EBSQEBSQ

Jim HillJim HillChairman Education and Training Chairman Education and Training

CommitteeCommitteeACPGBIACPGBI

Is coloproctology Is coloproctology certification/assessment required?certification/assessment required?Same qualification Same qualification breast/vascular/transplant colorectalbreast/vascular/transplant colorectal64 coloproctology training units 64 coloproctology training units – 183 surgeons > 75% activity in coloproctology183 surgeons > 75% activity in coloproctology

Article 14Article 14Allow members of the general public to Allow members of the general public to identify who is a trained colon and rectal identify who is a trained colon and rectal surgeon and assure the public that the surgeon and assure the public that the trainee is ready for unsupervised practicetrainee is ready for unsupervised practice

Union Europeene Medecins Union Europeene Medecins Specialistes - coloproctologySpecialistes - coloproctology

Main objective is to guarantee to patients Main objective is to guarantee to patients the highest standards of care in the field of the highest standards of care in the field of coloproctologycoloproctology

Recognised by EU but not by member Recognised by EU but not by member countries statutory medical bodiescountries statutory medical bodies

UEMS coloproctologyUEMS coloproctology

Define the content of coloproctology Define the content of coloproctology trainingtraining

Criteria for identification of training units Criteria for identification of training units and maintenance of standards and maintenance of standards

Development diploma EBSQ Development diploma EBSQ ColoproctologyColoproctology

Develop criteria for evaluation of Develop criteria for evaluation of Continuing Medical EducationContinuing Medical Education

Exam componentsExam components

EligibilityEligibility– Proof of identity and presentation of CCST or Proof of identity and presentation of CCST or

equivalentequivalent– General surgery five yearsGeneral surgery five years– Coloproctology two further yearsColoproctology two further years

ExaminationExamination– WrittenWritten– OralOral

Operative experienceOperative experience

IndexIndex

procedureprocedure

AA

(1 pt)(1 pt)

PAPA

(4 pts)(4 pts)

PP

(3 pts)(3 pts)

ToTo

Anterior resectionAnterior resection 2020 1010 1010

Rectal prolapse/Rectal prolapse/

Total colectomyTotal colectomy

1010 55 55

HaemorrhoidectomyHaemorrhoidectomy 1010 1010 1010

Fistula in anoFistula in ano 1010 1010 1010

TotalsTotals 5050 140140 105105 295295

Eligibility Eligibility

Quality of training – not specifiedQuality of training – not specified

Emergency experience – required, not Emergency experience – required, not specified specified

Proof of diagnostic skills – colonoscopy Proof of diagnostic skills – colonoscopy not essentialnot essential

Research - optionalResearch - optional

Relationship with National Certification Relationship with National Certification BodyBody

ExaminationExamination

Written clinical examinationWritten clinical examination

VivaViva– 30 mins on written examination30 mins on written examination– 30 mins on selected paper from literature30 mins on selected paper from literature– 30 mins general topics in coloproctology 30 mins general topics in coloproctology

PMETBPMETB

Nine standards for assessmentNine standards for assessment

Most UK examinations did/do not meet Most UK examinations did/do not meet these standardsthese standards

Principle 1Principle 1The assessment system must be fit for a The assessment system must be fit for a

range of purposesrange of purposes

Overall purpose needs to be Overall purpose needs to be documented and in public domaindocumented and in public domainPurposes of each component need to Purposes of each component need to be specified and available to trainees, be specified and available to trainees, educators, employers, professional educators, employers, professional bodies and the publicbodies and the publicSequence of assessments must match Sequence of assessments must match the progression through the career the progression through the career pathway pathway

PurposePurpose

Overall purpose: To determine whether the Overall purpose: To determine whether the candidate has proficiency to act as an candidate has proficiency to act as an independent practitioner in the field of colon and independent practitioner in the field of colon and rectal surgery and acquired particular skills and rectal surgery and acquired particular skills and knowledge of the medical and surgical knowledge of the medical and surgical management of diseases of the colon and management of diseases of the colon and rectum and perianal region. rectum and perianal region. The examination will allow members of the The examination will allow members of the general public to identify who is a trained colon general public to identify who is a trained colon and rectal surgeon and assure the public that and rectal surgeon and assure the public that the trainee is ready for unsupervised practicethe trainee is ready for unsupervised practice

Principle 2Principle 2The content of the assessment (sample of The content of the assessment (sample of

knowledge, skills and attitudes) will be based on knowledge, skills and attitudes) will be based on curricula for postgraduate trainingcurricula for postgraduate training

Assessment will systematically sample the Assessment will systematically sample the entire content appropriate to the level of entire content appropriate to the level of training with reference to clinical problems training with reference to clinical problems that the trainee will encounter in the that the trainee will encounter in the workplace and to the wider base of workplace and to the wider base of knowledge, skills and attitudes that the doctor knowledge, skills and attitudes that the doctor will require. will require.

