Barclay, J

Beamish, AJ

Bhatia, S

Blencowe, N

Bolton, W

Brennan, C

Burke, J

Chapman, SJ

Clements, M

Elsey, E

Fish, R

Glasbey, J

Gokani, VJ

Humm, G

Hurst, K

Hutchinson, P

Jones, C

Kasivisvanathan, V

Keates, N

Lawday, S

Lee, MJ

Lovegrove, C

Mann, H

Mason, J

McDermott, F

McLean, K

Mohan, H

Nally, D

Pucher, P

Sorial, AK

Staight, S

Trout, I

English

UCL Discovery

Nominal group consensus process to determineAssociation of Surgeons in Training quality indicatorsfor integrated clinical academic surgical training acrossthe UKAssociation of Surgeons in Training (ASiT)*Correspondence to: James Glasbey, ASiT/SRS Academic Representative 2019–2022, Association of Surgeons in Training, Royal College of Surgeons of England,Holborn, London WC2A 3PE, UK (e-mail: j.glasbey@bham.ac.uk)Members of the Association of Surgeons in Training are co-authors of this study and are listed under the heading Collaborators.Dear EditorIn the UK, a unique integrated clinical academic training pathwayexists to support co-development of clinical skills with skills inresearch, teaching, and leadership for trainees with an academicinterest1,2. In surgery, as a craft specialty, the balance ofacquisition and maintenance of technical skills combined withacademic development poses a challenge to surgical traineesand programme directors. As a result of this, clinical academictrainees in surgery have reported that their dedicated academictime is commonly lost to clinical service commitments, and alack of transparency around both clinical and academicexpectations3. The aim of this study was to agree consensusquality indicators for integrated clinical academic training posts(AQIs) to allow benchmarking and improvement of academicsurgical training in the UK. Details of background, researchmethods, and supplementary figures and tables are in thesupplementary material.This development process followed a modified nominal groupconsensus methodology across five sequential stages: in-personscoping exercise; virtual stakeholder consultation; nominalgroup consensus meeting; virtual stakeholder feedback; anddissemination and implementation (supplementary material). Designand reporting followed best practice methodology for consensusresearch4,5. Contributors were invited from the Association ofSurgeons in Training (ASiT) mailing list, social media, and throughthe UK Clinical Academic Training Forum. The expertise matrixwas designed to sample trainees of different sexes (male/female),training grades (postgraduate year 1–2/year 3–5/year 5 and above),and types (current integrated academic trainees/past integratedacademic trainees/trainees with an academic interest). All AQIswere required to be examples of existing real-world practice in oneormore UK region (deemed to be feasible not aspirational).After stage 1 and 2, 16 candidate AQIs were drafted forinclusion in the nominal group meeting (supplementary material).Thirteen nominal group members were present for theface-to-face stage 3 discussion, with a diverse range ofexperiences. Four new AQIs were identified during silentgeneration, and all 20 AQIs were discussed in the sharing ideasstage (supplementary material). Wording was further refined for 7indicators in stage 5, before final agreement of 20 AQIs acrossseven domains (Table 1): supervision and mentorship (assignedsupervisor, clear objectives, academic programme director,and administrator), protected academic time (protected fromclinical work, not used to fill rota gaps, trust responsibilities,flexibility to arrange time), clinical work (prioritized training,back to training interview, flexible on-call commitment), auditnd accountability (annual review with the quality indicators),financial assistance and resourcing (clinical and academicstudy budgets, local working space), training progression(clinical training plans, dedicated academic Annual Reviewof Competency Progression, flexible completion dates), andrecruitment (involving the clinical programme director). TheAQI indicators were designed to be delivered with existingresources (not to detract from resources available fornon-integrated trainees). Key external stakeholder groupswere identified and illustrative examples implementation ofthe AQIs were provided (supplementary material).Finally, the group designed an annual audit to provide feedbackto key external stakeholders. The audit will capture experience ofintegrated clinical academic trainees in surgery over a singletraining year. This seeks to have two main benefits. First, it willempower local integrated trainees with a set of agreed qualitystandards to discuss with their local training directors andhospital administrators (a ‘bottom up’ approach). Second, byleveraging real-world data, we hope to work with key externalstakeholders to promote high-quality, inclusive, and enjoyableintegrated academic clinical training (a ‘top down’ approach).The annual audit will launch in April 2022 and is available at:https://bit.ly/ASiTAQI.Received: November 11, 2021. Revised: March 4, 2022. Accepted: March 11, 2022© The Author(s) 2022. Published by Oxford University Press on behalf of BJS Society Ltd.This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), whichpermits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.BJS Open, 2022, zrac048https://doi.org/10.1093/bjsopen/zrac048Research LetterDownloaded from https://academic.oup.com/bjsopen/article/6/2/zrac048/6570929 by University College London user on 04 May 2022CollaboratorsAssociation of Surgeons in TrainingJ. Glasbey, N. Blencowe, J. Barclay, A. J. Beamish, S. Bhatia,W. Bolton, C. Brennan, S. J. Chapman, J, M. Clements, E. Elsey,R. Fish, V. J. Gokani, G. Humm, K. Hurst, P. Hutchinson, C. Jones,V. Kasivisvanathan, N. Keates, S. Lawday, M. J. Lee, C. Lovegrove,H. Mann, J. Mason, F. McDermott, K. McLean, H. Mohan, D. Nally,P. Pucher, S. Staight, A. K. Sorial, I. Trout and J. BurkeAcknowledgementsThis consensus process was led and funded by the UK ASiT.The UK National Research Collaborative Meeting providedsupport in kind for the