DOi: 10.

1308/147363513X13588739440690

Trainees FOrUM

The Association of Surgeons in Training (ASiT) is a sizeable organisation with the aim of ensuring pan-specialty representation of surgical trainees. in this months article JRL Wild and colleagues outline the benefits of being a member of ASiT and discuss the organisations role in addressing some of the important issues that have arisen with the evolution of surgical training in the UK. Bijan Modarai Series Editor

we welcome original articles for the Trainees Forum on any subject of interest to surgical trainees (maximum 1,500 words).we will also consider letters commenting on articles published in the Trainees Forum. please email submissions to bulletin@rcseng.ac.uk.

Ann R Coll Surg Engl (Suppl) 2013; 95: 107109

asiT: the pursuit of excellence in training

Jrl wild Vice-president of ASiT aJ Beamish Vice-president of ASiT JeF Fitzgerald past president of ASiT p sinclair Director of Education of ASiT sT hornby president of ASiT On behalf of the Association of Surgeons in Training The Association of Surgeons in Training (ASiT) has grown in size and influence in recent years. Despite this many trainees are still unaware of the extent of membership benefits that ASiT can offer. in this article we discuss ASiTs recent work and success in promoting the highest standards in surgical training and outline the strengths and benefits that a panspecialty trainee organisation has to offer. Background of asiT ASiT is a professional body and educational charity dedicated to the pursuit of excellence in surgical training for the benefit of trainees and patients. ASiT was established in 1976 by a group of senior registrars in order to meet socially and discuss issues in surgical training.The last four decades have seen the association expand, especially in the last five years, with ASiT now boasting a membership of 2,200 surgical trainees across all 10 surgical specialties, making ASiT the second-largest UK surgical specialty association.The ASiT council can also count numerous professional leaders and royal college presidents among its alumni. who makes up the asiT council? Figure 1 outlines the structure of the ASiT council.As an umbrella organisation, ASiT is built upon the objective of achieving complete representation across all surgical specialties and all regions of the UK and ireland.The ASiT council comprises elected representatives from surgical trainee specialty organisations and 24 regions. An executive committee of ten individuals is elected from council and include the roles of president, two Vice-presidents, past-president, Honorary Secretary, Director of Education,Treasurer, Webmaster, Publicity Officer and Yearbook Editor, all of which are voluntary. an independent voice representing surgeons in training ASiT representatives attend almost 40 committees which influence surgical training, varying from the Joint Committee on Surgical Training (JCST), RCS Council and the RCSEd Faculty of Surgical Trainers to a range of education and specialty association committees and public interest groups such as the RCS patient Liaison Group (pLG). The independent nature of ASiTs representation ensures the voices of trainees are not only heard, but carry influence on decisions affecting the future of surgical training. Despite the recent radical overhaul of surgical training in the UK, including the introduction of formal training curricula, competency-based assessment and the new core surgical training and run-through programmes, numerous threats remain to sustaining

Figure 1 The structure of ASiT council ensures pan-specialty representation of all training grades.

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high-quality surgical training and education in the modern working environment, especially service delivery pressures and the reduction of working hours.ASiTs contribution to the current debate is summarised in a 34-action-point plan, Improving the future of surgical training and education: recommendations from the Association of Surgeons in Training,1 which highlights areas for improvement at national, regional, local and individual levels. contemporary issues in surgical training The Health and Social Care Act 2012 will come into force this year with potentially far-reaching alterations to the surgical training landscape. increasingly, there will be more training opportunities available in the independent sector as private providers have a greater role in delivering healthcare for the NHS.As employers and members of the local education and training boards (LETBs), private providers funded by the NHS will be expected to contribute to the education and training of surgeons.As numerous aspects of surgical patient care shift towards independent sector centres, in particular day-case and low-risk procedures, appropriate access to the training opportunities that accompany each patient will be essential for trainees to achieve their logbook requirements. in a recent interview in BMJ Careers2 our president outlined some of the training opportunities in the independent sector but also warned about potential indemnity pitfalls.whether independent sector providers will fully commit to their training obligations and how trainees will be relieved from NHS service requirements in order to access such training opportunities also remains to be seen. The financial cost of surgical training continues to rise each year, as does the proportion of these costs that is met from the trainees pocket. in light of recent changes to the funding and delivery of training,ASiT has investigated the costs of surgical training borne by trainees themselves, demonstrating that contemporary surgical trainees are paying for around one-third of their postgraduate training costs.3 Study budgets are being top-sliced to support local curriculum delivery and are frequently insufficient to support trainees undertaking mandatory courses and exams required
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for progression.Also of concern are the effects of university tuition fees on postgraduate finances that are only now being seen by doctors, given the time lag to qualification. Recent penalising increases could in future preclude or dissuade trainees who are not independently wealthy from embarking on expensive surgical training. while the JCST has recently worked to improve awareness among trainees of its important role in surgical training, via a bi-annual newsletter and through social media, there remains dissatisfaction among trainees regarding the fee to support the JCST with many feeling that it does not represent good value for money. Further rises in the JCST fee are inevitable and with the General Medical Council (GMC) and Department of Health apparently unwilling to make a significant financial contribution to the process, despite the JCSTs work being carried out on behalf of the regulator, further disproportionate costs may be transferred to trainees. One solution may be for all surgical royal college members and fellows, not just trainees, to share the increased operational costs of the JCST via the annual college membership subscription a move that would be welcomed by ASiT. Of particular concern to trainees is the ongoing issue of the sub-consultant grade, which has reared its head again recently with a projected oversupply of trained hospital doctors and an estimated 2.2 billion increase in consultant salary costs in 2010.4,5 ASiT firmly believes that the certificate of completion of training (CCT) equips the individual to deliver high-quality care as a leader of the surgical team, rather than just a member, and that this gold standard must be maintained.A sub-consultant grade is likely to lead to demotivating and undesirable posts and produce significant workforce migration. we must all work hard to ensure that highly qualified and motivated CCT-holding consultant surgeons with autonomy, but a strong sense of collaborative practice, remain central to the delivery and development of excellent safe patient care. ASiT strongly opposes the introduction of a sub-consultant grade, whether it be in name or in terms and conditions. ASiT continues to oppose the European working Time Regulations (EwTR), which have led to a reduction in surgical

