COVID-19 has affected all aspects of medicine. Urologists have been called upon to work in vastly different working environments including acute pan-surgical teams, intensive care and medical wards.
The strategies put in place by hospital management teams vary significantly across the country as we all adapt our working practices to care for patients with COVID-19, as well as deliver our usual specialty care. As training and education is suspended, we summarise the issues and specific changes trainees are facing in this uncertain time (all information is up to date at the time of writing).
Courses and exams
Q: I was due to sit my FRCS exam in July, has this been rescheduled?
A: The spring and summer 2020 FRCS Urol examinations section 1 and 2 sittings have been cancelled. The next diet for Section 1 is 7 January 2021. There will be no additional sittings for section 1. This has been decided based on a complex exam calendar which includes multiple surgical specialities.
Q: Will there be enough space for the January 2021 candidates to do the May 2021 section 2?
A: The Joint Committee on Intercollegiate Examinations (JCIE) are expecting a high number of applicants for Part 1 in January 2021. All efforts will be made to ensure adequate space for all candidates to sit the Part 2 examination in May. They cannot guarantee this at this stage. BAUS Section of Trainees (BSoT) will continue to represent trainees and lobby for adequate capacity in May 2021, as they did this year.
Q: I was due to sit my FRCS section 2 exam in May, has this been rescheduled?
A: On the 13th of May the JCIE released a statement that the May 2020 FRCS section 2 examination has been cancelled. They plan to replace the November FRCS section 2 examination with a revised section 2 examination. The format of the exam will be the same but due to the need for social distancing the delivery may be different and has not yet been decided. It is hoped the examination will remain face-to-face but contingency plans for remote delivery may be developed. JCIE cannot guarantee all applicants will be able to sit the exam in November. If capacity is reduced trainees due to complete training (Certificate of Completion of Training - CCT) imminently will be prioritised. It is likely examinations will go ahead in November in different locations than previously published.
Q: Will there be a BAUS FRCS revision course for section 2 this year? Will those taking the exam in November be prioritised and what form will it take?
A: Yes. This is currently planned to run on 30 September but this may change. Anyone who was booked on the March 2020 course will be given first refusal for a place on the September course. There is ongoing discussion as to exactly how best to run the course while adhering to social distancing rules which may still be in place. The course organisers are expecting to double the number of candidates for the 2021 course and are looking at ways to meet this demand.
Q: Can I still claim study leave reimbursement from a course that has been cancelled?
A: Health Education England (HEE) asks that you first contact the course organisers directly. Where refunds are not possible, evidence of the course being non-refundable should be included in the claim, and “HEE will cover the cost to ensure no trainee is out of pocket.” Please contact your guardian of safe working and local British Medical Association (BMA) team if you are encountering difficulties.
Q: Can I apply for study leave during this time?
A: Yes. Applications for study leave in the future should be accepted. HEE asks that all parties are flexible, and that approval is “subject to the need to maintain NHS services.”
Q: I have not completed one of the essential courses. Can I still CCT?
A: It is highly likely this will not impact your CCT. “ARCP panels can take a pragmatic view over recommended courses”, “as long as the trainees’ portfolio shows they will be safe to practise.”
Trainee progression and ARCP
Q: I should finish my training this year: will I be able to CCT?
A: Yes, but only if you have met the necessary standards outlined by the Joint Committee on Surgical Training (JCST) and the Urology Specialty Advisory Committee (SAC). If you have not completed all of the requirements but were expected to achieve them before the COVID pandemic, your consultant supervisors feel you are safe to progress AND you feel ready to progress, you can CCT. You can choose to do an additional six months of training if you do not feel ready.
Q: Can I CCT without the exam?
A: No. It is an essential requirement for progression to consultant. Trainees who were due to sit section 2 in May will be required to extend their training to allow them to complete the exam.
Q: Can I still take my grace period?
A: Yes. You can take a grace period of six months and an additional six months of training if you feel you need this.
Q: How does the Annual Review of Competence Progression (ARCP) process account for the COVID-19 disruption?
