It is my pleasure as RCSI President to welcome you to the first RCSI Trainee eZine. COVID-19 has resulted in many unwelcome changes to our personal and professional lives however with disruption comes opportunity for innovation. While I cannot claim that the launch of the Trainee eZine is that innovative, it is a welcome improvement in the in how RCSI and trainees communicate.

I look forward to the eZine becoming a vibrant interactive portal in which issues important to trainees are voiced and a platform through which important information regarding training, assessment, continuing educational and research opportunities are communicated.

Professor Oscar Traynor’s article on the impact of COVID-19 on surgical training is a must read. You can be assured that I  have made clear the importance of maintaining access to high quality training opportunities in my interactions with the Department of Health, HSE, Irish Medical Council and other training bodies, including our sister Royal Colleges. Simply put, training and retaining the best of our surgical graduates is not optional and must remain a priority notwithstanding  the pandemic.

Dr. David Brinkman’s report of the activities of the Irish surgical Training Group reflects the activities of the Group over the past year and particularly the efforts of Ms Christina Buckley and her committee. I was privileged to have been present at the Careers Day during Charter Week. I hope that COVID-19 restrictions will have eased by next year’s meeting to allow the animated debate to continue.

Please do use the on-line links to the various sites on the College portal to assess information. It is especially important to look after your own health – physical and mental. Recognize early signs of burnout in yourself or in colleagues, access the resources available and take measures necessary to alleviate the causes. The message throughout is to keep safe for yourself, your family and for the patients who need your expertise.

I look forward to interacting with as many of you as possible through the eZine, newsletters, webinars and in person as soon as restrictions allow.

The COVID-19 pandemic has presented unforeseen and unprecedented challenges for surgical training worldwide, including here in Ireland. The almost complete cessation of elective surgery has profoundly impacted the operative surgical experience for trainees. This is clearly reflected in the electronic logbook records of trainees at all levels of training. But there has also been a significant reduction in urgent surgery (eg cancer surgery) and even emergency surgery (due partly to a reduction in major road trauma and sports injuries). However, the impact on surgical training goes significantly beyond the operating theatre.  There has also been a marked reduction in outpatient clinic activity, endoscopy, and even routine ward work. In many cases, trainees have had less interaction with their trainers with consequent effects on role-modelling and mentorship. In some cases, trainees have been redeployed to other non-surgical areas of the hospital, sometimes for prolonged periods of time. In addition, many trainees have been off work due to illness or self- isolation as a result of contact with COVID patients or staff. 

The net effect of all these challenges has been that trainees have had a significant reduction in training opportunities including reduced clinical decision-making and other areas of professional development.

 The impact of COVID-19 has also affected other elements of the surgical curriculum including national selection, workplace- based assessments, teaching activities in the hospitals and in RCSI, CAPA/ARCP reviews and conduct of MRCS/FRCS examinations.

In an era of competency-based education and training, the current pandemic will have a significant impact on career development and progression for many surgical trainees. RCSI has been pro-actively working to mitigate the effects of the current pandemic on surgical trainees at all levels of training.

The current wave of COVID-19 is now waning rapidly in this country and, luckily, the expected “surge” of cases did not occur. It is now time to focus on a return to normal clinical activity in our hospitals, albeit a “new normal”.  An important part of this focus must be mitigation of the negative effects of the pandemic on surgical training over the past 4 months and maximising the training opportunities going forward.

In planning for the next 12-18 months, there are certain realities which need to be considered:

• There will be a significant backlog of both urgent and elective clinical activity which will compound the already unmanageable waiting lists in our hospitals. The backlog will relate not only to surgical procedures but also to outpatient appointments and access to diagnostic services (e.g. endoscopy and radiology).

• There will be an ongoing need for social distancing/use of PPE in all clinical environments. This will significantly impact numbers of cases in operating theatres, OPD clinics and endoscopy lists.

