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Harvey et al.
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placement matching, while enabling quality assurance
for training placements for trainees of a given level.
Although not discussed further here, for completeness,
it is noted that phase 1 of surgical training corresponds
with core surgical training/improving surgical training
years 1 and 2.
Phase 2
Phase 2 of urological training is the ST3-5 years, and
focus on the acquisition of the knowledge, clinical and
communication skills expected of a day 1 consultant. This
includes the safe emergency management of the unselected
take. It is expected that procedural skills will have
started to be developed, but independence is only expected
in urodynamics by the end of phase 2. The critical progression
point (colloquially the 'ST5 checkpoint') is the summative
assessment by an Annual Review of Competence
Progression (ARCP) panel of whether a trainee has demonstrated
the knowledge, skills and attitudes necessary to
start the transition from supervised to more independent
practice, and to sit the Fellowship of the Royal Colleges of
Surgeons (FRCS) Urol examination. This incorporates the
evidence of generic
professional
capabilities (GPCs),
capabilities in practice (CiPs), index procedures (IPs) and
WBAs of critical conditions as discussed below.
Phase 3
Phase 3 of urological training is the ST6-7 years during
which they must complete the FRCS Urol examination.
There is a focus on building on phase 2 training to develop
the technical skills of a day 1 consultant while also undertaking
one of the five special interest modules:
* Advanced general urology
* Andrology and infertility
* Endourology
* Female functional and reconstructive urology
* Oncology.
The assessment processes in phase 3 are identical to those
of phase 2 but are assessed at a higher level.
Assessment in the 2021 curriculum
Assessment timeline
Figure 1 demonstrates an example placement year in the
2021 urology curriculum.
While the tools used to assess them are changing,
trainees can be reassured that the syllabus is unchanged,
and therefore the content of the FRCS Urol examination
will not change. The various assessments and how these
feed into each other in the 2021 urology curriculum are
summarised in Figure 2.
Multiple consultant report
Arguably, the single largest change to the curriculum is the
implementation of the multiple consultant report (MCR),
which assesses a trainee's progress biannually (in the yearlong
placement system of higher urological training). The
MCR places an emphasis on incorporating multiple clinical
supervisors' (CSs) first-hand experiences of the trainee to
deliver a holistic, collective appraisal, while carefully worded
feedback statements provide a secure format for trainers to
raise concerns and highlight areas for development collectively
with specific phraseology. This reduces the risk that
the comments of CSs who have actually had limited exposure
to the trainee are treated with equal weight to those who
work closely with them, while protecting trainers/departments
who are trying constructively to criticise trainees for
development (or fitness to progress) purposes from accusations
of bullying. MCRs should be started during the fifth
and eleventh months of a trainee's placement, as they are
completed in stages over 3 weeks, and feed into the subsequent
midpoint and final review meetings. To reduce the
time burden for CSs, it is expected MCRs will be initiated at
a time when multiple consultants are already present in the
same room (or virtual equivalent) such as departmental, morbidity
and mortality, or multidisciplinary team meetings.
Initially, the trainee completes a self-assessment with a
format identical to the MCR. Then the trainee's lead CS
(who is distinct from their assigned educational supervisor
(AES)) opens the MCR and, after discussion, transcribes collective
judgements of the trainee's GPCs and CiPs (discussed
in depth below). There are then 2 weeks for any CS (including
those absent from the initial meeting) to record free text
comments (but not to alter the collective judgement of the
level of practice), before the AES adds their own comments,
rendering the MCR visible on the trainee's portfolio.
The generic professional capabilities framework
As the name implies, the GPCs framework assesses
descriptors generic to all doctors, not just surgeons. Across
nine domains (Table 1), over 200 descriptors common to
all doctors, regardless of speciality, are set out. These
descriptors are the professional skills and attitudes identified
by the GMC as areas where most fitness to practice
problems arise. Up to five areas for development can be
identified for each of the nine GPCs via selection of specific
descriptors, with free text supporting statements. The
number of areas for development is limited to five, to
focus attention on the areas in which development is
achievable over the following 6 months. Descriptors can
be searched for by keyword for speed.
Capabilities in practice
CiPs are five surgery (but not urology) specific areas of
day-to-day practice (Table 2). They are assessed in terms

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