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SHARING NOTABLE PRACTICE
Holiday Inn, Regent’s Park, London
23 June 2010
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Sharing Notable Practice June 2010
SHARING NOTABLE PRACTICE
23 June 2010, Holiday Inn, Regent’s Park
Programme
rd
0930
Registration
10.00
10.05
Welcome and Introduction, Dr Mike Masding
Improving patient safety and experience – the importance of audit
(Chair: Prof Nick Black)
Don’t drop the baton! – Safe handover: safe patients, Dr Yealin
Chung, University Hospital Bristol
10.20
10.32
Documentation of Baseline Clinical Condition in Emergency
Department Patients and the Development of Information Support
Cards, Dr Sarah Frewin, Sunderland Royal Hospital
10.44
A pilot using the electronic patient list to improve the timeliness of
the inpatient inter-specialty referrals¸ Dr Rupert Scott, Salisbury District
Hospital
10.56
Discussion
11.06
Coffee & Poster Session
Judges: Prof Derek Gallen and Dr Andrew Jeffrey
11.45
Breakout sessions 1
 Induction (Chair: Dr Ashley Fraser)
Showing how Education can Improve Patient Safety during the August Intake, Dr Rebecca Aspinall,
Dr Natalie Blencowe and Dr Nic Jestico, University Hospital Bristol
Induction Programme for Foundation Year 2 – a prototype, Dr Rosemary Morgan, Wirral University
Teaching Hospital
Consolidation and Pre-FY1 shadowing in the North Western Deanery – a review, Dr Abigail
Whitehouse, North Western Deanery
Tackling Trust Induction at a Deanery-level: the EMHWD (South) Generic Induction Project, Dr
Rob Gregory, East Midlands Healthcare Workforce Deanery

Welfare and doctors in difficulty (Chair: Dr Salman Zaman)
Exercise Behaviour of FY1s: Are we fit Enough to Practice what we Preach?, Dr Alan Sweeney,
Manchester
A sense of community lost? First Year Foundation Programme Doctors: how does the loss of free
accommodation affect professional development? Dr Tikki Immins and Dr Tim Battcock, Bournemouth
University
Foundation Families; tips, tricks and pitfalls for Foundation Trainees with Young Children, Dr
Bridget Langham, East Midlands Healthcare Workforce Deanery
The whole is greater than the sum of the parts – a co-ordinated approach to the management of
foundation doctors with difficulties, Dr Ann Cadzow, NHS Education for Scotland

Quality management (Chair: Prof Justin Allen)
Competency Mapping in a Foundation School, Dr Jennifer Ruddlesdin, North Western Deanery
An evaluation of the Educational Supervision of Foundation Programme Trainees by non-medical
and non-clinical educational supervisors, Dr Jon Scott, South Tyneside NHS Foundation Trust
Developing 360 degree appraisal for Foundation Year (FY) Clinical Tutors, Dr Sarah Blundell,
Worcestershire Royal Hospital
Educational Supervisor e-Portfolio Engagement – is specialty important?, Dr Alex Haig, NHS
Education for Scotland
13.00
Lunch & Poster Viewing
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Sharing Notable Practice June 2010
14.00
Breakout sessions 2
 Careers (Chair: Dr Melanie Jones)
Future Plans for the NHS Medical Careers Website, Mrs Joan Reid, KSS Deanery
The Importance of good careers advice to Foundation Trainees, Dr Holly Bekarma,& Dr Jane
Couperthwaite Stepping Hill Hospital, Stockport
Mock Specialty Interviews for F2 Doctors in the Royal Glamorgan Hospital, Dr Gareth Davies, Royal
Glamorgan Hospital

Teaching 1 (Chair: Dr Andrew Jeffrey)
Embedding Public Health in Foundation Teaching Programmes: experiences from the East of
England, Dr Veena Rodrigues, University of East Anglia, Norwich
“Doctor, come quickly …”: an FY1 developed evidence based teaching programme to prepare
finalists for undertaking on-call work, Dr Ruth Heseltine & Dr Michael FitzPatrick, Homerton
University Hospital, London
Simulation training within the Foundation Programme in Portsmouth Dr Michael Glaysher,
Portsmouth Hospital NHS Trust

Teaching 2 (Chair: Mr Tom Crichlow)
Foundation Training and the acutely ill patient: developing an Emergency Department education
package based on national guidance, Dr Brad Wilson, Bradford Royal Infirmary
Implementing Patient Safety Training in the Foundation Programme, Dr Maria Ahmed, Manchester
Royal Infirmary
Enhancing deanery-wide Clinical Skills teaching: web-based MCGs bane or boon?, Dr Adam Malin,
Royal United Hospital , Bath
15.00
Tea
15.30
QIPP - E-learning, Simulation and Clinical Skills (Chair: Dr Stuart
Carney)
E-learning for health, Alan Ryan
Clinical Skills and Simulation provision for Foundation Trainees in
the United Kingdom, Dr Richard Porter, Montagu Hospital, Mexborough
15.35
15.52
16.10
Poster Prizes & short synopsis by winners
Prizes presented by: Dr Andrew Jeffrey or Prof Derek Gallen
16.25
Wrap-Up & Close
Dr Stuart Carney
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Sharing Notable Practice June 2010
POSTER PRESENTATIONS
F1 Leadership Project, Dr Naomi Brown, Dr Zaynab Baha and Dr Salman Zaman, Leighton Hospital, Crewe
A Guide to the ePortfolio System for F1 Doctors, Dr Toni Bryant, West Midlands Deanery
Safe handover from Accident and Emergency to the Emergency Assessment Unit, Dr Anna-Maria Bielinska, Dr Anita Fernando,
Dr Nasri Zreik FY1 Drs & Mr Hugh Millington ( Clinical Lead for EAU) Charing Cross Hospital, London
The Multimodel approach to Careers support within the North West Foundation School, Dr Eleanor Checkley, Dr Maire Shelly
Assoc Dean NWPGMD
