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23
Date of visit 20th March 2019 Level(s) FY/ST
Type of visit Enhanced Monitoring Hospital Ninewells Hospital
Specialty(s) General Surgery Board NHS Tayside
Visit panel
Professor Clare McKenzie Postgraduate Dean
Mr Robin Benstead GMC Representative
Ms Angela Carragher GMC Representative
Ms Clare McNaught Royal College Representative
Mr Alasdair Robertson Training Programme Director
Dr Peter Armstrong Foundation Programme Director
Dr Allan Green Trainee Associate
Mrs Penny McGregor Lay Representative
Ms Vicky Hayter Quality Improvement Manager
Mrs Gaynor Macfarlane Quality Improvement Administrator
Specialty Group Information
Specialty Group
Surgery
Lead Dean/Director
Professor Adam Hill
Quality Lead(s)
Dr Kerry Haddow, Mr Phil Walmsley and Dr Reem Al Soufi
Quality Improvement Manager
Ms Vicky Hayter
Unit/Site Information
Non-medical staff in attendance
13
Trainers in attendance 10
Trainees in attendance Foundation trainees 17 Specialty trainees 9
FY1 x 10, FY2 x 5
Feedback session: Managers in attendance
19
Date report approved by Lead Visitor
15 April 2019
2
1. Principal issues arising from pre-visit review
An enhanced monitoring visit was undertaken on 16 March 2018 and the following
extract is from the visit report.
The visit panel acknowledged that both the Clinical Leads and DME staff showed
awareness of the current training issues with plans in place for improvement and that
the senior staff were engaged in addressing training. The panel recognised the work
that has already been done to implement some of the recommendations from the visit
report in January 2017. This has been achieved at a time of significant service
change.
Requirements made in the report were as follows:
• Minimise the level of service provision tasks for Foundation year 2s to reduce
level of workload and improve training opportunities
• Ensure Foundation Year 2s receive a ward-based induction
• Ensure all Foundation trainees receive feedback
• Handovers timings must be reviewed and developed to be more effective
• Trainers must ensure the availability of Specialty Trainees and Consultants for
Foundation trainees and provide a clear documented escalation process
• Specialty trainees require increased access to non-operative training
opportunities
• Ensure specialty trainees are allocated to colonoscopy training lists
• Rotas should be adjusted to ensure Foundation trainees are not working
beyond their rostered hours
Background information
This visit is part of the Deanery’s Enhanced Monitoring process which requires an
annual visit to monitor progress and is a follow up to the most recent Enhanced
Monitoring visit on 16 March 2018. The visit team include College and GMC
representation in line with the nature of the visit. The visit team investigated the issues
previously highlighted. The visit team also took the opportunity to gain a broader
3
picture of how training is carried out within the department and to identify any points of
good practice for sharing more widely.
Survey data from Trainees include:
Foundation Trainees
NTS Red flags – Adequate Experience, Clinical Supervision, Induction, Overall
Satisfaction and Reporting Systems (FY2)
NTS Pink Flag – Curriculum Coverage
Core Trainees
NTS Green Flags – Overall Satisfaction and Feedback
Light Green – Reporting Systems, Team Work and Rota Design
Specialty Trainees
NTS Red Flag – Reporting Systems
NTS Pink Flags - Adequate Experience, Clinical Supervision and Clinical Supervision
OOH
2. Introduction
A summary of the discussions has been compiled under the headings in section 3
below. This report is compiled with direct reference to the GMC’s Promoting
Excellence - Standards for Medical Education and Training. Each section heading
below includes numeric reference to specific requirements listed within the standards.
Before the visit commenced the panel met with the Director of Medical Education,
Leads for Elective and Emergency Surgery, Clinical Care Group Nurse Manager and
Manager, Training Programme Director and Foundation Year 1 trainee who gave
presentations highlighting that there had been significant service changes as well as
improvements within the General Surgery departmental training since the last visit.