• There will be major capacity issues in our public hospitals as the traditional overcrowding in the wards, Emergency Departments and OPD clinics cannot be allowed to happen as before.  Most major hospitals will probably need to function at much less than full occupancy. This issue will certainly be compounded by the annual “winter surge” of non-COVID related admissions.

• There will be a need to develop new approaches to patient consultations/interactions both in the wards and in OPD clinics.

• There will be pressures on consultants to do operative cases themselves, rather than assist trainees, in order to maximise patient turnover in a reduced capacity environment

• The major infrastructural deficits in our health system were brought into sharp focus during the pandemic (e.g. national shortage of ICU beds/IT infrastructure issues/manual medication prescribing etc).  These problems have still not been addressed and will continue to be a challenge when we return to “normal”.

• The issues highlighted above will require “rethinking” of the working day/week in our hospitals.  For example, there will undoubtedly be pressures to extend the working day in operating theatres, OPD clinics and diagnostic services and also to carry out these activities at weekends. Also, there will be a need to contract out certain surgical services to the private hospital sector because of capacity issues in our public hospitals. All of this will have implications for surgical trainees. Whilst access to increased training opportunities must be protected, we need to be mindful of the implications of these new arrangements for trainees in relation to domestic issues such as childcare, schooling and creches.

For surgical trainees, a major concern will be getting access to sufficient surgical cases to achieve the indicative numbers required in order to be “signed off” for CCST. Our College will campaign pro-actively to establish the core principle that trainees must be facilitated to “follow the patients”.  This will almost certainly involve working in environments other than your main teaching hospital. That will bring it’s own challenges but rest assured that RCSI will do everything possible to ensure that trainees have full access to the cases they need in order to be trained.  The College will also work with each specialty to enhance the role of simulation in surgical training, not only in our world-class simulation centre in York Street but also in regional centres around the country.

Disruption to training as a result of the COVID-19 pandemic has meant that, through circumstances beyond their control, there have been difficulties for some senior trainees in acquiring the competencies/capabilities required to progress or complete their training programme. Where possible, the usual ARCP Outcomes will be used in 2020. However, where the acquisition of competencies/capabilities have been delayed due to COVID-19 and there are no serious concerns about the trainee, one of the two “new ARCP outcomes”, Outcome 10.1 or Outcome 10.2, will be used as agreed with our sister colleges in the UK through JCST. These have been introduced as “no fault” outcomes. The aim of introducing these new ARCP outcomes has been to enable trainees to progress to the next stage of their training or complete their programme where possible. Full details of these “new ARCP outcomes” are on the JCST website.

A major concern for many trainees has been completion of the required examinations, both MRCS (for Core Surgical Trainees) and Intercollegiate Specialty FRCS (for Higher Specialty Trainees).  These examinations have been suspended since the start of the pandemic.

Nevertheless, the MRCS is a requirement for progression to ST3 and the FRCS is a requirement for CCST.  I am pleased to report that the MRCS Part A will be held again in Ireland (but not in overseas centres) in September 2020 (in an online format) and the MRCS Part B will be held in October 2020 (again, in Ireland only). It is hoped that these examinations will run as normal in 2021. Applications for the Part A and Part B exams in autumn 2020 have already closed and I strongly urge Core Surgical Trainees to watch the RCSI website closely for details of the early 2021 diets of the examinations. The Intercollegiate Specialty Fellowship examinations are more challenging to deliver and there is currently no definite date for resumption of these exams.  It is hoped that Section 1 exams will resume in November 2020 but possibly with reduced capacity. Section 2 exams are currently being planned and it is hoped that they may also run in November 2020.  Again, I strongly urge potential applicants to follow the JCIE website closely.

Throughout the COVID 19 pandemic and beyond, a priority for RCSI has been to ensure the physical safety and emotional wellbeing of our trainees by putting formal support structures in place which are easily accessed by trainees at all times. This includes consideration of the impact of extraneous or domestic factors such as altered school schedules, reduced creche facilities and other childcare implications. A suite of “wellness” programmes and other supports are available on the trainee app mSurgery.

