In response to the workforce crisis that is affecting breast imaging services in the UK, the RCR has been working with the Association of Breast Clinicians (ABC), the National Breast Imaging Academy (NBIA) and Health Education England (HEE) to develop and pilot a credential in breast disease management with two main aims:
- to standardise and recognise the training of breast clinicians
- to increase the breast clinician workforce to support breast screening and symptomatic services
The credential has been implemented through a pilot programme which began in 2019 with the first cohort of 10 trainees in England, supported by Health Education England (HEE) which provided funding of £30,000 per trainee per year for the three years of the credential programme.
ABC has drafted its Vision for the future which outlines how the pilot trainees will contribute to, and support the service once trained.
Second cohort - opportunities for new pilot sites to get involved
In February 2021 HEE approved funding for a second cohort of trainees to undertake the credential. Though applications have now closed for trainee recruitment, expressions of interest from new training sites and breast imaging departments in England are still welcome. If you would be interested in hosting a credential trainee or would like to know more about the programme, please read Information for Potential Pilot Sites and contact email@example.com. For more information on what the credential involves and the first cohort, see below.
The Credential in Breast Disease Management for Breast Clinicians
In 2020 the credential was a finalist in the BMJ Awards Womens' Health Team category. As part of the submission the following video was submitted to the judging panel.
This video was produced by the National Breast Imaging Academy, in collaboration with the RCR, ABC and HEE, on behalf of the Breast Clinician Credential Project Board.
The credential curriculum is based around a number of high-level capabilities in practice. This is what a breast clinician will be expected to be able to do upon completion of the training. It includes considerable overlap with the breast content of the clinical radiology curriculum as well as covering clinical examination, risk factors such as family history and genetics, and the understanding of the use of prognostic and biological factors that influence oncological treatments. Download the curriculum to see the full programme.
Trainees will be required to pass the physics module of the First FRCR Examination in their first year of training. In addition to the physics examination, assessment is workplace based and formative in nature leading to an annual review and summative assessment to confirm progress. Full details of the assessment programme are included in the curriculum. Trainee breast clinicians will be given access to the RCR’s trainee e-portfolio, Kaizen, to document progress. Kaizen user guides are available for trainees and for supervisors.
Structure of training
The three-year training programme detailed in the curriculum covers multiple elements of training which will be learnt concurrently and will often dovetail across each other. There is no definite order in which each element of training or capability in practice should be undertaken but in order to provide some structure and logical progression in training, the first year focuses on clinical skills, family history, and physics teaching in order to pass the FRCR examination. The clinical and family history skills are built on during the second year whilst now incorporating imaging interpretation and reporting, in a highly supervised capacity. During the final year, increasing independence is expected in ultrasound and mammography work in addition to interventional procedures such as biopsy and localisation. Trainees will be employed by the breast screening units which will largely lead the training, but they will also be linked to the local radiology training programme to access relevant training and physics teaching.
Review of progression
Closely based on the Annual Review of Competence Progression (ARCP) process for specialty training, the review of credential trainees will be carried out by a national panel, convened by the Credential Project Board. A national review panel will ensure that a consistent standard is applied to all trainees across all training sites in this small pilot programme. It will be wholly independent of any of the pilot sites thereby ensuring impartiality and avoiding decisions on progression being made by the same people responsible for the training of any individual trainee. The 'Process for the review of trainee performance and progression' gives full details of the process and the panel.
Guidance for pilot sites
We have drafted a guidance document for the pilot sites which covers a variety of areas including the structure of training, supervision arrangements, the support that is expected to be given to trainees and much more. We hope this will be useful but if there is any other information you require please contact us.
Guidance on supervision
HEE has produced a suite of resources providing guidance on "Enhancing Supervision for Postgraduate Doctors in Training". This is of relevance for both trainees and supervisors in this programme and we would urge all those involved to read these documents:
- A report that sets out the different kinds of supervision (educational, clinical and workplace) and what good supervision looks like
- A handbook for trainees and trainers
- A benchmarking document for Trusts to help them to assess whether they are providing good supervision
- An animation for trainees explaining in simple terms what good supervision looks and what they should expect from their supervisors.#
Please see our advice for credential trainees and supervisors
The first cohort
The first cohort of the pilot programme began training in a handful of sites in the Autumn of 2019. Additional sites were recruited to over the following months and although COVID-19 caused some disruption, by the end of 2020 trainees were training in the following locations:
- Nightingale Centre, Manchester Foundation Trust
- Royal United Hospital Bath NHS Foundation Trust
- Bristol Breast Care Centre, North Bristol Trust
- Royal Victoria Infirmary, Newcastle upon Tyne NHS Foundation Trust
- Leeds Teaching Hospital NHS Trust
- Cheltenham General Hospital, Gloucestershire Hospitals NHS Foundation Trust
- Northwick Park Hospital, London North West University Healthcare NHS Trust
- Broomfield Hospital Chelmsford, Mid-Essex Hospital Services NHS Trust
- York and Scarborough Teaching Hospitals NHS Foundation Trust
In the first cohort, individual training posts were advertised and recruited to locally by each pilot site, using the same nationally agreed person specification.
A single national recruitment process was undertaken for the second cohort of trainees in the first half of 2021 and is still being finalised. Trainee recruitment has now closed, but applications are still open for training sites. If you are part of a breast imaging team in England and would be interested in hosting a credential trainee or would like to know more about the programme, please read Information for Potential Pilot Sites and contact firstname.lastname@example.org.
To be eligible to be a training site, your centre must:
- Meet the host centre eligibility criteria
- Secure the remaining funding for the post (there is a template business case to assist with this process which will be provided to you on request from email@example.com)
- Have sufficient training capacity to host a Credential trainee in addition to existing trainees
- Complete the host site application form which will be provided to you on request from firstname.lastname@example.org