skip to main content

High quality training at lower cost for the NHS

03 April 2019


An award winning way of training the surgeons of the future, started by pioneers at the James Paget University Hospital and University of East Anglia, is growing in national and international scope and has just been commissioned for a second pilot by Health Education England.
The blended learning programme uniquely gives trainee surgeons direct online access to teaching from experts across the UK, including renowned Professors in their field.  One of the most powerful features for trainees is the opportunity to share and learn from their peers through an innovative asynchronous learning system combined with a host of other resources to support their studies.
Two years ago, consultant surgeon trainers Professor Jerome Pereira, from the James Paget, and University of East Anglia (UEA) Professor Sam Leinster, assisted by James Paget surgeon Sue Down, launched the trial of an online programme for post-graduate medical education, to test if this could improve training and increase the expertise of surgeons across the UK.
The programme includes online lectures around operative procedures, discussion boards to critically pick apart best practice on real-world surgical cases and provides access to a range of expert opinions. Each activity is designed to enhance surgical knowledge and skills in a highly efficient way, making it easier for time poor junior doctors to supplement their understanding and hone surgical techniques.

Professor Sam Leinster said; “It is important that trainee surgeons understand and apply the basic principles behind the care of patients. This course will highlight these principles and will allow the trainees to discuss with a group of colleagues how they apply to exemplar cases. Each trainee will be challenged to formulate a management plan for the case, which they will be able to compare with the plan set out by experts in the field. Throughout the course, they will undergo formal testing of their decision-making skills.”

In addition to Professors Pereira and Leinster, Course Director Mr Raaj Praseedom, Consultant HepatoPancreatoBiliary & Transplant Surgeon at Addenbrooke’s Hospital in Cambridgeshire, ensures the high quality of the teaching team.
The new HEE funded course has a significant heritage.  At its inception, the blended learning programme in Oncoplastic Breast Surgery set up by Professors Pereira and Leinster in 2011 was the highest formal qualification in the specialism in the UK, with Colorectal Surgery and Regional Anaesthesia to follow shortly after.  The courses are now helping to train specialists from more than 25 countries, with China and African nations also looking to make use of the programme.
Prior to being shortlisted for best education team at the BMJ Awards in 2018, the collaboration picked up a Learning Technologies Silver Award in 2017 for ‘Best Use Of Blended Learning’, against tough competition from some well-funded organisations including AXA, Barclaycard, Waitrose and Transport for London. 
Health Education England (HEE) has commissioned the programme for a larger, national study following the success of the online pilot. From Friday, 5 April, over 100 surgeons will start training via the programme and Professor Pereira said students from all over the country would benefit from the expertise available.
“We’ve had some really positive feedback from the Presidents of Colleges across the UK, and from across the whole of the NHS, for the online training which supports the hands-on practical training that doctors receive. This blended learning has proved to be a high quality, more time efficient and more cost-effective method of teaching, and the new tailored programme has been enhanced following feedback from students on the initial trial. This means that each topic will be dealt with over two weeks, rather than one, extending the course from 10 to 20 weeks. For the first time it will include decision making on operative skills, with videos of operations being shown and surgeons having to make a choice about what they would do next, as well as anatomy and technique training to expand expertise.”
Professor Pereira would like to see the blended learning adopted nationally and can also see the benefits for training in other areas of the NHS, including nursing.
“We know that this blended learning works. It gives trainee surgeons the opportunity to study at the most convenient time for them, so this can be worked into their already busy schedule, and it allows access to top surgeons as well their peers who can provide all kinds of insights to help them develop their skills. This type of learning translates to other areas and we believe high quality training available nationally and internationally can benefit both medical staff and patients alike.”
HEE originally commissioned the development of the web-based educational course as a National Feasibility Study to assess the effectiveness of a new blended approach to training surgeons in the emergency general surgery curriculum with the ultimate aim of improving outcomes for patients with urgent surgical conditions.  Blended learning enables trainees to control both the pace and place of learning essential to their development.
Professor Pereira led the HEE and James Paget University Hospital (JPUH) funded National Feasibility Study, with the assistance of Professor Leinster, Sue Down, Andrew Simpson and Christopher Jones, and the support of the Royal College of Surgeons, East of England School of Surgery, NHS Deaneries and Training Programme Directors across the UK, between October 2016 and March 2017.
The randomised control trial assessed the delivery of the ISCP (Intercollegiate Surgical Curriculum Programme) emergency surgery curriculum for registrars who are starting their surgical training; they found that the flexible nature of online blended training improved access to formal education; that it freed up time for practical training and ensured access to comprehensive evidence based knowledge to underpin clinical practice.
The blended approach appeared to improve decision-making and critical thinking, with doctors demonstrating higher levels of confidence in managing clinical conditions.
The course has also been financially assessed and has been found to be deliverable at half the current spend for registrar training – giving strong potential for this to have significant financial savings for the NHS if widely adopted. 

Professor Pereira says the online training also provided evidence of engagement in formal education.
“The programme was designed to address the challenges of training junior doctors and has given us scientifically significant results. In a normal hospital teaching setting, there is often low attendance as junior doctors are committed elsewhere, but this is a wasted resource. Now one tutor can teach many students online – it’s a win-win in terms of efficiency and cost effectiveness and students get access to consultants who are experts in their field.
“Advances in medical knowledge mean there is a constant need to provide updates on best practice in all specialities and the internet is an effective and flexible platform to deliver this. The course builds on our existing model of interactive learning to fit in with clinicians busy working patterns.
“I believe this approach will improve junior doctor training – ultimately improving the quality of care given to our patients.”


Professor Pereira with the Learning Technologies Silver Award.