A: SAC advises ARCP should still go ahead for all trainees. There will be no face-to-face element for the trainee. The panel will be reduced and may be remote. The Educational Supervisor Report is key evidence. A new code, outcome 10, has been created for those trainees who were progressing at the expected rate but due to COVID-19 now require or would like additional training time of up to six months.
Q: How much additional training time can I have?
A: Any additional training time necessary will be reviewed at the following ARCP. No specific timeframe has been set by HEE but Urology SAC has suggested three to six months.
Q: I have been told I am not having an ARCP?
A: Trainees at critical progression points should be prioritised, but in those areas where it is not possible to do an ARCP due to COVID-19, the trainee can still progress; the ARCP outcome Code N13 will be used. There should be an early ARCP to set action plans as soon as is safe to do so.
Q: At ARCP can I still get an outcome one?
A: Yes. If your portfolio in the period before COVID-19 is unsatisfactory this is still possible.
Q: Has training been paused?
A: No. The effect of COVID-19 is highly variable from hospital to hospital. Some trainees may still experience training opportunities which they should continue to log as normal. ARCP will be used to discuss and decide on whether additional training is wanted or needed.
Q: When will the new curriculum start?
A: The new curriculum has been approved, but due to COVID-19 the start date has been delayed to August 2021.
Q: Will we rotate placements in August / October?
A: As it stands there are no plans to delay rotation progression, but this may change depending on the needs of individual hospitals.
Less than full-time trainees (LTFT)
Q: I have returned to full-time training to help with the demand for additional doctors, can I return to LTFT?
A: Yes. There should be no pressure to return to full-time work. This depends on individual circumstances. Where a trainee chooses to increase their working hours, a return to LTFT should not be questioned.
Q: Can I still apply to be LTFT?
A: Yes. “HEE will continue to both honour existing arrangements and accept new LTFT applications.” If workforce pressures were to change this statement may be retracted. OOPT and fellowships
Q: My current out of training programme (OOPT) has been stopped and I have returned to clinical work, can I get that time back?
A: HEE have stated that “unfortunately extensions will not be granted unless there are exceptional circumstances.” We advise you discuss this early with your supervisor and training programme director (TPD).
Q: Can I still go on my out of training programme in August / October?
A: Yes. If the programme has already been approved. This may vary depending on the programme and needs of the hospital.
Q: Can I still apply for an out of training programme?
A: Not in England, where all new applications have already been held. In Wales, you can still complete the application forms. Scotland and Northern Ireland have not released official documentation on this issue.
Q: Can I attend my fellowship?
A: As fellowships are post-CCT training, this is not the jurisdiction of the Urology SAC. This will be very dependent on the department you are going to and whether it is national or international. We advise close communication with your TPD and incoming department.
Q: My rota has changed for COVID-19 and my pay has been reduced what should I do?
A: No trainee should be financially impacted by COVID-19. Even if rota hours are reduced this should not be reflected in your pay. If this is the case, discuss this locally with your Guardian of Safe Working and if no resolved satisfactorily, then consider early discussion with your regional BMA representative.
How have the new urology ST3 trainees been recruited this year?
The Urology National Selection interviews were due to occur just as the spread of COVID-19 was rising in the UK (26-27 March). A task group led by HEE, Health Education and Improvement Wales, Northern Ireland Medical and Dental Training Agency (NIMDTA), and NHS Education for Scotland was established. These four main national groups made decisions they felt would be fair across all medical and surgical subspecialties. No face-to-face interviews would be possible. Virtual interviews could further stretch staff in the pandemic and was not a validated method. Portfolio self-assessment scores had already been submitted in advance of the planned interview, which ordinarily would be validated at interview. This has been used as the key source of information to rank urology candidates and assign training positions. These were seen by the four bodies as honest representations of the applicants’ experiences. No further amendments were allowed (other than to correct an accidental over-scoring). It is unclear how candidates with identical scores were differentiated. Although converting all training numbers for 2020 into single year locum appointment for training (LAT) ST3 posts was considered, the disruption this would cause was not felt to be a satisfactory or a suitable option. The task force recognises that this process has been controversial; Association of Surgeons in Training (ASIT) and BSoT have released a joint statement voicing concerns about this method.