The Development of a Foundation Programme Trainee Forum, Dr Marc Davison, L Creasy, S Dunkerley, T McAllister, K Sahota,
M Sinczak, S Edmonds, P Lintott
A snap-shot audit of good inpatient prescribing practice, Dr Catherine Essen, Worcester
Providing Protected Training Time, Dr Joanne Evans, Homerton University Hospital, London
Foundation Doctors Forum – encouraging trainee lead innovation and improvement of foundation training, Dr Francesca
Garrard, The Great Western Hospital, Swindon
The new-2-ICU Course: a novel course preparing Junior Doctors for working on the Intensive Care Unit, Dr Andrew Georgiou
and Dr Migual Garcia Rodriquez
Final Year Medical Student Teaching Programme for Foundation Trainees, Dr Michael Glaysher and Dr Simon Donhou,
Portsmouth Hospital NHS Trust
Evaluating Coaching for Foundation Doctors in South Tyneside NHS Foundation Trust, Mrs Claire Hoy, Northumbria
University
Introducing an Antimicrobial Prescribing Programme – the Sunderland experience, Dr Daniel Hufton, Dr Ali Hames, Dr Roland
Koerner and Dr Anita Jones
The rise of the internet based e-portfolio:” The essential guide to the e-portfolio”, Dr Richard James and Dr Jenna Powell,
University Hospital Bristol
Assessing foundation doctor career provision and needs within the North Western Deanery: closing the loop, Dr Kavan Joha &
Dr Paul Millel, Univeristy Hospital, South Manchester
Promoting medical education through the Gloucestershire Hospitals NHS Foundation Trust Medical Journal, Dr Sri Raveen
Kandan, Gloucestershire Hospitals NHS Foundation Trust
Is it time for Nights Out? The role of Junior Doctors, Dr Anji Lee, Stockport NHS Foundation Trust
Intravenous Fluid Prescribing by Foundation Year 1 Doctors during on-calls and out-of-hours ward covers, Mr Chung Thong
Lim, Mr Michael Dunlop and Mr Chung Sim Lim, London
Foundation Trainee Welfare, Dr Kate Marflow and Dr Sebastian Pillon, Trafford General Hospital, Manchester
Qualitative assessment of consent forms in the Endoscopy Unit, Royal London Hospital: how can we improve our
performance?, Dr Faidon-Marios Laskaratos and Dr Sean Preston, Royal London Hospital
Audit of the Bristol Paediatric Early Warning Tool Observation Charts, Dr Kiera Meade and Dr Natalie Quinn, Royal Victoria
Hospital, Newcastle-upon-Tyne
Re-Audit of Venflon Insertion and Documentation at the Royal Victoria Hospital, Newcastle-upon-Tyne, Dr Kiera Meade, Dr
Kate McVeigh and Dr Najibah Mahtab, Royal Victoria Hospital, Newcastle-upon-Tyne
Curriulum Mapping Project for the Foundation Programme with the London Deanery, Dr Daniel McGuinness, London Deanery
Foundation Year 1 Clinical Induction Programme, Mrs Helen Melville and Dr Colin Melville, ERMEC, Hull Royal Infirmary,
Yorkshire
Integrating Clinical Governance into the Educational Arena for Junior Doctors, Dr Victoria Naunton & Julie Oakley, Head of
Medical Education, North Tees & Hartlepool NHS Trust
What is the impact of remote and rural training during the Foundation Programme? Dr Suzanne Nabavian, Ms Fiona French
and Ms Mari Todd, NHS Education for Scotland
Venous Thromboembolism prophylaxis in the Acute Medical Unit, Dr Amina Rezgui and Dr Nick Rhodes, Stepping Hill Hospital,
Stockport
Providing a valuable teaching experience for Foundation Trainees, Dr Amit Sud, Dr Olivia Clancy, Miss Louise Turner, Dr
Constantinos Papoutsos, Dr Lolita Chan, Miss Judith Hadfield and Prof Simon Carley, Manchester Royal Infirmary
Drug prescribing in older hospitalized patients, Dr Amy Talbot, Dr Sam Atherton and Dr Anna-Louise Day, Manchester
Can Foundation Doctors participate in ‘on-the job’ educational research without compromising their clinical roles?, Dr Simon
Tso, Dr Gaggandeep Singh Alg and Dr Eleanor Wood, Homerton University Hospital, London
“They didn’t teach us that in medical school”. Evaluating the role played by junior doctors in preparing new trainees for
professional practice, Dr John Williamson, Dr Jonathan Pesic-Smith and Dr Kobika Sritharan, Hornchurch, Essex
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Sharing Notable Practice June 2010
Fluid Balance knowledge in Medical Students can be improved using Multi-dimensional Teaching intervention, Dr Jamie
Wilson and Dr Matthew Taylor, Southampton University Hospitals Trust
Regional Public Health teaching days: mutual benefits for tutors and learners, Dr Sid Wong, Dr Catherine Goodall and Dr
Veena Rodriques, Public Health StR, NHS Bedford
Improving the timing of CT brain requests in stroke patients at Salisbury District Hospital, Dr Andrea Yap, Salisbury District
Hospital
The FOOT Scheme: a near peer approach to undergraduate education, Dr Stuart Younie and Dr Richard Jones, Nottingham
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Sharing Notable Practice June 2010
ORAL PRESENTATIONS
Session 1 – IMPROVING PATIENT SAFETY AND EXPERIENCE – THE
IMPORTANCE OF AUDIT
Don’t drop the baton! – Safe handover, safe patients
Dr Yealin Chung and Dr Bhamini Puvaneswaran
University Hospital Bristol
Background: A foundation doctor must ensure safe continuing care of patients on handover1. An effective
doctor-to-doctor handover is even more important than ever with the increasing move towards shift-type
work pattern. Despite this, under- and postgraduate medical curriculum are still devoid of adequate training
in safe handover practice. It is often the junior doctors that are faced with such
task; young trainees who have received no or minimal guidance, training and/or experience on handover
practice.
