1. The Department in Difficulty

2. Aims and objectives of workshop
Share experience of managing depts with training challenges- ‘depts in difficulty’ and discuss an approach that’s been successful for UHL
Review a case study and discuss how to approach the issues raised
Share the UHL approach- based on experience and lessons learned
Explain the underpinning framework that supports the UHL approach

3. 600 Doctors in training
250 medical students
160 Trust Grade doctors

4. UHL Management structure- Clinical Management Groups (CMG)
Each CMG has at least 1 Medical Education Lead with time in their job plan for the role
Women’s and Children’s
Musculoskeletal and Specialist Surgery
Renal, Respiratory and Cardiovascular
ITAPS
(Critical Care, Theatres, Anaesthesia, Pain and Sleep
Emergency and Specialist Medicine
CSI
(Clinical Supporting & Imaging)
CHUGGS
(Cancer, Haematology, Urology, Gastroenterology and General Surgery)
Clinical Director
Deputy Clinical Director
Head of Operations
Deputy Head of Operations Head of Nursing Deputy Head of Nursing Human Resources Lead Finance Lead Patient Safety Lead Medical Education Lead PPI Lead
Research Lead

5. GMC Standards - Themes Learning environment & culture
Educational governance & leadership
Supporting learners
Supporting educators
Developing & implementing curricula and assessments

6. Assessing education quality in organisations: Information sources
National Surveys
Quality Visits
Annual reviews (ARCPs)
Quality surveillance groups
Soft intelligence
GMC visits

7. Assessing education quality in organisations: Information sources
National Surveys
Quality Visits
Annual reviews (ARCPs)
Quality surveillance groups
Soft intelligence
GMC visits

8. Case Study
A procedural based specialty with the following staff compliment:
FY1s
FY2s
CMTs
HSTs
Non training grade/ Trust grade doctors
GP trainees
Academic Fellows
Consultants

9. Case Study
Concerns are raised by several HSTs that their decreasing access to procedures/lists, due to an increasing number of clinics and rota gaps, may impact on ARCP outcomes.
Core and Foundation trainees suggest that supervision (in and out of hours) is weak and they are often not able to attend teaching due to service pressures
The turnover of non-training grade doctors is high and there are currently a number of gaps on the rota
GMC, NTS and the local UHL survey show emerging issues with Supervision and workload.

10. Case Study Your group task:
Using the flip chart, outline your expectation on
How this should/could be managed including who to involve, timescales etc?
How could/ would improvements be measured?
How would you monitor the outcomes?

11. Measuring/monitoring outcomes
Feedback
Who to involve
Timescales
Measuring/monitoring outcomes

12. The UHL approach ….

13. Example of Change
March 2016 UHL Survey
November 2016 UHL Survey

14. Example of Change
March 2016 UHL Survey
November 2016 UHL Survey

15. Example of Change
March 2016 UHL Survey
November 2016 UHL Survey

16. Example of Change
GMC NTS 3 Year Trend

17. The UHL approach….the benefits
Consistent
Scaleable
Expected/ anticipated
Inclusive
Accountability
Measurable
Pro-active
Item
Category
Action
Lead/Trainee Lead
Timescale
Progress
Evidence
RAG
1.5
Monitoring of sufficiency of senior ward cover to be ongoing through junior doctors forum and audit WN
July 16
Forum to set up. But format not well supported by junior doctors. Will try to join up with teaching session. 5
1.6
Set up Whatsapp group to improve communication with juniors and relaunch junior doctors forum WB
Dec 16
Whatsapp group set up, aiming to relaunch forum in Jan 17. 4
1.7
Daily schedule HST point of contact for ward with cross cover and a consultant buddy system to make clear the senior support for junior doctors.
ZK/RS/WN
Nov 16
This was shelved because the ward planning meeting was intended to replace – will do pending 1.4.

18. The UHL approach..the underpinning framework
UHL Medical Education Strategy
Education Quality Improvement Plan
Trust Board representation
Non-Executive Director for Medical Education
‘Strong educational team’- GMC Regional Review, Oct 2016
CMG Education Leads
Quality control mechanisms - Education Quality Dashboard
UHL Survey
Trainee engagements – LiA, Doctors’ in Training Committee
Patient Partners
CMG Lead- see poster

19. Questions?

20. A consistent recognisable approach improves effectiveness
Take home messages
A consistent recognisable approach improves effectiveness
Mapping to existing Trust approaches ensures that education speaks the same language as other priorities
An underpinning support framework is essential
Involve the right people
Use the right tools- national, regional and local
Follow up is essential !!!

21. Feedback from group discussions
Question 1 -Who to involve
– trainees, ES, CS, DME, RcT, Service Manager. External input – advice from GM or TPD – try and get some intelligence from others that may have been through this . A discussion with the Junior doctors forum, Local faculty groups may help. Discuss with HR and Medical Staffing at an early stage.
Timescales – 7 days for exception reporting. 24 hours if it’s a safety concern report. Reasonable timescales
Meet with each group of doctors separately – to engage with trainees and ensure that issues at each level are recognised.
One example – took 2 years to sort out. Concerns that these things cannot be resolved quickly and drag on.

22. Feedback from group discussions
Question 2- Monitoring
Monitoring trainees on a regular basis – especially after an intervention.
Local survey to support GMC/national surveys.
Repeat focus group (intermittently) exercise after the change to monitor how trainees feel about changes.
Monitoring attendance at teaching. Monitoring procedural log books.

23. Feedback from group discussions
Maybe getting faculty leads to look at different levels of grade and not just specialties as a whole.
Needs to be a multi-professional approach to get a view of the environment
What spin off effects have the work that you have done on patients? Has it improved?
When there are several grades of doctors complaining it is usually a dysfunctional department. It is important to look at the whole picture and not just the Educational issues.