The Intercollegiate Surgical Curriculum Programme (ISCP) website houses the curriculum for the nine surgical specialties and, in a secure area, trainees’ electronic portfolios and the learning agreements which supports training from CT/ ST1 to completion. The ISCP allows trainees and trainers to interact electronically file assessments and keep an electronic logbook and portfolio.
The intercollegiate surgical curriculum provides the approved UK framework for surgical training from completion of the foundation years through to consultant level. It achieves this through a syllabus that lays down the standards of specialty-based knowledge, clinical judgement, technical and operative skills and professional skills and behaviour, which must be acquired at each stage in order to progress. The curriculum is web based and is accessed through www.iscp.ac.uk.
The website contains the most up to date version of the curriculum for each of the ten surgical specialties, namely: Cardiothoracic Surgery; General Surgery; Neurosurgery; Oral and Maxillofacial Surgery (OMFS); Otolaryngology (ENT); Paediatric Surgery; Plastic Surgery; Trauma and Orthopaedic Surgery (T&O); Urology and Vascular Surgery. They all share many aspects of the early years of surgical training, but naturally diverge further as training in each discipline becomes more advanced. Each syllabus will emphasise the commonalities and elucidate in detail the discrete requirements for training in the different specialties.
After graduating from medical school doctors immediately move onto a mandatory two-year foundation programme in clinical practice. During their final year of medical school students are encouraged to identify the area of medicine they wish to pursue into specialty training. During the Foundation programme, recently qualified doctors are under close supervision whilst gaining a wide range of clinical experience and attaining a range of defined competences. Entry into surgery is by open competition and requires applicants to understand, and provide evidence for their suitability to become members of the surgical profession.
The provision of excellent care for the surgical patient, delivered safely, is at the heart of the curriculum.
The aims of the curriculum are to ensure the highest standards of surgical practice in the UK by delivering high quality surgical training and to provide a programme of training from the completion of the foundation years through to the completion of specialty surgical training, culminating in the award of a CCT/CESR CP1. The curriculum was founded on the following key principles which support the achievement of these aims:
• A common format and similar framework across all the specialties within surgery.
• Systematic progression from the end of the foundation years through to completion of surgical specialty training.
• Curriculum standards that are underpinned by robust assessment processes, both of which conform to the standards specified by the GMC.
• Regulation of progression through training by the achievement of outcomes that are specified within the specialty curricula. These outcomes are competence-based rather than time-based.
• Delivery of the curriculum by surgeons who are appropriately qualified to deliver surgical training.
• Formulation and delivery of surgical care by surgeons working in a multidisciplinary environment.
• Collaboration with those charged with delivering health services and training at all levels.
The curriculum is broad based and blueprinted to the Good Medical Practice and Good Surgical Practice frameworks to ensure that surgeons completing the training programme are more than just technical experts.
Equality and diversity are integral to the rationale of the curriculum and underpin the professional behaviour and leadership skills syllabus. The ISCP encourages a diverse surgical workforce and therefore encourages policies and practices that:
Ensure every individual is treated with dignity and respect irrespective of their age, disability, gender, religion, sex, sexual orientation and ethnic, national or racial origins;
Promote equal opportunities and diversity in training and the development of a workplace environment in which colleagues, patients and their carers are treated fairly and are free from harassment and discrimination.
It is expected that these values will be realised through each individual hospital trust’s equality and diversity management policies and procedures. This principle also underlies the Professional Behaviour and Leadership syllabus
The ISCP comprises the GMC-approved curricula for the ten surgical specialties and reflects the most up to date requirements for trainees who are working towards a Certificate of Completion of Training (CCT) or a Certificate of Eligibility for Specialist Registration via the Combined Programme (CESR CP). Where an older version of the curriculum is superseded, trainees will be expected to transfer to the most recent version in the interests of patient safety and educational quality. The GMC provides a position statement on moving to the most up to date curriculum.
The curriculum is appropriate for trainees preparing to practice as consultant surgeons in the UK. It guides and supports training for a Certificate of Completion of Training (CCT) or a Certificate of Eligibility for Specialist Registration via the Combined Programme (CESR CP) in a surgical specialty. The curriculum enables trainees to develop as generalists within their chosen surgical specialty, to be able to deliver an on-call emergency service and to deliver more specialised services to a defined level.
A CCT/CESR CP can only be awarded to trainees who have completed a fully/part approved specialty training programme. Doctors applying for a the Certificate of Eligibility for Specialist Registration CESR) will be required to demonstrate that they meet the standards required for a CCT/CESR CP as set out in the most up to date curriculum at the time of application.
The responsibility for setting the curriculum standards for surgery rests with the Royal Colleges of Surgeons which operate through the Joint Committee on Surgical Training (JCST) and its ten Specialty Advisory Committees (SACs) and Core Surgical Training Committee (CSTC). Each SAC has developed the person specifications for selection into its specialty and the person specification for entry to ST1/CT1 in any discipline. Postgraduate Medical Deaneries and their Schools of Surgery and/or Local Education and Training Boards are responsible for running GMC approved training programmes and for aiding the SACs in recruitment and selection of all levels of pre-CCT training.
The critical selection points for surgical training are at initial entry either directly into specialty training in the chosen discipline (ST1) or into a generic training period referred to as core training (CT1). Those who enter core training are then selected into the discipline of their choice after two core years and join the specialty programme at a key competency point (ST3) after which transfer from one discipline to another would be relatively unusual. Selection at both core and higher surgical training takes place via a national selection process overseen by the deaneries/LETBs and JCST.