Methods & Results: An audit of the written FY1 doctor-to-doctor weekend handovers found that none of
the handovers met the minimal standards recommended by the Royal College of Physicians2. A FY1
questionnaire confirmed only 18% had undergraduate training on handover practice. 100% would have
liked a formal teaching on handover before staring work. Recommendations made to the hospital medical
directorate and the FP directors have led to a local guideline development, a proforma implementation and
handover training module to be part of every induction. Initial feedbacks have been positive and postintervention evaluation is planned.
Key messages: Doctor-to-doctor handover is a significant point of vulnerabiliy in the patient care.
Education and guidance of junior trainees is the key to ensuring safe handover practice.
1. The Foundation Programme curriculum 2010 - available on http://www.nhseportfolios.org
2. The Royal College of Physicians Guideline 2008- available on http://www.rcplondon.ac.uk/clinicalstandards/hiu/Pages/Medical-records.aspx
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Sharing Notable Practice June 2010
Session 1 – IMPROVING PATIENT SAFETY AND EXPERIENCE – THE
IMPORTANCE OF AUDIT
Documentation of Baseline Clinical Condition in Emergency Department patients
and the development of Information Support Cards
DrSarah Frewin, Dr Kate Lambert and Dr Anita Jones
Sunderland Royal Hospital
Background: We developed of a pack of credit card size information cards for foundation trainees after an
audit within the Emergency Department (ED) demonstrated trainees were not using clinical scores and
guidelines to assess patients. The audit was undertaken to assess what information trainees were
documenting, how they accessed assessment tools, whether documenting severity scores influenced patient
care and what information senior staff would expect to see in the patients’ clinical record.
Results and Methods: Results demonstrated that in 84% of cases trainees were not documenting baseline
severity indexes for patients. In 35% of cases this would have changed the course of the patients’
management. The main reason cited for not documenting this information was difficulty finding and
accessing appropriate, evidence based and validated scores. Cards were developed over a nine month
period. Senior ED staff provided lists of what information should be documented and the appropriate
assessment tools. These were then collated into a set of cards which were approved by the Trusts’
Governance Department. Cards were rolled out to all foundation trainees within the Trust in August 2009.
Key Messages: Feedback has been extremely positive as to the usefulness / portability of the cards. A
documentation re-audit is currently underway.
*Foundation Year 2 Doctor, Sunderland Royal Hospital,
**Foundation Programme Tutor, Sunderland Royal Hospital,
***Consultant in Emergency Medicine, Sunderland Royal Hospital
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Sharing Notable Practice June 2010
Session 1 – IMPROVING PATIENT SAFETY AND EXPERIENCE – THE
IMPORTANCE OF AUDIT
A pilot using the electronic patient list to improve the timeliness of the inpatient
inter-specialty referrals
Dr Mohammed Al’Dahan, Dr Antonia Allen, Dr Simon Cleave, Dr Geoff Cockrell, Dr Daniel Henderson,
Dr Daniel Jolley, Dr Amanda Nagle, Dr Rupert Scott, Dr Andrea Yap
Salisbury District Hospital
Background: Inpatient referrals for a specialist clinical opinion at Salisbury NHS Foundation Trust
Hospital currently involve a written referral delivered to the relevant specialty, their ward or secretaries.
The time to patient review varies and can compromise patient safety. Patient experiences describe lengthy
periods of waiting. Here we describe our Healthcare Improvement Project for improving the time taken for
inpatient referrals.
Methods: We audited the turnaround time for the respiratory and cardiology specialties. We mapped the
referral process and consulted patients and consultants about the current system.
Results: The time to review varies from one to seven days. Paper referral systems do not allow all team
members to track a referral’s progress.
To address this we are introducing a referral system integrated with the electronic patient list. Accompanied
by a verbal handover and a record in the patient notes, the referral details will be available electronically to
all involved in the patient’s care. This will increase the likelihood of timely review; allow tracking and
audit of the process and facilitate trust payment for work undertaken.
Key messages: Multi-professional and patient input facilitates process mapping. This demonstrated paper
systems are not robust. Electronic records have potential for facilitating rapid referral and providing
evidence for future healthcare improvement.
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Sharing Notable Practice June 2010
Breakout Sessions 1 – INDUCTION
Showing how education can improve patient safety during the August intake
Dr Rebecca Aspinall, Dr Natalie Blencowe and Dr Nic Jestico
University Hospital Bristol
Background: The August changeover of new doctors has long been recognised as potentially dangerous for
our patients and frightening for our new doctors. Recent papers have shown an increase in mortality in this
month (1) and a significant lack of preparedness of our new doctors (2). We wanted to demonstrate a direct
relationship between an educational innovation and improved patient safety.
Methods: We surveyed F1s and year 5 medical students to determine their learning needs and analysed our
reported critical incidents to define the leaning objectives of the week. We designed and delivered a week
of education targeted at learning needs and common critical incidents. In 2008 attendance by F1s was
voluntary and in 2009 we made it a compulsory part of their employment contract. After 4 months of work
all our F1s completed a confidential questionnaire. This asked them details concerning their preparedness
for starting work as a doctor and also about the critical incidents they had been involved with over the
previous 4 months. An adverse incident index score was calculated using the Delphi technique to weight the
severity of the incidents
Results: Mistakes new doctors made in their first 4 months were reduced by 45% after this educational
intervention was made mandatory.
93% of F1 doctors in 2008 became prepared for their first day (27/29) after the course.
11% of F1 doctors not attending the course in 2008 felt prepared on their first day (1/9)
In 2009 97% (38/39) of F1 doctors felt prepared for their first day after all 39 had attended the course.
Key Messages: The transition between undergraduate and Foundation Training needs more direct support
and attention. F1 doctors should start their employment one week before the massive change round of
doctors in August so patients can be handed over correctly and education can focus on common mistakes
new doctors make.
1)
Early In-Hospital Mortality followingTrainee Doctors’ First day at work.
Min Hua Jen et al PLoS ONE
2)
A report for the GMC Education Committee Dec 2008
(Illing J.et al. How prepared are graduates to begin practice?)