Specific examples given were: education and training issues now regularly highlighted
at health board level through Staff Governance Committee; appointment with a
Clinical Lead and supporting clinicians (with dedicated time) to oversee H@N
changes; appointment of 2 new physician associates; new on call system of two
4
consultants and two registrars to support single emergency surgical site and ongoing
development of web-based teaching.
The panel met with the following trainee groups as well as a group of senior
nurses/pharmacists/dietician:
Foundation Trainees
Specialty Trainees
3.1 Induction (R1.13)
Trainers: Trainers advised that departmental induction has been re-designed and is
now multidisciplinary involving a wide range of staff. Included is a clear escalation
process and arrangements for clinical/educational supervision. Trainees also receive
an individual ward-based induction. Any trainees who cannot attend are given the
same induction at a later date.
Foundation Trainees: All trainees received both hospital and departmental induction
and were enrolled and refreshed on relevant systems. General Surgery roles, nights
and cross cover were discussed, and trainees also received a ward-based induction.
Foundation year 2 had no specific induction to ward 7. Foundation year 1 had no
induction to HDU. All were emailed several induction documents.
Specialty Trainees: All trainees received both hospital and departmental induction
and felt this worked well.
Non-Medical Team: The nursing staff felt the trainee’s induction programme was
robust. Senior charge nurses, ANPs (Advanced Nurse Practitioners) and Pharmacists
attend induction to meet trainees and discuss roles. The Pharmacists provide an
induction booklet. The Administration Manager attends induction to make trainees
aware of the point of contact for rota issues and sickness absence.
5
3.2 Formal Teaching (R1.12, 1.16, 1.20)
Trainers: There is a multidisciplinary local clinical effectiveness half day teaching
session once a month which is run by Consultants and Specialty trainees. Regional
teaching for specialty trainees occurs on the other half day of the clinical effectiveness
day so that all can attend. Foundation trainees are advised of the clinical effectiveness
teaching and have weekly bleep free Deanery teaching. Foundation trainees are also
encouraged to attend the student teaching. There is a colorectal MDT on a Friday.
There is online surgical teaching available which consists of a google classroom,
journal club, podcasts, what app, twitter and a Facebook page which has been
recognised with the Faculty of Medical Educators (FAME) award for excellence for
teaching.
Foundation Trainees: Trainees stated they attend weekly Deanery teaching and are
invited to the Clinical Effectiveness teaching but cannot attend due to clinical duties.
Foundation Year 2s find it difficult to attend weekly teaching due to workload.
Specialty Trainees: Trainees reported a significant improvement in teaching and
receive at least one hour per week. There is weekly ward-based teaching and well
organised monthly regional teaching which also includes Clinical Effectiveness training
which all trainees can attend. Trainees reported excellent online teaching which is
available through google classroom, what’s app and podcasts.
Non-Medical Team: Nursing staff fully support teaching and are advised of the
timetable. ANPs and nursing staff provide support to trainees to enable them to attend
bleep free teaching.
6
3.3 Study Leave (R3.12)
Trainers: There are no issues with study leave.
Foundation Trainees/Specialty Trainees: Trainees have no issues with study leave.
3.4 Formal Supervision (R1.21, 2.15, 2.20, 4.1, 4.2, 4.3, 4.4, 4.6)
Trainers: Educational Supervisors are allocated to Foundation trainees before
commencing in post. Specialty Trainees select their own Educational and Clinical
Supervisors. If there were any concerns regarding a trainee, the Training Programme
Director would notify the Educational or Clinical Supervisor in confidence. All trainers
have completed training and have time in their job plans to undertake educational
roles, this is currently being reviewed within the department. Educational roles are
included in the SOAR appraisal process.
Foundation Trainees: All trainees were informed of their educational supervisor
before commencing in post. All have had meetings and agreed a personal learning
plan. The majority of trainees found the meeting useful, but this was Consultant
dependent.
