At present there are 126 trainees on the West Midlands General Surgery training scheme and this has previously been run as a region wide scheme with trainees undertaking posts in sequential years in Coventry, Hereford and Stoke.  This places a significant burden on the trainees.  The scheme has in the past had a single programme Director and the burden of supporting such a large number of trainees as we move to ISCP is unsustainable.  To try and create a more structured and personal training scheme, the region is to be divided into 3 areas.  The hope is that most trainees will spend the first 4 years of their clinical training in a single area attached to an Intermediate Years Programme Director.  During this period they will then confirm their career intentions having been allocated a programme which will provide 2 years in the field they hope to specialise in, while having been exposed to all the aspects of General Surgery.  The fourth year will see liaison with The Later Years Programme Director in delivering a specialist programme to meet the career aspirations of the trainees. 

The 3 areas are Warwickshire and Worcestershire; Birmingham and the Black Country; and Staffordshire and Shropshire.  The Warwickshire and Worcestershire area covers Coventry, Nuneaton, Warwick, Redditch, Worcester, Heartlands and Good Hope Hospitals.  Staffordshire and Shropshire covers Stoke, Stafford, Shrewsbury, Telford, Burton and Wolverhampton hospitals.  The Birmingham and Black Country covers City, Sandwell, Queen Elizabeth, Selly Oak, Russell’s Hall, Walsall and Hereford hospitals.  This gives a roughly equal split of posts.  It is likely that the split will require revision as experience with the programmes develops.

The 4 Programme Directors have now been appointed.  Mr Peter Blacklay will be taking up the role of Programme Director for the Warwickshire and Worcestershire area.  Mr Funso Adedeji is the Intermediate Years Programme Director for the Stoke and Stafford area, while Mr Rajiv Vohra is the Intermediate Years Programme Director for the Birmingham and Black Country area.  Mr Alan Jewkes will take up the post of the Later Years Programme Director once Mr Blacklay has received hand over.

The first task, which the Intermediate Years Programme Directors have started, is to meet all the trainees.  From this a plan of how the trainees will be best allocated across the 3 areas will be developed for those in the Intermediate years.  At the same time a review of the training posts will be developed to identify those which will form the core of the Later Years programme which will then enable the Intermediate Years programmes to be identified. 

These 2 tasks are critical to the delivery of the third, which is designating the placements for the rotation in October.  This will be a separate process from the RITA/ARCP process as the regular meetings between the Programme Directors and their trainees will have allowed the areas of special need to be identified.  The RITA/ARCP process will now occur in September when the trainees have completed their posts and both they and their trainers can provide a complete assessment of their year in training.

We will see significant changes over the next few years as working time limits are implemented and patient demands grow.  With the likely creation of a separate SAC in Vascular surgery, the subsequent re-organisation of training in that discipline will have an impact on all trainees.  In addition, the need to ensure robust training in the area of specialist interest and sufficient exposure to be competent in the care of the acute surgical patient will be a significant challenge.

In addition to the changes in the supervision of training and a revision to the system of placements, there is a need to put in place a formal teaching programme that will deliver 6 teaching days annually with each area contributing 2 to the scheme.  To this end we are seeking to identify 3 Educational Leads to develop a programme that will run over 4 years to cover all aspects of the curriculum and prepare trainees for the intercollegiate FRCS examination.  This will require the support and involvement of both the trainees and the trainers.  It is envisaged that this will become mandatory, although it will take time for Trusts to put in place mechanisms that ensure that a safe service can be maintained in the absence of the trainees.  The Later Years trainees will have specialty specific training needs.  Work will be required to establish what is and what should be delivered in the Deanery and what can only be accessed elsewhere.  This will form a framework for establishing teaching programmes appropriate to the sub-specialties in conjunction with the Specialty Association representatives.  In addition, the Educational Leads will have a role in delivering training for the trainers in the ISCP assessment methodology, something which all areas of surgical training will increasingly use to deliver assessments through.

To support the trainee locally there will be Area Educational Committees which will include the area Programme Director, the Educational Lead, a representative from each hospital in the area and a trainee representative.  These Committees will be responsible for implementing local delivery of training and working with Trusts to ensure training needs are addressed.  These Committees would then have representation on the Specialist Training Committee which will oversee the whole programme, including the Later Years trainees who will work across all the areas as required to refine their training.

The first steps have been made in implementing this agenda but there remains much to be done.  The aim is to start the teaching programme for the Intermediate Years trainees at the beginning of the next rotation.  The support of the trainers and trainees is key to creating a training scheme that can meet the challenges that the next few years hold.