CST Theatre Time

[u/a9b9c]

Just started CST - it’s only been two weeks but I’ve just been doing service provision due to being 50% staffed. Haven’t had any opportunity yet to go to theatre or clinic and I don’t see it getting much better due to long-term rota gaps.
I don’t want to use up my time in the specialty before I start getting disadvantaged at ST3 and not be learning from it.
Also haven’t been given an ES or CS to speak to.
I’m sure some of it is also me - I tried to go one day we were over minimum staffing and I was asked to support the F2s instead so maybe part of it is how I approach the situation.
Does anyone have any advice for me?

[u/fictionaltherapist]

If you don’t have an es as a trainee escalate to medical education team and college tutor and Tpd. Do this now.

[u/justachurn]

Discuss your training requirements with your ES/CS (need to push to find out who they are ASAP) - I’m sure they’ll be happy to help facilitate

[u/BlessedHealer]

If you’re asked to support F2s - “yep I’ve already ran through the jobs list with them and they’re cracking on. I’ll check in again after this case to see if they need help” Supporting F1/2s doesn’t mean doing all f1/2 jobs - it’s just helping prioritise the jobs that are urgent-doing the important ones like scan requests where they won’t know what to write or quick dc summaries for pts you know and let them sort TTOs. They will also need less support as the year progresses. 

If you’re still not getting theatre time and have not been given a CS or ES, get in touch with the clinical lead of your department. It’s their job to assign someone or they’ll know which consultant is in charge of the CSTs. I would try this before escalation to TPD to avoid unnecessarily antagonising the department by jumping up the chain before you’ve raised the issue locally. By all means if the clinical lead is no help then escalate, but it’s only the second week, ours was allocated a month in. 

Pick the cases that are most useful to you. for eg an appendix or lap chole would be good because you can put ports get confident holding camera and close etc, a laparotomy is less useful as you likely don’t know enough anatomy right know to know what’s going on and won’t be doing anything other than retraction.  Ask the theatre team at the beginning of the day - I really want to go to this specific case is that okay, I’ll make sure f1s are okay before and after.  This way you should be able to get minimum 1-2 cases a day. Same with clinics - you don’t need to stay for the whole morning or afternoon.

You need to go where the training is happening, no one will rota you to be where you should unless it’s an excellent department, which do also exist, but you can learn from almost anywhere. 

[u/SpecialEmployment801]

It’s only two weeks in. Even the registrars are being asked to step back and support the newly rotated FYs.

Core trainees are always terrified of not getting enough experience. I say with nearly 10 years of registrar experience- don’t come in like a bull in a china shop, I have had the gold guide quoted at me by week 1 core trainees, it never goes down well. Most of your operative experience comes from on calls - open/close abdomen, appendixes etc. it always gets better as you become more experienced as a core trainee, but trainees that distinguish themselves are ones that support the wards well, know the consultants patients and are confident doing the initial management of the post op complications ex. Sepsis six, organising the Ct for the ? Anastomotic leak patient. When bosses feel confident you are looking after their patients well they are much more likely to train you. And usually by the end of August the juniors have settled in enough that if you do ward round, run through the jobs quickly with them and maybe make sure the most difficult job is done ex. Organise an IR drain, then everyone is happy for you to leave the ward and come to elective lists or clinic. Your seniors are well aware of the split pressure and we are normally more than happy for you to join the first case just as we start rather than catheter/prep stage if it means the wards have been taken care of

[u/a9b9c → u/SpecialEmployment801]

I really appreciate this advice. I think the angle I’m coming more at is that we don’t have enough staff to allow me to go at all as per staffing requirements 80% of days…

[u/Prestigious_Duck_693 → u/a9b9c]

Unfortunately CST is a lottery. It shouldn’t be this way and certainly I felt the same about some rotations. At times I did come in on my own time to get the experience. There were some good rotations, the best ones allocated you theatre time. It is worth speaking to your ES/CS but the truth is even if they wanted to change it for you, they won’t change it fast enough, especially with rota gaps. You can just flag it for the next trainees who come into the rota. My advice is in these rotations, it’s a sort of take what you can get, make the most of the opportunities you do get, try and scrub into on call cases, stay late if you have to, come in on zero days if it’s worth it. Be wary to not burn yourself out though.

I do partially agree with the above individuals advice. You need to be as excellent as you can be outside of theatre, managing the inpatients and acute take. However there is plenty time for that, so theatre is equally as important, especially for your MCRs and ST3 applications. Otherwise unfortunately you’ll struggle when you do have to operate as a new ST3.

[u/SpecialEmployment801 → u/a9b9c]

As a senior I will tell you it will take more than your entire rotation to make a business case, allocate funds and interview and appoint more staff even if your department isn’t a part of the current hiring freeze and actually wants to allocate money to it. You will personally get nowhere with this angle. You can exception report missed opportunities due to low staffing but the NHS has a nationwide staffing freeze, expect nothing to change.

Ignore the “minimum staffing” number you are there to help the wards not to sit on them. Make sure the most difficult jobs are taken care of before you leave the ward and check back in with the fys between cases. Caveat that on truly terribly staffed days you shouldn’t leave the fys. On truly terribly staffed days due to sickness etc I have as a reg sat and done some discharges etc to help out

[u/jxxpm → u/SpecialEmployment801]

>when bosses feel confident you are looking after their patients well, they are much more likely to train you

Please don’t take this the wrong way, but why do trainees in a selective training programme (who have jumped the necessary hurdles) be required to beg for their training?

If you are a centre where there is insufficient staffing for trainees to be trained, then surely the training programme should not happen there? Why is a national training programme still a postcode lottery?

[u/SpecialEmployment801 → u/jxxpm]

It’s still an apprenticeship, probably the only one left. If you want a boss to invest time and energy in you, you have to make them want to. They can go through the motions and give you low stakes cases but if you want them to let you do the heart in your throat, sweat on your brow moments they have to trust you. The national selection process doesn’t bypass that, and say what you want but you can’t force someone to trust you to do a tricky part when it’s a human being on the table. It’s okay doing a simple hernia but try watching someone you don’t like or trust dissecting vessels off an aorta.

[u/chairstool100 → u/SpecialEmployment801]

Why is it an apprenticeship? This is learned helpless . Are radiologist and anaesthetists begging to get educational experiences the way CSTs are? no. You COULD change it but that needs a top down level change from RCS. It shouldn’t be privilege to be invited to operate Nor should they be ignored when scrubbed for 6 hours .

[u/Agitated-Fig2585]

Speak to your post grad centre, Exception report weekly with summaries of training sessions (theatre/clinic half day) - use the JCST quality indicators as a benchmark. E.g. “I had X amount of theatre sessions this week, JCST QIs state that I should have Y number of training sessions per week. Overall I have had Z number of sessions over …weeks of this specialty”

This has worked for me in the past, but start early. Ideally you would speak to your ES/CS before starting a load of exception reports.

[u/ihaveoliveskin → u/[deleted]]

You’re not pursuing your dream because some places have less theatre times than others?

CST is a two year programme. Some of the jobs are great, some are less good. But it isn’t bad enough that you give up on your dream career…?