Training & Education
Education and Training Portfolio
The Pelvic Floor Society (TPFS) was established to support the specialist management of pelvic floor disorders. Education and training is central to this and the Executive Committee has a training lead (currently Jonathan Randall) and a trainee representative who is a dual appointment with the Duke’s Club (currently Annabelle Williams).
This portfolio has been produced to detail the Education and Training role of TPFS and how it can support trainees and consultants interested in developing a specialist interest in pelvic floor disorders. This will be covered in the following sections:
- Resources available for trainees.
- Supporting courses in Pelvic Floor Disorders
- Gaining further experience in Pelvic Floor Disorders
Whilst many of the resources have been developed for trainees in colorectal surgery, it is hoped that the current resources will have application for trainees in related specialties and allied health professionals.
Section 1: Resources available for Trainees
To support trainees developing an interest in pelvic floor disorders, TPFS has created a series of voluntary resources. These can be used by trainees to build a portfolio to demonstrate competence in knowledge, skills and performance in managing pelvic floor disorders. This is entirely voluntary at this time but it is anticipated they would be useful to an individual wishing to apply to, or establish, a unit providing specialist services. With increasing moves towards credentialing it is quite possible that demonstration of competence in specialist interests will become more formalised in the future.
The following are available on the pelvic floor society website:
The Intercollegiate Surgical Curriculum Project (ISCP) has produced a curriculum for trainees in Surgery including sections for colorectal surgery. These continue to be the foundation for Certificate of Completion of Training (CCT). TPFS have developed a curriculum along similar lines for trainees wishing to pursue a specialist interest in pelvic floor surgery. It is complementary to the ISCP curriculum but not a CCT requirement.
The curriculum follows a similar format to the ISCP. Each subject is detailed through Objectives- Knowledge- Clinical Skill- Technical skills
The following subjects are covered
- Assessment of pelvic floor function
- Constipation including obstructive defecation
- Rectal prolapse including solitary rectal ulcer syndrome
- Faecal incontinence
- Chronic Anorectal Pain
- Irritable bowel syndrome
- Anorectal Physiology
- Radiological Imaging of Pelvic Floor Disorders
2. Procedure Based Assessments (PBAs)
Work based assessments are provided for trainees in pelvic floor surgery to demonstrate training, and eventually competence, in procedures. They allow trainers to give feedback and it is anticipated a number of sequential PBAs can be used to show learning over time. Once again these are provided as a voluntary system to demonstrate learning and competence and are not required for CCT or job applications. However a trainee may wish to share them with subsequent trainers and potential employers.
The pelvic floor website currently contains the following PBAs:
- Laparoscopic Ventral Mesh Rectopexy
- Delorme’s Rectal Mucosal Resection
- Trial and Permanent Sacral Nerve Stimulation
- Sphincter repair
- Conservative Management
Example of a PBA: Sacral Nerve Stimulation
3. Logbook of Activities
A printable version of pelvic floor experience is available on the website. The following areas can be recorded in the logbook:
- MDTs attended
- Record of Procedures observed (inc Anorectal physiology, imaging and conservative management)
Electronic operative logbooks are widely available and trainees are also encouraged to keep a cumulative record of pelvic floor operations.
A completed portfolio can then be built to include:
- Posts Held
- Logbook of Operative Experience
- Logbook of MDTs Attended
- Logbook of Clinics, physiology sessions, radiology sessions, related clinics
- Copy of curriculum
- Work based assessments (eg DOPs, CEX, CBDs- available on the ISCP website)
- Procedure Based Assessments
- Record of courses and conferences
- Record of audits, research and publications produced
In the future these may help for certification that would potentially be provided by The Pelvic Floor Society, however at this stage the portfolio would be a supportive document for anyone wishing to pursue an interest in pelvic floor disorder.
Section 2: Supporting courses in Pelvic Floor Disorders
The Pelvic Floor Society runs a number of courses for trainees and also advertises courses that are likely to be useful to those with an interest in pelvic floor disorders.
ANNUAL CONFERENCE: This is hosted over 1-2 days in various locations across the U.K. Speakers are invited from a range of disciplines to discuss topical issues and there are often breakout sessions for radiologists and allied health professionals.
