PYA

Your PYA should happen in your penultimate year of training, with plenty of time to identify any knowledge or skills gaps. Start thinking about it and getting it organised 18 months before your CCT date. Remember that you need to have 2 PYAs – one for GIM and one for Respiratory Medicine. Make sure HEE arrange both, which are likely to be on different days.

For PYA it is wise to leave one or two outstanding requirements that you can then arrange to do in your last year. Ideally have these booked when you go to PYA so that you can give them a list of outstanding requirements. They are then much less likely to pick something random and difficult for you to do. Of course this means you need to make sure you have done most of the things on the ARCP decision aid before PYA, so stay on top of it throughout training.

ARCP decision aid

Know the ARCP decision aids very well:

You will need to have completed all the required workplace based assessments, MCRs etc, and be signed off for all relevant procedures in both Resp and GIM. Some of the key features of the decision aid as you approach CCT are:

  • competence for all curriculum items (for both GIM and Respiratory) confirmed on the curriculum by both trainee, and educational supervisor
  • Passed SCE
  • 1 MSF in ST6 or 7
  • 1 patient survey in ST6 or 7
  • 1 QIPAT or audit assessment in ST6 or 7 for Respiratory and 1 in training programme for GIM
  • valid ALS
  • evidence of teaching competence and theoretical knowledge – teaching course recommended
  • evidence of research competence – higher degree or published papers + courses
  • leadership and management course
  • attendance at national/international meetings
  • register with RCP CPD online diary (app recommended)
  • 100 hours of external GIM CPD
    • it is wise to create a spreadsheet to show where the 100hrs come from, in addition to the evidence in your library and in your reflections
  • 1000 patients seen on the medical take – use the JRPCTB calculator to estimate numbers of patients seen
  • 186 outpatient clinics done

Other things not specifically highlighted on decision aid but still essential:

  • Evidence of training in safe sedation – this requires a course (eg Bronch training course in ST3) and formal signoff of your competency with a DOPS
  • Subspecialty experience in Pulmonary Hypertension, CF, Occupational Lung Disease and Transplant as per the JRPCTB guidelines
  • Integrated care – go on a home visit with the COPD community team and attend PR and write reflections
  • HIV –arrange a clinic visit in a HIV service and write a reflection. Make sure you include patients with HIV and Respiratory complications in your CbDs etc
  • Genetic and developmental lung diseases – should be covered in a regional training day, and in your CF visit/placement. Try to attend a transition clinic and/or joint immunology clinic and write a reflection/get a CbD.

Procedures

Check carefully that you have fulfilled the requirements for procedure sign-off. Ensure you select ‘summative, life-threatening’ where relevant:

Respiratory

  • Bronchoscopy: 2 satisfactory DOPS in ST3 and 4 then 1 per year ST5-7
  • Safe sedation: 1 DOPS specifically for safe sedation (in addition to those for Bronchoscopy)
  • Pleural ultrasound: Level 1 competence by ST5, maintained through ST6-7. Maintain a logbook throughout training even after level 1 sign-off.
  • Pleural aspiration: 1 DOPS in ST3 required, after this logbook evidence is fine
  • Chest drain: 1 DOPS in ST3 and 4, then logbook evidence
  • NIV competence: 1 DOPS in ST3, then logbook of NIV initiation, CBDs and/or reflections
  • Spirometry; Ed supervisor confirmation of competence (can just be signed off on curriculum)
  • Lung function interpretation: Educational supervisor confirmation of competence (can just be signed off on curriculum)
  • CXR interpretation: no specific requirements, but should have some evidence of competence eg supervisor comment

GIM

  • Knee aspiration – 1 formative then 1 summative DOPS by 1 assessor
  • DCCV – 1 formative then 1 summative DOPS by 1 assessor
  • Abdominal paracentesis – 1 formative then 1 summative DOPS by 1 assessor
  • Intercostal drainage for pneumothorax – 1 formative then 2 summative DOPS with 2 different assessors
  • Intercostal drainage for pleural effusion – 1 formative then 2 summative DOPS with 2 different assessors

NB there is a statement on the decision aid “If a doctor has been signed off as competent in a procedure during CMT or GIM stage 1, then provided they continue to carry out that procedure it should not require further testing.” In practice, it is wise to get a DOPS to prove that this competence has been maintained, but you should be able to go straight to summative DOPS, not bothering with formative.

Before each PYA

Remember that you will need to have separate Respiratory and GIM PYAs. Your assessor may look at your ePortfolio in advance, so make sure it is ready for review a month before PYA.

Prepare your ePortfolio

  1. Set up new folders within your personal library on the ePortfolio called ‘Respiratory PYA paperwork’ and ‘GIM PYA paperwork’.
  2. Ensure that the summary of clinical experience (SOCE) form is completed and uploaded to the above folder(s). SOCE form available on JRPTB website.
  3. Ensure that an up to date CV is uploaded to the above folder(s).
  4. Ensure that your ePortfolio is up to date so that the assessor can check your progress.
  5. Make sure any paperwork related to OOP is uploaded, including pre-approval of counting OOP towards training
  6. Upload a Form R as you would usually do for an ARCP
  7. Prepare a PYA presentation

On the day of PYA

You will receive an invitation to your PYA which will remind you of the forms you need to upload, as listed above. It will also ask you to prepare a PYA powerpoint presentation. This is not stated anywhere on the JRPCTB website.

The guidance from HEE is that the presentation should be:

  • 5-10 minutes in length
  • no more than 6 slides
  • detailing your experience on the relevant programme (so either Respiratory OR GIM, remember these are separate)
  • relating specifically to the sub-sections of the curriculum, your goals and any outstanding issues for the remaining period until your CCT date

 

Good luck!