Avoiding Grey Wednesdays Trainee inspired, designed and delivered Tim Robbins, Petra Hanson, Shirish Dubey

2013: £4540 HEE funding to improve rotation changeover The Project 1 2 3 2012: Successful introduction of national pre-F1 shadowing week Patient safety risks remain at mid-year rotation changes 2013: £4540 HEE funding to improve rotation changeover Pilot among 96 F1’s in Coventry and Warwickshire Foundation School 2013: £4540 HEE funding to improve rotation changeover All FY1’s to spend a day shadowing the rotation they are moving onto next FY1’s supported to organise the shadowing day themselves over 2 month period Data collected from 2012 FY1’s (no shadowing) and 2013 FY1’s (with shadowing) HEE Grey Wednesdays - Results Jan 2014 drtrobbins@gmail.com

"Other F1s in other deaneries were jealous they had not had anything like this. They've said it would be really helpful" Direct feedback from FY1 participant

FY1’s experiences of rotation change in 2012 (without shadowing) 51% Did not feel prepared to start their second rotation 58% Did not understand the roles and responsibilities of their second post on starting that post 63% Did not receive any handover of patients they would be caring for on starting second rotation 93% Would have liked the opportunity to spend time shadowing the post they will move to next n = 55

“Good idea, hope it works” “Shadowing looks great” 2013: Project well received by new FY1’s “Good idea, hope it works” “Shadowing looks great” Following briefing to new FY1’s : n = 79 Understood the project 99% Thought the project was a “very good” idea 98% “No concerns :-)” “No concerns, sounds very useful” “Great idea! Alleviates Anxiety” “Great idea”

2014: Clear evidence of benefit (1) 77% understood the roles and responsibilities of their second post (83% increase from 2013) (P<0.05) 97% of F1s organised a shadowing day! 76% felt prepared to start their second rotation. (55% increase from 2013) (P<0.05) Improvements in the percentage of FY1’s who: Met their new team before starting (42% increase from 2013) (2) Received a handover of patients (25% increase from 2013) 94% found shadowing day very useful or useful.

63% 62% 52% 93% 83% 2014: Clear evidence of benefit (2) Believe the shadowing day significantly improved patient safety 62% Identified additional areas of medicine they wished to revise before starting their next rotation as a result of the shadowing day 52% Identified new educational or learning opportunities as a result of the shadowing day 93% 83% Feel all F1’s nationally should have the opportunity to complete a shadowing day Feel shadowing should be formally incorporated into FY1 rota’s

2014: Clear evidence of benefit (3) "Other F1s in other deaneries were jealous they had not had anything like this. They've said it would be really helpful" "This should be compulsory and part of the rota to ensure adequate handover takes place" “My London F1 [friends] were very jealous of my shadowing day" "Should be a national thing" “Great Project” "Serves as an ideal opportunity to ask questions and meet the team" "Was amazing for building confidence and most importantly for patient safety" “Really helped me feel more confident about starting my new job + to know the little things that no one tells you about” "Friends in other foundation schools felt unprepared and were jealous we were able to shadow our next post which made us feel less apprehensive and nervous about starting a new job

Wider adoption by simple replication of pilot Need to complete shadowing communicated to foundation schools Benefit, popularity and feasibility of project demonstrated by pilot Wider adoption by repeating the process in other foundation schools 1 Foundation schools communicate to F1’s and supervisors, including contact details of the trainees that will shadow each other 2 Trainees organise and complete a shadowing day as per the pilot project (97% completion rate seen) 3 Trainees record completion of shadowing in e-portfolio, including reflection on benefits gained 4 Immediate benefits achieved in: patient safety, identification of learning opportunities, trainee confidence, and hospital flow. Long term benefits as trainees develop the skills to safely change rotation applicable to their whole career.

Low cost of implementation Reasoning Amount Foundation school admin costs Foundation programme co-ordinators exist, and would need to send ~3 emails to trainees using information already in existence Minimal New page on e-portfolio Suitable pages already exist, simply an alteration to text needed. (Non essential cost) Minimal Opportunity costs Trainees are “off ward” for 1 day per rotation but are significantly more prepared to start each rotation. As with study-leave, shadowing days only taken when sufficient cover Minimal In total: Near zero financial costs alongside an opportunity cost greatly outweighed by statistically significant benefits

Summary: Trainee designed Trainee approved Low cost High Impact Simple to implement Clear proven benefits Sustainable Achievable at scale Trainee-led Inspire Improvement!

This project would not have been possible without: Health Education England Questions? Drtrobbins@gmail.com Warwick ICAT Patrick Mitchell Renee Knopp Sonia Panchal Maggie Allen Meghana Pandit Dan Higman Ruth Cottrell Sailesh Sankar Karen Busby Sankara Raman