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GASTROENTEROLOGY StR Handbook Wales Deanery

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Page 1: Wales gastro induction v2 · Dr Praveen Dr Jafri Dr Nagaraj Singleton Hospital, Swansea Dr Ch’ng Dr Williams Dr Henson Dr Thomas Princess of Wales Dr Yapp Dr Constable Dr Lai University

GASTROENTEROLOGY

StR Handbook Wales Deanery

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Gastroenterology  StR  handbook  –  version  2  (Feb  2015)  Jeff  Turner  

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WELCOME

This handbook aims to provide you with an overview and important information about the Welsh StR training scheme. The training programme in Gastroenterology aims to offer the highest quality training in hospitals situated throughout Wales. Each Health Board participating in the training programme has a nominated training lead who sits on the specialist training committee. The five year programme has been designed to provide trainees with dual accreditation in both Gastroenterology and General Internal Medicine (GIM), with each clinical placement commencing in the first week of September each year. This includes the opportunity to apply for ST6 sub-speciality posts in IBD/nutrition (University Hospital of Wales, Cardiff) and ERCP/EUS/Hepatology (Royal Gwent Hospital, Newport). We hope you enjoy your time in Wales and look forward to working with you.

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Contents

Page Wales Deanery 4 Gastroenterology STC 5 ST placements and sub-speciality ST6 posts 6 Annual calendar 7 Hospitals participating in training 8 Educational and clinical supervision 9 Gastroenterology and GIM curricula outline 10 JRCPTB (E-portfolio) 11 Curriculum requirements and assessments 12-14 Endoscopy training 15 Training days and leave 16 Speciality Certificate Examination (SCE) 17 Annual Review of Competence Progression (ARCP) 18 Completion of training & post-CCT extension 19 – 20 Out of programme (OOP) requests 21 – 22 Less Than Full Time Training 23 Professional Support Unit (PSU) 23 Useful websites 24 Appendix 1: Gastroenterology STC guidance for the educational 25 – 27 Contract between trainees, educational and named clinical Supervisors Appendix 2: WCAT placement policy 28 – 30 Appendix 3: Gastroenterology/GIM ARCP checklist 31 – 32 Appendix 4: GIM PYA checklist 33

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Wales Deanery http://www.walesdeanery.org/

The aim of the Wales Deanery is to commission, quality assure and support the education and training of trainees in Wales. Gastroenterology/GIM training consists of a 5-year program as outlined below: The Deanery manages out of programme experience, less than full time training, inter-deanery transfers and ARCPs in conjunction with the Gastroenterology/GIM STCs. There are several important people within the Deanery who will monitor and help support your training: Gastroenterology

• Trudy McMullin E-mail: [email protected] Telephone number: 02920 687483

General Internal Medicine (GIM) • Ceri Cook E-mail: [email protected]

Telephone number: 02920 687593 Speciality Training Manager

• Hilary Williams E-mail: [email protected] Telephone number: 02920 687444

18/05/2013 17:19

Page 2 of 6http://www.jrcptb.org.uk/trainingandcert/ST3-SpR/Pages/Gastroenterology.aspx

Entry into Gastroenterology training is possible following successful completion of both a foundationprogramme and a core training programme.

There are 2 core training programmes for Gastroenterology training:Core Medical Training (CMT)Acute Care Common Stem (Medicine) ACCS

AssessmentThe following methods are used as part of the integrated assessment system:

Specialty Certificate Examination (SCE)Workplace-based assessments (WPBAs)

The assessment blueprint, which is embedded in the clinical syllabus, shows the possible methods that canbe used to assess each of the competencies in the curriculum. Trainees and trainers should refer to theblueprint for guidance on the appropriate assessment methods for each aspect of the curriculum, and soplan the training programme according to the criteria set by the ARCP Decision Aid. It is not expected thatall competencies will be assessed by all methods, rather that there will be a sampling of competencies withina variety of settings, both within formal and workplace-based assessment, from which overall competenceacquisition has to be determined.

The diagram below describes the training pathway:

Please view the 2010 curriculum for Gastroenterology for full details on the training routes andselection criteria.

2007 CurriculumEntry into Gastroenterology training is possible following successful completion of both a FoundationProgramme and a core training programme.

Please view the 2007 curriculum for Gastroenterology for full details on the training routes andselection criteria.

AssessmentThe assessment blueprints show the possible methods that can be used to assess each of the competenciesin the curriculum. Trainees and trainers should refer to the blueprints for guidance on the appropriateassessment methods for each aspect of the curriculum, and so plan the training programme according to thecriteria set by the ARCP/RITA Decision Aid. It is not expected that all competencies will be assessed by allmethods, rather that there will be a sampling of competencies within a variety of settings, both withinformal and workplace-based assessment, from which overall competence acquisition has to be determined.

Further information on the various methods of assessment can be viewed in the Assessment section of thiswebsite.

The diagram below describes the training pathways in general terms.

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Gastroenterology Specialist Training Committee (STC)

The STC consists of gastroenterology consultants from each of the Health Boards within Wales and trainee representatives. A chair and two training programme directors oversee the STC. TPD’s are responsible for managing speciality training programmes including recruitment, placements, training days, ARCPs and in helping the Deanery in managing trainees in difficulty. STC chair Dr Peter Neville Consultant Physician & Gastroenterologist (Prince Charles Hospital, Merthyr Tydfil) E-mail: [email protected] Training Programme Directors (TPD) Dr Jeff Turner (ARCPs & progression) Consultant Physician & Gastroenterologist (University Hospital Llandough, Cardiff) E-mail: [email protected] Secretary telephone number: 02920 715583

Dr Vivek Goel (Recruitment & rotation) Consultant Physician & Gastroenterologist (Royal Gwent Hospital, Newport) E-mail: [email protected] Secretary telephone number: 01633 234447 WAGE Training representative Dr Rhodri Stacey BSG training representative (Wales) Dr Laith Alrubaiy