In 2017 and 2018 there was a very successful trainees day just before the main conference with a series of lectures and hands-on models for gaining operative skills. Feedback has been gathered from previous events in Bristol, Wales and Oxford to guide future events (1).
TRAINEES AND RESEARCH DAY: A separate single day national conference to allow trainees to present short papers and research in the field of pelvic floor disorders. Started in Bristol in 2016.
JOINT MEETINGS: Part of the ACPGBI annual conference programme is devoted to pelvic floor disorders and organised by TPFS. This will be advertised both on the TPFS and ACPGBI website.
In 2018 TPFS held its first joint conference with the UK continence society in Telford..
REGIONAL MEETINGS: Regional groups of Pelvic Floor Specialists have developed in parallel with TPFS but their meetings are now advertised on the TPFS website and TPFS provides logistical and financial support to these groups.
2. Regular courses in Pelvic Floor Disorders.
Several courses are run by senior members of TPFS. They are advertised on TPFS website and are a good opportunity for trainees to immerse themselves in the subject. Examples:
- St Thomas’ Endoanal Ultrasound course, London
- Pelvic Floor Dysfunction- from diagnosis to management. In depth course with hybrid animal models for operative skills. Cuschieri Skills Centre, Dundee
- Practical Skills in Pelvic Floor Surgery. In-depth course with animal models for operative skills. Poole
Advertising Pelvic Floor Courses
A variety of courses and conferences are advertised on the website including the UK and International Continence Society, The Royal College of Surgeons and bodies representing allied health professionals.
Section 3: Gaining further experience in Pelvic Floor Disorders
A number of peri/post CCT fellowships are advertised on TPFS website which offer significant exposure to pelvic floor disorders. Recent fellowships have been at Dundee, Leeds and St Thomas’, London.
Trainees are encouraged to consider the variety of exposure they will receive as well as operative numbers. Fellowships will vary in how much pelvic floor exposure is provided alongside other aspects of coloproctology and on-call commitments.
Trainees are also encouraged to consider using the resources in the above document to plan and record their fellowship activities with a nominated educational supervisor.
Short stay pelvic floor visits
TPFS is currently compiling a list of pelvic floor units and specialists nationally who would agree to be approached by trainees registered with The Pelvic Floor Society to spend a short period of time (likely 1-2 days) as an observer. A database of specialists and the exposure they can provide is currently being compiled.
It is anticipated that TPFS will provide a small number of travel bursaries to allow trainees to visit to these units. However trainees will be responsible for approaching the units and arranging the visits.
K. Gash; J. Randall; F. Carter; A. Clarke; M. Lamparelli. Training in pelvic floor surgery- time for a change in approach? Colorectal Disease (2014). 16: 207-209
Our mission is to improve standards of training and assessment in colorectal pelvic floor disease through delivering a quality assurance framework. We aim to achieve our goals by:
- developing with ISCP support a revised and voluntary PF curriculum - Click here for details
- develop a curriculum for pelvic floor investigation & conservative management - Click here for details
- developing voluntary workplace based assessments (see below)
- develop a voluntary competency sign off for Laparoscopic Ventral Rectopexy
- developing an e-portfolio
- development of a QA process for training courses and training centres
- ultimately move towards trainee portfolio certification
- development of a process of voluntary certification in anorectal physiology and endoanal ultrasound
- liaising with other key stakeholders the ISCP, relevant RCS, the speciality SACs, ACPGBI and Health Education England.
- recruiting a working group accomodating the various stakehoder representatives
- working closely with the QA & G chair
It is envisaged that these will serve as a tool for trainees to use over and above their CCT, to demonstrate a special interest in pelvic floor surgery. It will NOT be a requirement for the ICRP, GMC and to obtain your CCT. The whole process will be voluntary.
We will also move towards providing educational updates on this webpage as well as developing a library of presentations from previous conferences and videos/clinical presentations submitted by members. We also welcome members comments and positive suggestions.
Training Subcommittee Update & Recent developments:
The main focus of the committee’s activity in 2015/16 will be to liaise with the ISCP, T&E committee ACPGBI and the relevant SACs on curriculum development for a potentially new ATSM in Pelvic Floor and its components. This ATSM (currently aspirational) will provide you with the clinical foundation for managing patients with pelvic floor disorders and the development of a life long interest in the subject.
