Guide to Intermediate Training

Firstly, welcome to specialist training in Mersey.
My name is Stuart McClelland, your Training Programme Director - Stuart.McClelland@aintree.nhs.uk
I work at Aintree University Hospital and will be having a lot of communication with you. 
The Regional Adviser is Omar Al-Rawi and the Associate Head of School is Simon Mercer.

Curriculum

Full details of the 2010 curriculum, which you should read, are available HERE.
The curriculum has an emphasis on general duties with some additional units of training.
There is also a far more stringent requirement than Core Training in terms of the number of sessions done i.e. experience to achieve a unit of training sign-off.
You must complete all the Essential Units for Intermediate Training by the end of ST4.
There are a lot of units to cover in the two years, so by the end of ST3 many of the straightforward/smaller ‘general duties’ modules that can be done in any hospital should be complete, along with all the specialist blocks you have been to.

Unit of Training Sign Off

To achieve this, you need 3 things

• a minimum of 3 linked WPBAs (of at least three different types)
• logbook evidence of suitable experience.
  You must aim to get the equivalent of 20 sessions for all essential units (and ideally for the majority of the general duties e.g. day surgery, general/urology/gynae, ENT/maxfax, orthopaedics..., which should all be easy, although not absolutely essential).
  It may be more difficult for non-theatre and impractical for the rest so some common sense must prevail about how you demonstrate enough experience.
  Remember that you can multiple count so that a THR under spinal with sedation can count towards all three unit of training.
• Evidence of achieving the Core Clinical Learning Outcomes as detailed in the curriculum.
  This will be demonstrated from your WPBAs, MSF, consultant feedback and relevant courses, but this will ultimately be up to you and your College Tutor / Educational Supervisor / local unit of training lead.
  This should then be signed off on Lifelong Learning

In terms of getting unit of training acquisitions over the next 2 years, you need to take all your chances.
You will all be doing 3m at the Women’s for obstetrics so don’t waste your time getting that done anywhere else.
Paediatrics must be achieved in the districts and you must have the equivalent of 20 sessions by the end of your 9m in DGHs.
You will normally do your 3m block of ICM at the Royal: your DGH attachments are for general duties and not ICM so make sure that you only do one 3m block in ICM as any other time when not on call will be wasted.

You should meet with your Educational Supervisor and/or College Tutor at the start of each attachment and ensure that there is a plan as to what you are going to do and get signed off in the following 3-6m.
This should be documented on Lifelong Learning as a PDP for the placement.

You should also include a plan for an annual MSF in your discussion with your Educational Supervisor.
Furthermore, if there is something you particularly need to get done, getting in contact with the College Tutor as soon as you know your finalised allocation is often a good way of avoiding late panic and ultimate disappointment!

Workplace Based Assessments

The suggested topics for WPBAs are in the Assessment Guidance document on the RCA website HERE.
Because of the large number of training units to be achieved in the relatively short time period, you must plan ahead and ensure that everything is done in an organised fashion throughout the next 2 years.
Some of the WPBAs required for general duties can be done during your 3m ICM such as transfer medicine, sedation, some airway and perhaps some trauma and stabilization.
There are 19 units to be signed off, of which 16 need a minimum of 3 WPBAs so that is upwards of 50 in 2 years.
The good news is that technically a minimum of only 3 WBPAs is required across all the sub-units of general duties so this lightens the load a little.
However, you only have 15m in general hospital theatres, so you should be aiming to get one WPBA done every week whilst in the districts.

Rotation

The intermediate rotation has recently changed and the idea of the rotation now is to spend 15m in the teaching centres and 9m in the districts.
The time in the teaching centres usually comprises 6m at the Royal of which 3m will be spent in ICM, 3m at Aintree, 3m at Walton and 3m at the Women’s.
The districts may be in one 9m block at a larger hospital, or a 6m block at a smaller hospital with the remaining 3m at a large DGH /the Royal /Aintree.
Note that you will get complex airway experience by doing on-calls at Aintree, but intermediate trainees will not usually be able to be placed in elective ENT/MFU theatres due to all the higher trainees needing that – you must plan to do this elsewhere.
You will be allocated to your training unit on a 3m basis, even if you are expected to stay for more than 3m.
So you should expect to receive your placement every 3m.

Provisional versions of the rotation should be sent out from about 5m in advance, followed by the final version approximately 3m prior to the rotation date.
You will all receive a trainee ID number, which you should use to find out your allocation from the list of posts that will be sent out: make a careful note of this as you will need it for at least 5 years!

There are 2 supernumerary placements which you need to organise by contacting the secretaries yourself.
At least one of these modules should be completed during your longest DGH placement and the other could be while at Aintree / the Royal / a DGH.
Consider how absence for these placements combined with your exam timing may impact on the hospitals you are at.
You will likely be disappointed if you ask for a 2 week placement off during the same 3m as significant study/exam leave.

