MTASTic: The Sequel! A Programme Director’s personal view of training in Colorectal Surgery

David Jones, University Hospital of South Manchester

Consultant Colorectal Surgeon
Programme Director for General Surgery, North Western Deanery

Modernising Medical Careers (MMC) aimed to select trainees early in their careers and deliver focused training to a set curriculum. This is clearly set out in the ISCP with appropriate assessment tools developed with input from the ACPGBI. MMC was dependent on a robust validated selection process, which we do not have in the UK at present. The problems with MTAS are well known and are covered in the Tooke Report which is being considered by the Government. It is important to distinguish between MTAS and MMC because they are not synonymous. Unfortunately the MTAS issues diverted attention from implementing the new curriculum.

It is now proposed that selection into “Higher Surgical Training” should be by competition for ST3 posts from Core Surgical Trainees, rather than Run Through Training (RTT) from ST1. This leaves a cohort of ST1s and ST2s appointed in 2007 who will have RTT subject to satisfactory assessments and a group to be appointed in 2008 to Core Surgical Training (CST) who will compete for ST3 in 2010. There are very few ST3 posts available in 2008.

There was considerable workforce planning leading up to 2007. There has been uncertainty about the changes that would be made for 2008 and we are already in the middle of another round of appointments. As trainees can make as many applications as they so wish Deaneries have even more applications to process in 2008 than in 2007. This is probably distracting from workforce planning and implementing improvements in training.

There is a finite amount of training that can be offered in any Deanery or individual unit. Whilst there is a desire to increase training posts, it is difficult to identify posts where additional good quality training can be provided. A common complaint from trainees is that they perceive a lack of training opportunities in current posts.

Trainees have a choice of sub-specialisation for their final years of training. At present in the North West most trainees are selecting Colorectal or Breast Surgery. Vascular, Upper GI, HpB and Transplant are under subscribed. These choices are made on the basis of a trainee’s personal interest and their perception of likely future Consultant vacancies. This means that there is competition for the existing training opportunities in Colorectal Surgery.

There is a recent initiative to create post CCT Fellowships to offer training that could not be delivered during the training scheme to make trainees more appointable.

These various issues in the context of Colorectal training will be covered in the presentation with relevant workforce data.