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ST placements You will be informed of your first two years of placement (ST3 & ST4) on commencing the training programme. At the start of each post you should receive a general and endoscopy unit induction. It is important to arrange a meeting with your educational supervisor (ES) within the first couple of weeks to discuss your educational needs in both gastroenterology and GIM for that year (this should be recorded on an ‘induction appraisal form’ on the NHS e-portfolio). You will rotate to your subsequent post in the first week of September each year. This will be allocated by the STC and prioritised according to your training needs. Your timetable will vary with each placement, but as a minimum should consist: 1. Outpatient clinics 2 per week 2. Inpatients 1 - 2 consultant + 1 StR led ward round per week 3. Endoscopy Minimum 1 training list per week – 2 sessions recommended

(size of list & procedure type should vary with stage of training) 4. Audit/research/study 1 session per week (Bleep free)

Sub-speciality ST6 posts

Sub-speciality training is available during your ST6 year of training. Depending upon the level of interest each year, they will be appointed following an interview process. Two posts are currently available within Wales: 1. IBD/advanced nutrition

1 year post based at the University Hospital of Wales. Includes the in and outpatient management of patients with complex IBD & advanced nutrition including HPN. It has the option of a period of training in the Intestinal Failure Unit in Cambridge. No acute GIM on calls are required during this placement, however you may still be required to provide inpatient care to GIM patients.

2. ERCP/EUS/Hepatology

1 year post based at the Royal Gwent Hospital (Level 2 hepatology centre). Includes access to several ERCP and EUS lists per week, in addition to hepatology and hepatobiliary clinics and MDTs. It has the option of a period of training in a level 3 liver unit. No acute GIM on calls are required during this placement, however you may still be required to provide inpatient care to GIM patients. It should be noted that this post does not allow sub-specialisation in hepatology.

National posts for hepatology and nutrition are advertised annually through NHS jobs. They are recorded as periods of OOPT (Time out of programme for training) and count towards your CCT. One of these posts is required to achieve subspeciality accreditation in Hepatology.

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Annual calendar

Below is an outline of the principal programme and training events occurring annually. There may be some variance in these dates each year: ST3 interviews (Round 1) May Gastroenterology ARCPs May ST teaching week June WAGE meetings March/April

October

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Hospitals participating in training

Hospital Consultants Ysbyty Gwynedd, Bangor

Dr Ahmed Dr Gasem

Ysbyty Glan Clwyd, Rhyl

Dr Finnie Dr Ramanaden Dr Baghomian

Wrexham Maelor Hospital, Wrexham

Dr George Dr Khan Dr Mathialahan Dr Manoj (Training lead for BC UHB)

West Wales General Hospital, Carmarthen

Dr Salam Dr Bowen

Prince Philip Hospital, Llanelli

Dr Rees

Prince Charles Hospital, Merthyr

Dr Slowinska (Training lead) Dr Hurley Dr Neville (STC chair)

Royal Glamorgan Hospital, Llantrisant

Dr Alcolado Dr Hawkes (Training & endoscopy lead) Dr Patel Dr Lee Dr Berrill

Royal Gwent Hospital, Newport

Dr Allison Dr Goel (TPD) Dr Balaratnam Dr Yeoman Dr Czajkowski

Nevill Hall Hospital, Abergavenny

Dr Yearsley Dr Somesaker

Morriston Hospital, Swansea

Dr Dave Dr Praveen Dr Jafri Dr Nagaraj

Singleton Hospital, Swansea

Dr Ch’ng Dr Williams Dr Henson Dr Thomas

Princess of Wales Dr Yapp Dr Constable Dr Lai

University Hospital Llandough, Cardiff

Dr Swift (Endoscopy training lead) Dr Green Dr Dolwani Dr Turner (TPD) Dr Tibbatts

University Hospital of Wales, Cardiff

Dr Hawthorne Dr Durai Prof Godkin Dr Sunderraj Dr Thomas Dr Khan

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Educational and Clinical Supervisors (See detailed guidance Appendix 1)

Educational supervisors At the start of the training programme you will be allocated a single Educational Supervisor (ES) for the period of your training. Your ES has an overview of your training and is responsible for your educational planning and career development. It is your responsibility to arrange regular meetings with your ES and ensure that your e-portfolio is up to date and reviewed. If you have any difficulty arranging meetings with your educational supervisor/any other concerns you should speak with your TPD. You should have four meetings with your ES during each placement, with documentation completed on the e-portfolio: 1. Induction appraisal – within initial 4 weeks of the post 2. Mid point review – around January/February 3. ES report/review – end of April/early May (prior to ARCP) 4. End of attachment appraisal – end of August prior to rotation to the next post As you will be dual accrediting, it is important to look at and complete your training requirements for both gastroenterology & GIM – this includes audits, SLE’s and attendance at training days. Clinical supervisors During your placement one or more clinical supervisors will also supervise you. They are responsible for supervising your day-to-day clinical work, such as endoscopy, outpatient clinics and inpatient work. Your ES will also seek feedback about your progress and performance from your clinical supervisors – this will be recorded in your multiple consultant reports (MCRs). In some cases your clinical supervisor will also be your ES. Any concerns or problems (either personal or related to your job) that you experience during your placement can be discussed with your clinical or educational supervisor or any other member of the department you feel comfortable approaching. If you do not feel comfortable discussing or are unable to resolve any concerns raised you are welcome to contact one of the training programme directors. Patient safety concerns Any concerns you have relating to patient safety should be discussed with either your clinical or educational supervisor. If these concerns potentially relate to your supervisors they should be discussed with the head of department or local clinical director. Undermining/bullying If you encounter or witness any undermining or bullying during your placements you should discuss this with either your clinical or educational supervisor. If you feel this involves your supervisors you can discuss this with one of the TPDs.

