GMP) in order to remain licensed to practice.
Trainees who gain entry to higher specialty training despite some remediable and identified gaps in their speciality-specific curriculum competences must ensure these are dealt with expeditiously during ST3. All these gaps must be addressed by the time of an ST3 ARCP as part of their overall permission to progress to ST4. They must be specifically addressed through local learning agreements with educational supervisors. Trainees with identified gaps must be accountable to the training programme directors, who in turn must address this as part of their report to the ARCP process.
Intermediate and final years specialty training
The purposes of the intermediate and final years training are:
- To provide higher specialty training in the specialty with attainment of knowledge, skills and professional behaviours relevant to the practice in the specialty. This is defined within the specialty-specific component of the early years syllabus and the intermediate and final stages of the syllabus (and is also the syllabus of the FRCS).
- To develop competence to manage patients presenting either acutely or electively with a range of symptoms and conditions as specified in the syllabus (and the syllabus of the FRCS).
- To develop competence to manage an additional range of elective and emergency conditions by virtue of appropriate training and assessment opportunities obtained during training as specified by special interest or sub-specialty components of the final stage syllabus. This is tested either by the FRCS and/or by WBAs.
- To acquire professional competences as specified in the syllabus and in the General Medical Council’s Good Medical Practice or in the Medical Council of Ireland’s Guide to Professional Conduct and Ethics.