Subspecialty Training in General Surgery

Subspecialty Training Programme Overview

Entry for Subspecialty Training in General Surgery

Common Features of Subspecialty Training Programmes

Supervision of Subspecialty Training in General Surgery

Certificate of Post-Fellowship Training in Subspecialty

Rules and Regulations for Trainees

SUBSPECIALTY TRAINING PROGRAMME OVERVIEW

Trainees in Subspecialty Training in General Surgery will follow a structured programme of subspecialty training and assessment laid down by the CSHK. There are seven subspecialties in General Surgery, which the CSHK recognizes to be distinct and independent of each other in terms of training that independent subspecialty training programmes are recommended. These subspecialties are:

•         Breast Surgery

•         Colorectal Surgery

•         Endocrine Surgery

•         Head and Neck Surgery

•         Hepatobiliary & Pancreatic Surgery

•         Upper Gastrointestinal Surgery

ENTRY FOR SUBSPECIALTY TRAINING IN GENERAL SURGERY

NOTE: Please refer to the “List of Criteria for General Surgery Subspecialty Training Units and Trainees” for the information on the subspecialty training requirement.

After successfully obtained Fellowship of the College of Surgeons of Hong Kong (FCSHK) in General Surgery, trainee may apply for Subspecialty Training in General Surgery.

Subspecialty Training in General Surgery in the seven subspecialties below is under the auspices of the General Surgery Board of the College of Surgeons of Hong Kong (CSHK). The programme takes a minimum of 1 year depending on the subspecialty.

•         Breast Surgery

•         Colorectal Surgery

•         Endocrine Surgery

•         Head and Neck Surgery

•         Hepatobiliary & Pancreatic Surgery

•         Upper Gastrointestinal Surgery

Trainees in these subspecialties must register with the CSHK within the first month of their subspecialties training (either in July or January). It is the responsibility of the applicant to make sure the application form reach our office on time. Late application or incomplete application will not be accepted. No allowance will be made for postal or other delays. Failure to register in time will render the respective training period NOT recognized. A register of Subspecialty Trainees is maintained at the CSHK Secretariat. Registration, which includes an annual fee HKD2000, is applicable to subspecialty trainees until they complete the subspecialty training.

Overseas Subspecialty Training without prior approval in writing from the Chairman of the General Surgery Board of the CSHK will not be recognized by the CSHK.

COMMON FEATURES OF SUBSPECIALTY TRAINING PROGRAMMES

(1) Organization of Subspecialty Training Programmes

Although the seven subspecialty training programmes differ in terms of training schemes, exposure and clinical experience required of the trainees, they have the following common features:

a. Each programme is formally structured and is recommended and approved by the Council of the CSHK;

b. Each programme is directly under the supervision of the General Surgery Board;

c. Each programme includes the continuing evaluation of the quality and effectiveness of a trainee’s practice. Medical audit, quality assurance, patient care evaluation and performance review are important parts of the subspecialty training programmes;

d. All training centres involved in subspecialty training are inspected and recognized by the CSHK for the purpose of training in that area of surgery. Set criteria are laid down for centres to be recognized for the training of the subspecialties in General Surgery, including the availability of caseloads and training facilities;

e. Each centre is accredited a number of recognized training posts for Subspecialty Training in General Surgery by the CSHK;

f. Each programme is supervised at the hospital level by the CSHK appointed supervisors and trainers;

g. Subspecialty specialist supervisors and trainers (who must be Fellows of the CSHK) are appointed, on the recommendation of General Surgery Board, by the CSHK to supervise the subspecialty training of the trainees. There are set criteria laid down and approved by the CSHK on the definition and acceptance of subspecialty trainers.

h. Each trainee entering into the General Surgery subspecialty training programme has to be approved by the CSHK and occupies one of the recognized subspecialty training posts as accredited by the CSHK;

i. The CSHK maintains, and updates every 6-monthly, a central registry of subspecialty trainees who occupy the recognized subspecialty training posts as accredited by the CSHK;

j. Each trainee possesses a Log book and is required to update the Log book regularly. The clinical experience and exposure have to be certified by his/her supervisor in subspecialty training every 6-monthly;

k. The supervisor/trainer : trainee ratio in all training programmes is usually 1 : 1.

i. General contents of training of all subspecialty training programmes include:

-          Basic science

-          Clinical skills

-          Review of current literature

-          Communication skills

-          Prevention and treatment of illness and the promotion of health

-          Teamwork

-          Management skills

-          Knowledge and skills which cross specialty boundaries

-          Professional ethics and conduct

(2) Summary of the Subspecialty Training Programmes in General Surgery

All seven subspecialties in General Surgery have the surgical training in its related subspecialties for a minimum of 1 year depending on the subspecialty.

