BSUG Surgical Mentorship Scheme

This scheme is designed to guide training in surgical procedures currently subject to high vigilance scrutiny in the NHS. The scheme includes non-mesh continence surgery (namely colposuspension and/or autologous fascial sling) and vault prolapse support through the placement of abdominal mesh (sacrocolpopexy). It has been supported by the EQAC (Education Quality Assurance Committee) of the RCOG.

It is intended to be completed by consultant gynaecologists who are members of BSUG and who wish to (re)introduce one or more of these procedures into their practice for primary stress urinary incontinence or incontinence. The scheme is also open to consultant Urologists who are members of BAUS and wish to train in non-mesh continence surgery. Successful completion will provide a clinical foundation to offer these procedures for women with stress urinary incontinence. To join BSUG, please apply here

Practitioners should gain the approval of their Medical Director before commencing training. They should demonstrate a commitment to providing this type of care as part of a comprehensive urogynaecology service, which will include:

Evidence of appropriate training in urogynaecology, and/or laparoscopic urogynaecology (including but not exclusively Vaginal Surgery and Urogynaecology ATSM, Subspecialty training or laparoscopic urogynaecology module) or equivalent training in female urological conditions
An adequate ongoing case load
MDT working
Recording of procedures for continence and prolapse on the BSUG or BAUS database and national registry as they are introduced into clinical practice.
Evidence of review of outcomes and complications for Urogynaecological/ female urological procedures.

Registration and logbook:

Clinicians wishing to undertake this training are recommended to follow the below mentioned steps in sequence:

Seek agreement for undertaking training from their employing trust’s Medical Director
Identify a Mentor: This is by local arrangement with an appropriately experienced clinician.
It is the responsibility of the clinician wishing to undertake training to approach the Mentor to request training
All mentors must be approved via the BSUG mentors framework and be on the approved BSUG list
Agreement to train a clinician using this scheme is at the discretion of the Mentor. Factors such as previous experience of the clinician, geographical location and capacity of the Mentor to deliver the training will be taken into account and the Mentor may decline the request.
Complete online registration form here
On receipt of the registration form, BSUG will email the clinician and mentor confirmation of registration and a logbook for the surgical training

Training:

Attend relevant training courses/workshops, including a cadaver course, to gain hands on experience as agreed with mentor.
Attend the Mentor’s theatre lists and assist at these procedures.
Arrange procedures on their own theatre lists to be performed under the supervision of the Mentor. The Mentor will visit the host unit (if different to their own) to assist the clinician in (re)training and to ensure the learning objectives have been achieved.
Keep a log of all procedures and complications
BSUG assessment tool can be utilised by the mentee
The relevant sections of the log book are completed and signed off
BSUG advises Mentors to undertake regular progress reviews throughout the training scheme. If progress is inadequate, it will be the Mentor’s decision whether to discontinue training.
On completion of training, email a copy of the logbook to BSUG here.
A certificate confirming the member has completed the scheme will be issued by BSUG, however this cannot be used as evidence of competency in the procedure(s). The original training record completed by the clinician and Mentor will provide the evidence of training and competency.

*The Mentor is an experienced surgeon (gynaecologist/urologist) who has been signed off to perform these procedures by their own Medical Director or otherwise approved. The Mentor may act as preceptor and proctor during the training period, depending on local training arrangements, as defined below:

Preceptorship involves the consultant gynaecologist or urologist on the training program being trained by the preceptor in a setting where the preceptor has the primary responsibility of patient care and outcome.
A Proctor observes and guides the procedure carried out by the consultant gynaecologist on the training program, and assists if necessary. Here, the consultant gynaecologist or urologist on the training program is primarily responsible for patient care and outcome.

Learning outcomes of the mentorship scheme:

To be able to assess patients considering primary surgery for stress urinary incontinence or vault prolapse surgery
To be able to counsel patients who are suitable to be offered stress incontinence surgery or vault prolapse surgery with regards to alternatives, benefits, risks and obtain consent.
To be able to work within a dedicated continence multidisciplinary team with regular meetings.
To understand regional referral pathways for complex and recurrent cases.
To understand clinical governance procedures and enter outcomes onto database and review complications
To be able to use evidence-based guidelines and write new guidelines when needed.
To have a thorough knowledge of the anatomy and acquire the necessary surgical skills to deliver safe surgical care
If registering for mentorship in a non-mesh continence procedure, to undertake open colposuspension or where appropriate, laparoscopic colposuspension (this can be undertaken only by Urogynaecologists or Urologists who already undertake other laparoscopic procedures) and / or autologous fascial sling procedures
If registering for mentorship in abdominal vault prolapse support, to undertake open sacrocolpopexy or where appropriate, laparoscopic sacrocolpopexy (this can be undertaken only by Urogynaecologists who already undertake other laparoscopic procedures)

‘HIGH VIGILANCE RESTRICTION PERIOD’

Since July 2018 there has been a ‘pause’ across the UK, in the use of synthetic mesh/tape to treat stress urinary incontinence (SUI) and urogynaecological prolapse where the mesh is inserted through the vaginal wall. This referred to as the ‘HIGH VIGILANCE RESTRICTION PERIOD’.

During this period, high vigilance scrutiny arrangements are in place, and apply to prolapse procedures involving the placement of mesh and procedures to treat stress urinary incontinence.

These arrangements are laid out in the letter from NHS Improvement and NHS England to Trust Medical Directors and clinicians involved in the care of patients with stress urinary incontinence and pelvic organ prolapse in July 2018

MergedFile (emlfiles4.com)

For further details of about this high vigilance restriction period across the NHS in the UK please follow the links.

NHS England

NHS Scotland

NHS Wales | NHS Wales Appendix 1 | NHS Wales Appendix 2

NHS Northern Ireland

Apply to be a mentor.

Mentors must have appropriate clinical and surgical experience to provide this role.

It is recommended for the mentor to have completed a minimum of three years regularly performing the procedure as routine clinical practice

The mentor must adhere to High Vigilance Scrutiny arrangements that apply to the relevant NHS they practice in, including using BSUG or BAUS database for entry of surgical cases.

Please apply here to be a mentor.

Medical Director approval to act as a mentor

To satisfy the governance arrangements of this scheme, applying mentors must seek the approval and support of their employing trust to act in this role.

Please request the Medical Director (or equivalent Accountable Officer) to complete the form below

Please complete Medical Director approval form here