The blueprint from which the assessments The blueprint from which the assessments are drawn will be available to trainees and are drawn will be available to trainees and educators in addition to assessors/examinerseducators in addition to assessors/examiners

ACPGBI assessment in coloproctology ACPGBI assessment in coloproctology Examination “Blueprint”Examination “Blueprint”

ROWSROWSBABA Benign anorectalBenign anorectalBCBC Benign colonBenign colonCRNCRN Colorectal neoplasiaColorectal neoplasiaINFINF Inflammatory bowel disease and stomasInflammatory bowel disease and stomasFDFD Functional disordersFunctional disordersA&EA&E Anatomy and embryologyAnatomy and embryologyPHYPHY PhysiologyPhysiologyENDEND EndoscopyEndoscopyPTHPTH PathologyPathologyRADRAD RadiologyRadiologyPAEDPaediatricPAEDPaediatricGENGEN General questions related to multiple body systemsGeneral questions related to multiple body systems

COLUMNCOLUMNEMQ and MCQEMQ and MCQAETAET AetiologyAetiologyANATANAT AnatomyAnatomyCPCP Clinical presentationClinical presentationPATHPATH Pathology – microscopic and macroscopic and molecular processesPathology – microscopic and macroscopic and molecular processesPYSPYS Pathophysiology/physiologyPathophysiology/physiologyDIAGDIAG DiagnosisDiagnosisINVINV InvestigationsInvestigationsMMMM Medical managementMedical managementPROCPROC ProceduresProceduresOPSOPS OperationsOperationsIN/CINDIN/CIND Indications/contraindicationsIndications/contraindicationsCOMPCOMP ComplicationsComplicationsPRE/POSTPRE/POST Pre and post operative carePre and post operative careMCQ onlyMCQ onlyPROGPROG PrognosisPrognosisCLASSCLASS ClassificationsClassificationsSTAGSTAG StagingStagingCGCG Clinical governanceClinical governanceCONCON ConfidentialityConfidentiality

Principle 3Principle 3The methods used within the programme will be selected in The methods used within the programme will be selected in

the light of the purpose and content of that component of the light of the purpose and content of that component of the assessment frameworkthe assessment framework

The rationale for the choice of each assessment The rationale for the choice of each assessment method will be documented and evidence based.method will be documented and evidence based.The examiners will be trained to administer and score The examiners will be trained to administer and score the examination and document the candidates the examination and document the candidates performanceperformanceThe scoring forms and rules will provide examiners The scoring forms and rules will provide examiners with defined guidelines to evaluate a candidate’s with defined guidelines to evaluate a candidate’s clinical decisions against preset standardsclinical decisions against preset standardsThe psychometric properties of the examination will The psychometric properties of the examination will appropriate and documented including reliability (eg appropriate and documented including reliability (eg examination reliability, case difficulty, examiner/case examination reliability, case difficulty, examiner/case difficulty, overall exam consistency) and validity (e.g difficulty, overall exam consistency) and validity (e.g exam scores measure performance in making clinical exam scores measure performance in making clinical decisions).decisions).

Principle 4Principle 4The methods used to set standards for classification of the The methods used to set standards for classification of the

trainee’s performance/competence must be transparent trainee’s performance/competence must be transparent and in the public domainand in the public domain

Standards in tests of competence will be set using Standards in tests of competence will be set using recognised methods based on test content and the recognised methods based on test content and the judgement of competent assessors. Information from judgement of competent assessors. Information from the performance of reference groups of peers will the performance of reference groups of peers will inform the standardinform the standardThe precision of the pass/fail decision will be reported The precision of the pass/fail decision will be reported on the basis of data about the test. The purpose of on the basis of data about the test. The purpose of the test will determine how the error around the the test will determine how the error around the pass/fail affects decisions about borderline pass/fail affects decisions about borderline candidatescandidatesReasons for choosing either pass/fail will be Reasons for choosing either pass/fail will be describeddescribed

Principle 5Principle 5Assessments must provide relevant Assessments must provide relevant

feedbackfeedbackNeed policy for providing feedback to trainees Need policy for providing feedback to trainees following assessments – needs following assessments – needs documentation and be in public domaindocumentation and be in public domain

Form of feedback must match purpose of the Form of feedback must match purpose of the examinationexamination

Outcomes of assessment must be used to Outcomes of assessment must be used to provide feedback on the effectiveness of provide feedback on the effectiveness of education and training where consent from all education and training where consent from all interested parties have been giveninterested parties have been given

Principle 6Principle 6Assessors/examiners must be recruited against Assessors/examiners must be recruited against criteria for performing the tasks they undertakecriteria for performing the tasks they undertake

