Intercollegiate Surgical Education Committee for SAS, LED and Non-Consultant Hospital Doctors

The Personal Development Plan (PDP) can act as a preliminary reflective step towards a more formal Learning Agreement that defines and prioritises short and long-term goals such as training, clinical governance, and research. Once these are established, development needs that support these goals can be considered and set out in job plans. The agreed job plan can then be duplicated into the Rota tool that represents a sessional 7-day week, showing the schedule of activity between theatre, ward, clinic, on call, research, educational programmes, and skills learning.

The Learning Agreement, designed as an appraisal tool, opens the portfolio to specified appraisers. It ensures that learners have three dedicated feedback meetings (objective setting, a midpoint review, and a final review) culminating in an end of period appraiser report. Objectives may include training courses, shadowing of consultants, secondments, or opportunities to act up into more senior roles. The structure of the Learning Agreement provides the key information for any annual review. It would be particularly useful for SAS surgeons if this process was facilitated in the early years of their professional life.

The ISCP houses the curricula for core surgical training, the ten surgical specialties and twelve dental surgical specialties, embodying the generic professional and clinical capabilities required of all surgeons. The syllabuses detail the knowledge, clinical and technical skills in each phase of training/learning. The principal method for formative assessment of clinical and technical skills in surgery are workplace-based assessments (WBAs) which include the Case Based Discussion (CBD), Clinical Evaluation Exercise (CEX), Direct Observation of Procedural Skills (DOPS) and Procedure Based Assessment (PBA).

The CBD helps to demonstrate clinical judgement, decision-making and the application of medical knowledge in relation to the management of a challenging patient case. It tests the higher order thinking behind choices made and synthesis of the complexities involved. It also allows the demonstration of the quality of record keeping and the presentation of cases. The CEX allows the demonstration of good clinical care, communication, history taking, examination and clinical reasoning in any doctor-patient interaction.

The DOPS and PBA help to demonstrate technical, operative, and professional skills. The DOPS is for basic diagnostic and interventional procedures in wards, out-patient clinics, and operating theatres. The PBA is for advanced specialty procedures while scrubbed in theatre. The surgical logbook is equally important, providing a record of all operative procedures undertaken with the level of supervision required on each occasion (ranging from observation to performed in full and training juniors). It shows the breadth of experience which can be compared with the procedural competence of the DOPS and PBA and the indicative numbers of index procedures defined in the specialty.

There are several places in the ISCP portfolio that enable learners to demonstrate appropriate leadership and team working behaviour. As a peer review tool, the Multisource Feedback (MSF) provides developmental feedback from people from different grades with whom one works. It assesses the ability to manage time under pressure, make decisions, take initiative, teach, and communicate with colleagues.

Evidence of teaching activity can be uploaded with presentations and can be assessed using the Observation of Teaching assessment. Learners can also use WBAs to act as assessors for colleagues, providing evidence of education and training provision. Evidence of audit or quality improvement projects, presentations and publications can be uploaded and can be assessed using the Assessment of Audit.

These areas can provide evidence of health promotion and individual patient feedback can be uploaded to show collaboration with patients. Positions of responsibility, examinations, courses, awards and prizes and involvement in meetings and conferences can also be captured.

Insight gained from reflection on professional practice is an important feature that has relevance for the demonstration of professional values and behaviours, team working and leadership, patient safety, quality improvement and education and training. Reflection can be demonstrated in most of the ISCP tools. All the WBAs include a reflective element asking, what did I learn? what did I do well? what do I need to improve or change? and how will I achieve that? The MSF includes a self-assessment that maps to the standards of Good Medical Practice. Journal entries can be used as a diary of reflections on practice such as interactions with patients and the effectiveness of educational activities.

The ability to keep up to date with current research in a specific area of practice can be captured in various sections of the portfolio including, course notes, published papers, project reports, research study theses, presentations of research, audits and quality improvement exercises and reflective notes from attendance at national and international conferences.