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Curricula

Both the gastroenterology and GIM curricula and decision aids are available on the JRCPTB website or accessible through links on your e-portfolio (http://www.jrcptb.org.uk/specialties). These documents outline the requirements to gain your CCT, including assessments and progress required at each stage of your training. It is important to ensure that evidence of your training is uploaded to your e-portfolio on a regular basis, with adequate linking between your assessments/reflections and relevant curriculum (NB: you can link to more than one part of your curriculum). It is important to note that the GMC have now mandated that any trainee who will complete their training after the 31st December 2015 are required to transfer to the 2010 version of the gastroenterology curriculum. Links Gastroenterology curriculum 2010 (amended 2013) & decision aid (updated Aug 2014) http://www.jrcptb.org.uk/specialties/gastroenterology-­‐includes-­‐sub-­‐specialty-­‐hepatology   GIM curriculum 2009 (amended 2012) & decision aid (revised November 2014) http://www.jrcptb.org.uk/specialties/general-­‐internal-­‐medicine-­‐gim  

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E-portfolio (JRCPTB) https://www.nhseportfolios.org/Anon/Login/Login.aspx?ReturnUrl=%2fAuth%2fCommon%

2fPages%2fSelectRole.aspx  

You are required to enrol with the JRCPTB, which includes access to the e-portfolio - a mandatory component of your training. This can either be paid to the JRCPTB with an upfront one off payment of £845 (tax deductible), or as instalments of £169 per annum paid alongside Collegiate membership. It is important to become familiar with the different components of the e-portfolio early in your training, as it provides evidence of adequate progression, assessed at your annual ARCP. It includes a record of meetings with your educational supervisor, examination and certificates, personal library, supervised learning events (SLE’s) with links to your curriculum and Annual Review of Competence Progression (ARCP) outcomes. It is the trainee’s responsibility to ensure that the e-portfolio is kept up to date, including reflections on your learning experiences. If you have any difficulties in engaging your ES in the e-portfolio you must inform the TPD immediately – it will not be accepted as a reason for incomplete information provided at your ARCP’s. Key points • Ensure that all of your personal details including e-mail address are kept up to date

within the ‘Profile’ section. • You should complete a PDP (personal development plan) at the start of each clinical

attachment and prior to your ARCP to outline your objectives for your next placement (this information will be used to plan the rotation).

• Each review meeting and report entered by your ES must include that it covers both

gastroenterology & GIM. • You should review the decision aids for both Gastroenterology & GIM at the start of

each placement so that you are aware of your requirements for the forthcoming year – this includes the appropriate number of SLE’s.

• Your e-portfolio and assessments should be updated regularly throughout the

year and linked to the relevant parts of the curriculum. The number of times an SLE can be linked to curriculum competencies is limited to eight for each ACAT and two for CbD & mini-CEX’s.

• Your ES should sign off the different components of your curriculum. • It is worth using the Royal College of Physicians diary to record your CPD activity – an

annual summary can be uploaded as a PDF to your personal library (it is also recommended at your GIM PYA).

• Courses etc can only be validated if certificates are uploaded to your e-portfolio (this

usually requires completion of feedback).

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• Any absences from work should be recorded on your e-portfolio. This may be checked against your medical staffing records. Your TPD should be notified of periods > 2 weeks, which may potentially require an extension to your CCT date.

Audits Gastroenterology - you are required to complete an annual audit/quality improvement project (QIP), which should be uploaded to your personal library. An audit/QIP assessment tool assesses a trainee’s competency in completing an audit and must be completed after review of the audit documentation or presentation at a meeting. GIM – you are also required to complete a single GIM audit/QIP prior to your CCT (and audit assessment tool). Ideally you should commence an audit near the start of your placement so that you have opportunity to perform a second/further cycle later in the year. Involvement in a local service development is also equally acceptable. Teaching observation This provides structured, formative feedback to trainees at their competency at teaching. It is a GIM requirement that one teaching observation is completed before your PYA. Supervised Learning Events (SLE’s)

The cumulative percentage of assessments required for each year of the training scheme is summarised in the Gastroenterology and GIM decision aids (links above). An overview is provided below, however this is not exhaustive: Gastroenterology overview • Minimum of six assessments are required each year (3 mini-CEX and 3 CbD) • One assessment in each major domain should be covered during your placement • An MSF should be completed at the end of years 1 and 3 (i.e. ST3 and ST5). It should

have a minimum of 12 raters (at least 3 consultants) performed within a 3 month window. Don’t forget your self- assessment!

• A patient survey should be completed during years 2 and 4 (i.e. ST4 and ST6). A total of 20 forms should be returned to your clinical or educational supervisor. These are available in the assessment section of the JRCPTB website (http://www.jrcptb.org.uk/assessment/workplace-based-assessment). The summary form must be completed and signed off by your ES and then uploaded to your personal library.

• 4 – 6 multiple consultant reports (MCR) must be completed annually. For dual accrediting trainees, 2 MCRs must include feedback on GIM clinical abilities.

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GIM overview • Valid ALS certificate (these are valid for 4 years) – evidenced in the ‘Certificate and

Exams’ section of your e-portfolio. • 10 WPBAs per year (at least 6 must be ACATs). • Annual Firth (Summary of Training) calculator uploaded to your personal library. • Practical procedures:

o By completion of your ST3 year: signed off for ascitic paracentesis, DC cardioversion & knee aspiration

o By PYA: signed off for CVP line insertion, intercostal drain insertion using ultrasound

• Signed off for: common competencies, emergency presentations, top presentations & other important presentations

Patient survey Assesses a trainee’s communication and professionalism skills and effectiveness of patient consultations. It should be completed during years 2 and 4 of your training (ie: ST4 & ST6). Patient survey guidance, survey forms and summary forms are available in the assessment section of the JRCPTB website. The summary form must be completed and signed off by your ES and then uploaded to your personal library as evidence. Multi-source feedback (MSF) Assesses skills such as communication, leadership, reliability and team working focusing on GMC domains. Feedback is required from a minimum of 12 raters including doctors (to include 3 consultants), administrative staff and other members of the multi-disciplinary team. It is also important to complete a self-assessment form. An MSF should be completed during years 1 and 3 of your training (ie: ST3 and ST5). Mini-clinical evaluation exercise (mini-CEX) Evaluates a directly observed everyday clinical encounter with a patient to assess competency in skills for good clinical care such communication and history taking. It can be used at anytime where there is a trainee and patient encounter and an assessor is available. Direct observation of procedural skills (DOPS) Evaluates the performance of a trainee in undertaking defined practical procedures (eg: cardioversion, endoscopy). DOPS forms for endoscopy should be entered on JETS. Case-based discussion (CbD) Involves a discussion with the trainee that assesses their performance in the management of a patient including knowledge, clinical reasoning and decision-making and management. It might include new outpatient cases or inpatients.