Specialty Trainees: Trainees assign their own Education Supervisor and can choose
multiple Clinical Supervisors which enables a broad range of feedback from
assessors. Trainees have no issues arranging meetings as all trainers are easily
accessible and work closely with trainees.
Non-Medical Team: All trainees know who to contact both during the day and OOH.
There is a clear escalation policy for all trainees and nursing staff have an open-door
policy and can be contacted at any time.
7
3.5 Adequate Experience (opportunities) (R1.15, 1.19, 5.9)
Trainers: Foundation trainees have a clear curriculum; specialty trainees are mapped
to curriculum through ISCP. The rota is published every week, trainees are allocated
to clinics and theatre and have the opportunity to attend special interest areas. For
curriculum competencies which are difficult to achieve such as HPB experience, TPD
arranges external placements. Endoscopic training is provided by Gastroenterologists
for trainees with NTNs.
Foundation & Trainees: Foundation trainees reported a good training experience,
and all are achieving the required competencies. Foundation year 2s can find it
difficult to attend theatre due to workload. It was reported that when in a surgical
Foundation post, trainees are not required to consent for ERCP, however when in a
medical Foundation post, they are.
Specialty Trainees: The majority of trainees reported they are ahead of target
numbers to achieve the required competencies for CCT. Work placed based
assessments are easy to achieve and trainees regularly attend both theatre and
clinics. Trainees reported lower numbers for HPB work and Upper GI (which is
recognised as a UK wide issue). Trainees report being able to achieve endoscopy
training.
Non-Medical Team: Staff informally contribute to training by teaching on the wards
and help trainees as and when required. Pharmacists provide a training session to
junior trainees and offer a range of quality improvement projects.
3.6. Adequate Experience (assessment) (R1.18, 5.9, 5.10, 5.11)
Trainers: Trainers stated they discuss the required assessments with trainees at the
initial educational supervisor meeting and again throughout the year. Trainees have
checklists to make sure they are on track to complete the required competencies.
Trainers have completed train the trainer courses but do not currently benchmark
against each other.
8
Foundation Trainees: Trainees stated they have no issues obtaining the required
assessments.
Specialty Trainees: Trainees have no issues completing the required assessments
and all are fair and consistent.
Non-Medical Team: Staff regularly provide feedback to all trainees including TABs for
Foundation trainees.
3.7. Adequate Experience (multi-professional learning) (R1.17)
Trainers: A wide range of staff are invited to multi-disciplinary learning such as Nurse
specialists, Undergraduate staff, Postgraduate staff, Anaesthetics, O&G, Urology,
Radiology and clinical care departments. There is a weekly Colorectal meeting and
local monthly MDTs.
Foundation Trainees: Trainees are aware of Clinical Effectiveness teaching but
reported due to workload they cannot attend.
Specialty Trainees: There are many opportunities for multiprofessional learning such
as Clinical Effectiveness training, M&M meetings and teaching with various
departments such as Anaesthetics, Radiology and Paediatric Surgery. There is also a
weekly colorectal MDT and Endoscopy teaching with Gastroenterologists.
Non-Medical Team: Trainees can attend ANP teaching, MDT meetings and regularly
receive multi professional learning with Consultants or Specialty Trainees on daily
ward rounds.
9
3.8. Adequate Experience (quality improvement) (R1.22)
Trainers: All trainees are encouraged at induction and regular educational supervisor
meetings to undertake quality improvement projects. There is an informal weekly ward
meeting to discuss audits.
Foundation Trainees: Trainees stated there are opportunities to complete a quality
improvement project.
Specialty Trainees: Nursing staff stated trainees have many opportunities to engage
in quality improvement projects. The senior trainee representative attends the QI
meeting and supervises junior trainee projects. Trainees have recently submitted an
abstract for the upcoming national conference.
