Paediatric Surgery Curriculum

2 Purpose

he purpose of the curriculum is to produce, at certification, competent doctors, able to deliver excellent outcomes for patients as consultant surgeons in the UK. The curriculum will provide consultant surgeons with the generic professional and specialty-specific capabilities needed to manage patients presenting with the full range of acute conditions up to, including and beyond the point of operation and to manage the full range of acute and elective conditions in the generality of their chosen special interest. Trainees will be entrusted to undertake the role of the general Paediatric Surgery Specialty Registrar (StR) during training and will be qualified at certification to apply for consultant posts in Paediatric Surgery in the UK or Republic of Ireland.

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.

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.

The Shape of Training (SoT) review1 and Excellence by Design: standards for postgraduate curricula2 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 Capabilities3 (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)4. 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. In addition, core knowledge and skills gained in any surgical specialty training programme are transferable for entry into Paediatric Surgery. Trainees who choose to move from a different speciality training programme having previously gained skills transferable to Paediatric 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 Paediatric 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.

Trainees will enter Paediatric Surgery training via a national selection process following foundation training for run-through or following core surgical training for uncoupled programmes. The curriculum is outcome-based rather than time-based. It will, however, normally be completed in an indicative time of eight years (two years in phase 1 – core surgical training, four years in phase 2, and two years in phase 3).
The programme will be divided into three phases (figure 1):

  • Phase 1 will follow the Core Surgical Training curriculum.
  • Phase 2 comprises the first four years of specialty training to gain knowledge and experience to manage all patients in paediatric surgery, to the point of being able to sit and pass the FRCS(Paeds) and surgical competence to include routine day-case surgery, beginning to learn complex cases, demonstrated through the CiPs.
  • Phase 3 comprises the final two years to consolidate knowledge and experience with technical competence to be an emergency safe surgeon in paediatric surgery, to medically manage all cases presenting on an unselected on-call to be competent to manage surgically 90% of these.

Figure 1. Paediatric Surgery Training Pathway

Training will be in at least two centres during phases 2 and 3 so that trainees can experience different approaches to management.

Trainees who demonstrate exceptionally rapid development in knowledge, technical skills and acquisition of capabilities can complete training more rapidly than this indicative time. There may also be a small number of trainees who develop more slowly and require an extension of training in line with A Reference Guide for Postgraduate Foundation and Specialty Training in the UK (the Gold Guide)5. Trainees who opt for training less than full time (LTFT) have their indicative training time extended on a pro-rata basis.

1 Shape of training: Securing the future of excellent patient care

2 Excellence by design: standards for postgraduate curricula

3 Generic professional capabilities framework

4 Good Medical Practice

5 Gold Guide 8th edition