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Acute care assessment tool (ACAT) Assesses trainee performance during their practice on the acute medical intake and can be completed by any doctor supervising the intake. Multiple consultant report (MCR) This is intended to capture the views of consultant supervisors on a trainee's clinical performance. It must be completed by a minimum of 4 consultants (maximum of six) – excluding your ES. Out of programme trainees are also advised to complete these reports. Further information is available in the assessment section of the JRCPTB website. Note these are different to MSF assessments. Firth calculator This calculator calculates your acute medical and outpatient experience. It is available in the GIM section of the deanery website, with an alternative version downloadable from the JRCPTB website (http://www.jrcptb.org.uk/documents/summary-training-calculator-november-2012). It should be updated annually and uploaded to your personal library. The GIM decision aid states that 1000 patients should be seen on the acute intake and 186 outpatient clinics attended before a trainees CCT date. Personal library This section of the e-portfolio allows you to upload electronic documents to provide evidence of your training (eg: CPD/ALS certificates, audits). You can upload any file type, however it is limited to 80MB of space. The files can be organised into folders & subfolders. It is good practice to have 2 principal folders (Gastroenterology & GIM), which should include sub folders eg: audits, CPD, patient survey etc). Training quality surveys The national GMC training survey is to monitor the quality of medical education and training in the UK. It is a mandatory requirement of your training. In addition an online placement survey is sent out towards the end of each rotation. Completion is required for ARCP sign off.

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Endoscopy Training As part of your gastroenterology training it is mandatory for you to achieve competency in upper GI endoscopy. Competency in colonoscopy and ERCP is now voluntary. However accreditation in colonoscopy is advisable. The JAG Endoscopy Training System (JETS) website (http://www.jets.nhs.uk/) allows you to record all of your endoscopy procedures performed and is required to gain accreditation. You are required to complete at least 10 DOPS per modality annually for your ARCP. Once you have performed an adequate number of procedures and achieved a set competency level you will be able to undergo your summative assessment to apply for JAG certification. For diagnostic gastroscopy (OGD) all applications are for full JAG certification, there is no provisional phase. This is different for colonoscopy, where all initial applications will be for provisional JAG certification. Trainees can apply for full certification after additional training and criteria are met. JAG certification currently costs £70 per modality. With each change in clinical placement it is routine for your initial endoscopy lists to be supervised, even if you have gained certification in independent endoscopy. This is to ensure that you are familiar with the local endoscopy reporting software and processes, in addition to allowing your supervisors to discuss and assess your future training needs. There is an endoscopy lead within each Hospital/Health Board who will also have training access to JETS. Model endoscopy pathway The SPRINT endoscopy training programme has recently been introduced to facilitate accreditation in diagnostic gastroscopy (OGD) by the end of your ST3 year. You should aim to achieve provisional certification in colonoscopy by the end of your ST5 year, with full certification by your CCT date. Early accreditation in diagnostic procedures will allow you to focus on more therapeutic procedures & sub-speciality posts depending upon your interests. WIMAT The Welsh Institute for Minimal Access Therapy (WIMAT) provides courses at 4 satellite centres through out Wales. Courses and dates are available and can be booked through the JETS website. These currently include: 1. Endoscopic simulator course 2. PEG first assistant placement course 3. Basic skills in upper GI endoscopy 4. Advanced therapeutic upper GI endoscopy 5. Basic skills in colonoscopy 6. Training the endoscopic trainers (TET)

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Training days and leave

Mandatory Gastroenterology Training Week A training week is arranged for all trainees annually (usually around June time). A minimum of six weeks notice is provided to all trainees and trainers to ensure that clinical commitments (eg: clinics, endoscopy sessions) can be reduced or cancelled to allow for this. It is the responsibility of the trainee to ensure that any on call commitments are swapped to allow attendance. Attendance rates form a component of your ARCP. If the trainee does not comply with the minimum attendance percentage, they will obtain an unsatisfactory ARCP outcome. Any difficulty in obtaining leave for the mandatory training week should be reported to the TPD. GIM Training Several GIM, leadership and management training days are available each year, with dates advertised in your e-portfolio. You are required to obtain 100 hours of external GIM CPD points prior to your CCT, equating to 20 hours per year. However up to 20% (ie: 20 hours) can include gastroenterology CPD. We advise registering for the RCP CPD diary – a summary of your CPD for each year can be uploaded to your personal library as a PDF (this is also recommendation at your GIM PYA). GIM courses are advertised on the e-portfolio and RCP website. Study Leave The Wales Deanery defines the study leave budget annually. Each specialist trainee is entitled to 30 days study leave per annum. Attendance at ARCPs and core curriculum for specialist trainees is mandatory and therefore not deducted from your annual study leave. All study leave must be requested and authorised using the INTREPID 10 online system. This database keeps a record of all leave taken throughout your training and remaining study leave budget available. Study leave will be granted at the discretion of your departmental leave coordinator. Most hospitals require a minimum of 6 weeks notice to allow cancellation of outpatient clinics and other clinical commitments, although this can vary between different Health Boards (this should be discussed at your local induction meeting). Annual leave Similar to study leave, at least 6 weeks notice is often required to allow cancellation of your clinical commitments. The process for gaining annual leave will vary between Health Boards and should be discussed at your local induction meeting at the start of your placement.

