TO ALL PROGRAMME DIRECTORS August 1999

Dear Programme Director,

I am writing to detail two of the recent decisions made by JCHST.

1. Parallel Lists

The JCHST agreed that parallel lists will no longer be acceptable for training. This is because it is a weekly commitment and under these circumstances the trainee will not be gaining any training during that session each week. This is different to a trainee operating on a list when his/her Consultant is away.

Some confusion appears to have arisen and the assumption made that the JCHST has decided that trainees cannot operate in the absence of their Consultant trainer. This is not correct.

Training is progressive. The trainee needs to progress from minor procedures through intermediate procedures to major and complex procedures (the latter usually during his/her sub-specialty training). At each stage in their training they need to progress from assisting the Consultant, carrying out the operation with the Consultant assisting them, carrying out the operation with the Consultant supervising but not actively assisting and carrying out the operation without the Consultant being present in theatre, but a Consultant being easily available should the trainee require advice or help. When a Consultant has decided that a trainee is capable of carrying out a particular operation without a Consultant being present in the operating theatre, the trainee should be allowed to do so. This is usually done on a list when the Consultant is away but another Consultant is easily available should the need arise. This does vary slightly from specialty to specialty, and each SAC has its own view as to which type of procedures a trainee can carry out without a Consultant being present in the operating theatre, even as a Year 6 trainee.

2. Ratio of Consultants to Middle Grade Staff

The JCHST has also agreed that the maximum ratio of Consultants to Middle Grade Staff will be one Consultant to 1-1.2 Middle Grade Staff. The ratio varies between the different SAC defined surgical specialties and the staff mix of the Middle Grade Staff. Middle Grade Staff includes Specialist Registrars, Visiting Registrars, Staff Grades, Associate Specialists, Trust Doctors and any other non-Consultant Career Grades working at this level. Within this ratio each SAC has a separate ratio for Consultants to trainees. For example, in general surgery the ratio of Consultants to trainees (Type I and Type 2 trainees) is two Consultants to one trainee, and under exceptional circumstances, three Consultants to two trainees.

If the ratio of Consultants to Middle Grade Staff is greater than 1:1-1.2, educational approval will be withdrawn for trainees in the Unit until the ratio comes down to that agreed by JCHST. Consultants are responsible for supervising their Middle Grade Staff, in addition to training their trainees, and JCHST felt that Consultants could not adequately undertake this task if the ratio was exceeded.

With best wishes.

Yours sincerely,

Professor Charles S. B.Galasko,Ch.M., FRCS.,

Chairman,

Joint Committee on Higher surgical training