This is being circulated to all Trainees, Head of Schools, Training Programme Directors, College Tutors and all Trainers
Dear Colleague
Previously, in 2012, the Chair of the Training Committee wrote to
clarify the definitions for the four descriptors for surgery. I am now
writing to clarify how trainees should record any surgical
complications, in particular for cataract surgery.
Increasingly, the Curriculum Sub-committee has been made aware that
trainees do not record their complicated cataract operations in a
consistent way as they are not clear about how to do this. It is vital
for their Educational Supervisor to be able to identify complications
and for the trainee, potentially, to demonstrate a reduction in their
complication rate to an acceptable level over their training. They must
also be able to document their ability to manage the complications of
cataract surgery, in particular capsule rupture and vitreous loss, prior
to obtaining CCT and becoming an independent practitioner. The four
descriptors are:
Assisted at
or performed part of the operation only (the surgery comments box
should be used to record which part(s) of the operation the trainee has
performed).
PS performed under supervision
Trainee has completed the entire operation under direct supervision
i.e. the supervisor has been present in the operating theatre, scrubbed
or un-scrubbed.
P performed
Trainee has
performed the entire operation under indirect supervision. Indirect
supervision means that the supervisor has not been in the operating
theatre. They may be outside the doors, in the coffee room, in their
office etc. but not in the operating theatre. For trainees who do not
hold a CCT there should be a supervisor present on the hospital site who
can be contacted and go to the operating theatre if a problem arises
that is outside the trainees' competence to deal with.
SJ supervised (a) junior
Trainee has supervised a more junior trainee.
All trainees should record complications in this way:
PS + 'Takeover'
When a trainee who has a complication during cataract surgery that
requires the supervisor to take over should still record this as PS in
the logbook. Additionally the box for 'takeover' must be marked. This
identifies that the trainee is not able to manage their own
complications at this stage of training.
Note: The trainee
must not change the PS to A as it would then appear that the trainee had
assisted at a complicated operation and the fact that it was the
trainee's complication would be hidden from the Educational Supervisor
on review of the logbook.
A + 'Takeover'
When the trainee has a complication whilst performing only particular
steps of the cataract surgery and was never intended to complete the
whole procedure, but a complication supervened and takeover is earlier
than planned. Additionally the 'takeover' box must be marked and in the
notes/comments in the logbook the details of when the complication
occurred and what steps were performed by whom should be detailed.
SJ
When the senior trainee who is supervising a junior trainee and has to
take over from them to manage a complication the junior's complication
should record it as SJ and then record the surgery they performed e.g.
anterior vitrectomy etc. in the logbook.
It is important for
Educational Supervisors to pay attention to the logbook, noting capsule
rupture rate and takeover rate; to review the continuous cataract
complications audit each trainee should keep throughout training; and
look at the results of the 50 continuous cataracts audit, if present in
the e-Portfolio and comment on these in their report for the ARCP panel.
Kind Regards
Miss Fiona Spencer
Chair Training Committee