Although the next 12-18 months will present major challenges for surgical training there will nevertheless be opportunities to develop novel education and training strategies and also utilise existing platforms in a way that transcends current geospatial and temporal limitations. By doing this, our College will do everything  possible to maintain a rigorous educational experience for all surgical trainees despite the limitations imposed by COVID-19 and the post-COVID era.

The Irish Surgical Training Group was set up to provide trainees with a voice within RCSI. We represent trainees within the college at various committees, and have representatives from ST1, ST2 and each surgical specialty on the committee. Trainee-centred events are also run throughout the year.

This year's events began in November with the annual Careers Day for interns and students interested in surgery. 22 aspiring surgeons attended and there was great engagement from all the committee members who gave talks on their chosen fields. This was followed by our 'Aspiring Surgeons Research Symposium', a selection of presentations from medical students, interns and trainees. The winner, difficult to choose due to the exceptional quality of research presented by his peers, was Patrick Boland, who presented on his paper 'International Survey on Current Management Issues of Acute Appendicitis'

Following on from the success of the Careers Day, the next big event in the ISTG calendar is the Trainee Session at RCSI Charter Day. Again well attended by over 60 international faculty and trainees, the topic was "Resilience in Surgical Training: Nature or Nurture?" and made for an animated concluding debate: despite Ms. Sarah Early's best efforts, Mr. Sean Martin prevailed and the house voted against the motion "This House Believes We Need a More Supportive System, Not More Resilient Trainees”. The day concluded with the Bosco O'Mahony Lecture from Mr. Justin Geoghegan on the perils of a surgical career, imparting his extensive experience to the trainees in the room.

The Silver Scalpel award is presented to the annual trainee-nominated 'Best Trainer', but it being the last event of the year and having planned it for the 26th of June meant that it had to be postponed. The award winner this year is Ms. May Cleary in Trauma and Orthopaedics. We hope to present her award at next year's dinner along with the general surgeon that will be chosen by trainees in 2021.

All in all, Ms. Christina Buckley has been presiding effortlessly over the committee, running events smoothly and successfully and representing trainees on various issues such as increased train the trainer course capacity throughout the year, and I wish her the best of luck with future endeavours. We have a new website which should be up and running in the upcoming weeks so please keep an eye on this for the dates of events in the coming year: www.istg.ie

The situation around Covid 19 is changing rapidly and we are focussed on supporting you as surgeons in practice at this incredibly challenging time. 

RCSI are regularly updating all Fellows, Members and registered surgeons with updates and guidance if you are not receiving these please contact us at pcs@rcsi.ie, or you can access the dedicated section of the website where you will find up to date information, for further information please see RCSI support for Surgeons in Practice.

As you very keenly aware the changes to how surgical services are being delivered are colossal, with online and tele consultation and changes to the entire perioperative process.

The ability to maintain a focus on your training objectives can be challenging and the RCSI is here to help, we have identified a range of resources that can support you during this time of upheaval and be your best personal and professional self. www.rcsi.com/dublin/coronavirus/healthcare-professionals

There are further supports available for all trainees external to the RCSI such as Practitioner Health and an article on how to prevent Clinician Burnout in the Harvard Business Review.

Over the past number of years annual Bootcamp has become an established first step on the surgical training path. 

Many of you will have experienced a very different Bootcamp this year, as a number of elements were virtual for the first time.

The technical skills teaching will take place later in the summer with small group teaching adapting to the new situation. However, the College is committed to ensuring you receive the best in technical skills training and supports as you move forward with your career in surgery.

The final details of how this programme will be delivered is currently being developed and we will be updated you on this shortly.

The onset of Covid-19 has had a significant impact on the ability to run the scheduled training days for trainees in the College.

Most surgical specialties have now embraced the new norm “webinar” style lectures, ground rounds and case based discussions to ensure continued interaction and teaching across the training years from Core Surgical Training to Specialist Training.

