<p>Minutes of the meeting of the Scottish Board for Training in Medical Specialties held at 11.00 am on Thursday 28 June 2012 in the Boardroom, Lister Postgraduate Institute, 11 Hill Square, Edinburgh</p><p>Present: Donald Farquhar (DLF) Chair, John Lowe (JL), Ken McHardy (KM); Susan Nicol (SN), Claire Robinson (CR)</p><p>By video-conference: Central Quay, Glasgow: David Marshall (DM), Moya Kelly (MK) deputising for Alastair McLellan, Hazel Stone (HS), Janice Walker (JW); Victoria Hospital, Fife: Morwenna Wood (MW).</p><p>Apologies: Gordon Birnie (GB), Philip Cachia (PC), Nicki Colledge (NC), Graham Leese (GL), Lewis Morrison (LM), Robert Masterton (RM), Alastair McLellan (AMcL), Colin Perry (CP), David Reid (DR), Liz Sinclair (LS), Ian Longair (IL), Donald Smith (DS).</p><p>In attendance: Helen McIntosh (HM).</p><p>1. Welcome and apologies</p><p>Dr Farquhar welcomed Ms Clare Robinson, newly appointed Business Manager in the West of Scotland, to her first meeting of the board.</p><p>Apologies were noted.</p><p>2. Minutes of Medicine specialty board meeting held on Monday 21 May 2012</p><p>The following amendments were noted:</p><p>Page 4, Item 6.1 first bullet point to read ‘6 offers are dependent on results for PACES’ paragraph 5 to read ‘JL confirmed that both ST3 and ST3 LAT …’</p><p>Page 6, Item 7 Second bullet point to read ‘New Workplace Based Assessments: to apply in pilot sites only from July 2012 Penultimate paragraph to read ‘KMcH confirmed Aberdeen have organised training.’</p><p>Page 7, Item 9, final paragraph to read ‘The Board supported the effort to maximise patient safety at the start of…’</p><p>With these amendments the minutes were accepted as a correct record of the meeting and will be posted on the website.</p><p>3. Matters/actions arising from the previous meeting 3.1 National Recruitment</p><p>SRDB has approved in principle Scotland’s participation in UK national recruitment. This needs to be finally approved by SMTB and was also dependent on whether the UK adopted the NES offers system.</p><p>JL attended the most recent meeting of the ScotMT HR sub group. This was a single item meeting convened to discuss UK recruitment and consider resources and workload. The group accepted UK national recruitment was the direction of travel and members have been asked to contact English colleagues for information on their processes.</p><p>JL outlined the national recruitment arrangements for Medical specialties. One group of 8 specialties followed the single cascading model; another group of 5 specialties followed a central process. Chemical Pathology recruitment will remain a Scottish process.</p><p>In the single cascading model an algorithm was applied and applicants were linked to preferred Deaneries. Each Deanery set its interview capacity and if this was exceeded the applicant was interviewed by the next preferred Deanery if it had capacity and so on. This process did result in some delay between shortlisting and interviewing.</p><p>England has a ‘clearing’ system and unsuccessful but appointable candidates are informed of available posts in other Deaneries. The clearing process was currently taking place and there were substantial gaps in some areas of England and Wales eg 86% CMT fill rate with vacancies concentrated in particular areas ie East Midlands/ East of England/ Peninsula/ Yorkshire. The same specialties in England as in Scotland were experiencing difficulties with filling ST3 posts.</p><p>Paediatric Cardiology and Clinical Genetics were recruited by a host Deanery in a central location with ranking applying across UK. This has resulted in some problems in filling posts in some areas; otherwise this model worked well for smaller specialties.</p><p>4. CMT/ACCS</p><p>DLF reported AMcL was demitting as CMT lead and the next CMT leads meeting will discuss and agree who will succeed him. Once it was agreed who will replace him, the individual will be co-opted to join the STB, and asked if they will represent NES at JRCPTB in London.</p><p>4.1 Variation in ARCP outcome</p><p>In future, anyone who did not achieve the first part of membership at the end of the first year will get an Outcome 2. Deaneries currently dealt differently with individuals who did not get full membership at the end of year 2 ie Outcome 3 or 4. For successful CMT finishers, some were given Outcome 1’s in one Deanery and Outcome 6’s in another. SN reported WoS gave Outcome 1s based on GMC advice. Some trainees were listed as Outcome 5 and this was subsequently converted but in some Deaneries the initial award of an Outcome 5 was not recorded. DLF reported he was seeking the view of the CMT leads sub group on this issue. The College was currently contacting all Deanery CMT leads with a number of scenarios seeking information on what Outcome each Deanery currently awarded. JRCPTB will then consider all responses and agree a consistent stance for all Deaneries to apply in future. It was hoped to undertake a similar exercise for HST.