professor Norman williams chats to trainees in the welcome drinks reception at the 2012 ASiT Conference

training opportunities, with multiple handovers and fragmented care potentially jeopardising patient safety.6-10 Actual work bears little resemblance to the hours laid down by official rotas,11 as trainees are disregarding the legislation and taking their own steps to protect their surgical training and the provision of safe patient care.12 ASiT maintains its recommendation that a flexible working week up to a maximum average of 65 hours is required to provide an appropriate balance of the technical and non-technical training necessary for the craft specialities.13 we are pleased to see that our message is getting through to politicians as ASiTs stance on working time restrictions was referred to by several Mps in a recent House of Commons debate on the EwTR earlier this year.The president of ASiT was also invited and provided evidence to a parliamentary committee investigating the impact of the EwTR on training and patient care.ASiTs views on the EwTR, opposing those of the BMA junior doctors committee, were recently voiced on BBCs Newsnight.while we await the outcome following a scheduled review of the EwTR by the European parliament,14 and of course whether the EwTR will factor in the prime Ministers recent promise to negotiate a better deal for the UK in Europe following his pledge for a referendum on the EU, trainees must continue to be active in protecting training while at the same time remaining professional and ensuring patient safety. Surgical simulation training has been shown to reduce the technical learning curve and is now well recognised as an adjunct to surgical training.while providing additional learning opportunities to expand training and improve patient safety, simulation may compensate in part for reduced training time in the operating theatre.ASiT has already heavily endorsed the opinion that high-quality simulation programmes must increasingly be incorporated into surgical training.

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However, as highlighted in a recent ASiT survey and summarised in The availability, introduction and role of simulation in surgical education and training: review of current evidence and recommendations from the Association of Surgeons in Training,15 there is a paucity of surgical skills simulator facilities across all specialties and availability (or awareness of availability) varies widely between regions. For simulation training to become established within existing training programmes and integrated into the surgical curriculum it is imperative that consultants have time available to deliver simulation training. ASiT supports the General Medical Councils proposed recognition and approval of trainers16 and hopes that this planned licensing of surgical trainers will be implemented robustly in order to ensure training responsibilities are properly reflected in NHS job plans. The annual asiT conference As the only pan-specialty national conference for surgical trainees in the UK and ireland, the ASiT annual meeting offers a unique opportunity for clinical updates, training courses, research presentations and careers talks specifically aimed at surgical trainees.with numerous trainee prizes, a charity gala dinner and the opportunity to socialise with colleagues from across the country, the weekend has become an essential date in the diary for all surgical trainees.As the association continues to grow, so does the scale and popularity of the annual conference, as demonstrated by the climbing delegate registrations and abstract submissions over recent years. Following a rigorous peer-review process, the highest-scoring abstracts are accepted for poster presentations, with the best selected for presentation in one of the four oral prize presentation sessions.Accepted abstracts are published in citable form in the International Journal of Surgery (IJS). The 2012 ASiT conference at City Hall, Cardiff, brought together almost 700 delegates, speakers and guests for what was the most successful conference to date17.we certainly look forward to seeing even more fellow trainees in attendance at Manchester Central Convention Complex for the 2013 ASiT conference over the weekend of 57 April 2013. asiT prizes and awards During 2011 and 2012,ASiT awarded over 30,000 worth of prizes to trainees.

