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TEF Awards – Good practice 2017

RCOG education and training awards: What can we learn from our top performing units?

For the first time this year the RCOG has recognised highly performing education and training units across all 4 countries. The top performing units in 4 categories overall performance, gynaecology training, obstetric training and professional development were awarded their certificates of achievement at the National Trainees conference in Leeds in November this year. In each category 9 other units (from a total of 171) were highly commended for their achievements and were awarded their certificates from the president and vice president for education.

The awards for achievement were based on the feedback from national training data via the Trainee Evaluation Forms which were completed earlier this year. An analysis of all the indicators was undertaken which were informed by answers to specific questions within the survey. All the indicators were ranked and then the average score used to give a ranking for overall performance in all indicators, best performance in Obstetric training, best performance in Gynaecology training and best performance in professional development.

The indicators included in each ranking had questions related to the following areas:

  • Gynaecological Training - General, Procedural, Basic ultrasound, Overall recommendation
  • Obstetric Training - General, Procedural, Basic ultrasound, Overall recommendation
  • Professional Development - Education – support, supervision and local training, clinical governance, hospital processes and resources, working environment, behaviours experienced.

The overall ranking is a combination of all these indicators.

Results were also cross referenced with GMC survey data to ensure this good performance was maintained in the subsequent survey.

Our national training evaluation survey takes place each year and further information and reports of the subsequent analysis are available here.

These awards build on that process and recognise those high quality educational units.

Following analysis of the TEF data certificates were awarded to the following Trusts:

 

Overall winner: Antrim

Highly commended for overall performance were:

  • Ulster
  • NHS Borders
  • Southend University Hospitals NHS Foundation Trust
  • NHS Lanarkshire
  • Royal Devon & Exeter NHS Foundation Trust
  • South Tees Hospitals NHS Foundation Trust
  • Worthing & Southlands Hospitals NHS Trust
  • Craigavon Area
  • Peterborough and Stamford Hospitals NHS Foundation Trust

 

Gynaecology training winner: NHS Borders

NHS Borders were also highly commended for overall performance and professional development.

Highly commended for gynaecology training:

  • Antrim
  • Southend University Hospitals NHS Foundation Trust
  • NHS Lanarkshire
  • Royal United Hospital Bath NHS Foundation Trust
  • Ulster
  • Peterborough and Stamford Hospitals NHS Foundation Trust
  • Western Sussex Hospitals NHS Foundation Trust
  • Winchester & Eastleigh NHS Trust
  • Worthing & Southlands Hospitals NHS Trust

 

Obstetric training winner: Worthing & Southlands Hospitals NHS Trust

Worthing & Southlands were also highly commended for gynae training and overall performance.

Highly commended for obstetric training:

  • Antrim
  • Ulster
  • Norfolk and Norwich University Hospital NHS Foundation Trust
  • South Tees Hospitals NHS Foundation Trust
  • Royal United Hospital Bath NHS Foundation Trust
  • NHS Lanarkshire
  • Lancashire Teaching Hospitals NHS Foundation Trust
  • Imperial College Healthcare NHS Trust
  • Southend University Hospitals NHS Foundation Trust

 

All these units were asked 3 simple questions to identify some key themes from highly performing units which can be more widely shared in order to promote good practice:

  • What makes you particularly proud with regards to training and education in your unit?
  • If you could pick 3 top tips for success to share with other units what would these be?
  • What could you do to improve education and training even more?

Key themes were identified from the feedback:

 

What made units proud?

All units who contributed to this feedback were proud and pleased about their award.

"We are delighted that the trainees in Lanarkshire value the effort and dedication of all staff in the trust who help them achieve their personal training goals and that they have given us such positive feedback"

Evelyn Ferguson and Sikhar Sircar, NHS Lanarkshire

"This is important for me to know that our patients are getting great care from satisfied doctors and these great doctors want to come back as consultants to work with us”

Sanjaya Kalkur, College tutor, Southend University Hospital

"All our consultant body in Antrim area hospital are very approachable, respect and appreciate the hard work that the trainees undertake in order to run a safe efficient service”

Keith Johnston Antrim area hospital

"We have focused on creating an ethos based on support and training, and a 'culture change'. Our quality panel data was excellent in all areas, and also excellent in all areas for our foundation programme. We have an exchange programme that has seen our last exchange trainee for New Zealand coming back for a post-CCT job, and our last ST7 also stay for a benign gynae fellowship"

Katherine Edey Royal Devon and Exeter FT

 

We asked units for their top tips

  • Respect and acknowledge the hard work trainees undertake in your unit
  • Equally respect and acknowledge the contribution of all staff who are involved in training. In good units this is everyone -doctors, nurses, midwives and allied health professionals.
  • Design your rota with a focus on meeting the trainee’s needs
    • A consultant with an education focus needs to have oversight of the rota to ensure trainees access education and training relevant to their needs.  A rota administrator is also key to this.
    • Match junior and senior trainees whilst on call to maintain their training environment and develop their supportive relationship

"The rota is done by me as college tutor along with a rota admin person. I make sure the trainees are allocated to the appropriate lists and clinics according to their need. It makes a huge difference to their training. Nobody is allowed to pull the trainees out of their training to provide service commitment."

