Head of Schools Letter
From: Miss E McLarty, University Hospitals Plymouth NHS Trust and Mr R Longman, Department of Coloproctology, Bristol Royal Infirmary
Peninsula and Severn Schools of Surgery, 19/03/2020
We have tried to write this letter several times over the past week, and as fast as we seem to be able to type the news, advice and guidance changes.
These are unprecedented times, keep safe, keep smiling and look after each other.
As you know there have been multiple parallel pieces of work to ensure robust processes for managing postgraduate medical training during the COVID-19 outbreak. As you will understand the quickly changing situation is making this challenging.
The detail below is correct as of 5pm Thursday 19th March.
The national position is that we should not rotate doctors in training at the beginning of April. This is to ensure that we are not putting the workforce into a new, unfamiliar, environment and therefore avoiding the need for induction, statutory and mandatory training with new organisations.
The Dean can make exceptions to this and will do so on a case by case basis. Examples include:
- Trainees in high risk groups (health or pregnancy related) for whom a placement in a high-risk clinical environment may not be appropriate.
- Situations where a host community or mental health provider feels that they are unable to support a trainee, where a transfer back to secondary care would be more appropriate.
Redeployment of trainees
There are some fundamental principles:
- Trainees must not be asked to undertake any activity beyond their level of competence and must be advised they should seek senior workplace guidance if that arises.
- Trainees deployed to a different clinical area must have appropriate induction and be informed of who they are reporting to, and who is providing supervision with details of how to contact them.
- Arrangements for redeployed trainees should be reviewed weekly to ensure that trainees are adequately supervised in the host environment / specialty, and that they continue to work within the limits of their competence appropriate to their stage of training.
- Where training is interrupted or learning outcomes are not achieved due to a major incident response, these issues will be taken into account at the trainee’s next Annual Review of Competence Progression (ARCP) which will inform future training requirements and placement planning.
Nationally we have stopped all face to face recruitment and are working with Colleges to develop other systems to allow for the selection of trainees for the future rotations. We are having to communicate with applicants and faculty at short notice. Watch this space and ensure that your online portfolio shines through!
- All ARCPs will be in absentia and we will look at panels doing this remotely. We are also looking at the minimum requirements for a panel in order to try and ensure they happen.
- Feedback will be by email or locally face to face by TPD/College Tutor/AES.
- Where collegiate and other exams have been cancelled (and most have) trainees will still be able to progress as long as the rest of their portfolio meets the standard for an outcome 1 and will have 1 year to pass the necessary exam. This holds true for those rotating from core to specialty programme in August.
- Some recruitment has already been cancelled (e.g. ICM this week) and it is likely that other processes may also be delayed – we are working with colleges to look at alternative recruitment models to ensure that the progression of trainees and the workforce provision is not affected.
- It may be obvious - the panel will ONLY be looking at your ISCP. If it is not there it hasn't happened. Upload those ATLS certificates in your folders etc - but keep those portfolios up to date too. Your TPD's will have been in touch with final dates for submission of evidence.
We completely understand that allowing trainees to travel for education and training events should not, in the short term, continue. We will leave it to the discretion of trainers to advise trainees on a case by case basis. HEE has agreed to refund expenses where a trainee has needed to cancel study leave and a refund is not available through another route. Regional training days face to face should probably discontinue - I will leave that to each specialty to manage. Regional training has been successfully delivered in Urology this week via web-based conferencing.
Trainees on Out of Programme (OOP) including research
Trainees have expressed the wish to come back into clinical practice, and some research funding bodies have supported this by stating that research funding will be extended. We are expecting formal communication from NIHR about those on integrated academic training. Our position is that we will not coerce trainees to do so (this is in line with policy for all staff who have left clinical practice). Clearly Trusts will need to decide if they want the additional staff, but I suspect that will not be a difficult decision!
In support of the NHS plan to manage service delivery during this challenging period HEE has taken the decision to release all fellows from their secondment agreement as from Monday 23 March 2020. Trainees will be contacted and instructed to make contact with their clinical department to enable them to be fully integrated into the workforce.
It is unlikely that OOP's will be approved to start at this time during this time.
Many Colleges have postponed or cancelled exams that are a requirement for progression. JRCPTB have already communicated that trainees due to rotate to ST3 who have not passed MRCP will be able to rotate and have a 1 year period of grace during which they will need to pass the exam.
The Royal College of Surgeons have had similar discussions, but I have yet to see formal comms on this. It is likely that we will support a similar model for all specialties for those trainees who would otherwise have received an outcome 6 (completion of training) at ARCP. This will of course apply to run through trainees.
Those on un-coupled programmes who were due to apply for ST3 next session may find the exam criteria relaxed for 1 year.
Impact on trainees
The changes to rotations and the unavailability of regional teaching and study leave and is significant and will be challenging to manage. It is also understandable that accessing workplace-based assessments and elective surgery may be limited.
We are committed to ensuring that if, without the advent of COVID-19, a trainee would progress normally through their programme we will do everything we can to facilitate their progression without extending training. This may require taking ‘Dean’s prerogative’ at ARCP and providing flexibility. Part of this will depend on reports from Clinical Supervisors assuring that a trainee is progressing. For trainees who cannot demonstrate key competencies and capabilities against curriculum, to an extent that progression is threatened we will need to look at ways of providing targeted training, including no fault extensions if required.
It is equally important that trainees who are not progressing are appropriately supported and we will look at a process that provides quality assurance, supported by the TPDs, Heads of Schools and clinical and educational supervisors to ensure that progression through the programme is acceptable and sufficient to allow sign off.
As noted above, the health and wellbeing of the workforce will be sorely tested in the coming months and we are keen that we work in partnership with employers to minimise the impact and maximise our ability to support trainees and training where needed. Please remember your trainers and colleagues are also working in this stressed environment that will challenge us all.
Your College Tutors are there to support and advise you, please use them, your AES and TPD.
As Heads of School we will do what is possible to look out for you and your training.
With best wishes to you and yours in this difficult time.
Miss E McLarty
University Hospitals Plymouth NHS Trust
Devon PL6 8DH
Mr R Longman
Department of Coloproctology
King Edwards Building
Bristol Royal Infirmary
Bristol BS2 8HW