Core Surgical Training - Paediatric Surgery at a Glance

Welcome to Core Surgical Training - Paediatric Surgery recruitment at the North Western Deanery

Number of Vacancies | Recruitment Timetable | Training Locations | Application Process |  Programme Details

Number of vacancies for 2010*

*The start dates for these posts are likely to be 4th August 2010.

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Provisional recruitment timetable for CT2 Core Surgical Training - Paediatric Surgery

Hospital sites for CT1 & CT2 Paediatric Surgery:

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Application Process

Longlisting: All application forms will be checked to decide whether they are eligible to go forward to the shortlisters. The longlisting will look to see that you meet the following areas of the relevant person specification:

1. You possess the qualifications required

2. You have the correct amount of experience in the specialty you are applying to

3. You have fully completed all the relevant sections of the application form and

4. Doctors who are not UK or EEA nationals and whose immigration status entitles them to work without restriction in the UK will be considered on an equal basis with UK and EEA nationals. Other non-UK or non-EEA nationals with limited leave to remain in the UK and whose employment will require Tier 2 sponsorship are subject to the Resident Labour Market Test (RLMT). Applicants may only be considered if there is no suitable UK or EEA national candidate for the post. Evidence of immigration status should normally consist of a date stamped passport and accompanying letter from the Home Office. Please visit http://www.ukba.homeoffice.gov.uk for more information.

Shortlisting: Application forms will be scored by two trained assessors against a set of shortlisting criteria that will have been agreed in advance. Application forms will be anonymised.  If you score highly enough you will be invited to attend a selection Centre.

Selection Centre: Previous selection centres for this specialty have consisted of 3 interview stations each lasting 10 minutes. The stations covered the following areas:
1. Structured Interview
2. Scenario
3. Logbook

It is likely any future selection centres will work to a similar format.

Programme details

The Paediatric Surgical core training programme will aim to take individuals who have successfully completed foundation training through a training programme that will enable them to meet CT1 and CT2 competencies in line with the surgical curriculum.  The syllabus covered will reflect the ISCP documentation as developed by Graham Lamont whilst chair of the British Association of Paediatric Surgeons Education Committee and reviewed regularly by Eleri Cusick who now chairs the BAPS education committee

With the opening of the new children’s hospital on the central Manchester site in May 2009 the early years of the programme will be based at the Central Manchester and Manchester children’s University Hospitals NHS Trust.  CT 1 will include 6 months in paediatric surgery and 6 months of general surgery at Manchester Royal Infirmary and CT2 will involve 6 months of paediatric urology and 6 months paediatric surgery with significant exposure to neonatal care.

The first two years of the programme are designed to ensure that there is exposure to the generality of Paediatric Surgery, Neonatal Intensive Care, Paediatric Urology and some general surgery.  During this part of the programme those in post will be expected to complete a basic surgical skills course and obtain both a Neonatal Life Support and Advanced Paediatric Life Support course. For those candidates who already have the college BST course attendance at the Alderhey paediatric surgical skills course will be expected.

For the first time in Manchester the children’s surgical service will be the first point of call for children subjected to trauma via a dedicated paediatric A&E on a site that serves a very large district general population. Paediatric Surgical core trainees will be expected to from part of the multi-disciplinary team required for such a service.

Trainees will have to successfully participate in the interim and annual ARCP process organised by the Deanery.

General Description of Rotation

In CT1 individuals will move through 2 x 6 month posts

The CT1 post will include 6 months of surgery at the new Children’s Hospital. As we move to this site their will be a reorganisation of the consultants’ job plans and service configuration. It is likely that this post will be supervised by Mr Morabito. Clinical work load during this post will facilitate exposure to the basic surgery of childhood allowing the post holder to become confident at examining children, communicating effectively with children across a wide range of ages and their parents. Understanding of the physiology of childhood and how it differs from adults, fluid balance, acid base and pain management will be taught in this block. Exposure to the management of abdominal pain, vomiting in childhood and constipation thereby allowing completion of CBD’s in these arenas to be completed.