1. Intermediate cardiothoracic module

You all must do two weeks of cardiothoracic training during your intermediate training, ideally before you sit your exam to get the most out of it.
To organise your attachment contact the secretaries at LHCH

Sue Macklin - sue.macklin@lhch.nhs.uk or
Lorraine Boyne - lorraine.boyne@lhch.nhs.uk
Tel. 0151 600 1396

Please note that it’s not a choose-and-book service: you check with them when it is mutually suitable to be allocated, taking into consideration your placement and available slots at LHCH.
It is your obligation to inform the department you are working in that you need two weeks off for this attachment.
If the department won’t let you go due to rota shortages, then let Sue or Lorraine know and they will re-arrange the attachment.

2. Intermediate pain module

Similar to the above, you all need to do two weeks of pain training at Whiston OR RLUH. To organise your placement contact:

Kirsty Dineley at RLUH - kirsty.Dineley@rlbuht.nhs.uk
Senthil Jayaseelan at Whiston - senthil.Jayaseelan@sthk.nhs.uk

Again, it is your responsibility to contact either of the above to arrange your placement, taking into consideration your leave plans and slot availability at RLUH/Whiston. You are expected to complete 20 pain sessions during this placement and get your intermediate pain training signed off.

Leave spread across placements

If full time, you probably have 32 days AL in a year to take and up to 30 days SL.
Study leave often occurs in blocks around exam times.
As a school, we have advised that in any one placement, SL and AL be grouped together so that if you are doing lots of 3m blocks, you can take 15-16 days per 3 month block of AL/SL combined (pro-rata for LTFT).
This may require forward planning by you, so that you do not leave too much leave to be taken in your last 3 month block for example. Also bear this limit in mind when scheduling the cardiothoracic and pain blocks.

Maternity Leave

For organisational purposes, please inform me as soon as possible when you plan to go on mat leave and when you are likely to be coming back into the rotation (after any accrued leave).
Remember the rotation is worked on from at least 5 months ahead.

ARCP

Your training progression will continue to be reviewed on an annual basis by an ARCP panel (HoS, RA, TPD and a deanery representative).
Your attendance is not compulsory but it is encouraged and highly appreciated! If you cannot attend, you are expected to provide a minimum of 300 words reflective summary for the year of training, which should include your plans and aspirations for the coming year.

For further details of the documentation that we expect at ARCP, click HERE

Intermediate Training Certificate

The Intermediate Training Certificate must be completed by the end of ST4 for you to enter ST5.
This should be ideally signed off contemporaneously but can be done in retrospect from ARCP or Unit of Training sign-off documentation.
It can be downloaded HERE

Intermediate Teaching Programme

HEE-NW School of Anaesthesia now ‘top-slice’ Intermediate Trainees £600 in ST3 and £500 in ST4 from their study leave allocation.
This is to pay for a range of courses, a list of which you will be sent, and further details are available on our website (https://mmacc.uk/Mersey.html).
You will receive an email from Dr Mruga Diwan with the dates for the MAFIT 1 programme.
These dates should go into your diaries and it is your responsibility to request these days off as study leave from the departments in which you work to be able to attend. They will take place at Whiston Hospital unless otherwise stated.
The education programme will roll annually, so if you miss the day in ST3, you should try to attend the following year, particularly as some days can count towards your sessional commitment to a unit of training sign-off. The ARCP panels receive details of your attendance at these sessions.
The fees for MAFIT 1 have been top sliced from your study leave budget, so you do not have to pay to attend, but you must ask for permission from your hospital to attend.
Any courses on the top-sliced list do not require formal deanery approval but any not on this list require submission of a study leave form to study.leave@aintree.nhs.uk.
More information is available at the following link: https://www.nwpgmd.nhs.uk/study-leave

Exam Preparation Class

We expect most of you to take the Final FRCA at the start of ST4 when you have at least a year’s ST experience and have completed the MAFIT 1 educational programme.
For 3m prior to your planned written exam date, there will be a weekly morning exam preparation class (MAFIT 2).
When you attend it, you should not expect to attend MAFIT 1 at the same time (unless this is in your own time).
There is also a viva class (MAFIT 3) along these lines for 3m prior to the Structured Oral Exam.

There is increasing bureaucracy in training and it will be a test of your organizational skills to get everything done and signed off in time.
The best consultants are usually the best organised and chaos will inevitably lead to failure.
Consultant appraisal and revalidation is following the trainee model to some extent, and therefore the electronic /paper workload will sadly be unending throughout your entire career. Get into good habits now!

Before emailing me with questions, please ensure that you have read everything as there is a lot of information to digest. Then please feel free to come back to me with any queries.

Stuart McClelland - Stuart.McClelland@aintree.nhs.uk