Key Objectives

Objectives of Cleft Training

The training objectives are outlined in detail on the ISCP website under special interest sections of the speciality syllabus and the training objectives for the trainee should be set by the AES in reference to this and the trainees previous experience and competencies

Suggested key objectives for TIG trainees in cleft lip and palate surgery during the first six months of training

Points for consideration

  1. Based on assessment of competency using WBA’s on cleft skills , knowledge and MDT working
  2. Importance of a fair but rigorous and dependable uniformly applied assessment process at six months of training directed by TIG committee visit utilising interview of trainee, AES and other members of the cleft team and review of ISCP portfolio
  3. To recognise the different backgrounds, previous training and qualifications of trainees and how this impacts on the proposed key objectives at six months.
  4. To consider inclusion of optimal numbers of operative activities alongside a competency based system

Competency Assessment for Appointed Trainees

  • Assessment on commencement of post by AES and trainee to direct a learning agreement and PDP for trainee on ISCP
  • Continual assessment during first six months using WBAs and ISCP
  • Formal assessment at six months by TIG in conjunction with ARCP in base speciality

Levels of Competency from ISCP

Level at which completed elements of the PBA were performed on this occasion
 Level 0 Insufficient evidence observed to support a summary judgement
 Level 1 Unable to perform the procedure, or part observed, under supervision
 Level 2 Able to perform the procedure, or part observed, under supervision
 Level 3 Able to perform the procedure with minimal supervision (needed occasional help)
 Level 4 Competent to perform the procedure unsupvervised (could deal with complications that arose)

Surgical 'Index' Procedures

Operation / Procedure Expected Competency Level at 6 months 
Repair of unilateral cleft lip   2/3
Primary of cleft palate   2/3
Alveolar bone graft (including bone harvest)   2/3

Key Objectives/Competencies (to be achieved in the first six months)

Basic Sciences as Applied to Cleft Surgery7

  • Surgical anatomy of face, oral cavity and soft palate/pharynx in non-cleft and cleft situation
  • Normal physiology of speech production/development and swallowing
  • Normal physiology of the infant and child
  • Genetics of cleft lip and palate and common craniofacial syndromes
  • Oro-facial embryology
  • Basic knowledge of dental development
  • Aetiology and pathogenesis of CLP

Multidisciplinary Management

  • Demonstrable team working ability
  • Well developed communication skills
  • Empathy and sensitivity
  • Organising and planning skills
  • Knowledge of antenatal diagnosis and counselling
  • Data/record management
  • Evidence of audit activity
  • Evidence of research activity

Patient/Parent Management

  • History taking
  • Clinical examination of infant/child (general and cleft specific)
  • Perioperative management
  • Basic knowledge of cleft infant anaesthesia
  • Good knowledge of principles and techniques of primary and secondary cleft surgery (including the evolution/development of cleft surgery)
  • Appropriate use and knowledge of speech investigations (videofluroscopy/nasendoscopy).

Methods of Assessment

  • Initial assessment/interview with trainers on commencement to establish baseline and goals
  • Continuous assessment of operative/procedure skills by trainers
  • Training competency contracts
  • Set written/verbal (teaching) exercises throughout training period
  • Critical evaluation of published research
  • Formal assessment at six months - competency based structured interview/ARCPto evidence progression and development of competencies
  • Review of WBAs in ISCP
  • Presentation of audit/research project