Nominal group consensus process to determine Association of Surgeons in Training quality indicators for integrated clinical academic surgical training across the UK

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Dear Editor In the UK, a unique integrated clinical academic training pathway exists to support co-development of clinical skills with skills in research, teaching, and leadership for trainees with an academic interest1,2. In surgery, as a craft specialty, the balance of acquisition and maintenance of technical skills combined with academic development poses a challenge to surgical trainees and programme directors. As a result of this, clinical academic trainees in surgery have reported that their dedicated academic time is commonly lost to clinical service commitments, and a lack of transparency around both clinical and academic expectations3. The aim of this study was to agree consensus quality indicators for integrated clinical academic training posts (AQIs) to allow benchmarking and improvement of academic surgical training in the UK. Details of background, research methods, and supplementary figures and tables are in the Supplementary material. This development process followed a modified nominal group consensus methodology across five sequential stages: in-person scoping exercise; virtual stakeholder consultation; nominal group consensus meeting; virtual stakeholder feedback; and dissemination and implementation (Supplementary material). Design and reporting followed best practice methodology for consensus research4,5. Contributors were invited from the Association of Surgeons in Training (ASiT) mailing list, social media, and through the UK Clinical Academic Training Forum. The expertise matrix was designed to sample trainees of different sexes (male/female), training grades (postgraduate year 1–2/year 3–5/year 5 and above), and types (current integrated academic trainees/past integrated academic trainees/trainees with an academic interest). All AQIs were required to be examples of existing real-world practice in one or more UK region (deemed to be feasible not aspirational). After stage 1 and 2, 16 candidate AQIs were drafted for inclusion in the nominal group meeting (Supplementary material). Thirteen nominal group members were present for the face-to-face stage 3 discussion, with a diverse range of experiences. Four new AQIs were identified during silent generation, and all 20 AQIs were discussed in the sharing ideas stage (Supplementary material). Wording was further refined for 7 indicators in stage 5, before final agreement of 20 AQIs across seven domains (Table 1): supervision and mentorship (assigned supervisor, clear objectives, academic programme director, and administrator), protected academic time (protected from clinical work, not used to fill rota gaps, trust responsibilities, flexibility to arrange time), clinical work (prioritized training, back to training interview, flexible on-call commitment), audit nd accountability (annual review with the quality indicators), financial assistance and resourcing (clinical and academic study budgets, local working space), training progression (clinical training plans, dedicated academic Annual Review of Competency Progression, flexible completion dates), and recruitment (involving the clinical programme director). The AQI indicators were designed to be delivered with existing resources (not to detract from resources available for non-integrated trainees). Key external stakeholder groups were identified and illustrative examples implementation of the AQIs were provided (Supplementary material). Final ASiT integrated clinical academic surgical training quality indicators ASiT, Association of Surgeons in Training; ARCP, Annual Review of Competency Progression; CCT, Certificate of completion of training. Final ASiT integrated clinical academic surgical training quality indicators ASiT, Association of Surgeons in Training; ARCP, Annual Review of Competency Progression; CCT, Certificate of completion of training. Finally, the group designed an annual audit to provide feedback to key external stakeholders. The audit will capture experience of integrated clinical academic trainees in surgery over a single training year. This seeks to have two main benefits. First, it will empower local integrated trainees with a set of agreed quality standards to discuss with their local training directors and hospital administrators (a ‘bottom up’ approach). Second, by leveraging real-world data, we hope to work with key external stakeholders to promote high-quality, inclusive, and enjoyable integrated academic clinical training (a ‘top down’ approach). The annual audit will launch in April 2022 and is available at: https://bit.ly/ASiTAQI. Association of Surgeons in Training J. Glasbey, N. Blencowe, J. Barclay, A. J. Beamish, S. Bhatia, W. Bolton, C. Brennan, S. J. Chapman, J, M. Clements, E. Elsey, R. Fish, V. J. Gokani, G. Humm, K. Hurst, P. Hutchinson, C. Jones, V. Kasivisvanathan, N. Keates, S. Lawday, M. J. Lee, C. Lovegrove, H. Mann, J. Mason, F. McDermott, K. McLean, H. Mohan, D. Nally, P. Pucher, S. Staight, A. K. Sorial, I. Trout and J. Burke This consensus process was led and funded by the UK ASiT. The UK National Research Collaborative Meeting provided support in kind for the face-to-face nominal group consensus meeting. Supplementary material is available at BJS Open online.

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.