We will continue to work with each specialty over the coming months to build on this format for the future and to ensure continued supported learning for our trainees as we work back towards the reintroduction of training days in the College.

The individual surgical specialties all have their own unique requirements for courses and exams and it is important to understand the financial supports that are in place for trainees, these are all funded by the HSE NDTP.

There are four individual schemes;

1. Clinical Course & Examination Refund Scheme for NCHDs

This scheme is open to all NCHDs.

The HSE has issued an approved list of qualifying clinical courses and examinations, these can be viewed in the.  guidance document.

It is important to note that changes came into effect on the 8^th July 2019 so the full cost of an approved examination/course taken on or after this date is eligible to be refunded for the first sitting of the exam. An application form must be completed to apply for this refund.

2. Training Supports Scheme (TSS) for NCHDs

This scheme is open to all NCHDs. Funding is allocated based on Grade and the table below indicates the amount available under the TSS for each registration training year, July – July. Funding is available pro-rata for doctors employed on shorter contract durations.

Core Surgical Trainees qualify for a grant of €1,250.00 per year

Specialist Trainees qualify for a grant of €2,000.00 per year

A list of approved clinical courses, conferences and examinations that can be claimed for under the TSS are listed here.

Please see the NCHD Training Supports Scheme (TSS) Guidance Document for Employers & NCHDs here which contains a detailed explanation of the Scheme

The Training Supports Scheme User Guide explains the steps required to making a Training Supports Application via the NER Portal

3. Specialist Training Fund for Higher Specialist Trainees

This scheme is open to higher specialist trainees only. The funding available to each trainee is €500 per year of training and the fund rolls over if not claimed in a particular year. 

The Specialist Training Fund for Higher Specialist Trainees (2019) guidance document contains a detailed explanation of the Scheme should be completed and submitted claim your refund.

4. Financial Support for Surgical Loupes

https://msurgery.ie/home/specialist-training/financial-support/surgical-loupes-fund/

We’re delighted to advise that RCSI’s innovative part-time interprofessional postgraduate programme in Human Factors in Patient Safety is now available to complete in one year as a Postgraduate Diploma or over two years as a Postgraduate Master’s Degree.  The progamme brochure can be viewed here.

This programme supports candidates who wish to become experts in delivering patient safety and quality improvement initiatives in acute hospitals. The programme is positioned at level 9 on the NFQ and is a fully inter-professional programme developed to meet the needs of surgeons, anaesthesiologists, emergency medicine doctors, obstetricians, pharmacists, nurses and midwives working in the hospital setting, as well as safety and quality managers.

The programme is now open for enrolment and will commence as scheduled in September 2020. If COVID-19 restrictions apply in the autumn that impact onsite delivery then the programme is ready to commence with online delivery.  Places will be offered on an ongoing basis during the summer so early application is advisable.

You can find out more about the programme from the attached flyer or by clicking here to register your interest, request a call or read testimonials from graduates of the programme.

The Human Factors team at RCSI Surgical Affairs would be delighted to hear further from you at MScHumanFactorsPS@rcsi.ie if you should have any queries or questions.

If you have just started your ST2 surgical placements for this year it won’t be long before you begin considering your options for next year and we would like to update you on how this process was managed in March this year.

In light of COV-19 Higher Specialist Training successfully moved the selection process for ST3, 3 weeks earlier than advertised. With the support of all the surgical specialties the team managed the delivery of 7 interview panels across 3 days to ensure candidate appointments to Specialist Training Programmes were competed on time and under the normal process to ensure transparency to all candidates. In total the process was supported by 90 panel members and Chairs. A total of 62 candidates where interviewed and 42 appointed to Specialist Training programmes for July 2020.  Without the collaborative working by with the respective trainers, Surgical Affairs staff and Chairs (RCSI Council members), who willingly engaged in the process understanding the urgency required to ensure its success.

For the 2021 intake, interviews will take place week commencing 15^th March 2021, we will be adhering to guidelines in place at that time and will adapt our processes as necessary, you will be updated prior to recruitment.