3.9. Clinical supervision (day to day) (R1.7, 1.8, 1.9, 1.10, 1.11, 1.12, 2.14, 4.1,
4.6)
Trainers: Supervisors are aware of individual trainees’ abilities and training
requirements and work closely together as a team. Coloured lanyards are worn
throughout the department making it clear of the different stages of training. Trainees
are aware of who to contact for advice or support both during the day and out of
hours. There is a clear escalation process which is discussed with trainees at
induction and a minimum of 2 Registrars and 2 Consultant surgeons are on call every
day. There is a simplified system of on call bleeps making it easier to contact
individuals. Named consultants cover the wards. Generally, it is the responsibility of
Consultant to consent patients. No Foundation trainees consent patients.
Foundation Trainees: All trainees stated they know who to contact both during the
day and out of hours. Foundation year 1s are expected to cover HDU when FY2s are
in theatre or on sick leave. Trainees did not feel safe covering this as they do not
receive an induction for HDU. Foundation year 2s reporting working beyond their
rostered hours when working in ward 8 due to the timing of handover (commencing at
5pm which is the end of the trainee shift).
10
Specialty Trainees: Trainees can access senior support both during the day and out
of hours. Trainees do not feel they have to deal with problems beyond their
competence and find the Consultants both approachable and accessible.
Non-Medical Team: The rota enables staff to differentiate between grades and levels
of competence of staff. Staff do not feel trainees cope with problems beyond their
competence but if they did they would speak to any of the senior team to review and
discuss concerns.
3.10. Feedback to trainees (R1.15, 3.13)
Trainers: Trainers reported immediate feedback is given to trainees informally and
formal feedback is documented on ISCP. Supervisors have regular informal chats with
trainees and provide both positive and negative feedback. Trainers recognised that
not all these interactions were perceived as feedback by trainees. One trainer
highlighted that laparoscopic procedures are videoed and discussed with trainees.
Foundation Trainees: Trainees reported a lack of feedback unless it is specifically
sought out by individuals.
Specialty Trainees: Trainees receive a mixture of informal and formal feedback
regularly and find it constructive and meaningful.
3.11. Feedback from trainees (R1.5, 2.3)
Trainers: Trainers are currently looking at a tool for trainees to provide 6 monthly or
annually feedback on the trainers. Some trainers have sent Multi Source Feedbacks to
trainees (for their revalidation).
Foundation Trainees: Some Educational Supervisors ask trainees for feedback, but
this is Consultant dependent. The Foundation year 1 representative can feedback any
issues on behalf of trainees. Foundation year 2 do not have currently have a
11
representative and there is no feedback mechanism in place for trainees to feedback
on trainers.
Specialty Trainees: Trainees complete multi-source feedback requests to provide
feedback to trainers. There is a junior and senior representative on the Specialty
Training Committee where feedback of any concerns can be communicated.
3.12. Workload/ Rota (1.7, 1.12, 2.19)
Trainers: Trainers reported no current rota gaps. Two specialty trainees and two
Consultants are always on call at the same time to allow greater flexibility. The
Emergency rota has been embedded in the last 18 months and the FY rota has been
re-designed.
Foundation Trainees: Foundation trainees reported a varied and unpredictable rota.
There is an uneven distribution of Foundation trainees on the wards and trainees
would like a better balance. Foundation year 2 trainees reported a heavy workload at
the weekends which can impact on patient safety. The rota is not always up to date
and is managed by an administrator. The foundation trainee representative has
escalated the issue. The rota is currently only accessible from within the hospital,
trainees would like the ability to access this out with.
Specialty Trainees: Trainees reported no gaps in the rota due to the appointment of
board funded posts which have made a significant positive impact. There are no rota
implications for patient safety and the rota does not impact on training. Trainees
praised the Training Programme Director for all his work achieving this.
Non-Medical Team: Staff do not have any issues regarding the rota impacting on
trainees.
12
3.13. Handover (R1.14)
Trainers: Trainers reported a robust electronic handover.
Foundation Trainees: Trainees reported a good handover for specific jobs, but the
weekend handover could be improved by trainees providing more patient detail as the
context is not always clear.
