The Specialty Advisory Commitees and Surgical Training: a Trainee's Perspective

created 01 December 2016

It is late on a Friday night and I am returning home on the train from an Association of Surgeons in Training (ASiT) council meeting in London. One of the items on tonight’s agenda was a debate regarding the relative merits of two proposed reforms to the structure and function of the surgical Specialty Advisory Committees (SACs) that would also be applicable to the training interface groups. These proposals represent the culmination of the work undertaken by the SAC review group, of which I have been part in my capacity as the ASiT representative.

In an era of austerity, increased accountability and an ever changing surgical landscape, the review group was tasked with exploring potential means of streamlining the function of SACs and redefining the responsibilities of its members. The initial stage of the process was to conduct a survey of all stakeholders who interact directly with the SACs, as well as current and past SAC members, with regards to their opinions on what the terms of reference of the SACs should be. Unsurprisingly, the monitoring of trainee progress, curriculum development and quality assurance were the three most highly rated responsibilities, while workforce planning was rated as the lowest. Over 80% of respondents felt that the key curriculum matters on which the SACs should focus were the development of the ISCP website and the design of WBAs. Opportunities were also identified to redefine the role of liaison members, in particular the type of input they should offer to the deaneries and schools of surgery.

Based on these responses, a strengths, weaknesses, opportunities and threats analysis was conducted on four options for change that ranged from maintaining the status quo to a radical redesign of the SACs. The more radical options focused on a dramatic reduction in the size of each SAC with liaison members assigned an associate role. The main advantages of these options were seen as the potential to dictate a more rapid pace of change, increased efficiency and ensuring the full engagement of all members of the SAC. However, there would be a dramatic increase in the workload of individual members and a possible disenfranchisement of liaison members who would perceive their role as being diminished. Conversely, an option that would be seen as maintaining the status quo may not be acceptable in a climate of reform. It is with these thoughts in mind that the review group has settled on a ‘minimal change’ option and a ‘moderately radical’ option for consultation with the relevant stakeholders. Once the consultation process has finished, a final report with recommendations will be sent to the Joint Committee on Surgical Training in March.

My work with the review group has provided an invaluable insight into the sheer volume of work undertaken by the SACs, a fact that has not always been readily apparent from the other side of the table at an ARCP! It was interesting to note the responses of many SAC members who appear to devote a significant proportion of their time to their respective roles, often at significant personal expense. I am among the first of the ‘MTAS/MMC generation’ to approach the end of their training and have witnessed first-hand the sea change in the surgical training culture since 2007. Can we still produce world class surgeons within the confines of the European Working Time Directive mandated 48-hour week? My interaction with surgical trainees both here in the UK, and abroad, leads me to believe that we still do.

In my opinion, the finished article from the UK system outranks those from other Western nations in terms of technical attributes, clinical acumen, management abilities and leadership skills. Our higher surgical training may appear long, but the fervour with which most senior UK trainees seek post-CCT fellowship training opportunities would suggest that any attempt to shorten training is misguided. This fact must not be lost as the Shape of Training Review looms large on the horizon of the surgical community. It is imperative that we are able to maintain, and seek to continually improve, the assessment of our surgical trainees in a manner that is rigorous, fair and transparent. In this respect, quality assurance of the SACs has never been more important.

David Messenger, ST8 General and Colorectal Surgery trainee, Severn Deanery

Lewis Ashman

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