Since the end of 2004, the Royal College of Radiology (RCR) , The Royal College of Surgeons (RCS) and the Vascular Society (VS) have been in negotiations to establish a joint training programme. The BSIR, who entered the talks at the invitation of the Royal College of Radiologists (RCR), were concerned that interventional radiology as a specialty was in danger of being lost 'piece by piece' to other societies. Therefore, officers of the BSIR, RCR, RCS and VS have been working towards developing a new joint training programme that will train specialists to work in teams and who can perform both vascular and non-vascular procedures, in an elective and emergency setting.
Interventional News talked to Professor Anthony Watkinson, President of the BSIR, about the need for a joint-training programme, its structure and the benefits such a programme will bring to the patient, interventional radiology and vascular surgery.
"The establishment of a joint training programme will aim to train specialists who can work in teams with complimentary skills and mutual respect. This will enable provision of high quality patient care in the elective and emergency setting in a small speciality in an area that is likely to lead to centralisation of services," commented Watkinson. "What the joint training programme is aiming to produce is specialists practising to high levels of expertise who we would be happy to perform procedures on members of our families when we are consumers rather than providers of healthcare."
However, he warned that if care is not taken this may produce a 'Jack of all trades and master of none'. According to Watkinson, this will produce a 'lowbrid' rather than a 'hybrid' specialist who will be mediocre at best. "It is important to get this right from the start. Decide on the end product and gear the training to take this into account. The programme must aim to develop key skills to a high level."
He commented that the negotiations have been progressing well and escalated to involve the Royal College of Surgeons and the Educational Committee of the RCR. "The end product is seen as a truly valuable commodity and we are keen to develop a pathway to make this happen.
The proposals concerning the training of image-guided specialists coming to post in eight to ten years time. It is hoped that the end product of training will produce teams whose members between them possess the necessary skills to manage all aspects of diagnosis and management of vascular disease and have a broad grounding in endovascular and open surgery. Those with endovascular skills will be able to provide interventional services across a range of specialities and those with surgical skills will be able to provide for the increasingly complex nature of modern vascular surgery. The teams will be able to deliver robust and resilient elective and emergency care with a common ability to assess, diagnose and plan management in the outpatient and ward context.
"But the devil is as always in the detail. What will go into an initial co-operative two years and how to tailor the remaining three to four years to produce the end product," Watkinson said. He stated that the individual must have a wide range of skills to be able to be useful and work in teams. These skills must include clinical, diagnostic, interventional and surgical. There will be overlap and different emphasis although the new person whilst having special interests must have a broad range of skills including non-vascular to support the other services that interventional radiology currently supports and provide cover 24 hours a day, seven days a week.
The individual competencies will be focused on either open or interventional skills with some overlap in basic skills. With these requirements in mind the proposed training programme would be divided into an initial co-operative two years following on FY 1/2 (+/- one to two years post foundation training). Entrants will possess either a radiological or surgical NTN and the co-operative years will have equal emphasis on imaging, interventional radiology (vascular and non-vascular), emergency and elective surgery. Assessment may lead to MRCS/FRCR one equivalent examinations. This would lead into years three to four focused on core training. This would be competency based and include diagnostic and clinical care and basic surgical and endovascular skills. This would be followed by years five to six focusing on additional modules to hone surgical or interventional skills. The exit qualification would depend on the modules undertaken and reflect this bias. Training will be assessed by the RCR/RCS and be competency based around the knowledge, skills and attitudes required by this group of professionals.
This training would hopefully lead to a format applicable to other areas of post-graduate medical education, be competency based and allow flexible entry and cross over in keeping with the ethos on MMC. It will provide potential exits into the combined training scheme or surgery or radiology as required by the individual/service requirements. "This acknowledges the likelihood of centralisation of services in small specialities to support service provision," he added.
"These proposals benefit the patient, interventional radiology and vascular surgery. The patient benefits by having access to a team with the wide range of skills to provide high quality care 24/7 and the vascular specialist and interventional radiologist can focus earlier in their career pathways and not waste time in areas of unrelated surgery and diagnostic radiology that just serves to pass the current exams," said Watkinson.
Implicit in all of this is workforce planning. Training the right numbers of people to do the right things along a training pathway that is fit for purpose, shares common skills of knowledge and trains appropriate numbers. He commented that the PMETB needs to approve the proposals and to this aim the development has been along a pathway through syllabus/curriculum from the education committees of both the BSIR and Vascular Society. The IR syllabus has been approved by the IR subcommittee, the Education Board and the Faculty Board of the RCR. All this has had a close eye on what PMETB will require, he added.
Watkinson said, "These steps I think are important to ensure the provision of patient care that is high quality, available to all and not post code specific." He cited the recent example of a 14-year-old girl who was transferred to his hospital after a riding accident after being thrown off her horse and trampled on. This severed and fractured the left kidney and on admission she was haemodynamically unstable. CT demonstrated ongoing haemorrhage and she was immediately transferred to the angiographic suite for embolisation to good effect within one hour of arriving in the hospital. "This was appropriate management for this patient but relied on individuals being available," said Watkinson. "This standard of patient care should not be post-code specific, but be available around the clock and be performed by fully trained specialists and this is what these training proposals aim to provide."
It is hoped that an agreement will be reached by the end of 2006 and the joint training programme implemented in 2007/8.
Published: Nov 2006
|
