1. SAS Tutors Development Yohanna Takwoingi, SAS Tutor Rep, NACT UK Council Liz Spencer, Clinical Tutor, Education Adviser, NACT UK Claire Mallinson, DME, Chair NACT UK 3 October 2014 Developing a safe Learning Environment The wider Role of the SAS Tutor

2. Objectives Identify ways that SAS doctors can influence the culture of the workplace Ingredients for a learning environment Define the role of the SAS Tutor moving forward Engaging with the wider faculty And what else………?

3. The journey to becoming a value-based leader starts with self-reflection. If you are not self reflective, how can you know yourself? If you do not know yourself, how can you lead yourself? If you can not lead yourself, how can you lead others?

4. In pairs discuss Greatest Achievement this year What do you want from today

5. What is the role of SAS Tutor now ? Why did/does the DH give you money ?

7. SAS Doctors Past Failed, demoralized, underpaid…. Present “Hidden heroes of the NHS”, Herculean contribution to patient service Future Our role in modern NHS times You can’t have better tomorrow if you are thinking of yesterday all the time

8. CPD for all

9. Options for SAS development Clinical –CESR –Subspecialise –Service improvement –Change to new specialty / subspecialty Non-clinical –Trust Appraiser or mentor –LNC rep, Trust committee, League of Friends –Management role in dept eg induction lead, audit lead –Education – undergrad, Foundation, journal club, teaching –Education / Clinical Supervisor Go part-time –Set up a business, sheep farm, GMC/BMA role –Medical writing, medico-legal, pharma –Charity work Do stuff outside work

10. Developing people for health and healthcare working on behalf of Your Role in Supporting SAS to Manage their Careers Katharine Hankins

11. working on behalf of Developing people for health and healthcare The power of the role model? Role Model Clinical knowledge ? Practical skills ? Personality Temper- ament ? Team leading Skills ? etc Think of Examples ?

12. Workplace Learning Culture Liz Spencer Consultant Anaesthetist Clinical Tutor for Professional Development, Glos Hospitals Education Adviser NACT UK “..the community within which students and novice staff engage in the clinical setting directly influences how students and novices perform their practice, make sense of their knowledge, and contribute to safe and contemporary care.” (Egan & Jaye 2009).

13. Outcomes 1.Place patient safety & patient care central in medical training / CPD 2.Your role in creating a safe learning environment 3.Clinical Learning – engagement & opportunity 4.Candour in our relationships with our team

14. Candour the quality of being open and honest; frankness. honesty, candidness, truthfulness, sincerity, forthrightness, directness, lack of restraint, straightforwardness, plain- spokenness, plain dealing, plainness, calling a spade a spade, unreservedness, bluffness, bluntness, outspokenness; telling it like it is "he spoke with a degree of candour unusual in political life" antonyms:guardedness, evasiveness, insincerity

15. 2013 Francis Report – Feb 2013 Keogh Report – July 2013 Berwick Report – Aug 2013

18. Place the quality of patient care, especially patient safety, above all other aims, Engage, empower, and hear patients and carers at all times Foster whole-heartedly the growth and development of staff, including their ability and support to improve the processes in which they work Embrace transparency unequivocally and everywhere, in the service of accountability, trust, and the growth of knowledge

19. Culture will trump rules, standards and control strategies every single time …… … achieving a vastly safer NHS will depend far more on major cultural change than on a new regulatory regime Berwick 2013

20. …culture of learning and improvement Culture – “the ways things are done round here.” Importance of positive interactions, sharing experiences and learning

21. What are we cultivating? What is a good learning environment List 3 essential ingredients for positive learning culture in the workplace Pairs / small groups 3 minutes

22. Successful Learning Environments Inspirational LeadershipEffective ManagementPositive Partnership Open, trusting, OK to ask & reflect Appropriate rota Time for discussion Between healthcare providers & tertiary institutions Task focused to Behaviour focused inductionClear definition of roles & expectations Role-model Professional Knowledge Evidence of proficiency Consistent behaviour Released for trainingMultiprofessional team know what is needed & their role to engage with novices Assist staff to integrateFeedback, discussion & support (supervisor) HENDERSON A., BRIGGS J., SCHOONBEEK S., & PATERSON K. (2011) A framework to develop a clinical learning culture in health facilities: ideas from the literature. International Nursing Review 58, 196–202

23. Faculty Guide www.nact.org.uk

24. A doctor in both foundation and specialty training should be a valued member of their multi-professional team, and be responsible for providing high quality and safe clinical care to the patients, relatives and carers with whom they interface during the working day. To maximize the learning from these clinical encounters all members of the clinical team are involved, both individually and collectively, in observing performance, advising, teaching, giving feedback and encouraging discussion. The culture within the workplace environment is key to the safe and successful learning of all learners. All doctors, nurses and allied health professionals have a professional duty to support and develop colleagues of their own and other professions, particularly students, less experienced staff and those new to the department. This role should be clarified and discussed in annual appraisal for all staff.

26. It is through doing, and the opportunity to deliberately reflect, that we develop ideas, understanding and learn more about practice (Higgs & Titchen 2001)

27. If staff are to feel a sense of comfort and connectedness with the work environment, the work context must be free from bullying and immediate threatening behaviors (Murray, 2009). Equipping staff to recognize bullying and providing them with strategies to address this problem is essential because bullying behaviors undermine learning. Students should be prepared to deal with bullying behaviors (Levett-Jones & Lathlean, 2009).

28. Pearson DJ, Lucas BJ. 2011. Engagement and opportunity in clinical learning: Findings from a case study in primary care Medical Teacher;33: e670–e677

29. Developing a learning culture: twelve tips 1. Value and recognize the need for lifelong learning 2. Energize active learning amongst students 3. Develop self-awareness 4. Be open to new ideas 5. Make time for learning 6. Teams should provide protected time for learning 7. Develop a shared team, departmental or organizational vision 8. Take time out to build the team 9. Develop leadership skills 10. Learn from mistakes 11. Think about the wider environment 12. ‘Take time to smell the roses’ Stinsin L, Pearson D, Lucas B. Medical Teacher, Vol. 28, No. 4, 2006, pp. 309–312

30. “Leaders …..have a crucial role to play in shaping a positive culture…” We all need to work at it all of the time. Berwick August 2013

31. Leadership Behaviours “There are attending physicians who take the time and are prepared to discuss something even in stressful situations and who are willing to accept suggestions from subordinate doctors. There are others, who are relatively dominant, and handle things rather one-sidedly” Medical Education 2013: 47: 463–475 What are you doing about this? Articulate expectations Set bar high Consider whole professional Discuss & reflect when standards not met

32. What is your role in creating / developing the Learning Culture? What is your role in the professional development of others……and other members of the MDT developing you? How often DO you give feedback… to whom? Could you do more? Is that feedback Task or Behaviour focused? How could you make the shift?

33. This House believes that SAS doctors have different education and training requirements YESNO PreDebate105 PostDebate126

34. Influencing Identify those with power and interest Engage with the multiprofessional Faculty internally Liaise with external stakeholders –SAS Lead Deanery –LETB Trust representative Director of Education & Quality (DEQ) Be positive, specific & constructive