Lapco  

Sign Off Process

NATIONAL TRAINING PROGRAMME - SIGN OFF PROCEDURE
It is the requirement of an NTP Trainer to make a recommendation to the National Programme Manager by email (laura.langsford@nhs.net) when an NTP Trainee has reached the required level of competence who will then be invited to undertake the the ‘Sign Off’ assessment.  As a guide, we recommend that Trainees should undertake 20 'completed' supervised cases evidenced through the GAS forms recorded on the Lapco web site.  However, a Trainee can still be invited to sign off if less cases have been undertaken if the trainer feels that a satisfactory competence level has been achieved.  We highlight that trainees are encouraged to submit DVDs of training cases during their training period to Imperial College, which will enable a trainee to receive an independent assessment of their progress with assessor feedback.

1.0 SIGN OFF REQUIREMENTS
The trainee will be issued with the following letter: VIEW: SIGN OFF INVITATION LETTER
This states that the Trainee should p
rovide two case DVDs that fulfil the following critieria:
1.Full length, ie non-edited and including port insertion
2.For two different cases, eg one right-side resection and one left side resection
3.From operations done without supervision (This means a trainer should not be scrubbed, be holding a camera or coaching the trainee at any point in the case. A trainee will be asked to resubmit their material if any of the above is identified to any extent during the procedure. The trainer maybe present, but inactive, in theatre).

2.0 SIGN OFF ENCLOSURES
Each DVD should be marked with the name of the delegate and the type of operation performed, and sent to Dr Melody Ni at Imperial College, London with the following:
1. A manually completed GAS form for each case:VIEW: FORM B GAS FORM
2. A pathology report for each case
3.A copy of the patient trust consent form
4.A Cheque for £450.00 if submitted after 28th February 2013 made payable to "Imperial College London" - See below

3.0 TIMING/PAYMENT
Sign Off DVDs must be submitted to Melody Ni at Imperial College by 28th February 2013 to be assessed under the funding for the Lapco programme which comes to an end in March 2013. DVDs can be submitted for a period of up to a further 12 months to February 2014, and will still be assessed through the programme, but a charge of £450.00 will be made for a trainees submission. Cheques should be made payable to "Imperial College London" and need to be sent with the submission.

4.0 RECOMMENDATIONS
We strongly recommend the following:
1. Trainees sign off DVDs, GAS forms and pathology reports are reviewed by your trainer before they are submitted for the sign off assessment
2. Trainees view the full length DVDs below of a right hemicolectomy and a sigmoid colectomy which have been submitted by NTP Trainees and successfully been signed off through the assessment process.
3. Trainees view the series of short clips a& commentry available at www.lapco.nhs.uk/sign-off-feedback.php relating to unsuccessful sign offs to assist with case selection

5.0 DVD PRESENTATION/FORMATS
All DVDs should be clearly referenced with the trainees name on the box, and the DVD itself with the type of operation, please only lable the DVDs using a permanent marker on the DVD cover. Stickers can cause problems in reading the DVDs. DVDs should be sent in one of the following formats: Quick Time, MPEG, MOV, FLV, AVI

6.0 DVD SUBMISSIONS
NB - Both DVDs should be submitted at the same time and sent to :
Dr Melody Ni - Education Manager
Surgical Skills Programme
Imperial College London
Academic Surgical Unit
10th Floor, QEQM Building
St Mary’s Hospital
London, W2 1NY
Contact: 07788270398
E
mail: z.ni@imperial.ac.uk

7.0 THE ASSESSMENT PROCESS
Upon receipt, the DVDs will be made anonymous and passed on to two independent assessors (National Training Programme Trainers) who will report to Imperial College on their recommendation of competency for ‘sign off’. DVDs are assessed using the L-CAT (Laparoscopic Colorectal Assessment Tool) to view this document go to www.lapco.nhs.uk/LCAT-forms.php.  It is anticipated that the sign off procedure will take in the region of 6-8 weeks from the reciept of submission of DVD material, but this will depend on the turnaround of the assessors. The sign off decision will be reported to the National Clinical Lead who will inform the trainee & training centre in writing by email and hard copy correspondance of the outcome recommendation for ‘sign off’ which will be accompanied with a copy of the assessment feedback from the DVD material submitted. Some Frequently Asked Questions (FAQ) about the sign off assessment are listed below, underneath the DVD examples from Trainees with successful sign off assessments.