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Sharing Notable Practice June 2010
Breakout Sessions 1 – INDUCTION
Induction Programme for Foundation Year 2 – a prototype
Dr Rosemary Morgan
Wirral University Teaching Hospital
Background: Not all rotations enable the FP 2 trainee to acquire specific clinical skills during their
attachment’s [1]. The curriculum is specific in terms of the competencies that are expected [2] but accept
that they may only be achieved in the clinical skills laboratory. Feedback from successive cohorts included
requests to have clinical skills training before they start as F2’s.
Methods: An induction programme (F2 IP) was developed using a six stage approach to curriculum design
[3]. Topics included six core clinical skills and career guidance. F1 trainees have had the opportunity to
observe the procedures before their performance was assessed in the clinical skills laboratory. Feedback
from 3 successive cohorts using a Likert scale and open text questionnaire assessed at the end of the IP and
again at the end of the F2 year.
Results: 136 FP trainees have completed the F2 IP since 2007 with most strongly rating the programme on
a Likert scale as helpful (median 5 mean 4.48 +/- SD 0.57) and reducing their anxiety (median 5 mean
4.39+/-1.06).
Discussion: Most FP 2 trainees found a specific F2IP helpful and think it reduced their anxiety about their
clinical skills irrespective of the rotations they undertook .
References:
1] Higgins R and Cavendish S. Modernising Medical Careers Foundation programme curriculum
competencies will al rotations allow the necessary skills to be acquired ? Postgrad Med J 2006;82:684-687
2] Academy of Medical Royal Colleges Curriculum for the Foundation years in postgraduate education and
training London F2 Curriculum Committee of the Academy of Medical Royal Colleges in co-operation
with MMC Implementation group, 2005 and 2007
3] Bruner J The process of education 2nd ed Cambridge, MA Harvard University Press 1977
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Sharing Notable Practice June 2010
Breakout Sessions 1 – INDUCTION
Consolidation and pre-FY1 shadowing in the North Western Deanery – a review
Dr Abigail Whitehouse and Prof Paul Baker
North Western Deanery
Background: In 2009 Manchester Medical School reorganised its final year. The traditional month-long
‘consolidation’ period in May was dropped and instead a two weeks of shadowing compliant with GMC
requirements, was organised to occur after graduation. This meant drastic changes to Trusts’ timetables to
fit in all the relevant components of shadowing, e-learning and mandatory induction. This review
scrutinised the 12 Trusts and 16 programmes within the Deanery.
Methods: All programmes provided the timetables for their shadowing period. We looked at the time spent
in shadowing and other teaching. This data was collated and analysed.
Results: In the absence of clear guidance as to what constitutes shadowing, considerable variability was
found. The average amount of actual shadowing time varied from 30 hours to 64 hours with an average of
47 hours within the two weeks.
Key Messages: The pre-work shadowing period provides the opportunity to settle into the job with no
responsibilities. However the large amount of mandatory trust induction can impact significantly on how
useful this time is to new doctors. This review highlighted much good practice but also areas for
improvement. Clarification and central guidance is needed on what constitutes shadowing in general,
shadowing for the particular job and Trust induction.
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Sharing Notable Practice June 2010
Breakout Sessions 1 – INDUCTION
Tackling Trust induction at a Deanery-level: the EMHWD (South) generic induction
project
Dr Rob Gregory
East Midlands Healthcare Workforce Deanery
Background: Induction for new doctors is mandatory, but the traditional lecture-based format has been
criticised for its impact on productivity and possibly putting patients at risk. We undertook to provide
mandatory web-based generic induction for Foundation Trainees placed in five LNR-affiliated Trusts.
Methods: A project board defined the specification and milestones. A generic-curriculum was agreed for
nine core modules. Trusts nominated expert authors to contribute material and to approve the final content.
The modular material was translated into an interactive e-learning package and F1 trainees were mandated
to complete it during their shadowing period. TPDs were able to track the progress of their trainees.
Feedback was sought by questionnaire.
Results: 109 of 131 trainees (83.2%) completed the package, taking a median 10.9 minutes (IQ range 8.414.8) per module. Thirty-six trainees completed the satisfaction questionnaire with satisfaction ratings of
58-80% for all attributes surveyed.
Key messages: An e-learning approach to Trust induction can successfully replace traditional lectures for
new doctors and is acceptable to the trainees surveyed. It is more efficient and less disruptive to the service
at a critical time. This is the first stage of an ongoing commitment to provide up-to-date quality-assured
induction material in an accessible format for all doctors working in the deanery. Evaluation of its costeffectiveness is required.
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Sharing Notable Practice June 2010
Breakout Sessions 1 – WELFARE AND DOCTORS IN DIFFICULTY
Exercise behaviour of FY1s: are we fit enough to practice what we preach?
Dr Alan Sweeney
Manchester
Background: Evidence suggests that increased physical activity (PA) reduces morbidity1,2 and produces
doctors more likely to encourage similar behaviours in their patients3,4. This study aims to evaluate whether
Foundation Year 1 (FY1) exercise rates compare favorably with the Department Of Health's (DoH)
recommendations of 500-1000 MET-mins/wk (metabolic equivalent minutes per week)5,6, and whether
exercise rates are affected during the transition to doctor.
Methods: All Northwest FY1s received an online questionnaire addressing demographics, health
behaviours, working conditions and Godin's PA Questionnaire 7. (n=131)
Results: As students, 60% of candidates met DoH recommendations, falling to 31% once qualified (agematched national average: 42%)8. 58% of students meeting DoH recommendations, failed to do so as
doctors. 50% of these candidates left work, on average, >40mins late (33% amongst other candidates).
70% demonstrated reduced MET-mins/wk once qualified (mean: 60% reduction), blaming tiredness (70%),
reduced free-time (54%) and working beyond end of shifts (35%). Commonly suggested solutions included
an on-site gym, gym NHS discounts and stricter enforcement of leaving at 5pm.
