Learning and Working in Clinical Environments Anél Wiese Dr. Caroline Kilty Dr. Deirdre Bennett

In the media

Your Training Counts 2014 National Score Ireland 170 Very wide variation Lower scores for more junior trainees Areas of weakness – feedback, educational supervision

Quality Data Published data : Limited to surveys of satisfaction amongst trainees, variable quality and response rates Year Trainee Group Outcome 2004 Interns 63% agree training abroad better 2005 2 cohorts 6 &11 years post grad Better facilities, further training and better career prospects abroad 2011 65% rate internship excellent or good 2012 GP Trainees >80% satisfied with training post All NCHDs 50% dissatisfied with training in current post 2013 Surgical BST 49% would NOT undertake BST in Ireland again Add the GMC data here as a benchmark

Why do this research? Learning & Working in Clinical Environment Interested in looking at activities that trainees undertake in the clinical environment. Activities include service delivery, pt care, learning, etc. Many competing activities, of which learning is just one How do the competing activities, interact with each other, and impact on learning. Clinical learning environments are complex systems to analyse

Methodology “What is the relationship between PGMET and the competing activities happening in clinical learning environments?” Qualitative methodology to find out what activities trainees undertake in day-to-day job. And when or how does learning happen during the course of the activities that they undertake daily. Data collection: interviews, audio-diaries and observation of staff (trainee, consultants, nurses, allied health, management) within a department across 4 different hospitals. Departments: infectious diseases, geriatrics, paediatrics and surgery Include alternative departments? Up to date: n= 50 interviews completed and transcribed Data analysis has not yet commenced

Service vs Learning Trainees learn through service - on the job learning main driver for junior doctor training Increased busyness and demanding service delivery create a problem for learning Difficult to find balance of optimal clinical exposure for learning

Relationship with Senior Doctors Trainees value relationships and interactions with senior doctors Relationships shaped and influenced by competing activities within the CLE - i.e. motivation (consultants’ and trainees’), demands of providing patient care EWTD - clinical exposure, lack of patient continuity – contradictive to learning

Perception of learning Junior trainees – view learning with undergraduate mind set Perceive learning to happen away from CLE – lectures, courses, tutorials Lack of protected time for learning due to constraints within CLE – issue worthy of addressing Further consideration of trainee expectation and awareness?

Level of Training Difference between learning opportunities and the grades of doctor. Miss learning opportunities, doing other jobs at the same time.

Funded by HRB, Medical Council and HDTP The Team Principal Investigator : Dr. Deirdre Bennett Co-Investigator : Dr. Caroline Kilty Collaborators: Prof. Martina Kelly, Dept. of Family Medicine, University of Calgary. Dr. Michelle Reardon, Mercy University Hospital Prof. Mary Horgan, Dean, School of Medicine, UCC. Prof. Agnes Higgins, School of Nursing, TCD. Prof. Colm Bergin, Dean of Postgraduate Training, Royal College of Physicians of Ireland. Dr. Mike O’Connor, Clinical Director, Cork University Hospital Prof. Patrick Flood, Professor of Organisational Psychology, DCU. Dr. Bridget Maher, Senior Lecturer, Medical Education Unit, UCC Dr. Siun O’Flynn, Head of Medical Education, UCC. Mrs. Margaret Murphy, Patient Advocate Dr. Dubhfeasa Slattery, Consultant Paediatrician, Children’s University Hospital, Temple St. Dr. Na Fu, Business School, Dublin City University Royal College of Physicians of Ireland Dr. Sinead Murphy, Consultant, Children’s University Hospital, Temple St. Funded by HRB, Medical Council and HDTP