*The Breast Surgery and Endocrine Surgery program will only accept candidates who have more than 1 year general surgery experience after successfully completed the stipulated period of training and passing the fellowship examination. The training period required was 1 year but trainees would be required to be post-fellowship for 2 years in order to be awarded the Certification of Subspecialty Training in Breast / Endocrine. During the 2 year post-fellowship period, the trainee should be under the concerned subspecialty for 12 months and could be in any other subspecialty for the remaining 12 months.

SUPERVISION OF SUBSPECIALTY TRAINING IN GENERAL SURGERY

The responsibility for accreditation and recommendation for approval by the Education & Examination Committee (E&EC) and the Council of the CSHK is vested by the General Surgery Board. All trainees embarking on Subspecialty Training in General Surgery must obtain a Logbook which could be purchased from the CSHK Secretariat.

The Logbook provides information on:

In-training Evaluation

A “Flagging Criteria” for monitoring subspecialty training is being enforced. Subspecialty trainees should have the ability to achieve the number/percentage of caseloads stipulated in the criteria which is available from CSHK Secretariat.

(1) Individual trainee’s log book should be reviewed regularly

- 3 monthly (mid-term assessment) by mentor

- 6 monthly (half yearly assessment) by

(i) Supervisors

(ii) The respective Subspecialty Group under the General Surgery Board

(2)  On completion of every 3-month training period, an interim face to face assessment between the mentor and the trainee should be carried out to thrash out any problems. During this interim debriefing assessment process, if serious deficiencies are evident, the mentor has to report in writing to the Chairman of the General Surgery Board. The trainee should be advised what measures are required to reverse these deficiencies.

(3)  On completion of every 6-month training period, every trainee would be required to

- Complete a Log Book Summary Report

- Submit one Mentor Assessment Form for assessing his/her performance in the past 6-month training period. The mentor who must be delegated or designated by the supervisor of the training hospital should complete these forms.

It is the obligation of Subspecialty Trainees to submit the above requisite documentation through their supervisors/trainers for vetting regularly semi-annually by General Surgery Board

The E&EC of CSHK would endorse the respective training period on condition that satisfactory assessment must be achieved. In the event that individual trainee who has been warned of the deficiencies during the 3-month mid-term assessment still performs unsatisfactory at the end of the 6-month period, the General Surgery Board would interview this trainee as well as the mentors whom the trainee has worked for in the unsatisfactory period. Below average assessment of performance in any six-month period will constitute grounds for disqualification of that six-month training period.

On-going in-training evaluation is required throughout the Subspecialty Training period. Trainees who fail to meet the above requirements would be required to undertake further training. Any trainees who do not satisfy the standards set by or have unsatisfactory assessments twice will be disqualified from the subspecialty training programme.

Absence from training longer than 1 month out of 6-month training period can be granted only if the trainee can provide good reasons such as sick leave or maternity leave. Under such circumstances, the actual period of satisfactory training within that 6-month assessment can be counted provided the absence is pre-approved and the performance of training is up to the satisfaction of mentors. Trainee would be required to repeat the stipulated subspecialty training requirements if there is more than 6-month discontinuity of Subspecialty Training.

However, if training was suspended due to the trainer’s factor, pass training would be recognized provided that trainees could take up the training post no later than the total time required for the training in respective subspecialty.

Interrupted Training

Application for suspension from the continuous subspecialty training programmes is allowed for a maximum of 6 months and such application must seek prior approval from General Surgery Board and E&EC of the CSHK. Application for suspension of subspecialty training exceeding 6 months would be considered only under special circumstances such as prolonged sickness. Trainees would be required to repeat the stipulated training requirements. However, if training was suspended due to the trainer’s factor, pass training would be recognized provided that trainees could take up the training post no later than the total time required for the training in respective subspecialty.