8.0 EXAMPLES OF SIGNED OFF DVD MATERIAL
SIGMOID COLECTOMY
See below to view a real time DVD that successfully passed sign off for NTP Trainee Qamar Zaman from Queen Marys Hospital, Sidcup, Kent who trained through NTP Trainer Amjad Parvaiz at Portsmouth.
Click 'Play' button to play:

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RIGHT HEMICOLECTOMY
See below to view a real time DVD that successfully passed sign off for NTP Trainee Roger Brammer from Pennine Acute Hospitals NHS Trust, Bury, who trained through NTP Trainer Dominic Slade at Salford Royal, Manchester.  
Time: 1hr 25 Mins

 

Imperial College Education team have prepared some edited clips of DVDs that have been submitted by trainees that have successfully passed the Sign Off Assessment process.  Click on the sections below to view as follows:
1. EXPOSURE - Duration 3' 55"

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2. VASCULAR - Duration 1hr

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3. MOBILISATION - Duration 34' 24"

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4. ANASTOMOSIS - Duration 12' 55"
 

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9.0 FREQUENTLY ASKED QUESTIONS ON SIGN OFF

Q.How do I enter sign off?
To be eligible for sign off, delegates should have reached a level of performance that is deemed safe by their trainers. Usually, twenty supervised operative cases as a guide are the minimum required to reach this level, but this can be less as long as trainer recommendation has been provided that the required standard of competency has been achieved. Once an agreement has been reached between the delegate and the training centre to enter into the sign off process, the trainer or training centre should inform the National Training Programme Manager (laura.langsford@nhs.net) having confirmed this delegate is eligible, Lapco will then issue an invitation letter to the delegate, and inform Imperial College.
  
Q.What happens after the submission?
The material is anonymised and then duplicated by Imperial College, and then a copy of both cases is passed onto two independent assessors. The two assessors are selected from the cohort of active Lapco trainers. They will be from different training centres from each other and also from the trainee’s centre. The assessors are instructed to use a structured assessment form (LCAT) to evaluate each case. They are also required to grade the case difficulty from 1 (very easy) to 6 (very difficult), give an overall impression of the performance on the case (see next section), and provide additional written feedback whenever necessary.

Q.How is the Sign Off decision made?
Each trainees DVDs are sent to two seperate assessors, which will produce a total of 4 assessments. Using the assessors
L-CAT Form, each case receives one of three possible verdicts: “Needs Improvement”, “Safe performance”, or when crucial steps or information are missing, “Insufficient evidence”. The overall decision is based on a majority rule. A sign off is successful if “Safe performance” is demonstrated in 3 out of 4 assessments.  In the circumstance where the assessments reach a draw (e.g., two counts of “Needs Improvement” combined with two counts “Safe performance”, or one count of “Needs Improvement”, one count of “Insufficient evidence” combined with two counts “Safe performance”), a third assessor is engaged. In such cases, the sign off is successful if both cases are judged as “Safe performance demonstrated” by the final assessor.

Q.How do I learn the sign off outcome?
Once all the sign off assessments are completed and returned to Imperial College, the feedbacks are transcribed and an overall decision made based on the majority rule stated above. The outcome is passed onto Lapco, to be scrutinized by the National Clinical Lead, who will then inform the relevant parties with the final decision.

Q.What are the possible sign off outcomes?
Depending on the feedback given to each case, a delegate will receive one of the four possible recommendations:
1.      Successful sign off
2.      Resubmit 1 DVD (left or right)
3.      Resubmit 2 DVDs for both cases (left and right)
4.      Undertake further training and await confirmation from the trainer until they recommend that you undertake the sign
     off assessment again.
 
Q.What happens if my sign off is not successful?
If after the sign off assessment the opinion is that a trainee requires further improvement, the trainee will decide with the National Clinical Lead how they would like to proceed. Training would then continue until a time again when both trainer and trainee are happy to enter the submission process.
 
Q.What happens if my sign off is successful?
Delegates are requested to keep record of their surgical outcomes and training activities for 12 months post sign off and share, in due time, such information that will allow invaluable insights into the value of supervised training. Please go to the "Post Sign Off Requirements" page of the web site or click on the link for further details www.lapco.nhs.uk/post-sign-off.php
Any queries on the Sign Off procedure should be directed to NTP Programme Manager
Laura Langsford Email: laura.langsford@nhs.net