Many health professionals will be familiar with QALYs: quality-adjusted life years. QALYs assume health to be a function of the length of life and the quality of that life, combining these factors to produce a number. Whilst imperfect, this number can be helpful in economic evaluations of medical and surgical interventions - and certainly helps to focus the mind.
Is it now time that we adopt a similar concept to assess surgical training, by assuming training to be a function of the length of time on the frontline and the training quality during that time? One person’s core surgery training rotation may pale in comparison with another’s – owing to the quality of the training experience. Yet when it comes to annual reviews of competence and progression, there is often little recognition of this variation. Moreover, UK certification guidelines continue to include a stipulation based purely on time spent training (amongst several other factors such as operative numbers, exams, and workplace-based assessments).
Imagine a situation where surgical rotations had a QATY attached to them – a quality-adjusted training year. This would incorporate key training opportunities such as lists for core and index operations, appropriate outpatient exposure, as well as the balance between service delivery and explicit training. As someone who feels that service is intimately connected with training (we are in training, after all, to provide the NHService and to train the next generation ourselves) there must still be a balance.
A QATY score of one would mean that one year in rotation enabled a year’s worth of experience commensurate with ‘good’ training (as defined by the ISCP and JCST). Less than one illustrates a deficiency in training whilst greater than one shows a rotation that is punching above its weight. Much as trainees respond better to the carrot than the stick, the QATY could be used to encourage training schemes to get the balance right. Certain deaneries are already more or less competitive, informed by geographical and reputational issues. A formal QATY would be embraced by training programmes that are doing a good job and provide motivation for others. A trainee underperforming in a unit with a QATY <1 might be given some leeway. Conversely, a trainee struggling in a unit with a QATY of 2 might help to clarify where the issue lies. In situations where hospital pressures are undermining training (for instance un-filled rotas demanding more on call, reducing elective list exposure), the QATY may also help to provide the ‘stick’ that is sometimes needed; giving an objective illustration to empower training bodies to work with management to make it better.
From our perspective at eoSurgical, and as trainees/new consultants, we are convinced of the QATY ‘value add’ that simulation brings to a surgical training rotation - and perhaps this concept deserves broader application.
Skull-base neurosurgery fellow, Leeds General Infirmary