The College, in consultation with both trainers and trainees, has developed a mentoring programme which aims to ensure every surgical trainee has the opportunity and access to the benefits that structured mentoring by an experienced surgeon can offer. 

The key participants are the mentors and mentees with support and oversight from individual specialty committees under the governance and stewardship of the Department of Surgical Affairs at the RCSI.

The mentor’s role will be to act as an advisor to their trainee on areas as follows:

1) Current difficulties/problems

2) Future career planning and development  

Trainees are expected to fully engage with mentorship and in particular to focus on any of the issues identified under the defined headings.

Although mentorship is a voluntary exercise and participants should not be compelled to participate in the programme.  It is intended that if this initiative is successful and beneficial, it will be extended to all trainees which will necessitate a corresponding increase in participation, for further information please email;  traineementorship@rcsi.com

The HSE National Health Library and Knowledge Service (NHLKS) have now made the BMJ’s decision support tool BMJ Best Practice available to healthcare professionals and patients across the Republic of Ireland.

BMJ Best Practice provides healthcare professionals with quick, easy access to the latest information and evidence for diagnosis and treatment decisions. Its content is updated daily and draws on the latest evidence-based research, guidelines and expert opinion to offer step-by-step guidance on diagnosis, prognosis, treatment and prevention.

Access is automatically enabled via the national IP address. BMJ Best Practice can also be accessed anytime via the mobile responsive website or the app. 

Further information is available at www.hselibrary.ie.

The Spark Innovation Programme is an initiative that encourages healthcare providers to develop and implement their ideas so that we can improve our health service.

National Doctors Training and Planning (NDTP) established Spark in July 2017 as a national programme to encourage, support and recognise innovation among doctors in Ireland. The programme is now also being supported by the National Quality Improvement Team with the goal of encouraging innovation across our health service

As our patient cohort becomes more complex, providing high standards of care becomes more challenging. Frontline members of staff are ideally placed to recognise the issues faced by their patients and colleagues and implement creative solutions to these issues. NDTP and the Spark programme aim to support projects that make our health service a better place to work and receive care. 

The first Spark Ignite event took place in Galway in 2018. Applications were open to all healthcare staff working in the Galway region. Entrants were asked to plan, perfect and then pitch their ideas at the event.  The winners of the competition were given funding to further develop their ideas and are getting on-going support and mentorship from Health Innovation Hub Ireland. 

One of the first winners of the Spark Ignite competition was Professor Derek O’Keefe, consultant physician in GUH, and his team members Brendan Tuohy, Clinical Engineer UHG, Frank Kirrane, Clinical Engineer UHG, Michael Kerin Consultant Surgeon, UHG, Peter McCarthy Consultant Radiologist, UHG. Prof O’Keefe and his team proposed to develop an inexpensive handheld medical electronic device that will accurately tell if a Naso-Gastric (NG) tube has been placed correctly in the stomach before NG feeding commences.

The winners of the competition will be given funding to further develop their ideas and will receive on-going support and mentorship from Health Innovation Hub.

The NDTP Aspire (Post CSCST) Fellowships are fully funded supernumerary posts.

These fellowships are designed to address the need to provide the specific post CSCST training opportunities required for a range of roles and skill sets at consultant level in the Acute Hospital system at present and into the future.

The RCSI Surgical Trainees have been successful in the recent past attaining a number of scholarships in specialities such as; General Surgery,

Applications are assessed by an expert advisory panel, and NDTP may seek specific advice from relevant experts, Clinical Directors etc. as required. Fellowship proposals are assessed on the basis of quality of the proposal, identifying an unmet patient need, specialty and service priorities, the unavailability of such training in Ireland and the potential benefits to the Irish health service and patients. Other factors may include specialty spread, geographical distribution and other considerations.

In April the HSE has announced there will be an increase in the annual intake of medical interns this year, from 734 to approximately 1,100. The medical interns recruited took will up their posts at the earlier start date of May 18, 2020.