Specialty Trainees: There is a protected handover twice a day. Trainees reported a
disconnect at the handover as all Foundation doctors attend the hospital at night
handover and therefore are not involved with the ST handover.
Non-Medical Team: There is a robust daily handover between junior and senior
trainees. Foundation trainee’s handover with hospital at night to review and update the
lists. Hospital at night attend the conference call and any concerns are raised and
managed.
3.14. Educational Resources (R1.19)
Trainers: Trainees have access to a wide range of online learning resources and
teaching opportunities which are advertised on what’s app. There is a registrar room
with computers. Trainees have access to simulation through the Dundee Institute for
Healthcare Simulation (DIHS) formerly the Cuschieri skills centre.
Foundation Trainees: Trainees have access sufficient computers but reported these
were extremely slow.
Specialty Trainees: Trainees have access to a dedicated reg room and doctors mess
and the University of Dundee library. There are computers available, but these are
very slow.
13
3.15 Support (R2.16, 2.17, 3.2, 3.4, 3.5, 3.10, 3.11, 3.13, 3.16, 5.12)
Trainers: If Trainees are struggling with the health issues or the job they can contact
their Educational or Clinical Supervisor or escalate to the Training Programme
Director or Associate Postgraduate Dean or Clinical Lead. Trainees can also inform
their trainee representative or attend the drop-in sessions with the clinical lead. TPD
can attend the monthly deanery performance support meetings regarding trainees
who need support. Trainers give trainees career advice or refer to the Deanery APGD.
FY taster weeks are available.
Foundation Trainees: Trainees stated they would speak to their Educational
Supervisor if they were struggling with job/health issues. Trainees report that if they
report in sick, this information is not always cascaded to the staff in the department.
Specialty Trainees: Trainees felt they would be well supported if they are struggling
with the job or had any health issues. A trainee who returned from maternity leave was
well supported on the return to the department.
Non-Medical Team: If staff had any concerns regarding the performance of a trainee,
these would be escalated to the trainees Educational Supervisor. Previous examples
were given, and staff felt these were addressed promptly and both the trainee and
member of staff who raised the issue felt well supported.
3.16 Educational governance (R1.6, 1.19, 2.1, 2.2, 2.4, 2.6, 2.10, 2.11, 2.12, 3.1)
Trainers: Trainers stated the quality of education and training is manged by the
Training Programme Director, Associate Postgraduate Dean and the Director of
Medical Education.
Foundation Trainees: Trainees stated they have Deanery teaching on a Wednesday
and fill out feedback forms. Trainees would contact the Clinical Lead regarding their
education and training.
14
Specialty Trainees: Trainees would contact the Training Programme Director
regarding their education and training.
3.17 Raising concerns (R1.1, 2.7)
Trainers: Trainers stated they have an open-door policy and a team approach to
discuss any concerns. Trainees can raise a Datix, which is undergoing a Health Board
review to update and improve feedback systems. There is a red flag meeting and a
quarterly M&M meeting to discuss any concerns raised.
Foundation Trainees: Trainees would contact a Specialty Trainee, Senior Charge
nurse or raise a Datix if they had any patient safety concerns. Trainees reported rarely
using Datix. Foundation Year 1s would also contact their Foundation representative.
All would contact their Educational Supervisor if they had any issues in relation to
education or training.
Specialty Trainees: Trainees would contact a Consultant, trainee representative or
raise a Datix if they had any patient safety concerns. Any education or training
concerns would be raised with an Educational/Clinical supervisor or Training
Programme Director.
Non-Medical Team: Staff have a clear escalation policy and can report any concerns
through a variety of networks including Datix. There are regular Clinical Governance
and Clinical Effectiveness meetings and weekly meetings with the Lead nurse, Case
Manager and the Clinical Director to discuss any concerns.