Key Messages: 69% of FY1s within the Northwest Deanery are not meeting DoH recommendations for
PA, predisposing to chronic illnesses and hindering delivery of lifestyle interventions to patients. Those
most affected tended to leave work on-time less frequently than their colleagues.
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Sharing Notable Practice June 2010
Breakout Sessions 1 – WELFARE AND DOCTORS IN DIFFICULTY
A sense of community lost? First Year Foundation Programme Doctors: how does
the loss of free accommodation affect professional development?
Dr Tikki Immins, Dr Tim Battcock and Dr Mike Masding
Bournemouth University Hospital
Background: Evidence suggests that increased physical activity (PA) reduces morbidity1,2 and produces
doctors more likely to encourage similar behaviours in their patients3,4. This study aims to evaluate whether
Foundation Year 1 (FY1) exercise rates compare favorably with the Department Of Health's (DoH)
recommendations of 500-1000 MET-mins/wk (metabolic equivalent minutes per week)5,6, and whether
exercise rates are affected during the transition to doctor.
Methods: All Northwest FY1s received an online questionnaire addressing demographics, health
behaviours, working conditions and Godin's PA Questionnaire 7. (n=131)
Results: As students, 60% of candidates met DoH recommendations, falling to 31% once qualified (agematched national average: 42%)8. 58% of students meeting DoH recommendations, failed to do so as
doctors. 50% of these candidates left work, on average, >40mins late (33% amongst other candidates).
70% demonstrated reduced MET-mins/wk once qualified (mean: 60% reduction), blaming tiredness (70%),
reduced free-time (54%) and working beyond end of shifts (35%). Commonly suggested solutions included
an on-site gym, gym NHS discounts and stricter enforcement of leaving at 5pm.
Key Messages: 69% of FY1s within the Northwest Deanery are not meeting DoH recommendations for
PA, predisposing to chronic illnesses and hindering delivery of lifestyle interventions to patients. Those
most affected tended to leave work on-time less frequently than their colleagues.
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Sharing Notable Practice June 2010
Breakout Sessions 1 – WELFARE AND DOCTORS IN DIFFICULTY
Foundation Families: tips, tricks and pitfalls for Foundation trainees with young
children
Dr Bridget Langham, Dr Natasha Lovell and Dr George Mason
East Midlands Healthcare Workforce Deanery
Background: Foundation training is a major transitional period in the life of a doctor. Major life events
impact on this phase, starting a family being one of these. We realize that this may be stressful so we have
developed a resource to aid trainees. Trainees who have young families have the experience of balancing
the competing demands of foundation training and family life.
Method: We engaged current trainees with families and created an “e-community” for them to share
solutions. In addition we have developed an online resource available to all trainees; the majority of
content has been developed by our foundation family trainees. Each contributor has provided a vignette of
themselves and an account of their experiences including “Tips, Tricks and Pitfalls”. The remainder of the
resource details Deanery processes and useful links.
Results: We are aware of 12 trainees in our school who are raising young families and have asked for our
support. Each has been contacted and all have agreed to join the “e-community”. From this group 10 have
been keen to contribute to the online resource.
Key Messages: Engaging a highly motivated group to share their solutions, will reassure others and enable
them to plan and succeed.
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Sharing Notable Practice June 2010
Breakout Sessions 1 – WELFARE AND DOCTORS IN DIFFICULTY
The whole of greater than the sum of the parts – a co-ordinated approach to the
management of foundation doctors with difficulties
Dr Ann Cadzow and Dr Rob Laing
NHS Education for Scotland
Background: It is an important deanery responsibility to identify and provide appropriate support for the
relatively small proportion of Foundation Doctors (FDs) with significant difficulties. In the North of
Scotland Deanery, the nine Foundation Programme Directors (FPDs), based in three geographically distant
locations, take the major role in this process. Each FPD has responsibility for thirty FDs and, as an
individual, does not see enough trainees with difficulties to become experienced in this area.
Methods: To help in dealing with trainees with difficulties, a process was established in 2006 enabling
FPDs to meet bi-monthly by video conference. Information and action points are recorded on a confidential
database. This process is actively supported by key deanery staff and a representative of NHS Grampian,
the largest local health board ,.
Results: There are positive outcomes for all stakeholders .Each FD’s situation is managed equitably,
consistently and with continuity. FPDs benefit from peer support and an increase in their experience and
expertise. The deanery can evidence good educational governance and the employer has improved clinical
governance and better staff management.
Key message: Structure and coordination are key to achieving the optimum outcome for trainees with
difficulties.
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Sharing Notable Practice June 2010
Breakout Sessions 1 – QUALITY MANAGEMENT
Competency mapping in a Foundation School
Dr Jennifer Ruddlesdin, Dr Lauren Wentworth, Dr Sarita Bhat and Prof Paul Baker
North Western Deanery
Background: Competency-based curricula now dominate medical training, focusing on outcomes in terms
of application of knowledge and acquisition of competencies. The competencies deliverable by Foundation
Programme placements are normally considered by inference from the host specialty. The aim of this
exercise was to analyse posts and programmes for potential training outcomes.
Methods: A mapping process against the UK Foundation curriculum was designed. Data was gathered in
terms of competencies from Foundation School directors using red/amber/green judgments for each post.
Results: 40% of programmes found the timescale challenging. Occasional non-returns from individual
posts left gaps in tracks’ records, but did not, in practice, disrupt the process. Certain competencies were
highlighted as being problematic across the majority of providers, allowing programme directors to ensure
deficiencies are compensated by targeted training, simulation or teaching. After submission no
correspondence was needed on any programme about educational arrangements suggesting the process had
a significant formative effect.
Key messages: Competency based training requires regular assessment of the experiences provided for
competency attainment. Without this it is impossible to claim that the programme meets training needs.
Introducing competency mapping has been shown to be extremely useful in highlighting problem
competencies and is also formative for education providers.