</p><p>SN asked the Board’s advice regarding the appropriate Outcome for an ACCS Acute Medicine CT2 who had not passed PACES but did not want extra time. It was agreed the individual should be given an Outcome 3 as they had not fulfilled curricular requirements. However if the individual wanted to enter ST3 and the reason for the Outcome 3 was on the basis of exam non completion and they </p><p>2 subsequently passed, they could enter ST3 recruitment with no detriment. This would have to be documented at ARCP so the information could be taken into account during the recruitment process. It was agreed a national model for this was required.</p><p>KMcH noted the CMT decision aid stated workplace based assessment must be conducted by consultants; he felt this was high risk. He further noted the WoS CMT group required 3 different types of evidence for each competency which he felt was unrealistic and not mandated by the Gold Guide. The STB concurred with this view. There was still a degree of inconsistency and he noted the CMT sub group was rewriting the decision aid.</p><p>DM noted WoS Deanery has taken a hard line on Outcome 5s for HST and the ARCP committee required clear evidence at time of ARCP. DLF said Outcome 5s has also increased this year in SES. </p><p>Although concerns remained, the process was evolving and the College was working to reduce variation. The GMC will continue to scrutinise this.</p><p>DLF confirmed that JRCPTB workplace based assessment evaluation will be piloted in 3 Deaneries from August; no Scottish Deanery was involved.</p><p>5. HST 5.1 Recruitment 2012</p><p>DLF thanked JL and his colleagues for their work in ensuring a successful recruitment process. There were 199 applicants for 185 vacancies; the highest number of ST3 posts since 2007 and the highest number of LATs ever. This should be borne in mind when considering the fill rate.</p><p>Interviews took place over a 5 week period. Many people applied for only one or 2 specialties. Total applications has reduced from 2011, but it was unclear whether Medicine specialties were less popular or people were targeting their applications; perhaps a mixture of both elements. Six offers of ST3 posts were provisional on exam results. JL will ask Health Boards to check with trainees when they expected their results and let the recruiting Health Board know when they get the exam. It could be mid July before all exam results were known (follow-up showed 3 failed; 2 passed; 1 withdrew on 4 July and no information on whether trainee passed or failed).</p><p>5.2 Fill rate and Deanery variation</p><p>This year’s fill rate was 76% as compared to 86% last year and represented 83 posts filled from 109. LAT fill rate has also dropped from 40% to 33%. Fill rates in England and Wales were ST3 88% and LAT 66%. There was no guarantee the Scottish fill rate would improve in a UK national recruitment process but it seemed probable. Scotland generally had to look at promoting itself. Overall the Scottish fill rate was disappointing as was the fill rate between Deaneries.</p><p>DLF has been assured that under the JRCPTB system a higher proportion of candidates were interviewed. As a Unit of Application Scotland will be asked to decide its interview capacity and he felt unless there was a strong reason not to, they should interview as many people as possible. JL said they should base interview numbers on applicants’ scores; the national lead will make a judgement on setting the appointable score level and will interview as many candidates as needed </p><p>3 to fill vacancies; 27 interviews was the capacity per day. DLF said this would be stressed at the National Leads meeting in December when National UK recruitment will be a major agenda item for discussion. He hoped this discussion would also increase attendance at the meeting.</p><p>If Scotland did join UK national recruitment it may participate in the second recruitment round, however this was not automatic. SN noted Psychiatry and Anaesthesia were actively pursuing inclusion in the 2nd round of recruitment this year. DLF suggested that national UK recruitment was a step forward and that there was little likelihood of returning to any previous recruitment process. Once in the UK process, he will push for involvement in any second national recruitment round.