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Sub speciality PCI training in the United Kingdom. Tim Gray Cardiology SpR Manchester Heart Centre. Current System. Currently no formal arrangements for sub-speciality training: Arrangements for sub-speciality training made at deanery and trust level No formal training programme

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Sub speciality pci training in the united kingdom l.jpg

Sub speciality PCI training in the United Kingdom

Tim Gray

Cardiology SpR

Manchester Heart Centre


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Current System

  • Currently no formal arrangements for sub-speciality training:

    • Arrangements for sub-speciality training made at deanery and trust level

    • No formal training programme

    • Often ad hoc start to training

    • No clear end goals

    • No proficiency assessment


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Current Training model

  • Ad hoc apprenticeship based training


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Proposed training model

  • Apprenticeship based training

  • DOPS (Directly observed procedural skill) assessment

  • 3 monthly appraisal by Supervisors and exit appraisal by Training director

  • Examination (in association with European Society)


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Problems Now

  • European Working Hours Directive

    • Reduced PCI exposure

    • Reduced continuity of care

    • Reduced emergency experience

  • SpR competition leading to several trainees with partial training

  • Competition for PCI from established consultants re-training

  • Dilution of training with other clinical pressures


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Problems now

BJCA survey 2005


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Benefits of change

  • Minimum standard for clinical competence

  • Higher quality of candidates if competitive selection

  • Higher SpR motivation

  • Stimulates focus on peri-procedural care as well as cath lab time


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Benefits of change

  • Allows focus on sub-speciality

  • Allows for dedicated teaching sessions by motivated trainers.



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Problems of change

  • The interview process

    • Huge regional variation in first few years

    • Will there be a national recruitment?

    • Less likely to have higher degree

    • Trainees themselves may be less likely to appreciate sub-specialities

    • Interview process needs to be open and transparent


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Problems of change

  • What happens if fail to secure training placement?

    • Forced to choose different sub-speciality?

    • Take time out to find appropriate placement?

  • Will trainees be expected to move around the country to find a programme?

  • ?encourage local vs regional vs overseas fellows


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Conclusion

  • Change to a formal training programme is welcomed

  • Ideal time to instigate change in sub-speciality training

  • Need to decide on recruitment process soon.


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