A.S Sriemevan, Peterborough-North West Anglia NHS Foundation Trust

  • Take an interest, encourage and guide individual trainees depending on their skill set.
    • Some units particularly encourage the use of written PDPs which are completed early in their attachment. 
    • Respond promptly and appropriately with targeted training and support when trainee needs are identified. Utilise a wide range of feedback mechanisms, educational supervisors, risk management reports, complaints, other trainees, midwifery staff
    • Encourage trainees to submit projects/audits not just at local meetings but national and international meetings for presentation.  They then have the opportunity to travel and engage with the specialty as a whole.
    • Some units report other professionals such as ultrasonographers being willing to teach even when it is not part of their job description.
  • Good units have consultants with lead roles such as college tutors with paid time in their job plans for education. Use of SpA time for education is encouraged and promoted as equally important as other lead roles such as risk.
    • They also appoint new consultant colleagues who have a track record in education and are motivated to train.
  • Encourage hands on consultant supervision.
    • Where the structure of the units permitted there was one to one consultant supervision on labour ward thus enhancing the opportunities for trainees to learn and develop.  Other units described the engagement of Obstetricians their pride and enjoyment in creating opportunities for teaching and learning.
    • Appointment of resident consultants on call with high quality job plans (with opportunities to develop) who are motivated and engaged and also keen to teach and supervise.
    • In successful units consultant gynaecologists were reported as very keen to teach in theatre and fantastic at encouraging and developing good surgical technique in trainees. Trainees were given ample opportunity to develop their skills with training lists.
  • Be approachable and open to feedback as a consultant team.
    • Have effective mechanisms in place to give and receive feedback between trainers and trainees and act on the feedback. This includes appointing a trainee representative, trainees attending the consultant meeting and all trainees attending a monthly faculty meeting with trainers.  Some units have a monthly trainee forum. If concerns or complaints are raised involving a trainee these are always passed through the educational supervisor or college tutor. Trainees therefore feel well supported if issues arise.
    • Reflect on your own and the trainees you are supporting career pathway. Build on the positives.
    • Consider organising social events.

"As well as the usual allocation of rota coordinator, teaching coordinator we also ask the trainees to nominate a social secretary who has the responsibility to organise at least one night out every couple of months-consultant/middle grades/trainees and medical students are al encouraged to attend if possible. Modern shift working patterns means that we have lost some of the camaraderie within O&G and in the long term trainees are simply our future colleagues"

Lorraine Johnston, Northern Trust NI

  • Take every opportunity to teach-be innovative
    • Teach on a case /topic at every morning handover
    • Roster senior staff (e.g. associate specialists) to take on training such as ultrasound lists outside of service commitment.
    • Arrange teaching clinics with more time to do workplace based assessments
    • Send weekly questions via email to the trainees-the best answer is shared
    • Develop your in house MRCGOG part 3 programme or similar
    • Use immersive simulation, PROMPT and ROBUST courses, clinical skills and in situ drills.
    • If you have more than one site use video conferencing to ensure access for all

"Videoconferencing facilities have ensured that most of our meetings are cross bay and learning between both sites is encouraged. The handover is cross bay with a 3 minute brief reminding staff of achievements and also learning points for the week"

Dr N Shantha and Dr Alcide Morecambe Bay NHS Foundation Trust

  • Develop a meaningful induction
    • Contact the trainees prior to arrival to ascertain their training needs and thus  tailor their work schedules to their training needs even prior to arrival.
    • Previous trainees have contributed to the pre-employment information which is sent to new appointees. This is reviewed yearly by the outgoing team. The emphasis is on making the induction as practical and useful as possible.

 

We also asked what could you do to improve education and training even more?

  • Reduce rota gaps by recruitment of more service focused doctors to free up time and expertise for training. Ensure that service needs are adequately  met with enough tiers of staff to provide a safe service with opportunities to educate and train.
  • An honest, clear advising/channelling of trainees down a more Obstetric or Gynaecological pathway at ST6/7
  • A number of units mentioned scan simulators as a resource which would help support improved ultrasound training.
  • Use all 24 hours  of the day more effectively for training and ensure staff are aware of the trainee’s individuals needs
  • Ensure you maintain and develop an environment that is positive and enthusiastic about improving everyone’s skills
  • Focus on developing resilience not just support

 

Summary

What is striking about all of this feedback from many units in different part so f Britain is in fact its consistency?

All of the top tips fall into a model which was described may years ago following a research project in Wessex deanery looking at high performing educational units across all specialities.

These were known as the 3Cs:

Community: The sense of community, of belonging within the unit, finding identity within it and striving for cohesion

Collegiality: Culture of collegiality; a shared vision that is known, understood and owned by all, such that senior members treat more junior members or trainees as colleagues.

Criticality: Commitment to Criticality: the critical reconstruction of practice of those within the community. Thus educational practice is reviewed and refreshed by those engaged in the endeavour.