</p><p>There were very few CT(A) posts – around 4 in total - so they will need to keep fewer posts back in future years. DM noted that OOPE requests were increasing for various reasons and this will continue to compound vacancy problems. DLF confirmed he has stressed at TPD level the need for requests for OOPE to be considered at appropriate points of the year only and he has already started refusing applications due to the volume. He felt it would be helpful to have centralised advice. KMcH added that grant giving bodies needed to be aware of training timings; DLF noted that SES holds regular meetings with the University at which it has raised this issue.</p><p>Action:  UK national Recruitment to be discussed as major agenda item at joint meeting in December.</p><p>5.3 Training Establishment</p><p>The National Training Leads and Specialty Societies had produced valuable information on consultant headcount to compare with ISD data. ISD information varied in its accuracy and there was huge disparity between ISD and specialty information in some areas. DLF has sent the compiled information to Professor Padfield and hoped this would assist discussions.</p><p>Training establishment was moving away from target annual intake. The training establishment for each specialty will be agreed and NES will have responsibility for reaching the target. Deanery split would usually be on the agreed proportional basis. This will be reviewed annually and overseen by Scottish Government. The suggestion was that the STB would be the group responsible for giving an impartial view or recommendation in future regarding proportional splits – where a case was made for a variation from the “norm”.</p><p>5.4 Postgraduate Qualifications for 2013</p><p>MRCP(UK) may become the required qualification for entry to ST3 from 2013; only MD Singapore and MD Hong Kong included this. The GMC may seek an extra year’s notice for this change so it might be introduced in 2014 instead of 2013. There was a view that this was not a good time to make entry to specialties more difficult given current difficulties in filling posts. While the change may only affect small numbers this could be in hard to fill specialties. GMC will issue its edict regarding the year of introduction and this will be confirmed before ST3 recruitment next year.</p><p>The number of posts for recruitment will probably still have to be advertised as indicative only and will be labelled as Scottish plus an outline of their location. DLF </p><p>4 reported the Edinburgh College was updating its website information on Scotland and this needed to be more promotional to retain those already in the country and attract people from elsewhere.</p><p>6. JRCPTB matters</p><p>The item will be discussed at the joint meeting.</p><p>7. Subspecialty training issues – cardiology, GI, oncology, rehab medicine etc</p><p>Certain specialty elements were undeliverable within some Deaneries and some additional experience for subspecialties required time spent elsewhere. For periods of less than 3 months the HR sub group has agreed funding will remain with the trainee’s own Deanery however there was an impact on service when a trainee moved and LAT salaries could not be used. There was a feeling there was a general need to topslice funding for subspecialty training.</p><p>KMcH felt access to additional experience should not be based on funding and also considered there was a need to establish what was essential to the curriculum rather than what a trainee wanted to do. It was not possible to provide opportunities in all areas and he felt that anything above core training required separate arrangements ie competition, resourcing, etc. DLF confirmed Hepatology and Stroke Medicine were the only 2 subspecialties with separate funding streams.</p><p>It was agreed that sub-speciality training should be separated into “essential” for curriculum, and “optional” where extra experience was sought by a trainee in a specific area. If essential, the Host Deanery required to fund it. If optional, there needed to be some form of selection process and agreement on funding. The growing problem of such training suggested a central funding pot might be appropriate. DLF agreed to prepare a paper for MDET.</p><p>8. AOCB 8.1 Hard to fill ST3 posts</p><p>It was agreed to discuss this as an agenda item at a future meeting; the STB would identify posts in scope and discuss what should happen with them.</p><p>Action:  To discuss as agenda item at a future meeting.</p><p>9. Date of the next meeting</p><p>The next meeting will take place at 1.30 pm on Thursday, 30 August 2012 in the Calman Room, 2 Central Quay, 89 Hydepark Street, Glasgow (with videoconference links).</p><p>Actions arising from the meeting</p><p>Item no Item name Action Who 5.2 Fill rate and Deanery variation UK national Recruitment to be DLF/HM discussed as major agenda item at joint meeting in December. 7. Subspecialty training issues To prepare a paper for MDET. DLF</p><p>5 8.1 Hard to fill ST3 posts To discuss as agenda item at a DLF/HM future meeting.</p><p>6</p>