3.18 Patient safety (R1.2)
Trainers: Trainers have no patient safety concerns. Patient safety was central in the
recent service re-design. There are two specialty trainees and two consultants on
during the day to minimise risk. Although boarding is rare, all surgical patients are
seen every day.
15
Foundation Trainees: Trainees reported during busy periods at handover or
weekends urgent jobs have to be put aside due to workload. Foundation year 1s
reported covering HDU when FY2s are in theatre of if there is staff sickness and feel
this is a potential patient safety issue as they have not received in induction or worked
in HDU before. Trainees believe covering surgical receiving and 5 other wards when
its busy is also a patient safety concern. Foundation year 2s reported making
antibiotics which can be difficult when there are several unwell patients.
Specialty Trainees: Trainees would have no concerns if a friend or relative was
admitted to the department. Patients are rarely boarded out and if they are they are
location in another surgical ward such as ENT or Plastic Surgery. The clerkess has a
dedicated list and patients are seen every day. There is a whiteboard with all boarded
patients listed on the acute admissions ward.
Non-Medical Team: Staff have no concerns regarding patient safety and any patients
at risk are discussed at safety huddles. Patients are rarely boarded out but if they are
there is a clear mechanism in place to monitor patients.
3.19 Adverse incidents (R1.3)
Foundation Trainees: Trainees are aware of the procedure should an adverse
incident occur. Several have raised a Datix in the past but have never had feedback.
Specialty Trainees: If an adverse incident occurs the trainees record this on the Datix
system and receive feedback. Incidents would be discussed at the M&M meeting and
clinical effectiveness meeting. There is weekly multi-disciplinary red flag meeting to
discuss any adverse incidents.
Non-Medical Team: Adverse incidents are recorded on the Datix system and a review
will take place depending on the severity of the issue. Any red incident is escalated
immediately to the executive team and discussed as a learning opportunity. Pharmacy
reported medication which had changed brand which was at risk of error therefore
educational material was produced to mimimise the risk.
16
3.20 Duty of candour (R1.4)
Trainers: Trainers comply with a robust complaints system and all complaints are
addressed at level 1. There is a no blame culture and all responsibility lies with the
Consultants. Trainees are led by example.
Specialty Trainees: Trainees reported supportive Consultants who would openly
discuss any concerns.
3.21 Culture & undermining (R3.3)
Trainers: Trainers reported a close working department which is like family. There
have been difficulties in the past, but these have been overcome and the department
has a good culture of training. All surgical units work closely together and although
bullying and undermining officers have been put in place officers have never been
contacted. There is a clear bullying and undermining policy and zero tolerance.
Foundation Trainees: Trainees reported excellent ward-based nursing staff. Support
is available for trainees, but this is consultant dependent. Alleged undermining
behaviour was reported by another specialty and has been raised through Datix.
Specialty Trainees: Trainee’s reported a supportive department. Trainees are
listened to and have a good working relationship with nursing staff, PAs and
Pharmacists. Trainees have not witnessed any bullying or undermining behavior but if
it happened any issues would be raised with senior Consultants, Educational or
Clinical Supervisors or a well-being Ambassador.
Non-Medical Team: Staff reported a well-established and supportive team with good
working relationships and are not aware of any undermining or bullying behaviour.
17
Other:
Specialty Trainees: Trainees reported a very good training experience in comparison
to other units they have trained in. Trainees feel that all have benefitted from a period
of time at another location in Scotland.
Trainees reported a high pass rate in the department for FRCS and have received 2
gold medals in the last 5 years.
There are currently no Core trainees based within General Surgery at Ninewells
Hospital and trainees feel it would be an excellent training experience for core
trainees.
There is now access to Endoscopy which has improved over the last 6 months.
Interventional Radiology offer a day for Vascular trainees to take part in cases which is
unique across Scotland. Trainees have access to simulation through the Dundee
Institute for Healthcare Simulation (DIHS) formerly the Cuschieri skills centre. This is
an excellent training resource as trainees have the opportunity to teach on courses,
appreciate lectures and participate in teaching.
