1. Multiprofessional Learning Environment Supporting the role of Junior Doctors in Work & Education Liz Spencer, Consultant Anaesthetist Clinical Tutor, 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

2. Objectives 1. Role of the junior doctor and the MDT 2. Identify ways how YOU can promote a safe learning environment 3. Clinical Learning – engagement & opportunity 4. Candour in all our relationships

3. ROLES What is the role of your trainee? – job description? job plan? Induction? Introductions? Learning Opportunities Support – how we do it round here. Expectations of them, you & team Educating your MDT to understand learning & support needs & expectations of the trainee Educating the doctors to understand learning needs & support of non-medics

4. Recent reports Francis Keogh Berwick

5. Berwick Report Aug 2013

8. Place the quality of patient care, especially patient safety, above all other aims, 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

9. 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

10. 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

11. What are we cultivating? What is a good learning environment

12. Successful Learning Environments Inspirational Leadership Effective 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

13. What can YOU do? ROLE-MODEL Good professional inclusive behaviour Demonstrate expert knowledge Proficiency in providing holistic care of pts & staff Assist staff to integrate into team Reward for effort Create situations where staff feel comfortable sharing ideas, thoughts & reflections & seeking assistance Open communication, trust & respect Patient = person + pathology Trainee = person learning from work

14. Faculty Guide www.nact.org.uk

15. 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.

17. Dept Education Group Local Faculty Group Attended by Medics & non-medics Learning needs of Medics & non-medics discussed Clarity of role & expectations of MDT Monitor and Feedback Leadership role of Specialty Tutor

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

19. 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

20. Leadership Activities Sharing expectations Agreeing appropriate behaviours & how to manage inappropriate ones Implement strategies that reward desirable behaviours and reprimand negative behaviours Be positive & solution-focused

21. 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).

22. 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 Articulate expectations Set bar high Consider whole professional Discuss & reflect when standards not met

23. Supporting Education in a Clinical Environment Wessex Deanery October 1999 Community Trainees “belong”, education a priority Sense of fellowship, safety & trust Collegiality All staff are “colleagues”. Trainees “accepted” Shared purpose Criticality Open discussion of professional judgements Reflection & Review via open questionning not interrogation

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

25. “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

26. What are YOU waiting for Walk the Talk Talk the Walk Multiprofessional Learning Environment