Intended for healthcare professionals

Careers

Finding your way around the Intercollegiate Surgical Curriculum Programme website

BMJ 2011; 342 doi: https://doi.org/10.1136/bmj.d3437 (Published 23 June 2011) Cite this as: BMJ 2011;342:d3437
  1. Anna H K Riemen, specialty registrar year 1 in trauma and orthopaedic surgery1,
  2. David F Finlayson, consultant orthopaedic surgeon1
  1. 1Department of Orthopaedics, Raigmore Hospital, Inverness, UK
  1. ariemen{at}nhs.net

Abstract

Anna Riemen and David Finlayson explain how to get the most out of the website of the Intercollegiate Surgical Curriculum Programme

So, you are now training in surgery and have been introduced to the Intercollegiate Surgical Curriculum Programme (ISCP) website.

Love it or hate it, ISCP is now mandatory for all surgical trainees. Used across the nine surgical specialties, ISCP provides web based assessment tools and a portfolio. It sounds great, but trainees have not been uniformly enthusiastic about adopting it and many trainers even less so. With the annual review of competency progression (ARCP) now, in theory, paper (and electronic) based, the need to be slick with portfolio documentation has never been greater, because inadequate documentation is an automatic ARCP outcome 5, requiring re-interview.

Here are our tips and tricks. Trainees and trainers find it difficult and time consuming to find the correct forms.1 Investing energy to understand the curriculum when starting your training programme and familiarising yourself with the website allows you to hit the ground running as there is no formal training in how to get the best out of a website that has not been intuitive even for the computer game generation.

Approaching the website

Log in at www.iscp.ac.uk. The Home screen’s main navigation bar provides access to the different areas of the website.

Home—This gives generic information about the website and training syllabus, with links to each specialty’s curriculum. Be familiar with your specialty syllabus before the first meeting with your assigned educational supervisor.

Figure1

Fig 1 Home: Generic information about website and training syllabus plus links to each specialty’s curriculum

Dashboard—For trainees and trainers this is the lead in to the personal portfolio. From here, you can update personal details, training history (that is, rotations and supervisors), and password and pay the mandatory annual ISCP trainee fee, which is currently £125.

Figure2

Fig 2 Dashboard: Leads into the personal portfolio. From here, update personal details, training history, and password; upload latest CV; and pay the ISCP fee

Learning plans—Used for supervisor meetings at the start (objective setting), middle (interim review), and end of placement (final meeting). Your learning agreement is set up on the basis of the global objectives set by your programme director, the curriculum, your learning needs, and your supervisor’s expertise. Add topics to work on during the placement, which for the initial years are congruent with the membership of the Royal College of Surgeons (MRCS) syllabus and specialty syllabuses. The second part of the learning agreement is free text, allowing trainee and trainer to plan and document how the learning objectives will be achieved. A third part allows comments by trainee and trainer. Document your personal development plan and monitor progress using the Topics and Progress link.

Figure3

Fig 3 Learning plans: These are used for your three supervisor meetings. On the basis of global objectives set by your programme director, the curriculum, your learning needs, and your supervisor’s expertise, you set up your learning agreement

Workplace based assessments—It is best to do workplace based assessments (WBAs) continuously throughout the attachment and to complete procedure based assessments (PBAs) and direct observation of procedural skills in surgery (DOPS) as soon as possible after a case—for example, between cases with a supervisor present to avoid completion in batches and being held hostage by the restriction in opportunities resulting from the European Working Time Directive. It is important that trainee and trainer enter comments where applicable, especially for those points where the rating indicates a development need. Giving timely feedback increases a trainee’s motivation and satisfaction and helps develop proficiency.

Figure4

Fig 4 Workplace based assessments: Complete these day to day assessments from the start. You can show your progress when competencies improve. Complete procedure based assessments and direct observation of procedural skills as soon as possible after a case

For DOPS the top marking is “satisfactory standard for CST,” which means satisfactory for the standard expected at completion of core surgical training (CST), giving meaningful and timely feedback to the early years trainee.234 PBAs are marked against the standard at certificate of completion of training.

PBAs and DOPS are divided into sections under specialty headings. Trainee and trainer should realise that because of specialty overlap a particular procedure may be found in the section of another specialty. For example, paediatric surgery has a large number of PBAs relevant to general surgery and urology as well as core skills such as abscess drainage and chest drain insertion. Forms aligned to another specialty may be completed and mapped to your own specialty. Trainees should search PBAs and DOPS of other specialties and take a note of those relevant to their own specialty. But, if all else fails, ISCP has now added a generic DOPS to the website. It has not been validated and may act only as a template for discussion. Try to use the existing DOPS if you can.

Case based discussion (CBD) and clinical evaluation exercise (CEX) assessments are entered here. CBD entails structured, in-depth discussion about a case managed by the trainee, using the patient records for the dialogue, and it considers reasons for particular actions, thereby evaluating the clinical reasoning and documentation. Try to bring the patient’s notes, and you might want to read around the topic.

CEXs were developed and validated in the United States for the assessment of residents under strict exam conditions. Trainees are directly observed by the examining supervisor during a clinical encounter for 15 to 20 minutes, and this is followed by feedback. Assessments can focus on particular skills, history, examination, diagnosis, or clinical management.256 New patient clinics are particularly useful for the completion of CEXs. Trainees may want to make use of these for their MRCS part B preparation.