In addition to the 18 prizes awarded at the annual conference, other prestigious awards were made throughout the year, including the highly competitive ASiT Covidien Travelling Fellowship, the Shorland Hosking and pitts-Tucker ASiT Operation Hernia Fellowships, the ASiT Dutch Microsurgery Travelling Bursary, multiple ASiT research and regional meeting grants, and many others.These awards are generally made through open competition, with applications judged by ASiT council. asiT education ASiT aims to provide high-quality, affordable educational opportunities for our members. By securing industry support and volunteer faculty, we provide courses to our members either free of charge or, when necessary, for a nominal fee to help cover some costs.within the last 3 years,ASiT has directly organised 34 courses and additionally secured significant discounts and free places for our members on many more courses run by third-party providers.ASiT also plans to expand its portfolio of courses in 2013, including microsurgery courses in Amsterdam, a local flap reconstruction course, an ultrasound course for surgeons in training and operative skills courses in neurosurgery, cardiac surgery and ENT. ASiT is also undertaking a new venture to support surgical trainees through a peer-to-peer national mentoring scheme. we believe that mentoring has a valuable role to play in enabling trainees to achieve their maximum potential, while developing leadership and interpersonal skills.we are currently running a survey on mentoring to understand what surgical trainees want from a national mentoring programme. From the preliminary survey data (n=500), 48% of surgical trainees did not have a mentor, 47% acted as mentors and 83% wanted some formal mentoring training. we are developing a one-year pilot and a key component of this will involve training mentors in coaching and group feedback techniques using an accredited coach. we aim to have trained mentors located across the country to act as local contacts for the mentoring scheme and ultimately tutor new mentoring volunteers. in this way, we hope to create a mentorship scheme that is robust, self-sustaining and available to all ASiT trainees across the UK.

asiT: run by trainees for trainees The ASiT website (www.asit.org) is our most important channel of communication with our members.within its pages can be found information relating to all of the activities and benefits described in this article as well as details of your regional and specialty representatives and the latest news, events and resources for surgical trainees. if you have any thoughts as to how ASiT can assist surgical trainees, or if you have any concerns or issues about your training, please contact your regional representative, consult our website or email info@asit.org.You can follow us on Twitter @ASiTOfficial and also find ASiT on www.facebook.com/ASiT.org.
1. Fitzgerald JE, Giddings CE, Khera G, Marron CD. improving the future of surgical training and education: consensus recommendations from the Association of Surgeons in Training. Int J Surg 2012; 10: 38992. 2. Oxtoby K. private providers: a help or hindrance to training? BMJ Careers 4 Sept 2012 (cited Jan 2013); http://careers.bmj.com/careers/advice/view-article. html?id=20008682. 3. Harrison E, Shalhoub J.The Cost of Surgical Training: position Statement by the Association of Surgeons in Training. London:The Association of Surgeons in Training; 2007. 4. Centre for workforce intelligence. Shape of the medical workforce. Starting the debate on the future consultant workforce. London: CFwi; 2012. 5. Hornby S,wild J, Shaloub J, et al. Shape of the medical workforce. Starting the debate on the future consultant workforce.A response from ASiT. London: The Association of Surgeons in Training; 2012. 6. Kara N, patil pV, Shimi SM. Changes in working patterns hit emergency general surgical training. Ann R Coll Surg Engl (Suppl) 2008; 90: 6063. 7. Stephens MR, pellard S, Boyce J et al. Influence of EwTD compliant rotas on SHO operative experience. Ann R Coll Surg Engl (Suppl) 2004; 86: 12021. 8. Maxwell AJ, Crocker M, Jones TL et al. implementation of the European working Time Directive in neurosurgery reduces continuity of care and training opportunities. Acta Neurochir (Wien). 2010; 152: 1,20710. 9. Marron CD, Byrnes CK, Kirk SJ.An EwTD Compliant Shift Rota Decreases SHO Training Opportunities. Ann R Coll Surg Engl (Suppl) 2005; 87: 24648. 10.Bates T, Cecil E, Greene i.The effect of the EwTD on training in general surgery:An analysis of electronic logbook records. Ann R Coll Surg Engl (Suppl) 2007; 89: 106109. 11.Tait MJ, Fellows GA, pushpananthan S et al. Current neurosurgical trainees perception of the European working Time Directive and shift work. Br J Neurosurg. 2008; 22: 2831. 12.Khan MEA, Jordan AD, Strange T,Vig S. Response to: post-EwTR: is the UK still a centre of excellence for surgical training? Ann R Coll Surg Engl (Suppl) 2012; 94: 26873. 13.Fitzgerald JEF, Caesar BC.The European Working Time Directive:A practical review for surgical trainees. Int J Surg 2012; 10: 399403. 14.williams N.The long and winding road to better training. Ann R Coll Surg Engl (Suppl) 2012; 94: 33435. 15.Milburn JA, Khera G, Hornby ST et al. introduction, availability and role of simulation in surgical education and training: Review of current evidence and recommendations from the Association of Surgeons in Training. Int J Surg 2012; 10: 39398. 16.GMC. Recognition and approval of trainers. www.gmc-uk.org/education/10264.asp (cited March 2013). 17.Fitzgerald JEF,Wild JRL, Khera G.The Association of Surgeons in Training Conference: Cardiff 2012. Int J Surg 2012; 10: 38388.

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