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Speciality Certificate Examination (SCE) http://www.mrcpuk.org/mrcpuk-examinations/specialty-certificate-examinations

The SCE is a compulsory component of assessment for the Certificate of Completion of Training (CCT) for all trainees who commenced specialist training on or after the 1st August 2007. It should be undertaken from ST4 level onwards. Key Points • There are no entry requirements for the SCE in gastroenterology • There are no limits to the number of attempts you can make at the exam during your

training – although you should allow sufficient time for completion before your CCT date

• It covers the whole of the 2010 gastroenterology curriculum and comprises two 3 hour ‘best of five’ papers containing 100 questions each

• It is a computer based examination held April time each year, in Pearson VUE test centres throughout the UK

• Current cost - £861, this is tax deductable Useful resources • Text books (eg: Sleizenger) • BSG/NICE guidelines • MRCP website (link above) – example questions • ‘On-examination/123 doc’ on line questions • St Marks/Nottingham SCE courses (BSG endorsed)

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Annual Review of Competence Progression (ARCP) Your training progression is monitored through an annual review of your e-portfolio and JETS by a panel of trainers/educational supervisors, and lay person (usually held around the end of May for gastroenterology). You will have separate face-to-face ARCPs for both the gastroenterology and GIM components of your training in your ST3 year and for your PYA. In the remaining years, progress in both specialities will be assessed at face-to-face gastroenterology ARCPs. ARCPs are required for all trainees including those out of programme (OOP), LAT and WCAT trainees. It is important that you complete and upload all of the necessary documentation for both gastroenterology and GIM in advance, including: ES reports, curriculum components, WBPAs/SLEs, audits tools, MCRs, MSFs and patient surveys. Leaving this until the last minute will risk an unsuccessful outcome at your ARCP. Principal ARCP outcomes Outcome 1 Satisfactory progress (this is what you want!) Outcome 2 Development of specific competencies required. Additional training time not

required Outcome 3 Inadequate progress. Additional training time required (this is usually only

issued on a single occasion, except for extenuating circumstances) Outcome 5 Incomplete evidence presented. Additional training time may be required.

Further evidence must be provided within a 2 week period to allow progression with training. Failure to achieve this will result in an outcome 3

Outcome 7 Used for LAT trainees Outcome 8 Used for out of programme trainees Penultimate Year Assessment (PYA) (http://www.jrcptb.org.uk/training-certification/penultimate-year-assessment) This will involve a meeting with a ‘PYA panel’ approximately 12 – 18 months before your provisional CCT date and includes a representative from the SAC, external to the Wales deanery. Your PYA will summarise your progress to date and any specific training objectives required to achieve your CCT. This includes any areas the trainee identifies where they perceive extra training is required. You will have separate PYA meetings for gastroenterology and GIM. It is important that you ensure that all aspects of your e-portfolio/JETS are up to date a minimum of 4 weeks prior to this meeting. This includes all previous ARCP outcomes and educational supervisors reports. You are also required to upload your CV and a summary of clinical experience (SOCE) form to your personal library in a folder titled ‘PYA paperwork’. The GIM PYA will also assess your completion of management and teaching courses. External assessors now complete their PYA report directly onto the e-portfolio. This will document any agreed mandatory and recommended training requirements and should be available within 10 days of your PYA. You will be unable to progress to your final year of training until your PYA has been achieved.

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Completion of training

• Trainees whose CCT date falls after 28th February 2015 will no longer need to

complete a yellow notification form.

• The PYA tab on your e-portfolio will list any mandatory and recommended requirements from your PYA. Separate PYA forms will be completed for Gastroenterology & GIM. Once these requirements have been achieved, you should arrange a meeting with the speciality TPD (below) for review of the evidence and issue of an ‘Outcome 6’ (recommendation for completion of the training programme):

o GIM: Biju Mohamed - TPD (UHW) [email protected] o Gastroenterology: Jeff Turner – TPD (UHL) [email protected]

• Any enquires regarding this process can also be discussed with the Higher Training

Office: o Ceri Cook (GIM) [email protected] o Trudy McMullin (Gastroenterology) [email protected]

• These new changes mean that the SAC will receive CCT applications within 10 days of

the trainee receiving an ARCP outcome 6. Depending on your employer, some of them will allow you to start the day after registrar training finishes as locum consultant, pending formal acceptance of CCT. This then becomes substantive once you have your CCT.

• Once the form is approved the JRCPTB will send a recommendation to the GMC who will then contact you to join the Specialist Register:

o This currently costs £390 (this will rise to £420 from 1st April 2015) o GMC website: www.gmc-uk.org o This cannot be done before your CCT date o Do not forget to inform your medical indemnity (MDU/MPS)

Post-CCT extension Once you have gained your CCT you are eligible for post-CCT extension for a 6 months period. Unless you advise otherwise, the STC will presume you wish to take advantage of this and that you will leave the training scheme 6 months after your CCT date. A second 6 months extension will only be granted in exceptional circumstances after application to the Postgraduate Dean and with written support from your STC.

Resigning from the training programme You must give 3 months notice that you wish to resign, even if this is during your post-CCT extension period. Should you be in the latter 3 months of your extension you must work up to the end of the original extension date.

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To resign from the training scheme you must send a letter of resignation to: Professor Derek Gallen Postgraduate Dean Postgraduate Deanery for Medical and Dental Education 9th Floor Neuadd Meirionnydd Heath Park Cardiff CF14 4YS With copies to: • Your Training Programme Directors (TPD) – Dr Jeff Turner (Gastroenterology) & Dr

Biju Mohamed (GIM) • Postgraduate Secondary Care Training Section, 1st Floor, Neuadd Meirionnydd, Heath

Park, Cardiff. CF14 4YS • The Medical Personnel Department of the Health Board where you work

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Out of Programme (OOP) requests http://www.walesdeanery.org/index.php/en/deanery/wales-deanery-policies/203-oop/301-

out-of-programme-oopt-oope-oopr-oopc.html

An ST trainee may take a period of time out of programme to undertake research or training, gain clinical experience or as a career break. Trainees are required to obtain formal approval from the Wales deanery to take time out of programme and will not normally be agreed until a trainee has been in programme for at least 1 year. The Deanery ask for requests for OOP to be submitted at least 6 months prior to your start date (form available on the Deanery website) and after discussion with your ES and Training Programme Director, as StRs can only be released at certain times of the rotation to allow sufficient time for a replacement to be appointed (April or September for OOPR, OOPE or OOPT requests). Any extensions to time out of programme should be discussed and requested through the Deanery & signed off by the TPD. Types of OOP category (detailed descriptions are available in the Gold Guide): 1. OOPR – Time out of programme for research

A period of research may be undertaken often for a higher degree (eg: MD, PhD) and will not normally exceed 3 years. If you want time out of programme to count towards the award of CCT, the GMC must approve the post before it starts. Any request must therefore be submitted to the JRCPTB at least 8 weeks prior to the start date (http://www.jrcptb.org.uk/training-certification/out-programme). Up to 12 months credit may be included towards your CCT. An OOPR period is not advised or ordinarily approved in the final (ST7) year of training. An annual Deanery review and renewal form along with the relevant report must be completed prior to your ARCP (available on the Deanery website above).