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Sharing Notable Practice June 2010
Breakout Sessions 1 – QUALITY MANAGEMENT
An evaluation of the Educational Supervision of Foundation Programme Trainees
by non-medical and non-clinical educational supervisors
Dr Jon Scott, Ms Nicola Whitelock, Mrs Diane Johnson, Ms Viv Lund, Mr Hani Fawzi and Mr Ian Frame
South Tyneside NHS Foundation Trust
Background: Foundation Programme (FP) trainees take responsibility for their learning and professional
development as adult learners. The traditional model of doctors’ Educational and Clinical Supervision is
one of supervision by consultants, but other professional disciplines are also experienced in both clinical
and educational supervision. There are currently 49 FP trainees at South Tyneside NHSFT and 22 FP
Educational Supervisors (ES) of whom 14 are consultants, 5 are senior nurses/midwives and 3 are nonclinical staff with coaching/mentoring experience. All ES have access to Trust and Deanery FP training
events and are monitored for compliance against PMETB trainer standards.
Methods: F2 ARCP outcomes were assessed in 2008 and 2009 and a F2 trainees’ questionnaire was
administered in July 2009.
Results: There was no significant difference in ARCP outcome for 38 F2 trainees irrespective of the
professional discipline of the ES. The questionnaire (response rate 100%) indicated an overall satisfaction
score of 8.6/10 for nursing ES (n=8) v 7.3/10 for non clinical ES (n=4) v 7.3/10 v medical ES (n=13). More
detailed results will be presented and discussed.
Key Messages: With appropriate support and training, non-medical professionals can successfully transfer
their skills to the educational supervision of FP trainees and evaluate well from the trainees’ perspective.
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Sharing Notable Practice June 2010
Breakout Sessions 1 – QUALITY MANAGEMENT
Developing 360 degree appraisal for Foundation Year (FY) Clinical Tutors
Dr Sarah Blundelland Dr Ratan Alexander
Worcestershire Royal Hospital
Background: Multisource and Team Assessments of Behaviour (TAB) have been found to positively impact
behaviour, provide constructive feedback and highlight areas of concern (1,2,3). At present there is no
feedback process for clinical tutors (CT) at Worcestershire Royal Hospital which has 58 FYs. Our CT (new
to the post) agreed to participate in this audit.
Methods: 36 FY Doctors were asked to complete two appraisal forms (randomised for order of
completion). One form was based on the TAB used in the FY e-portfolio. The second provided a five point
scale to assess our CT on 24 points in areas of “attitudes”, “behaviour” and “educational leadership”. This
was based on the CT peer assessment form NACT trialled.
Results: 32 FYs returned forms, five declined to submit more than one form. Refusal was more likely had
the trainee first filled out the graded form, which was perceived as longer. The CT received a mean score of
four (good) in most areas on the graded form, in total six comments were left.
Key Messages: The graded form was useful in quantifying strengths/weaknesses in many aspects and
allowed a range of grades rather than “no concern” as per the other form.
References
1.
Joshi R, Ling FW, Jaeger J. Assessment of a 360-Degree Instrument to Evaluate Residents'
Competency in Interpersonal and Communication Skills. Academic Medicine. Special Theme:
Residents. 2004, 79(5):458-463.
- 19 -
Sharing Notable Practice June 2010
Breakout Sessions 1 – QUALITY MANAGEMENT
Educational Supervisor e-portfolio engagement – is specialty important?
Dr Alex Haig, Dr Tim Brown and Dr Joel Smith
NHS Education for Scotland
Background: Educational supervisors have a crucial role in monitoring foundation doctors’ progress and
their engagement with ePortfolios is critical. Although most ePortfolio requirements are trainee driven, the
educational supervisor contributes records of induction, mid-point and end of attachment meetings as well
as an end of placement supervisors report. Foundation doctors gain experience in a range of specialties and
there should be consistency of approach from each. ePortfolio submissions will be analysed to illustrate
how supervisors record and engage with supervision of foundation doctors.
Methods: Submission of required induction/mid-point/end of attachment forms and supervisor reports to
the ePortfolio by educational supervisors for foundation doctors will be reported by specialty for all
foundation doctors in post between August 2008 and August 2009 (n=12,452). The use of supplementary
reports from clinical supervisors will also be reported by specialty and patterns of usage will be described.
Results & Key Messages: Variation in engagement of educational supervisors across different specialties
indicates potential training gaps. Deaneries should ensure consistency of approach for all supervisors of
foundation doctors, and the kind of information about educational supervisor use of ePortfolio that could be
made available to Deaneries to improve quality assurance will be discussed.
- 20 -
Sharing Notable Practice June 2010
Breakout Sessions 2 – CAREERS
Future plans for the NHS Medical Careers Website
Mrs Joan Reid, Mr Jason Yarrow and Ms Lisa Stone
KSS Deanery
Background: The medical career pathway in the UK has changed as a result of the Modernising Medical
Careers initiative and the provision of careers information, advice and guidance is an important activity for
postgraduate deaneries and foundation schools. KSS manages the NHS medical careers website
(www.medicalcareers.nhs.uk) on behalf of the Department of Health.
The website was re-launched in July 2009 to address the need for medical careers advice. It is based on the
career approach developed by the Association of American Medical Colleges (AAMC) and utilises a range
of materials licensed from them within a four stage career planning framework).
Methods: The site has a wide user base and the content is updated on a regular basis. Site usage is
monitored each month and feedback obtained both formally and informally. A focus group comprising
medical students and foundation trainees has been recruited.
Results: The results from the focus group will be presented together with an analysis of other feedback
which has been received. Our plans for the development of the site will be included.
Key Messages: The importance of providing quality information over the web is recognised and the site
includes a range of tools, information and resources for medical students, foundation doctors and trainers.
- 21 -
Sharing Notable Practice June 2010
Breakout Sessions 2 – CAREERS
The importance of good careers advice to Foundation Trainees
Dr Holly Bekarma and Dr Jane Coupethwaite
Stepping Hill Hospital, Stockport
Background: Stepping Hill Hospital provides extensive careers advice to its Foundation doctors to prepare
for specialist training applications. Throughout the two years a variety of teaching sessions, lectures and
workshops are provided to ensure trainees are prepared to the highest possible standard.