Research/Higher Degree

The Subspecialty Training Programme can be interrupted for one or two years for prospectively approved research or pursue for a university higher degree. Prior approval must be sought from General Surgery Board and E&EC of the CSHK. In such a situation, the trainee is still required to complete the required years of subspecialty training.

Overseas Training

The E&EC may prospectively pre-approve elective subspecialty training in an overseas post for a trainee. The trainee must seek advice from the Committee before they start any subspecialty training in overseas post for prior approval and should not spend more than one quarter of the required training period on pre-approved overseas training. The trainee concerned would be required to submit the assessment through his supervisor after the completion of his subspecialty training. The Committee may consider recognition of the respective subspecialty training upon receipt of the respective assessment.

Appeal Procedures

A trainee can appeal to the General Surgery Board of the CSHK concerning disqualification. However, the notice of such appeal must be lodged within 21 days from the date of notice in writing of such disqualification to the trainee.

CERTIFICATE OF POST-FELLOWSHIP TRAINING IN SUBSPECIALTY

Upon satisfactory completion of Subspecialty Training, trainees will be awarded a Certificate of post-fellowship training in the respective subspecialty by the CSHK.

RULES & REGULATIONS FOR TRAINEES

1. Subspecialty Trainees are trainees under various Subspecialty training programmes accredited by the CSHK for Subspecialty Training in General Surgery.

2. The Subspecialty Trainees must obtain FCSHK in General Surgery or equivalent before they will be considered for entering the Subspecialty Training programmes in General Surgery accredited by the CSHK.

3. The retrospective recognized training period in a subspecialty for trainee should not be more than half of the required training period that immediately preceding the date the centre became a recognised subspecialty training centre.

4. Each Subspecialty trainee will be assessed by his/her supervisor every 3 months and monitored by the CSHK every 6 months. All subspecialty trainees must submit their training assessment and documentations within 6 weeks after their completion of training rotation, i.e. 31 December or 30 June every year The assessment should be endorsed by the Chairman of General Surgery Board semi-annually during the continuous training period.

5. All trainees must submit 1 completed research report and being approved within one year after their completion of training and case report should not be accepted. Trainees must submit an interim report if they could not submit any completed report during the completion of training. Trainees would be disqualified from the training if they were unable to complete the project within the time limit.

# Starting from 1 January 2020 onwards, all newly admitted trainees must submit 1 full paper and being approved within one year after their completion of training and case report would not be accepted.

6. If the trainee who failed to submit 1 completed research report within the time limit. The General Surgery Board would interview the non-compliant trainee and discuss whether his/her standard could fulfil the requirement for him/her to re-enter the subspecialty training programme. The Board would then decide whether the trainee was allowed to re-enter the programme, and the decision would be made on a case-by case basis; the re-entry application must be initiated by the trainee, and such application could be rejected by the training centre even it was approved by the Board.

7. The subspecialty trainers would be responsible for vetting the research report  submitted by trainees in their respective subspecialty .

8. Absence from training longer than 1 month out of 6-month training period can be granted only if the trainee can provide good reasons such as sick leave or maternity leave. Under such circumstances, the actual period of satisfactory training within that 6-month assessment can be counted provided the performance of training is up to the satisfaction of mentors.

9. Trainees may apply for suspension from the continuous subspecialty training programmes for a maximum period of 6 months and such application must be made beforehand. It is only under exceptional conditions (e.g. health, family or personal reasons) that the suspension period can be longer than 6 months.

10. Overseas training in a subspecialty without prior approval in writing from the Chairman of the Education & Examination Committee will not be recognized by the CSHK. Trainee should not spend more than one quarter of the required training period on pre-approved overseas training.

11. Any trainees who do not satisfy the standards set by or have unsatisfactory assessments consecutively twice or will be disqualified from the training programme. A trainee can appeal to the General Surgery Board of the CSHK against such disqualification (provided that notice of such appeal is lodged with the Secretary of the Appeal Subcommittee within 21 days from the date of Notice in writing of such disqualification to the trainee).