Background

Phase 1 Initial Development (March 2003 – September 2004)

The initial development phase involved:

• The development of a curriculum framework. The nine Surgical Specialist Advisory Committees (SACs) developed the specialty syllabuses, identifying what trainees should know and be able to do at each stage of surgical training using four broad domains:
  • Specialty-based knowledge
  • Clinical judgement,
  • Technical and operative skills and
  • Generic professional skills.
• The trialling of individual assessment tools for operative competence and generic professional skills.
• Initial faculty development for training programme directors.
• The initial development of a website to support the above activities.
• Establishing links with the Royal College of Physicians and Surgeons of Canada and the Accreditation Council for Graduate Medical Education (USA) on curriculum development.

Phase 2 Pre-Pilot Phase (December 2004–March 2005)

The pre-pilot phase had two key objectives: to pre-pilot the new surgical curriculum and to produce a needs analysis of the learning and teaching resources required to modernise and reform surgical training.

Five deaneries self-selected for the pre-pilot: London North East, Northern, South West, Yorkshire and South Yorkshire and South Humber. An assessment was made of the local, regional and national systems that underpinned training in these deaneries. The ISCP team engaged with each deanery in a variety of ways, including visits, administering questionnaires and holding consultative discussion groups.

Throughout the pre-pilot phase, data was collected on:

• How surgery is taught and learnt;
• The resources and systems which underpin surgical training; and
• Management issues which would affect the implementation of the new surgical training programme, including attitudes towards organisational change.

The information enabled the project to begin to identify the relationship between existing resources and those needed to support the implementation of the new surgical training programme. Overall, the pre-pilots highlighted a number of existing issues, all of which would affect the success of the new curriculum:

• Lack of clarity over the roles and responsibilities of those involved in surgical education in general and surgical trainers in particular;
• Lack of educational resources and opportunities for surgical training;
• Concern over the quality of assessments and the accreditation of trainers;
• The ability of local organisational structures to support curriculum reform.

The two most important pieces of information to come out of the pre-pilots concerned:

• the lack of consultant time available for training, and
• a reduction in the access that trainees have to patients – in terms of theatre time, clinics and ward based care.

A report on the pre-pilot phase and an evaluation report of phase 2 of the project written by Professor Michael Eraut, of the University of Sussex, were published in 2005.

Phase 3 Pilot Phase (September 2005 - July 2007)

Phase 3 comprised a national pilot of the syllabus content, assessment strategy and tools, interactive portfolio and website concentrating on trainees in ST1 and ST2 pilots in six deaneries. Other trainees and consultants were also encouraged to participate in the pilot to ensure both national and specialty coverage for trainees at different stages of training.

The concentrated pilot study was supplemented by nationwide awareness raising activities and preparations for implementation including:

• Stakeholder meetings involving trainers, trainees, deanery staff and health care management professionals;
• Consultation forums with trainers and trainees;
• A faculty development programme for key surgical and deanery educators;
• User testing of the web site; both the open access part of the site housing the curriculum and the secure area housing the trainees’ portfolio and learning agreements.

Part of the purpose of the pilot was to provide evidence to support the case for better defined, recognised, rewarded and supported roles for trainers. The pre-pilot had raised the concept of schools of surgery as a means of assisting in the delivery of the new curriculum and clarifying the contributions and roles of those delivering training.

During the pilot, the concept of schools of surgery started to become a reality and seven heads of school were appointed in this phase.

Phase 4 Review and Evaluation Phase (April 2007 – March 2008)

The evaluation was a multi-strand investigation building on the pre-pilot evaluation results. Four sub-projects were commissioned as follows:

• Kent Surrey and Sussex Deanery - an analysis of the processes through which the intercollegiate surgical curriculum faculty groups are developed in trusts and the success of these groups in implementing the curriculum.
• Wales Deanery and Cardiff University - an investigation of clinically-based learning under the intercollegiate surgical curriculum in Wales with reference to the interaction of learning agreements and website tools to support the learning process
• Wessex Deanery and Southampton University - do current specialist training posts provide appropriate experience and support for future surgical trainees?
• Warwick Medical School - evaluating the impact of changes in continuity of care on stakeholders in the new surgical curriculum.

The study results were submitted to Professor Michael Eraut, who produced a comprehensive report based on the evidence obtained.

In addition:

• The assessments recorded in the ISCP e-portfolio, including the context in which they were made and the stage of training to which they refer, createda unique database of trainees’ progress through the ISCP curriculum and specialty training. This database can be used to monitor, evaluate and quality assure the workplace based assessments used within ISCP and, over time, contribute towards their validation.

The Royal College of Surgeons of England carried out a survey of the last pre-MMC cohort of SHOs on their experience of supervision.