Operative skills of opening and closing skin incisions and of undertaking soft tissue operations will be expected in order that the trainee can start to develop core surgical skills with regard to tissue and instrument handling. Depending on progress it is likely that at the end of this attachment the trainee will have been able to perform parts if not all of the more common paediatric surgery procedures such as circumcision, incision and drainage of abscess, inguinal hernia repair (non-neonate, non premature) and orchidopexy. The appointment of nurse practitioners should remove the need for on the day clerking of a large number of day case patients through the new dedicated day case centre. However, we would expect the CT1 to take advantage of the work going through this area as it will provide excellent exposure to the generality of paediatric surgery and allow the individual to realise just how varied “normal” is alongside being able to see surgical pre-operative care for day case surgery especially the importance of site marking and consent.  On call exposure should allow the individual to obtain the skills of surgical clerking for the more complicated admissions to the main ward areas. In addition this will allow the individual to develop the skills of organising appropriate investigations and become proficient in obtaining peripheral vascular access. Surgical exposure to emergency procedures will include assisting with the surgical workload and ultimately undertaking of pyloromyotomy and appendicectomy.

The second 6 months of the rotation will be based at Manchester Royal Infirmary enabling exposure to the core skills of surgery in the adult population. As this is a significant change from the ST1 programme previously developed the exact post will be reviewed towards the middle of 2009 once the current CT1 post holder has fed back to us how he feels this has contributed to his training needs.

The CT2 programme again will undergo changes as the service moves to a single site. One 6 month posts allowing exposure to specialist paediatric surgery, laparoscopic surgery  and gastrointestinal neonatal surgery will be facilitated by attachment to the surgical team providing this service – Miss Kapur, Mr Bowen, Mr Morabito and Mr Morecroft. This post will allow exposure to multi-disciplinary team working with our regional gastroenterology service thereby learning about the importance of nutritional support across a wide range of paediatric pathologies. Exposure to the skills of upper GI endoscopy for insertion of PEGs allowing the individual to become competent at passing gastroscopes through the upper GI tract and understanding of normal and abnormal appearance of the oesophagus, stomach and duodenum. Taking part in the insertion of central venous access devices will be expected during this second year so that this key skill can be developed in a competency based fashion. Further exposure to major abdominal surgery within the abdomen along with laparoscopic skills of port insertion should be developed along side wider exposure to paediatric surgery.

The second 6 months of exposure will be within the department of paediatric urology with Mr Cerviollone as the educational supervisor for attachment. This post will allow exposure to paediatric urology at both general and highly specialist levels. Team working within the department of nephro-urology skills will be learnt further enhancing the understanding of paediatric fluid and acid base balance. The robust uro-radiology meeting will facilitate understanding of the importance of contrast and cross-sectional imaging alongside the embryology of this large area of paediatric surgical practice. Operative exposure to catheterisation, vesicostomy and orchidopexy will be available.

Education Opportunities

Attendance at the regional core training programme is mandatory. Additional education opportunities will vary according to the attachment. It is expected that the CT1/2 post holders will take an active part in both the department of paediatric surgery and department of paediatric urology.

For general surgery the individual will be expected to attend a 2 hour training forum on Monday mornings which takes the form of a radiology / pathology meeting and a critical appraisal topic presentation.  In addition a further 2 hours of formal education is provided by the paediatric Urology department on Thursday afternoons.  Attendance at these will be considered essential.

If possible / more appropriate for the individual needs of a trainee attendance at the paediatric CT1 and CT2 training programme meeting will be facilitated to ensure that individuals can understand the full range of paediatric pathology in recognition of the fact that most complex paediatric surgical patients have multiple medical problems.

There is a comprehensive core teaching programme which takes place on Wednesday afternoons at Wythenshawe Hospital, attendance is mandatory and an attendance register is kept and monitored.

The timetable for teaching can be viewed at www.surgicalcourses.com

Further educational opportunities include:-

1. urology x-ray meeting 1 hour once a week.
2. A multidisciplinary oncology meeting 1 hour once a week
3. A joint ward round with the gastroenterologists at Booth Hall 1 hour once a week.

All sites have access to a well resourced medical library and weekend access to allow personal reading and literature review.

Research / audit / teaching

Research along clinical lines will be developed according to the individual’s needs and interests – basic science research is not available at the children’s hospitals but clinical cases and review of practice will be encouraged.

Each CT trainee will be expected to complete an audit cycle at the 2 year programme and take part in part of the audit cycle in several areas.  These will be assigned by the educational supervisor.

All trainees will be expected to teach at the training meeting by taking part in critical appraisals of topics.  Topics will be assigned three months in advance so that there is adequate time for a full literature review discussion.

There is a monthly audit meeting.  Attendance at this meeting is compulsory as all other surgical activity is cancelled by the Trust.  Morbidity and Mortality are discussed at this meeting and with a topic presentation or audit reports.

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