From 1st July 1996 neurosurgical trainees started to enter the Specialist Registrar (SpR) training programme. The ultimate goal of training changed from accreditation to the award of a Certificate of Completion of Specialist Training (CCST). Previously it was the JCHST that granted accreditation, on the recommendation of the SAC, before appointment to the consultant grade. In 1996 this came under the control of the Specialist Training Authority of the medical Royal Colleges (STA) still on the recommendation of the SAC. In September 2005 the Postgraduate medical education board (PMETB) will take over this role. The GMC is responsible for maintaining and publishing a specialist register. All consultants, except those who have only been a locum, and all those accredited by the SAC are included in the register.
From January 1st 1997 it became a legal requirement for all doctors to be on the specialist register before they could take up a consultant appointment. Individuals who were recognised to be training in neurosurgery were career registrars or senior registrars who had enrolled with the SAC for training and had been allocated a number. At the point of entry into SpR all previous experience is taken into account and a CCST date notified.
The arrangements for flexible training within the specialist registrar grade are certainly beneficial. The trainee can work a percentage of full time and if he / she so wishes can automatically work at 100% full time. The CCST date can therefore be annually modified according to the total time for the year.
All the training & accreditation requirements are held at the JCHST website
The SpR Training
All training programmes in neurosurgery are for 6 years. Programmes have been devised by local trainers and agreed by the SAC. Many include rotational commitments such as Edinburgh - Dundee - Bristol - Plymouth. It is possible for trainees to move between regions and deaneries where they have well-founded reasons at the discretion of the dean. Trainees should discuss the details of the training programme with the local trainer and confirm their agreed CCST date.
Assessment of progress is a key feature of the training programmes and a Record of In-Training Assessment (RITA) will have to be kept by the trainee which will contain details of assessments carried out. A similar training record folder will also be kept by the postgraduate dean. Failure to maintain the RITA or failure to inform the postgraduate dean of changes in training may mean that the SpR might lose their NTN. Assessments will be carried out annually by the Dean or his representative and the SAC will interview trainees during their training. The trainee should make sure that any period of research or optional experience has prospective educational approval.
The intercollegiate specialty exam may be taken in two parts from the first year and from the fourth year. Alternatively it can all be taken together from the 4th year onwards but failure of the exam does not prevent the trainee from entering the subsequent years, preparation for the examination should be part of the SpR training programme.
Failure to progress satisfactorily
The process for dealing with trainees not progressing well in their training programmes is in place mainly for the benefit of the trainees. If the training programme coordinator identifies problems with training then the following stages of further review must be followed.
Stage I will be a period of targeted training to provide specific training needs, the trainee will be provided with a written statement of the programme they have to undertake and the criteria by which it will be judged they have achieved the required standard.
Stage 2 is a period of intensified supervision with the repetition of a part of the training programme and the lengthening of overall training.
Stage3 is withdrawal from the training programme and would only follow formal action as described in stages 1 and 2. Trainees have the right to appeal against any actions that mean lengthening of training or withdrawal from the training programme.
Study Leave
SpRs should receive day release for 1 day a week during university terms or leave with pay and expenses to maximum of 30 days per year. These 30 days can accumulate over the whole programme but the full amount cannot be taken until after one year. In other words 6 months leave in a block can be taken with pay and expenses at some point in the programme.
After CCST
Employment will not end for a period of six months after the date of completion of training, or after the date that the trainee is formally notified by the postgraduate dean that training is complete and he/she is eligible for CCST, whichever date is the later. A further contract can be awarded, at the Dean's discretion, if the trainee is making reasonable steps to find a consultant post, will be for a limited period and cannot be renewed or extended. After that the postgraduate dean offers counselling to those who are not placed in consultant posts! The position with regard to sub-speciality appointments is unclear.
FTTA's, LATs, LASs
CCST training is open to all EEC nationals with EEC qualifications who satisfy the minimum criteria to enter the specialist grade. All overseas doctors with a right of residence in the UK can also enter CCST training and be given an NTN. Overseas doctors without right of residence can hold a Visiting SpR and require a Visiting Training Number (VTN).
A Locum Appointment Service (LAS) is designed to fill an SpR vacancy for a short period of time where there is little educational benefit in the post and limited to a maximum of 3 months. When the vacancy is for a longer period prospective approval for a Locum Appointment Training (LAT) can be given by the SAC. The LAT contract is the same as for an SpR but the holder is not issued with an NTN or VTN. To count the LAT in later CCST training prospective approval for this purpose is required from the SAC. LATs should not last for more than one year. A Fixed-term Training Appointment (FTTA) can also be offered to overseas doctors with no right of residence, the candidate would not be wishing to enter CCST training but wish to under-take some of the elements of a training programme. FTTAs require a VTN and are not available to EEC nationals.