A curriculum in EAUS will become available and will involve credits from working through lectures on TPFS website & attendance at a course either St Thomas’, Sheffield or Birmingham. Click here for details.
Hosting further "bespoke PFS trainee days" where the focus will be on "interactive discussion"
- Exeter Feb 2015
- West Midlands in 2015
- Specialty Skills in Coloproctology Stage II RCS March 2015. Click here.
Training statistics for Pelvic Floor:
Of the 67 responding NHS Hospitals to the 2014 ACP Census, 104 surgeons reported having a specilaist interest in pelvic floor disorders: 39 have a "fully functioning" PF MDM and 38 run dedicated PF clinics. A total of 25 units offer SNS. 26 hospitals consider themselves to be tertiary referral centres. 14 units have PF research fellows whilst 6 units offer post CCT PF training. The number of consultant appointments in 2014 asking for a special interest in PF was 8.
As of January 2015 we will be considering establishing subspecialty training centers and PF training programmes throughout the UK as well as working towards setting up a number of PF fellowships. The success of these programmes will be assessed through the development of appropriate tools. This committee is also keen to establish a register of Pelvic Floor preceptors/mentors, clinical supervisors and trainees. Remember, his PF training is voluntary and is not a requirement for ICRP and the GMC
How will I register for training in pelvic floor?
Trainees should be seeking career advice from their educational supervisor, deanery programme director and once it has been arranged, the pelvic floor preceptor/mentor in their region. They should discuss their preferences and rotations within their region. SpRs will be expected to plan their specialist options during year ST6 which should be documented on their ARCP on conclusion of year 6. During year ST7 they should make arrangements for specialist pelvic floor training commencing at the end of year 7.
How will I register for subspecialty training?
Trainees should seek career advice from their educational supervisor and the pelvic floor subspecialty training programme director or pelvic floor subspecialist within their region.
Both SST and specialist pelvic floor trainees will be expected to complete workplace-based assessments contemporaneously, which demonstrate progression towards full competency in the skills required for signing off completion of training.
Trainees will be able to download generic mini-Clinical Evaluation Exercise, DOPS [summative and formative] and OSATs (objective structured assessments of technical skills) for ARP, ARUS, Haemorrhoidectomy, fistula surgery, sphincter repair, PPH, STARR, LVMR, SNS/PTNS
The ethos of TPFS e-portfolio will be to support trainees in their PF training, to facilitate the formative and summative assessment processes and ensure that trainees receive appropriate quantity and quality of training. The e-portfolio will be a log book for trainees to record and monitor their PF experience, demonstrate their performance, progression and competencies and to apply for TPFS "certification". You will NOT be required to submit this log to the RCS, ICRP or the GMC but your school and programme director may want to see evidence of your experience. Record your training in as much detail as possible, for your own benefit as well as for your PF Preceptor and local deanery.
The purpose of the TPFS e-Portfolio is to provide a format for:
- Recording previous PF experience
- Recording recent activity/training experiences
- Record PBAs
- Recording DOPS assessments
- Creating personal development plans
- Automatically creating performance data summaries
- Providing anonymous feedback on training received
Download Procedure based Assessments PBAs
- Laparoscopic Ventral Rectopexy
- Delorme's Rectal Mucosal Resection
- Temporary & Permanent SNS
- Sphincter Repair
- Excision Haemorrhoidectomy
- Endo Anal Ultrasound
- Conservative management
Anorectal physiology Training
Pelvic floor subspecialty trainees will be expected to receive training in anorectal physiology, biofeedback principles/techniques and endo-anal ultrasound as well as having a working knowledge of urodynamics. Trainees will be expected to attend a theoretical course, in addition to practical experience acquired through regular attendance at anorectal physiology and EAS clinics.
POP-Q measurement made easy
Chairman: Mr Jonathan Randall, Bristol [member ACP Education & Training committee]
- Michael Lamparelli, Dorchester [Member ACP E&T committee]
- Dorin Ziyaie, Dundee
- Jennie Grainger, (Dukes’ Club)
- Andy Williams, St. Thomas’
- Steve Brown Sheffield
- Oliver Jones, Oxford
- Mark Scott PhD (Queen Mary University London)
- Jane Dixon (Cambridge) POGP
- Tony Dixon, Bristol