2. OOPT – Time out of programme for training A trainee may gain opportunity to undertake training outside of their regular training programme either in the UK or abroad. The SAC will review how much credit may be provided towards your CCT. This usually includes hepatology when undertaken for subspecialisation.

3. OOPE – Time out of programme for clinical experience

A trainee may gain experience similar to OOPR or OOPT, but not related to the curriculum. There is therefore not the ability to credit this period towards your CCT. This includes the Wales Deanery Clinical Leadership Training Fellowships.

4. OOPC – Time out of programme for career breaks

It may occur for a variety of reasons including a period of parental, sick or exceptional leave. Episodes of sick leave > 2 weeks duration should be entered on the absences section of your e-portfolio.

No credit can be awarded for time OOP without JRCPTB approval. Approval is no longer approved retrospectively.

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Acting up as a consultant (AUC) Trainees are eligible to act up as a consultant within 1 year of their provisional CCT date. It is a type of OOPT period. A total of 3 months can be counted towards the CCT. Please note that this is NOT the same as a locum post that can only be undertaken after obtaining your CCT. If you are considering a period of acting up, it should initially be discussed with your educational supervisor and Training Programme Director. If suitable you should complete the AUC form available on the deanery website (minimum of two months notice required). A three month notification period is usually also be required by your employing Health Board to arrange appropriate cover for your existing post (in some cases you may be required to resign from your post within the Health Board). You must also have a named supervisor in the hospital where you are attached.

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Less Than Full Time Training (LTFT) http://www.walesdeanery.org/index.php/en/less-­‐than-­‐full-­‐time-­‐training-­‐ltft/ltft.html  

The Less Than Full Time (LTFT) training scheme is available to men and women, married or single, who have reasons which prevent them from working full-time such as:

• being the parent of a young child\children • caring for an ill or disabled relative • having a disability • having a health problem Lisa Williams (Consultant Gastroenterologist, Singleton Hospital) is the LTFT lead for Gastroenterology in Wales. If you are considering flexible training you should inform the Deanery & your TPD as soon as possible. The LTFT training policy is available on the Wales Deanery website (link above) and includes the application form. Trainees are required to undertake no less than 50% of full time training. CCT dates can be estimated using the JRCPTB completion date calculator.

Professional Support Unit (PSU)

http://walesdeanery.org/index.php/en/careers-­‐and-­‐recruitment/wales-­‐deanery-­‐professional-­‐support-­‐unit.html  

The deanery is responsible for all trainees throughout Wales and for any issues that arise that may affect their training and progress through the training programme. The PSU provides support for any trainees in the form of advice and guidance and access to experts who can deal with specific areas. Trainees may approach the PSU through a need they have identified themselves or after being advised to seek their support after training difficulties have been identified by clinical or educational supervisors or highlighted through ARCP’s. Early identification and support will reduce the potential risks to the trainee, colleagues, patients and the organisation.

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Useful training related websites

BSG http://bsg.org.uk/ GMC http://www.gmc-uk.org/ JETS http://www.jets.nhs.uk/ JRCPTB http://www.jrcptb.org.uk/   RCP http://www.rcplondon.ac.uk/ Wales Deanery http://www.walesdeanery.org/

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Appendix 1: Gastroenterology STC guidance for the Educational Contract between Trainees, Educational Supervisors and Named Clinical Supervisors 1 Trainees

a. Will be allocated an educational supervisor at appointment to LAT / ST3 post. b. Should know the name and contact details of their ES before commencement of

their contract (see clause 1 from “The Trainee Doctor” below) c. Will normally be expected to continue with the allocated ES for the duration of

their training programme. d. Will expect to have regular progress meetings* (a minimum of a 1 month, 6

month and 11 month face-to-face meeting each year) with their ES to monitor and discuss progress, and plan learning (see clause 2 from “The Trainee Doctor” below).

e. Will identify a Named Clinical Supervisor for every rotation attachment (the NCS can be the ES when based on site)

f. Will have the right to request change of ES from a pool determined by the STC. g. Will have the right to request additional ES meetings when required. h. Will be expected to attend ARCP annually and fulfil the National Training

Requirements of the chosen curriculum/curricula. i. Has the right to request referral to the Deanery Professional Support Unit if a

specific need is identified.

2 Educational Supervisors (ES)

a. Will be STC members and have the right to attend STC meetings. b. Will have regular progress meetings with their allocated trainees to monitor and

discuss progress, and plan learning. c. Will be responsible for mentorship, guidance of progress, careers advice and

liaison with STC members concerning trainees. d. Will be expected to make themselves available at ARCP sessions to update the

ARCP panel on trainee progress. e. Will be expected to give reasonable notice if unable to fulfil their responsibilities

as an ES, both to the TPD and to the trainee. f. Will need to liaise with their trainees’ Named Clinical Supervisor/see multiple

consultant reports (MCR) prior to ARCP, and signing off of the ES annual report. g. Will have the right to request additional ES meetings when required. h. Will need to discuss with TPD if concerns are raised about the knowledge,

behaviour or progress of a trainee. i. Must have signed the Wales Deanery Educational supervision agreement and

agree to participate in educational CPD as described (8 hours p.a; of which 4 hours must be CPD accredited – covering all 7 AoME GMC framework areas over a 5 year period).

j. Has the right to recommend referral of the trainee to the Deanery Support Unit if specific training needs or concerns are identified.

k. Must ensure they are familiar with the assessment tools used in the curriculum, and the requirements (tools and numbers needed) of the curriculum.