Those who are selected into training programmes will then have to achieve agreed milestones in terms of College examinations and the Annual Review of Competence Progression (ARCP)
Trainees progress through the curriculum by demonstrating competence to the required standard for the stage of training. Within this framework each specialty has defined its structure and indicative length of training. Each individual specialty syllabus provides details of how the curriculum is shaped to the stages of training.
In general terms, by the end of training, surgeons have to demonstrate:
• Theoretical and practical knowledge related to surgery in general and to their specialty practice;
• Technical and operative skills;
• Clinical skills and judgement;
• Generic professional and leadership skills;
• An understanding of the values that underpin the profession of surgery and the responsibilities that come with being a member of the profession;
• The special attributes needed to be a surgeon;
• A commitment to their on-going personal and professional development and practice using reflective practice and other educational processes;
• An understanding and respect for the multi-professional nature of healthcare and their role in it; and
• An understanding of the responsibilities of being an employee of an NHS trust, hospital and/or a private practitioner.
In the final stage of training, when the trainee has attained the knowledge and skills required for the essential aspects of the curriculum in their chosen specialty, there will be the opportunity to extend his/her skills and competences in one or two specific fields. The final stage of the syllabus covers the major areas of specialised practice. The syllabuses are intended to allow the future CCT/CESR CP holder to develop a particular area of clinical interest and expertise prior to appointment to a consultant post. Some will require further post-certification training in order to achieve the competences necessary for some of the rarer complex procedures. In some specialties, interface posts provide this training in complex areas pre-certification.
The ISCP Curriculum based Training program will be offered to Bangladeshi Medical Graduates planning for a career in Surgery. The time period they will need to be with RAHETID for which RAHETID will charge an annual fee will vary between 1 to 4 years. RAHETID will also sponsor these trainee surgeons to spend 2 years of salaried training job at a higher specialist level through the MTI/ISTP of the Royal College of Surgeons of England.
RAHETID is the Partner Institute of the Royal College of Surgeons of England for the MTI/ISTP Programme.
The ISTP comes under the generic Medical Training Initiative (MTI) scheme and provides a route for high-quality International Medical Graduates (IMGs) from outside the UK/EU/EEA/Switzerland to obtain registration with the General Medical Council (GMC) and undertake training and development in UK hospital posts for a maximum of two years. The scheme was developed by the Department of Health and operates under the Home Office Tier 5 Government Authorised Exchange (GAE) visa category. The College is a GMC-approved sponsor of the MTI scheme. IMGs will undertake a range of clinical work, with the possibility of completing placements in multiple hospitals and gaining sub-specialty experience. As well as gaining clinical skills, IMGs will be given the opportunity to develop a range of transferable skills such as leadership, management, developing guidelines, conducting audit and research and understanding clinical governance. IMGs will be supported throughout their training by an allocated Supervising Consultant based within their employing trust, an Educational Supervisor, their other colleagues and the College MTI Officer who will periodically contact them throughout their time on the scheme. The location will depend on the training required, with placements identified throughout England, Wales and Northern Ireland.
The most important aspect of MTI/ICTP from RAHETID point is the fact Bangladeshi Medical Graduates interested to go to UK for surgical training must be working within an RCS/ISTP Partner Institution RAHETID.
The Target group includes all Surgical Trainee doctors in Bangladesh working both in private and public health sector. The Training of Medical students and other Doctor trainees will also be facilitated by the short courses of the RCS England such as:
Basic colonoscopy course – 3 days
Lectures and live demonstration of basic techniques in diagnostic and therapeutic colonoscopy.
The RAHETID Colonoscopy Workshop
This is a 3-day course for Higher Trainees wishing to gain/ improve their skills in Colonoscopy. This is an intensive, interactive, practical course covering the theoretical basis of performing a safe colonoscopy and safe and effective peri-endoscopy management. Topics range from the understanding of the basic principles and practice of colonoscopy, Understanding the provision of a colonoscopy service and the resources needed, the latest equipment and finally acquisition of the basic skills to perform safe, accurate total colonoscopy.
The RAHETID Basic Colonoscopy Workshop is specifically designed for physician and surgeon colonoscopy trainees, to cover the basic principles and practice of colonoscopy. When numbers permit, endoscopy nurses are also invited to attend.
The workshop will comprise:
• Live colonoscopy demonstrations broadcast from the endoscopy suite
• Short, state of the art reviews by British faculty
• Interactive panel discussions of clinical challenges in colonoscopy
The course includes a series of small group and one-to-one teaching sessions, videos, hands-on model work and supervised endoscopy. Each trainee may undertake colonoscopies under the supervision of expert trainers depending on experience, which will be transmitted to other delegates to facilitate training. The one-to-one teaching focuses on the development of individualised learning outcomes and plans to progress skills.
Trainees are advised to have a guarantee of 6 months supervised training on completion of the course. It is essential that trainees have at least one training list per week available to them following this course to gain confidence and to avoid loss of skill gain.
Upon completion of the workshop, participants will:
1. Understand the principles of diagnostic and therapeutic colonoscopy
2. Understand the principles and practice of patient preparation for colonoscopy, including indications/consent /bowel preparation
3. Know the indications for use of prophylactic antibiotics during colonoscopy
4. Be familiar with the design and function of the endoscope
5. Be familiar with the controls and handling of a colonoscope
6. Understand the principles and techniques for colonoscope insertion including torque steering, loop recognition and reduction
7. Understand the principles and techniques for colonoscope withdrawal to maximise mucosal views and lesion detection
8. Understand the principles and safety considerations of diathermy and its use in endoscopy
9. Be familiar with the accessories used and understand the principles of colonoscopic biopsy and polypectomy