Specialty trainees stated there had been a significant improvement in the department
over the last few years and praised both the Training Programme Director and Clinical
Director.
The Clinical Fellow has gained all training requirements and would highly recommend
this post to colleagues.
18
4. Summary
The visit panel acknowledge that there has been significant improvement across the
department and a high level of engagement in addressing any ongoing training issues.
Significant work has been done to improve the recommendations from the previous
visit held in March 2018.
The panel recommend de-escalation from the enhanced monitoring process which will
be reviewed by the GMC after final submission of this report.
What is working well:
• Approachable and supportive Consultants, engaged in undertaking
assessments.
• Contribution by non-medical staff in supporting trainees – nurses, pharmacists
and physician assistants.
• The department has established a culture of education.
• Evidence of engagement by senior clinical and managerial staff, visible to
trainees.
• New structure where Health Board are made aware of training concerns.
• Trainees have a clear known escalation process.
• Introduction of two on call registrars and two on call consultants is a positive
development.
• Excellent google classroom, and online learning such as WhatsApp, podcasts
etc.
• Highly regarded regional teaching and Clinical Effectiveness teaching.
• Recognised improved access to Endoscopy teaching for Specialty Trainees.
19
• Recognition of the impact of improvements to the quality of training by Mr
Moses and Mr Kulli.
• Introduction of the trainee representative role is welcomed which should be
further developed to allow trainees formal routes to influence service changes.
What is working less well:
• Workload for FY1/2 remains a concern e.g. inconsistencies in the number of
FY1 trainees allocated to wards on a daily basis, requirement for FY2s to make
up iv antibiotics, timing of ward round in Ward 8 means FY2s are required to
work beyond rostered hours.
• No current induction for FY1s in HDU – this is necessary as they can be
expected to cover this area when F2s are required in theatre or are on sick
leave.
• Lack of involvement of Foundation trainees in attending Clinical Effectiveness
Teaching.
• Disconnect at handover with Specialty Trainees as FY trainees currently attend
H@N handover.
• Lack of trainee engagement with Datix as a lessons learned opportunity.
Overall satisfaction scores:
Foundation Year 1 – 7/10
Foundation Year 2 – 6/10
Specialty Trainees – 8/10
Is a revisit required?
Yes No
Highly Likely Highly unlikely
20
5. Areas of Good Practice
Ref Item Action
5.1 Google classroom, WhatsApp groups, podcasts N/A
5.2 Impressive success rate in college exams N/A
5.3 Facebook page recognised by Faculty of Medical
Educators award for excellence for teaching
N/A
6. Areas for Improvement
Ref Item Action
6.1 The department should work with
other surgical departments to
develop a clear process for
supporting trainees who have
been allegedly undermined from
staff out with the general surgery
department. Trainees should be
provided with feedback on actions
taken to address issues raised.
N/A
6.3 Accessible Rota out with hospital N/A
6.4 Consideration of a trainee
representative, with clear role
descriptor and link to service
leads, for all training grades
N/A
6.5 Barriers preventing Foundation
trainees attending Clinical
Effectiveness teaching should be
addressed
N/A
21
7. Requirements - Issues to be Addressed
Ref Issue By when Trainee
cohorts in
scope
7.1 Minimise the level of service provision tasks
for Foundation year 2s to reduce level of
workload and improve training opportunities
(e.g. making iv antibiotics)
December
2019
FY2
7.2 Ensure Foundation Year 1s receive induction
to HDU
December
2019
FY1
7.3 The rota must ensure even and consistent
distribution of Foundation trainees to wards
December
2019
FY1 & FY2
7.4 Handovers timings must be reviewed and
developed to be more effective to enable
Foundation year 2s to leave work on time
(e.g. Ward 8)
December
2019
FY2
7.5 Improve trainee involvement in Datix
particularly lessons learned.
December
2019
ALL