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3 Named Clinical Supervisors (NCS)

a. Are the key clinician(s) responsible for the clinical supervision and training of the trainee.

b. Must be in regular clinical contact with the trainee. c. Will usually change each year, according to the site base of the trainee. d. May need to liaise with other team clinicians in order to formulate a MCR,

depending on the work pattern of the team. e. Need to complete a multiple consultant report before the ARCP date, for the ES

to see. f. Should escalate any concerns about the trainee to the trainee’s ES, or the TPD. g. Must have signed the All-Wales Trainer Contract and agree to participate in

educational CPD (parameters yet to be defined). h. Must ensure they are familiar with the assessment tools used in the curriculum.

4 The Specialty Training Committee (STC)

a. Are responsible for the oversight and delivery of good quality training in

gastroenterology in Wales, in a fair and equitable to manner to all the trainees, according to the most recent curriculum.

b. Must ensure that ESs and NCSs adhere to the GMC guidance on maintaining skills as trainers (as per the GMC document “Recognising and Approving Trainees”).

c. Must ensure that training is delivered at equivalent quality on all training sites in the Deanery (accepting that not all sites will deliver all, or the same curriculum competences as each other).

d. Must ensure that trainees are rotated appropriately around posts within the Deanery, to provide broad-based training as per the JCRPTB gastroenterology curriculum (most recent iteration).

e. Must monitor quality of training across the Deanery, including clinical and endoscopic training.

f. Need to ensure that G(I)M training quality is satisfactory, by liaison with the G(I)M STC.

*The GMC suggest 3-monthly meetings but do not describe how these should be run. Such meetings do not necessarily all need to be face-to-face, but initial meeting, six and final meeting of each year should be. Final meeting of each year can ‘book-end’ with first meeting of next year (but this should be held before the commencement of the next job). For additional or interim meetings, telephone conversations, Skype/Facetime or VC meetings are adequate if both trainee and ES deem it so. Relevant quotes from “The Trainee Doctor, domain 6”

1 “A trainee doctor must have and be told the name and contact details of a designated educational supervisor”.

2 “Trainees must meet regularly with their ES (or representative) - at least every three

months for specialty trainees”.

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3 “There must be a review of progress and appraisal within each post and a process for transfer of information by supervisors of trainees between placements”.

4 “Trainers must understand and demonstrate ability in the use of the approved in-work assessment tools and be clear to what is deemed acceptable progress”.

5 “Trainers must regularly:

a. Review the trainee’s progress through the training program b. Adopt a constructive approach to giving feedback on performance c. Ensure the trainee’s progress is recorded d. Identify their development needs e. Advise on career progression f. Understand the process for dealing with a trainee whose progress gives

cause for concern”.                                                                      

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Appendix 2: WCAT placement policy The Gastroenterology STC has been asked to oversee clinical training in gastroenterology for trainees on the Welsh Clinical Academic Program (WCATs). This is a scheme run by the Wales Deanery whereby trainees (usually at late CT level) apply by competitive interview for WCAT posts, and choose / declare their chosen speciality at the time of interview. Selection is based on overall academic and clinical merit and not influenced by the choice of specialty.      

       As the above graphic shows (taken from the Wales Deanery website), the WCATs spend a total of 3 years in research and 5 years in clinical training. They carry WCAT training numbers and are not part of the Gastroenterology training program. However, the STC in Gastroenterology bears the responsibility to oversee their Gastroenterology (and GIM training) and is expected to perform ARCPs to assess progress in clinical training. The trainees are working towards achieving the same CCT in gastro as standard gastroenterology trainees and need to satisfy the same curriculum and JRCPTB criteria as the numbered gastroenterology trainees. Clinical Training for WCATs For the purposes of achieving their CCST, WCATs need to be exposed to the same level of clinical experience as standard gastroenterology / GIM trainees. Although they are supernumerary to other trainees in Wales, for training purposes, and to satisfy the 2010 curriculum they will need to observe the following conditions:

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a) Rotating through placements annually and gaining a wide experience of multiple centres during the clinical component of their training (to the standards laid down in the 2010 curriculum and PYA guide).

b) Being allocated an educational supervisor (according to the new protocol) who is responsible for the overall supervision of their clinical training. This will need to be a separate individual from their academic supervisor, to avoid conflict of interest issues.

c) Participating on a GIM on-call rota with normal level of commitment to standard

trainee (if they are accrediting in G(I)M). If they are not accrediting in G(I)M, they should be prepared to work in G(I)M in locations where the service requires it (for example, where gastroenterologists are managing patients with general medical conditions). The trainee will be required to fulfil the clinical duties pertinent to the post in all circumstances, regardless of whether they are dual or single accrediting (pace JRCPTB precedents for single-subject cardiology).

d) Looking after inpatients and outpatients of all subspecialties pertinent to the 2010 gastro curriculum.

e) Accepting that during their clinical years, clinical training is the priority.

f) Submitting the standard requirements of the 2010 gastroenterology curriculum in terms of SLEs, MSFs, patient surveys, supervisor’s reports etc (as laid down by JRCPTB), and being signed off for the curriculum requirements.

The WCAT’s clinical supervisor needs to ensure that:

a) The WCAT is timetabled 2 research sessions per week as part of their weekly sessional commitments and reasonable effort is made to ensure that these sessions are ring-fenced for this purpose. These sessions should be negotiated prior to commencement of the post, and may be taken off the premises of the clinical worksite. This will mean that the WCAT’s timetable will need to have one clinical session LESS than a standard clinical trainee’s timetable (assuming that the standard trainee was already offered a research / audit session, which should be the case already).

b) In the event of an uncorrectable clash between clinical and research

commitments, clinical work must take priority, but the lost research session can be reclaimed later as ‘lieu time’ according to mutual convenience.