face-to-face nominal group consensusmeeting.Supplementary materialSupplementary material is available at BJS Open online.References1. Tunbridge M. Monitoring the clinician scientist scheme. Clin Med2004;4:141–1432. Clough S, Fenton J, Harris-Joseph H, Rayton L, Magee C, Jones Det al. What impact has the NIHR Academic Clinical Fellowship(ACF) scheme had on clinical academic careers in England overthe last 10 years? A retrospective study. BMJ Open 2017;7:e0157223. Blencowe NS, Glasbey JC, McElnay PJ, Bhangu A, Gokani VJ,Harries RL. Integrated surgical academic training in the UK: across-sectional survey. Postgrad Med J 2017;93:581–5864. Waggoner J, Carline JD, Durning SJ. Is there a consensus onconsensus methodology? Descriptions and recommendationsfor future consensus research. Acad Med 2016;91:663–6685. Schlessinger DI, Iyengar S, Yanes AF, Chiren SG, Godinez-Puig V,ChenBR et al.Development of a core outcome set for clinical trialsin squamous cell carcinoma: study protocol for a systematicreview of the literature and identification of a core outcome setusing a Delphi survey. Trials 2017;18:321Table 1 Final ASiT integrated clinical academic surgical training quality indicatorsSupervision and mentorshipAQI1 Academic trainees in surgery should have an assigned academic supervisor. Where possible this shouldmatch their specialty interest andtrainees should be supported to change academic supervisors if their research interests do not matchAQI2 Academic supervisors should set clear objectives at the start of each training year in partnership with the academic trainees and theseshould be reviewed on at least a quarterly basisAQI3 Academic trainees should have a dedicated academic training programme director whose responsibility it is to safeguard interests of theacademic trainee and liaise with local trust clinicians/managers where requiredAQI4 Academic trainees should have a named regional academic administrator who can provide information on academic training/educationalopportunities and can liaise with local trustsProtected academic timeAQI5 The contracted academic time of academic trainees should be protected from non-academic activities. This should be communicated tothe departmental NHS managers, rota coordinator, and local clinical supervisors by the training programme director at least 3 monthsbefore starting the placement, and any unmet service need covered by the trustAQI6 Academic trainees should not be required to fill ‘rota gaps’where these arise during their dedicated academic time, to allow for progressionin line with a competency-based curriculumAQI7 If academic trainees’ clinical duties are left uncovered because of protected academic time, the trust should be responsible for providingcoverAQI8 Academic trainees should be given flexibility to arrange their academic time in days/weeks/months, according towhat frequency best suitstheir academic workClinical workAQI9 Academic trainees should have key local training opportunities prioritized, which may be at the expense of some service deliveryAQI10 Academic trainees that are on an on-call rota should be offered flexibility to reduce their on-call commitment to reflect their reducedoverall clinical time (pro rata, akin to ‘Less-Than-Full-Time’ training)AQI11 Following an extended interval of academic time, academic trainees should be able to request a ‘back to training’ interview and, wheredesired, keep-in-touch days, or phased return to clinical dutiesAudit and accountabilityAQI12 Annual review of academic trainees’ experiences within training units should be undertaken by programme directors. This could besupported, for example, by the ASiT integrated clinical academic surgical training quality indicatorsAQI13 Quality indicators for academic training posts should be clearly communicated to all hospital administrative and co-ordinating staffthrough which academic trainees rotateFinancial assistance and resourcingAQI14 Academic trainees in surgery should have access to the same clinical study budget for additional clinical training courses as non-academictraineesAQI15 The process for academic trainees to access additional training and study budget available from the National Institute for Health Researchshould be transparent, and made available by the academic training programme director at the start of the integrated training postAQI16 Academic trainees should have a local working space (such as a shared office), and institutional library access made available for them tocomplete academic work during clinical postingsTraining progressionAQI17 Academic trainees should have individualized clinical training plans discussed at ARCP, to provide flexibility, and understanding inplacements given the need to balance academic and clinical commitmentsAQI18 Academic trainees should have a dedicated academic ARCP (either as part of a clinical ARCP, or separately) where the panel specificallyreview their academic objectives and outcomesAQI19 Academic trainees should have theflexibility to extend their CCTdateswhere required, reflecting their reduced clinical commitments. Thisdecision should be made with the trainee, based on competency-based progressionRecruitmentAQI20 Clinical training programme directors should be part of the selection panels for integrated academic clinical training posts, where possibleASiT, Association of Surgeons in Training; ARCP, Annual Review of Competency Progression; CCT, Certificate of completion of training.2 | BJS Open, 2022, Vol. 6, No. 2Downloaded from https://academic.oup.com/bjsopen/article/6/2/zrac048/6570929 by University College London user on 04 May 2022

Nominal group consensus process to determine Association of Surgeons in Training quality indicators for integrated clinical academic surgical training across the UK

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Nominal group consensus process to determine Association of Surgeons in Training quality indicators for integrated clinical academic surgical training across the UK

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