The roles of the assessors/examiners will be The roles of the assessors/examiners will be specified and used as the basis for specified and used as the basis for recruitment and appointmentrecruitment and appointmentAssessors must demonstrate their ability to Assessors must demonstrate their ability to undertake the roleundertake the roleAssessors will only assess in areas where Assessors will only assess in areas where they have competencethey have competenceThe relevant professional experience of The relevant professional experience of assessors should be greater than that of the assessors should be greater than that of the candidate being assessedcandidate being assessedEquality and diversity training will have been Equality and diversity training will have been completed by the assessorscompleted by the assessors

Principle 7Principle 7There will be lay input into the development of There will be lay input into the development of

assessmentassessment

Principle 8Principle 8Documentation will be standardised and accessible Documentation will be standardised and accessible

nationallynationally

Principle 9Principle 9There will be sufficient resources to support There will be sufficient resources to support

assessmentassessment

ConclusionsConclusions

EBSQ only coloproctology assessment in EBSQ only coloproctology assessment in EuropeEurope

EBSQ does not currently meet PMETB EBSQ does not currently meet PMETB standardsstandards

Not feasible for the ICE in General Not feasible for the ICE in General Surgery to assess competency/completion Surgery to assess competency/completion of coloproctology trainingof coloproctology training

What is requiredWhat is requiredWork place based assessmentWork place based assessment– PBAs, numbers, robust RITA assessmentPBAs, numbers, robust RITA assessment

AssessmentAssessmentMeet PMETB standardsMeet PMETB standardsHigh reliabilityHigh reliabilityConfidence of trainees (80% pass rate)Confidence of trainees (80% pass rate)Administered by speciality associations under Administered by speciality associations under

auspices of ICE/EBSQauspices of ICE/EBSQBETTER INTEGRATION OF SAC/ICE/ACPGBIBETTER INTEGRATION OF SAC/ICE/ACPGBI

The futureThe future

Documentation will record the results and consequences of Documentation will record the results and consequences of assessments and the trainee’s progress through the assessments and the trainee’s progress through the assessment systemassessment systemInformation will be recorded in such a way as to be disclosable Information will be recorded in such a way as to be disclosable and available for appropriate access within the confines of data and available for appropriate access within the confines of data protectionprotectionDocumentation will be suitable for submission of purposes of Documentation will be suitable for submission of purposes of registration and performance reviewregistration and performance reviewDocumentation will provide evidence for compliance with Good Documentation will provide evidence for compliance with Good Medical PracticeMedical PracticeDocumentation will be transferable and accessible as the Documentation will be transferable and accessible as the trainee moves through locationtrainee moves through locationDocumentation will be comprehensive and accessible to the Documentation will be comprehensive and accessible to the trainee and those responsible for trainingtrainee and those responsible for training

Resources will be made available for Resources will be made available for the proper training of assessorsthe proper training of assessors

Resources and expertise will be made Resources and expertise will be made available to develop and implement available to develop and implement appropriate assessment methodsappropriate assessment methods

Principle 1Principle 1

To determine whether the candidate has proficiency to To determine whether the candidate has proficiency to act as an independent practitioner in the field of colon act as an independent practitioner in the field of colon and rectal surgery and acquired particular skills and and rectal surgery and acquired particular skills and knowledge of the medical and surgical management of knowledge of the medical and surgical management of diseases of the colon and rectum and perianal region. diseases of the colon and rectum and perianal region. The examination will allow members of the general The examination will allow members of the general public to identify who is a trained colon and rectal public to identify who is a trained colon and rectal surgeon and assure the public that the trainee is ready surgeon and assure the public that the trainee is ready for unsupervised practicefor unsupervised practiceIt will provide evidence for the award of a CCTIt will provide evidence for the award of a CCTIt will be a stimulus to learning for the candidates.It will be a stimulus to learning for the candidates.It will provide feedback to the trainee about progress and It will provide feedback to the trainee about progress and learning needslearning needs

Principle 2Principle 2

The curriculum has been written and has defined The curriculum has been written and has defined knowledge, skills and attitudes that the trainee will knowledge, skills and attitudes that the trainee will require at the end of their training. This Intercollegiate require at the end of their training. This Intercollegiate Curriculum Surgical Project* is accessible on the Curriculum Surgical Project* is accessible on the internet to all interested parties. These assessments internet to all interested parties. These assessments will comprise eligibility criteria of satisfactory work will comprise eligibility criteria of satisfactory work place based assessments, the testing of knowledge place based assessments, the testing of knowledge with a written examination and testing of the with a written examination and testing of the management of clinical problems will be tested with management of clinical problems will be tested with an oral examination. An examination blueprint will be an oral examination. An examination blueprint will be written to ensure that the entire content of the written to ensure that the entire content of the curriculum is sampledcurriculum is sampled