What is the Clinical Fellowship?
Cosmetic surgery is a specialty exclusively dedicated to the enhancement of appearance through surgical and medical techniques directed to all areas of the head, neck and body.
Cosmetic surgery is performed by a variety of doctors of different backgrounds, including plastic surgeons, general surgeons, ENT surgeons, gynaecologists, ophthalmologists, oral and maxillofacial surgeons, dermatologists, and physicians from other fields specifically trained in performing cosmetic interventions.
Cosmetic surgery is currently learned through continuing professional education (CPD), individual training, and experience. There are no formal means for young surgeons to get accredited training in a structured manner. For this reason, the British Association of Body Sculpting (BABS) is a professional body devoted to supporting the Continuing Professional Development (CPD) of doctors who desire to specialise and continue their developing their knowledge in body sculpting and cosmetic surgery.
The BABS Clinical Fellowship is an educational clinical programme dedicated to post-graduate education in cosmetic surgery for young surgeons wishing to obtain practical skills in this field. The BABS is focused on patient safety and client satisfaction through doctors’ education and training. The association’s principal objectives are to foster, promote, support, augment, develop, and encourage the science of cosmetic surgery and art of body sculpting.
In order to achieve its aims, the BABS will create and sponsor two UK-based fellowship posts, and the BABS’s Education Committee (EC) will oversee the training of two doctors in body sculpting and cosmetic surgery. The EC will monitor and assess the Programme’s compliance with the educational requirements set by The Academy of Medical Royal Colleges, GMC, PG Deaneries and the RCS.
Purpose of the fellowship and background information
Medical education and training in the UK has a specific structured. After completing medical school, and getting a license to practice, a doctor enters into two-year foundation programme (FY 1 and 2).
After completing FYs, a young doctor will follow specialty or general practice training, lasting five to eight years. This type of training, based in NHS hospitals, is service oriented, and it is overseen by Local Education and Training Boards (LETB) in England, NIMDTA in the Northern Ireland and PG Deaneries in Scotland and Wales.
The current curricula set by the Royal Colleges does not make any provision for training in cosmetic interventions. Post-graduate, NHS-based training prepares doctors to treat illness and injury, and aesthetic considerations are not supported by any of the standard training programmes. Some aspects of cosmetic surgery are included in the training of plastic surgeons, however their main focus remains on reconstruction and not on aesthetic outcomes. As a result, doctors providing cosmetic interventions can have a wide variety of backgrounds. This means that there is a lack of common standards and processes, and significant ambiguity in the application of a uniform code of practice such as that stipulated by the BABS.
In the process of the review of regulations of cosmetic interventions in 2013, Cosmetic Surgery Inter-specialty Committee (CSIC) of RCS and Expert Panel for The Review of Non-Surgical Cosmetic Interventions of Health Education England (HEE) recommended standards of training and competencies for health care professionals providing cosmetic interventions.
General Medical Council (GMC) is developing a system of credentialing that may be appropriate for cosmetic surgery and interventions for doctors practicing in the field.
The BABS has been involved in all the consultation processes conducted by Cosmetic Surgery Inter-specialty Committee of the RCS (CSIC), the Expert Panel for The Review of Non-Surgical Cosmetic Interventions of Health Education England (HEE), and the specification of competencies for health care professionals providing cosmetic interventions proposed by the General Medical Council (GMC). As a result of the process, the BABS has started the initiative of the Clinical Fellowship Programme (CFP, the Programme) in cosmetic surgery and body sculpting.
The result has been the establishment of this Clinical Fellowship Programme, intended to provide well-documented, structured training for specific cosmetic interventions techniques in a supervised training environment.
2. Application for the Clinical Fellowship
Requirements for the application
To apply for training in the BABS Clinical Fellowship Program a doctor must meet following criteria:
- Possess a medical degree
- Have full GMC registration with a license to practice, current appraisals and revalidations
- Certificates of Completion Training (CCTs) with at least 2 years-experience in a surgical specialty
- Membership of a Royal College or equivalent qualification
- Medical Indemnity Insurance
- ILS or ALS qualifications
- Satisfactory employment references
- BABS Associate membership
- CRB clearance
- Hepatitis B immunity and an occupational health clearance
The process for the selection and appointment of candidates is described here:
- Posts are advertised in professional publications
- The Director of the Fellowship Programme will be responsible for evaluating and shortlisting candidates
- Best practices will be followed to ensure non-discrimination in the candidate selection process
- A panel approved by the Education Committee will interview each candidate
- Aptitude for surgery and personal qualities will form the basis of a scoring system
- Training placements will be allocated to each of the successful candidates
3. Duties of a Clinical Fellow
Clinical fellows (Learners) are responsible for their own learning and achieving the learning outcomes required by the curriculum. They should take part in structured support and learning opportunities. Learners must make their first concern the care of patients, and must not compromise in any way patient safety and care through the absence of adequate performance, health or conduct. Learners have a duty to follow the guidance in the GMC’s Good medical practice and expect to suffer appropriate consequences if they fail to do so.
- Learners must follow professional standards, as set out in the GMC’s Good medical practice as well as other standards and guidance that uphold the medical profession. Learners must raise ethical concerns if any arise during their training or assessment.
