Surgical trainees

The current outbreak of the COVID-19 (coronavirus) has resulted in some changes in Irish hospitals. Up-to-date information is available on the HSE and HPSC websites. As part of the response to this challenge, a number of hospitals have cancelled or reduced out-patient visits as part of their COVID-19 containment strategy.

RCSI fully supports the decisions made by the Department of Health and HSE in seeking to address the numerous issues facing our acute hospital services when, over the coming weeks, we will see a massive influx of acutely ill patients, many of whom will require respiratory support and critical care.

We are aware that many of our trainees and trainers have many questions on the impact the current situation will have on surgical training and progression. We have been working with JCST (Joint Committee on Surgical Training) as the advisory body to the four surgical Royal Colleges of the Ireland and UK for all matters related to surgical training. The JCST is the parent body for all 10 Specialty Advisory Committees (SACs) responsible for surgical specialties, the Core Surgical Training Committee (CSTAC), the Training Interface Groups (TIGs) and the Intercollegiate Surgical Curriculum Programme (ISCP).

RCSI have a statutory duty to deliver, among other things, trainee recruitment and selection, training delivery and the ARCP process. The Surgical Royal Colleges of Ireland and UK deliver postgraduate exams through the ICBSE (for MRCS) and through the JCIE (for FRCS). RCSI works with the JCST for the maintaining of a record of trainee progress, providing externality into the ARCP process and writing the curriculum.

RCSI’s primary concern is the safety and well-being of our trainees and trainers and indeed all our surgical colleagues and other healthcare colleagues. All the bodies involved in surgical training are working together to find the safest and most pragmatic solution to the current situation. We hope that the following information provides some clarity and support, and allows trainees and their trainers to plan for the coming months.

Given the rapidly changing nature of the current situation, however, the advice below may need to change.

For additional information and regular updates on COVID-19, please visit mSurgery.

Owing to a huge effort and co-operation with specialties, trainers and trainees we managed to complete our selection processes for 2020. We have completed the process for Core Surgical Training and rotations and posts are being finalised with Medical Manpower Managers in the hospitals.

Week ending 14 March we completed the face-to-face process for appointment to ST3. We are completing the quality assurance of the scores and will be communicating with training programme directors this week to confirm the successful candidates across the specialties. We will then work on the rotations for July 2020.

The planned diets of these examinations have been cancelled up to the end of August 2020. We are making plans to ensure that we have sufficient capacity to support candidates in taking the exams in the autumn, but this will be subject to the ongoing public health advice. We will be updating information in relation to all professional exams here.

Annual Review of Competence Progressions (ARCPs) can be run remotely if it is possible to do so – RCSI Surgery will help in the coordination and preparation as needed.

Trainees entering their final year in training (ST7/8 depending on specialty) must have passed both sections of the FRCS exam before they can be awarded their final ARCP outcome 6 and be recommended by RCSI to the Medical Council of Ireland for specialist registration. RCSI is not aware of any people due to be awarded CCST this year to be affected by the cancellation of the FRCS exams. 

There is a facility for Specialty Training Committees and training programme directors to extend training to allow trainees to sit the exam in programme. RCSI will be guided by the Gold Guide advice (See Gold Guide advice on extending training due to environmental issues beyond the trainee’s control – section 4.72ix, rather than using the ARCP outcome 3 process).

ARCP panels will continue to be able to review trainees’ portfolios online via the ISCP.

During training, the aims should be to ensure that progress towards curriculum requirements has been on track and that the trainee has engaged in training (as evidenced by WBAs and the AES report) prior to the COVID-19 outbreak. A pragmatic view should be taken if some requirements have not been met due to the current circumstances and this will not be held against the trainee in determining the ARCP outcome. Any outstanding requirements should be recorded and would then need to be met by the ARCP after the COVID-19 period is over.

We fully appreciate that with widespread cancellation of surgical lists and OPD clinics our traditional approach to the log book will be severely affected. Where you can, you should continue to enter log book activity. We advise that locally, with trainers, surgical activity should be considered on how the whole team can avail of any learning opportunities. RCSI will also look at alternative approaches, including simulation, which could help achieve learning outcomes.

We appreciate that this is not equivalent to normal clinical and operative experience, but we are not in normal times and we will have to be creative, innovative and open minded. RCSI can assure you that the current situation will be fully taken into account and we will not be penalising trainees as a direct result of the impact of COVID-19.

Those trainees who have already passed the FRCS exam and are due to finish their training in the coming months, should still be able to complete training and be awarded their ARCP 6 if they have met all the requirements. ARCP panels can take a pragmatic view over recommended courses. An ARCP 6 can still be awarded even if these courses have not been completed as long as the trainees’ portfolio shows they will be safe to practice.

Trainees awarded an ARCP outcome 6 (ST8 (7)) and ready to certify will leave training, as at present, subject to the optional period of grace. Vacancies arising should be filled by the national selection process. RCSI will support any appointments process with documentation or otherwise where needed.

Core trainees at ST2 who are due to complete the two-year programme in July 2020 will be signed off for their CST Certificate if all criteria as per the CST Training Guide are met. ST2 trainees who are progressing to ST3 will be advised of appointment and ST3 rotations in line with normal procedure.

Any gaps in training should be filled by appointments made locally. If RCSI can help with any aspect of local recruitment to posts then please contact us.

RCSI knows that many will be required to work in areas which are not the usual role for surgeons and surgical trainees. This is necessary and RCSI knows that your professionalism, concern for patients and solidarity for your colleagues will carry you through these unprecedented times. Each local hospital will have varied requirements and requests and positive and constructive response will be vital. RCSI will support you and will also develop guidance and training resources to help our trainers, trainees, members and fellows in so far as we can.

We recognise that out of programme training or experience, for research or other experience, can be an important part of training and personal development. We do not expect trainees to return to clinical training immediately unless the COVID-19 crisis escalates and all available medical staff are called in.

RCSI in conjunction with the specialty committees and TPDs will review this on an ongoing basis and trainees should therefore discuss the best course of action with their TPDs and educational supervisors. If OOPs are suspended, it will be important to record the reasons why and local support should be in place for the trainee.

Trainees who apply for training interface group (TIG) fellowships are normally expected to have passed both sections of the FRCS exam and demonstrate that they have met certification requirements or will do by the time their TIG fellowship is due to start.

Due to the postponement of several sittings of the FRCS exam, this would impact on trainees’ ability to meet the entry requirements for a TIG fellowship. Trainees who are successful at TIG selection will be able to undertake the fellowship even if they have not passed section 2 of the FRCS exam as long as they have their AES’s and TPD’s support that they are on track to meet their parent specialty curriculum requirements and are expected to do so by their new provisional certification date. They will need to pass section 2 of the FRCS during their TIG fellowship year in these circumstances.

This would mean that trainees’ final ARCP would take place soon after the fellowship is complete, and that at that point they would have fully met their certification requirements and be ready for specialist registration.

No trainee shall be disadvantaged if they develop COVID-19 symptoms or become ill.

As addressed above progression will be based on evidence provided via the ISCP and demonstration that trainees showed prior engagement with training processes. This evidence will include WBAs and AESs reports.