Methods: We informally discussed the outcome of specialist training applications amongst FY2’s and
established opinions on the quality, importance and impact of careers support provided.
Results: 21 out of 28 trainees applied for specialist training, 100 % were successful in achieving their first
choice position and all felt the advice they received gave them an advantage over other trainees.
Key messages: A careers meeting rated Stepping Hill Hospital as the lead trust for careers provision in the
Northwest deanery. A large emphasis is placed on careers with dedicated sessions covering career
exploration and planning, CV structure, application processes, interview preparation and the Windmills
career planning. Advice is provided by a careers lead, clinical and educational supervisors, speciality
tutors, foundation programme and medical education directors.
Comments from trainees included;
“provision of excellent advice compared to other trusts”
“well structured”
“designated careers tutor”
“every effort is sort to find the right person to deliver advice”
“gave me an advantage over other trainees in the deanery”
- 22 -
Sharing Notable Practice June 2010
Breakout Sessions 2 – CAREERS
Mock Specialty Interviews for F2 Doctors in the Royal Glamorgan Hospital
Dr Gareth Davies,Mrs Rachel Heycock and Ms Anne Cowell
Royal Glamorgan Hospital
Background: F2s attend specialty interviews with little or no interview experience and struggle compared to more
senior candidates. Realistic mock interview sessions have been established aiming to enhance interview success. The
third iteration was held in January 2010.
Methods: Fourteen candidates were interviewed. Interviewers included 15 Consultants (2 Clinical Directors), Deanery
Careers Advisor and an HR Manager.
The stations were;
 Portfolio/presentation
 Clinical scenario (with actors)
 Competency-based (problem solving, professional integrity, coping with pressure).
Candidates were scored on their performance. Generic verbal feedback and individual written was given. Candidates
and interviewers provided feedback.
Results:
Trainee Feedback
1=Not at all 5=Extremely
5
4
3
2
1
The session w as
benef icial to trainees
The session w as
relevant to trainees
The session w as
interesting
The process w as w ell
explained
The session w as
usef ul f or personal
development
Interview Panel Feedback
1=Not at all 5=Extremely
5
4
3
2
1
The session w as
w ell organised
The session w as
beneficial to
trainees
The session w as
relevant to trainees
The session w as
interesting
The process w as
w ell explained
The session w as
useful for personal
development
All felt it should be repeated annually. Many trainees were successful in their first choice. Interviewees comments –
“invaluable opportunity, especially if you haven’t had an interview for many years”, “learnt how to sell myself and
structure my answers”. Interviewers – “role play team were an excellent investment”, “I think both the panels and the
juniors got a lot out of it”.
Key Messages: Mock interviews prove vital in enhancing F2s application at Specialty interviews. Involvement of
senior staff demonstrates the value they place on helping the trainees in their career progression. Trainees gained an
important boost to skills and confidence at this pivotal career stage.
- 23 -
Sharing Notable Practice June 2010
Breakout Sessions 2 – TEACHING 1
Embedding public health in Foundation Teaching Programmes: experiences from
the East of England
DrVeena Rodrigues and Dr Celia Duff
University of East Anglia, Norwich
Background: There is growing recognition that improving clinician awareness and skills of key Public
Health (PH) issues such as the social determinants of health, is central to prevention and treatment of illhealth among the population. A baseline survey revealed substantial variation in PH content of Foundation
teaching programmes in Acute Trusts in the East of England.
Methods: Links between Foundation teaching programmes and local PH specialists were established/
strengthened as necessary to ensure inclusion of PH teaching sessions in all Acute Trusts. A set of tried and
tested interactive teaching materials to address key Foundation competences were made available to tutors
for this purpose.
Results: There was a marked improvement in the consistency and content of PH teaching delivered within
the Region. The generic teaching materials were easily adaptable to suit individual tutor styles. Feedback
from Foundation doctors was very positive and in several Trusts included requests for more contact time to
develop key PH skills. Better links also enabled better sign-posting for PH career advice and knowledge
resources.
Key Messages: Establishing good links between PH specialists and Foundation teaching programmes had
mutually beneficial results. Delivering interactive teaching sessions facilitated learning of key PH
knowledge and skills for junior doctors.
- 24 -
Sharing Notable Practice June 2010
Breakout Sessions 2 – TEACHING 1
“Doctor come quickly …”: an FY1 developed evidence based teaching programme
to prepare finalists for undertaking on-call work
Dr Ruth Heseltine, Dr Michael Fitzpatrick, Dr Hefina Gwyn-Jones and Dr Dana Sibony
Homerton University Hospital, London
Background: FY1 doctors find ‘on-call’ shifts a challenging experience, for which they often feel
inadequately prepared. We developed an FY1 delivered evidence-based curriculum for finalist medical
students specifically addressing commonly encountered ‘on-call’ situations.
Methods: We used quantitative questionnaires to survey the tasks FY1 doctors completed during 18
separate ‘on-call’ shifts at the Homerton Hospital. From these data we constructed a list of common ‘oncall’ tasks. We then surveyed 153 final year medical students (90% response) about their perceived ability
to undertake such work.
Results: The students’ confidence in performing FY1 “on-call” tasks varied, with particular deficiencies in
decision making; patient management, prescribing, radiology interpretation. Using these data we
constructed a curriculum, syllabus and teaching resources. FY1 doctors will deliver 4 local pilots (6hrs
small-group finalist teaching), with senior clinicians supervising the development of teaching resources and
content to ensure patient safety. Students’ perceptions will be reassessed to ascertain effectiveness of the
teaching. Expansion across NETFS is envisaged with centrally developed resources ensuring quality and
consistency of student experience.
Key messages: We developed an FY1-led evidence-based teaching programme which prepares finalists for
the challenging work of ‘on-calls’, specifically addressing common FY1 tasks for which students feel
under-prepared.