- Learners must to take responsibility for looking after their own health and wellbeing.
- Learners must have non-discriminatory attitudes towards colleagues and patients.
- Learners must demonstrate progress in achieving the educational goals of the programme. This will be evaluated at regular staged assessments, as described in the curriculum
- Learners must show initiative, and proactively seek information about their curriculum, assessment and clinical placements requirements; they must take initiative in developing their educational portfolio.
- Learners must take financial responsibilities for the training or assessment activities not funded directly by the program.
- Learners must be open and honest about their prior knowledge and experience, about whether they have the appropriate skills and aptitudes, and about their dedication to the personal development needed to obtain these through the process of learning.
- Learners must be open to any learning opportunity, and be prepared to learn from multidisciplinary team members.
- Learners must be flexible in that training may be full-time or part-time, depending on circumstances.
- Learners must participate in educational and training activities appropriate to their curriculum or training program.
- Learners must participate in the regular, constructive and meaningful feedback on their performance, development and progress at appropriate points in their training program. They must demonstrate that feedback has been integrated into their work. Feedback can come from educators, other doctors, health and social care professionals and, where appropriate, patients and families.
- Learners whose progress, performance, health or conduct gives rise to concerns must accept support and guidance, where reasonable to overcome these concerns.
- Learners, if they fail to meet the required learning outcomes for the curricula, must accept plans for remedial actions or additional training, before they attempt repeat assessments.
- Learners, who are not able to complete their training, must make alternative career plans.
Appraisal and revalidation
Learners will need to undergo an annual appraisal. The appraisal will be facilitated by the RO associated with the program. Revalidation will take place every 5 yearly, as according to GMC guidance.
4. BABS Organizational commitment
All cosmetic interventions in the UK are offered in private healthcare settings. Currently, most cosmetic surgery and cosmetic intervention training is provided through paid private courses. These programmes are typically punctual workshops that do not benefit from a programme of structured accreditation and assessment.
For this reason, the BABS aspires to support the Clinical Fellowship Programme through a Fellowship Fund (FF) sponsored by BABS members and charitable donations.
The Clinical Fellowship Programme is a not-for-profit initiative, and a part of the BABS’ commitment to support education of young cosmetic surgeons in a structured and accredited manner.
BABS will endeavour to set up 4 CFP training centers in UK: 2 in the Midlands/North of the country and 2 in London area. These training centers will be based at the existing and established clinics of members of BABS.
The Clinical Fellowship will be designed for doctors post CCT. The CFP will run initially for 12 months with subsequent review of length of training requirements.
Each of the post CCT trainees will be working simultaneously at 2 geographically near centers to ensure enough clinical exposure in variable settings. The trainees schedule will be individually tailored to accommodate that need and in agreement with the Director of CFP and Named Clinical Supervisors.
The clinics wishing to become a training centre should have enough capacity and clinical workload to meet the training purpose. Not less than 100 various cosmetic surgical procedures per year should be performed on site.
The training centers (clinics) should be CQC registered and accredited for performing surgical procedures. GMC will be consulted for guidance on formal approval of the training clinics.
Training also might take place at various sites away from the base center but should be in the CQC regulated sites and where the Named Clinical Supervisor has practicing privileges and performs particular procedures the trainee is learning.
Facilities, personnel and training environment for CFP will need to meet GMC set standards (for example, see http://www.gmc-uk.org/education/27388.asp), and put patient safety as the first priority for CFP training.
The BABS has appointed an Educational Committee that is responsible to the BABS Board of Directors. The members of the Education Committee include the following roles:
- The BABS Director of CFP and Procedure Proficiency Program (3P)
- The BABS Director of Education and CPD
- A Chair of the Board of Examiners (who may or may not be a BABS member)
- BABS’s Clinical and Education Advisers
- A lay member representing patients
The Education Committee will oversee:
- The setting of acceptance criteria for the Clinical Fellowship and oversight of the application process
- Managing and allocating the Fellowship Fund
- Assessing and approving educational facilities
- Collaboration with the Royal Colleges, the GMC and Local Deaneries/LETB
- Approve and appoint Named Educational and Named Clinical Supervisors in cooperation with LETB.
- Oversee the educational curriculum of the CFP
- Approve the system of assessment of educational progress and outcomes (tests and assessments).
- Approve the final certification of completion of training
The Education Committee shall meet every three months to evaluate the progress and strategies of the CFP, and will assess reports of the Named Educational and Clinical Supervisors on the progress of each of the trainees.
5. Certificate of Completion of the Clinical Fellowship
The certificate of completion of the Clinical Fellowship is issued at the end of training and on obtaining the following cumulative and summative criteria.
Over the length of the fellowship the clinical fellow must accumulate
- 25 Case Based Discussions (CBD) on cosmetic surgery cases
- 12 Mini-Clinical Evaluation Exercises (Mini CEX)
- 50 Direct Observation of Procedural Skills (DOPS)
- MSF from the colleagues and MSF from patients
The certificate of completion of the Clinical fellowship is based on:
- The fellow’s log book, including a summary of 50 of body sculpting and 50 of other cosmetic surgeries interventions
- Completed Audit summary
- Report from the Educational Supervisor ( based on summary of the quarterly reports from the Clinical Supervisors)