In the WBAs section trainees can request raters to complete mini-peer assessment tools (mini-PATs), a form of peer assessment developed and used in industry and business.237 Either you pick raters from a list, one of whom must be your assigned educational supervisor, or, if the assessor has not yet registered with the website, you pre-register them. The mini-PAT collects data from 8-12 colleagues, including other trainees, nurses, and other healthcare professionals, and these data are then compared with the trainee’s self rating. Try to get feedback from senior and junior trainees. Comments can be seen on the final rating and sign-off summary that the assigned educational supervisor needs to complete. Whomever you pick, start early and ask more than the minimum number of people.

In the Evidence sections trainees can enter exams passed, courses and seminars they attended, teaching they are involved in, and research projects and audits they have completed. Many trainees will have completed courses relevant to their specialty as foundation doctors, such as basic surgical skills and advanced trauma life support, and these can be included here too. Include placements such as the extra week you spend shadowing in the intensive treatment unit. The evidence summary gives an overview of evidence from a current placement in comparison with the whole training.

Figure5

Fig 5 In the Evidence section enter exams passed, courses or seminars attended, involvement in teaching, and research projects and audits completed

It is important that WBAs and evidence are assigned to topics while they are being completed to show progress in completion of topics assigned in the learning agreements.

In the Logbook section either add operations directly to the ISCP logbook or you can allow the website to access your pan-surgical FHI (Faculty of Health Informatics) e-logbook and automatically import procedures that have been added to the e-logbook into the ISCP summary sheet. Many trainees prefer to use the e-logbook to record their procedures. Setting the correct date range on the top of the page allows ISCP to create a summary sheet for the current attachment. However, it will not show any of the observed procedures.

Figure6

Fig 6 In the Logbook section either add operations directly to the ISCP logbook or allow the website to import procedures from the pan-surgical FHI e-logbook automatically

The Portfolio section allows an overview of all your documents and entries from all the sections.

The Help section contains step by step guides on creating a PBA, CEX, CBD, learning agreement, and so on.

Figure7

Fig 7 The Help section contains documents that explain step by step how to create a PBA, CEX, case based discussion, learning agreement, and so on

If trainees take charge they can use their understanding of how the ISCP website works to influence their surgical education, improve training delivery, and direct their own progress.

The ISCP website, while greatly improved in recent versions, has not had an enthusiastic following. Although information technology specialists and internet savvy surgeons may use it with ease, many trainees have failed to complete their paperwork because of frustration at the website.1 This review shows the wealth of useful material available and, more importantly, gives guidelines for the less computer literate to access the required forms with as little effort as possible.

Box 1: This is easy, but how do you get your trainer to cooperate?

  • At the start of your placement clarify your expectations with your trainer.

  • Ensure that you know what the trainer has to complete on the ISCP and how. If in doubt, you should be able to talk them through each step of setting up a learning agreement or completing your final sign-off.

  • Take the relevant section of your syllabus with you to the meeting.

  • Always express an interest. If you don’t understand, ask.

  • Specifically ask to do a specific procedure. “Mr Bone, please may I do the DHS on Mrs Hip today?”

  • Study rotas and other consultants’ operating lists. They too can do assessments, and their registrar might be away. You might discover someone who is an excellent teacher.

  • Be honest in your feedback forms on the programme and your attachment. If there is a problem, the deanery needs to know to fix it.

  • Be ready: read up before you go to theatre.

  • If there is a big problem speak to someone early (your or another consultant, mentor, programme director, dean, and so on).

  • If there is an exceptionally good teacher, mention it on feedback or nominate him or her for an award (such as Silver Scalpel, trainer of the year award).

Box 2: PBAs from other specialties relevant to orthopaedics

General surgery
  • Vascular below knee amputation

  • Vascular above knee amputation

Neurosurgery
  • Carpal tunnel decompression

  • Ulnar nerve decompression

Paediatric surgery
  • Abscess drainage

  • Insertion of chest drain

Plastic surgery
  • Closed reduction of hand fracture and K-wire fixation

  • Carpal tunnel decompression

  • Debridement of complex wound

  • Flexor tendon repair

  • Open reduction, internal fixation metacarpal fracture

  • Open reduction, internal fixation phalangeal fracture

Box 3: DOPS from other specialties relevant to orthopaedics

General surgery
  • Ability to administer local anaesthetic safely

  • Abscess drainage

  • Central venous line insertion

  • Radial artery cannulation

Neurosurgery
  • Carpal tunnel decompression

  • Laminectomy

  • Lumbar puncture

  • Muscle biopsy

  • Lumbar fenestration

Paediatric surgery
  • Peripherally inserted central catheter line insertion

  • Insertion of urethral catheter

  • Ingrowing toenail avulsion; wedge resection; phenolisation

Plastic surgery
  • Bone graft harvest

  • Digital terminalisation

  • Drainage of infected collection in hand

  • Excision of ganglion

  • Flexor sheath washout

  • Harvesting full thickness skin graft

  • Nail bed repair

  • Repair digital nerve

  • Trigger digit release

  • Wound debridement

  • Use of Z-plasty

Box 4: Orthopaedic WBAs relevant to other specialties

PBAs
  • Carpal tunnel decompression (plastics, neurosurgery)

DOPS
  • Removal of K-wires (plastics)

  • Surgical approach to lumbar spine (neurosurgery)

  • Surgical debridement of traumatic wound (all)

Footnotes

  • Competing interests: None declared.

References