Professor David Sowden Challenges facing (medical) training in a shorter working week

The life so short, the craft so long to learn ( Hippocrates - c BC)

Change will not come if we wait for some other time or some other person (Barack Obama)

EWTD 2009 Dropping from 56 hours to 48 hours represents an approximate 14% reduction in hours worked/ training Presently hours worked comprise: –day time (routine and on call) work –OOH (evening, nights & weekend) work –formal (non-experiential) training/teaching High risk that inadequate planning will compromise daytime work, learning opportunities and formal training

EWTD 2009 – Educational Opportunities Learning context and access to learning An exposure to a variety of learning contexts A balance of time allocated to different, particular contexts, eg ward, clinic, theatre Appropriate allocation of tasks (OPD example) Senior supervision and opportunities for “modelling” Current PGME arrangements are implicitly dependant on:

EWTD 2009 mitigation (non-educational measures) Comprehensive review of service provision 24/7. Implementation of best practice: Night” –Rostering & rota planning –Skill mix Legally enforceable requirement for Trusts to provide “an adequate training environment” for PGME (Learning Development Agreements)

Educational Issues: Learning is a process not an event: New knowledge or skills FACILITATED LEARNING FACILITATED AWARENESS Consciously incompetent REFLECTIVE PRACTICE & EXPERIENCE Consciously incompetent Unconsciously incompetent Unconsciously incompetent

Implications of EWTD Education and training will be more likely to be provided in “work” (MMC also predicated on this assumption) Maximise non-traditional formal elements of learning e.g. e-learning, access to simulation Places increased demands on learner and educational supervisor/trainers Heightens need for organisational responsibility for educational governance (x ref: distributed apprenticeship)

Learning strategies Remind trainees that every clinical episode, exchange or encounter is a learning opportunity Reemphasise that “formal” teaching is but a small proportion of PGME Learning requires reflection especially where opportunity is limited. Senior clinicians reinforcing the “process of learning” Encourage clinicians to use the “business of work” in a legitimate learning environment e.g. business v teaching rounds After Liberating Learning

Adaptive approaches to enhance learning: High level facilitation of an understanding of the patients journey from “snap shots" (NB: as much a by-product of shorter admissions) Skilled educators Literate learners

Learning strategies for literate learners Active reflection (?facilitation) An understanding of the competency framework An assessment system that supports and confirms the commitment to genuine performance Feedback (objective, several observers, and properly structured)

Skilled educators “good-enough and relevant” training (generic and specific) Preparation for both educator and assessor roles Review of performance Accreditation and re-accreditation Time and recognition of role

Conclusions PGME will not continue to be delivered to the standards required post EWTD 2009 without careful attention/adjustments Balance of day time and night time activities, learning contexts and of tasks become more critical post 2009 Delivery of PGME will become more reliant on high-quality educational supervision and training (preparation, time, accreditation, re-accreditation)