The STC needs to ensure that:

a) The WCATs clinical placements are planned to satisfy the clinical and training requirements of the 2010 gastro curriculum and PYA guide (to deliver broad-based training to cover the curriculum as a whole, including at least 2 years in separate DGHs).

b) That the local placement supervisor understands and allows the WCAT’s allocation of two research sessions per week, and job plans the WCAT accordingly during the placement.

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c) That the STC tries (as a secondary issue to clinical training need) to satisfy any

geographical/placement needs that assist the WCAT in maintaining their research without compromising clinical training.

Like all clinical trainees, the WCAT will be asked to submit a PDP prior to the annual placement decision, and can specify reasons why they wish to work in a particular site. The STC panel will decide location placements according to these reasons, and will try to satisfy requests. There is no guarantee however that such requests can be satisfied, as the STC have to take into account the training needs of ALL trainees and prioritise accordingly. The STC also need to assess the impact of additional trainees on local training provision before approving any request for supernumerary placement. Document ratified at the STC AGM (31st Jan 2014).                                                                      

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Appendix  3:   Gastroenterology/GIM  ARCP  checklist  Date  of  ARCP:    Name  of  trainee:    Grade  of  trainee:      Satisfactory  ES  report    Completed  MCRs  (minimum  4  required:  2  GIM  +  2  Gastro)      Extended  leave  noted  in  absences  Comments  (if  applicable)      Valid  ALS  (valid  for  4  years)      Satisfactory  MSF  (ST3  +  ST5  years)  Comments  (if  applicable)        Satisfactory  patient  survey  (ST4  +  ST6  years)  Comments  (if  applicable)        GI  Audit  +  assessment  tool  completed  (annually)  Comments  (if  applicable)        Completed  total  of  6  mini-­‐CEX  +  CbD  SLE’s  -­‐  usually  3  of  each  Comments  (if  applicable)        Satisfactory  curriculum  competencies/linkage  &  ES  sign  off  Comments  (if  applicable)        Adequate  endoscopy  progression  (JETS)  -­‐  10  DOPS  per  modality  Comments  (if  applicable)      SCE  obtained  (ST4+  prior  to  CCT)    Trainee  BSG  member  (recommended)  

 Yes/No  

 Yes/No  

 Yes/No  

   

 Yes/No  

   

Yes/No/Not  applicable          

Yes/No/Not  applicable          

Yes/No          

Yes/No          

Yes/No          

Yes/No    

     

Yes/No    

Yes/No  

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GIM  component  (Separate  GIM  ARCPs  held  in  first  year  of  training  and  for  PYA)  

Required  annually    10  WBPB’s  (includes  minimum  of  6  ACATs)  Comments  (if  applicable)        Updated  ‘Firth  calculator’  (uploaded  to  personal  library)  (1000  acute  patients  +  186  clinics  required  before  CCT)      Satisfactory  curriculum  competencies/linkage  &  ES  sign  off  Comments  (if  applicable)        External  GIM  CPD  (100  hours  required  before  CCT  –  can  include  maximum  of  20  hours  speciality  CPD)  Comments  (if  applicable)        Advisory  (required  pre-­‐CCT)    1  GIM  audit/service  development  +  assessment  tool    1  teaching  observation    Teaching/management  courses    Register  with  RCP  CPD  diary    

   

Yes/No          

Yes/No        

Yes/No          

Yes/No                

Yes/No    

Yes/No    

Yes/No    

Yes/No  

REQUIREMENTS/OBJECTIVES                  

   

ARCP  outcome:    

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Appendix 4: GIM PYA Checklist Requirements  for  GIM  CCT   Y/N Will   the   trainee   have   had   experience   of   the   management   of   a   minimum   of   1000  unselected   patients   on   the   acute   medical   take   which   should   take   place   over   a  minimum  of  3  years?  

Has   the   trainee   obtained   the   degree   of   ITU/CCU   experience   defined   in   the   relevant  curriculum?  

Has  there  been  an  ITU  secondment?   Will  the  trainee  have  had  responsibility  for  the  continuing  care  of  inpatients  providing  GIM   expertise   &   exposure   to   a   selection   of   specialty   outpatients   including   GIM  patients   on   a   one-­‐to-­‐one   basis   in   a   minimum   of   186   clinics   over   the   years   of   the  training  programme?  

Is  the  trainee  likely  to  be  competent  at  performing  the  practical  procedures  detailed  in  the  GIM  curriculum?  

Will  the  trainee  have  a  valid  ALS  certificate  at  the  planned  CCT  date?   Has  he/she  used  a  proportion  of  allocated  study  leave  to  train  in  GIM  (Target  of  100  hours  external  training,  including  regional  training  days)  

Has  the  trainee  received  confirmation/certificate  of  attendance  for  training  days?   Have  satisfactory  reports  from  CS/tutors  been  received  and  reviewed?   Has  the  training  portfolio  been  satisfactorily  completed?   Has   the   trainee   obtained   adequate   competency   in   the   ‘Top   Twenty’   presentations?  Are  there  outstanding  ones  for  which  further  training  is  required?  

Has  the  trainee  demonstrated  adequate  competencies  in  the  other  40  presentations?  Will  further  training  be  required  to  obtain  these?  

Has   the   trainee   demonstrated   appropriate   knowledge   of   management   &   received  formal  management  training  to  include  committee  work  within  the  trust?  

Has   the   trainee   attended   formal   training   in   teaching  methods  &   shown   satisfactory  participation  in  an  organised  teaching  programme?  

Has  the  trainee  led  an  audit  for  each  training  year?   Are  you  satisfied  that  the  trainee  has  fulfilled  the  curriculum  requirements  for  generic  skills?  

Has  the  trainee  registered  with  the  CPD  on  line  diary?   Have  there  been  significant  periods  of  absence  for  sick  leave  or  maternity  leave?   Have  the  mandatory  curriculum  objectives  been  met?   Has  the  trainee  successfully  completed  the  required  amount  of  WBPA’s  as  stated  on  the  ARCP  decision  aid?  

Does   the   trainee   have   any   targets   that  must   be  met   before   completion   of   training?  (list)