Specialty specific guidance for CESR in General Surgery
The new surgical curricula were published on 17 November 2020. Due to the significant changes that are being made to the curriculum we will be offering applicants the opportunity to make your CESR application in either the new curriculum or the previous version of the curriculum. This option of dual running of curricula for your specialty will be available until 31 July 2023. See the position statement on transition of curricula for further information.
Specialty Specific Guidance
The Joint Committee on Surgical Training and GMC have produced guidance documents for each version of the curriculum.
How to apply
You can apply through your GMC online account. There is one application form which includes sections for both versions of the curricula. You should declare which curriculum version you wish to be assessed against in sequence one and only provide evidence in the sections of the application relevant to your curriculum.
The GMC designed its new standards for postgraduate medical curricula Excellence by Design and its framework for Generic Professional Capabilities, published in May 2017, to help postgraduate medical training programmes re-focus trainee assessment away from an exhaustive list of individual competencies, towards fewer broad capabilities required to practice safely as a day-one consultant.
As a result, the 2021 surgical curricula are outcomes-based, meaning that trainees will be assessed against the fundamental capabilities required of consultants in the working week. These include the general skills which all doctors need to have (the GMC’s Generic Professional Capabilities) as well as those needed to carry out all the specific day to day tasks undertaken by a consultant surgeon (Capabilities in Practice – CiPs).
Content shared between all surgical specialties
There are now generic requirements shared between surgical specialties in the following areas.
- Quality Improvements
- Medical Education and training
- Management and leadership
You can find out more in section 5.4 Completion of training in your specialty.
There are five CiPs which are shared between all surgical specialties:
- CiP 1. Manages an out-patient clinic
- CiP 2. Manages the unselected emergency take
- CiP 3. Manages ward rounds and the on-going care of in-patients
- CiP 4. Manages an operating list
- CiP 5 Manages multi-disciplinary working
A new assessment tool has been developed for outcomes based assessments. The Multiple Consultant Report (MCR) allows assessment of performance relative to the level required of a Day 1 consultant in each CiP and the GPCs. The MCR is an assessment based in the workplace using observations gathered over an extended period of time. For trainees, this is the entire duration of a placement. For CESR applicants we would expect observations to be over a similar time frame. The MCR for CESR should reflect the final MCR for a trainee and should be a summative assessment. The MCR should cover a period of at least 6 months prior to making the CESR application. Applicants should bear this in mind when they first begin to gather their evidence for CESR.
The MCR and guidance for applicants and their supervisors can be found on the JCST website.
Changes in knowledge and skills
There have been changes in general surgical practice and these changes are reflected in the 2021 General Surgery curriculum.
- The development of specific oesophagogastric, hepatopancreaticobiliary and trauma special interests in the new curriculum reflect the changes in service reconfiguration over the past few years.
- The current lack of provision of general surgery of childhood (GSoC) is addressed by enabling trainees to develop GSoC alongside another special interest.
- The introduction of a gastrointestinal module incorporating general surgery of childhood is in direct response to identified needs of the service in some parts of the UK. This special interest module will provide trainees with a general route to CCT equipping them with technical skills across a broad range of open and laparoscopic abdominal operations, endoscopy and paediatric day case procedures.
- The development of oncoplastic breast services has resulted in the breast special interest section being completely rewritten to reflect the training needs of a modern day breast surgeon.
The curriculum has become modular and there are 11 possible modular combinations. To see this look at section 2.3 The trainee pathway and duration of training on pages 5-9.
One of the effects of this is that trainees following certain modules outlined in the curriculum will not be required to do emergency work in their final two years of training. All trainees will be able to manage the unselected take up to the point of operation and all will be able to manage postoperative care. You’ll need to demonstrate this as part of your CESR application.