Sign Off Process

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.

 

 Sign off assessments require two case videos that fulfil the following criteria:

1.      Full-length, i.e. non-edited and including port-insertion

2.      For two different cases, e.g. 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 the 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 may be present, but inactive, in theatre.)

 

Please note that each case video must be:
i)        Marked with the name of the delegate and the type of the operation performed (see Form B).
 ii)      Accompanied by a manually completed Form B (SIGN OFF GAS FORM) and a relevant hospital pathology report.

NB - Delegates are strongly encouraged to show the case videos to their trainers prior to submission.
Please mail both DVDs, along with the GAS Forms and the pathological reports to:

Melody Ni
Educational Manager – National Laparoscopic Training
Imperial College London
Department of Surgery and Cancer
10th floor, QEQM Building
St. Mary's Hospital, London W2 1NY 
Telephone: 020 331 27657       
Email: z.ni@imperial.ac.uk

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.

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 no fewer than 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.

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.

Depending on the feedback given to each case, a delegate will receive one of thefour 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.

 

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. They can either continue training with their index training centre, or, should they wish, embark on further cases at a different centre. Training would then continue until a time again when both trainer and trainee are happy to enter the submission process.

 

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. Click on AUDIT DATA (to be uploaded shortly) to view the template document which needs to be completed, defintitions are outlined on a worksheet within this document.

 

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