- 25 -
Sharing Notable Practice June 2010
Breakout Sessions 2 – TEACHING 1
Simulation training within the Foundation Programme in Portsmouth
Dr Michael Glaysher, Dr S Donhou, Dr G B Smith and Dr K Harris
Portsmouth Hospital
Background: The UK Foundation Programme (FP) Office stipulates that medical simulation should be
fully exploited as a method of learning throughout foundation training, as it has been shown that simulation
enhances communication, enriches learning experiences and promotes safer practice. 1,2 Using the FP
Curriculum, the Training, Education and Assessment by Medical Simulation (TEAMS) Centre at
Queen Alexandra Hospital developed a simulation training programme for Foundation Trainees (FTs) using
high-fidelity techniques.
Methods: A recent questionnaire-based audit evaluated the impact of simulation exercises on Foundation
training using qualitative and quantitative data from FTs’ feedback.
Results: 100% of FTs (n=59) found courses to be beneficial and relevant to their clinical practice.
Scenarios were thought to reflect clinical practice accurately (100%). 96% of FY1s (n=46) and 100% of
FY2s (n=13) felt that they were more confident in managing a critically ill patient following simulation
training, and 100% (n=38) of FY1s and 92% of FY2s (n=12) found the debriefing process helpful. FTs
liked the small group training, found it more useful than lectures and requested further opportunities for
simulation training.
Key Messages: High-fidelity simulation training has been highlighted as an effective tool in delivering key
elements of the foundation curriculum, mediating professional development, enhancing communication and
developing core clinical skills.
References:
(1) The UK Foundation Programme. Curriculum. London: The UK Foundation Programme, June
2007.
(2) Department of Health (DoH). 150 Years of the Annual Report of the Chief Medical Officer.
London: Department of Health, 2009
- 26 -
Sharing Notable Practice June 2010
Breakout Sessions 2 – TEACHING 2
Foundation training and the acutely ill patient: developing an Emergency
Department education package based on national guidance
Dr Brad Wilson and Dr David Robinson
Bradford Royal Infirmary
Background: We aimed to evaluate an existing Emergency Department (ED) FY2 education programme,
and identify new strategies to deliver the recommendations made in NICE CG50 “Acutely ill patients in
hospital”.
Methods: We analysed our existing FY2 educational resources and identified competencies for which there
was no educational component. A consensus was reached on action that was required that would allow
opportunities for trainees to achieve these competencies.
Results: The existing educational resources adequately covered 58/72 (81%) competencies, and we
identified 5 (7%) for which there was no educational resource. The resource that covered the largest number
of competencies was the departmental induction (44/72, 61%), followed by ALS (27/72, 38%),
departmental pathways and guidelines (24/72, 33%), Deanery training days (16/72, 22%), and the
departmental e-learning programme (15/72, 21%). Resources that were developed to deliver the 14
outstanding competencies included 6 structured workplace based assessments, 4 new e-learning modules,
and formal handover guidance.
Key messages: Our existing FY2 educational resources covered the majority of the nationally
recommended competencies for dealing with acutely ill patients. However, we were required to develop
extra resources to provide a comprehensive educational package to the trainees in our department.
- 27 -
Sharing Notable Practice June 2010
Breakout Sessions 2 – TEACHING 2
Implementing patient safety training in the Foundation Programme
Dr Maria Ahmed
Manchester Royal Infirmary
Background: Junior doctors are vital to promoting Patient Safety in the workplace, often being directly or
indirectly involved in patient safety incidents (PSI).1 Despite the inclusion of Patient Safety in the
Foundation Programme curriculum2, there are limited opportunities for trainees to develop safety
competencies through discussion of PSIs.
Methods: Dedicated half-hour sessions ‘Lessons Learnt’ were built into the FY1 Foundation teaching
programme at Central Manchester University Hospitals Foundation Trust. Trainees led peer-group
discussions on PSIs experienced in the workplace, using National Patient Safety Agency frameworks to
discuss the contributing and mitigating factors, within a safe, facilitated environment.
Results: Lessons Learnt generated powerful discussion and action-points for improvement. Evaluation
revealed the majority agreed/strongly agreed that reflection is a powerful tool for learning from mistakes
(94%, n=18) and that trainees can learn from each other’s mistakes (100%). Following the success of the
pilot, competitive funding was secured from NHS North West to roll-out Lessons Learnt across all
Foundation programmes within the North Western Deanery. Full implementation is planned for March
2011 in expert collaboration with the Imperial Centre for Patient Safety and Service Quality.
Key messages: Patient Safety is a key healthcare agenda. Trainees can co-develop innovative strategies to
enhance safety skills and competencies.
References
1. Long S, Neale G, Vincent C. Practising safely in the foundation years. BMJ 2009;338:887-890
2. Foundation Programme Curriculum, June 2007. Available from
www.foundationprogramme.nhs.uk
- 28 -
Sharing Notable Practice June 2010
Breakout Sessions 2 – TEACHING 2
Enhancing deanery-wide clinical skills training: web-based MCGs bane or boon?
Dr Adam Malin, Dr Mark Mallet and Dr Gerrit Van Rensburg
Royal United Hospital, Bath
Background: How can we best enhance the teaching of psychomotor skills relevant to Foundation 2
trainees across eight Hospital Trusts within the Severn Deanery? We will describe a method for preparing
trainees prior to a whole day of Clinical Skills teaching, its follow up and evaluation.
Methods: The Royal United Hospital Bath is one of two centres currently teaching Clinical Skills for
Severn Deanery F2s. We offer three days a year, each for 36 trainees. Trainees receive an email two weeks
prior to the event with a web-link to an MCQ page
(www.ruh.nhs.uk/gps/education/foundation/f2_clinical_skills_pre_course.asp) and are asked to complete
prior to receiving their pre-read material. They attend the day which covers nine stations. They complete a
booklet during three minute breaks between stations for scored and free-text feedback. Following the
course, they receive the same set of formative MCQs. Their certificate of attendance is forward when this
second set is completed and includes their final but not first score.
Results: Written feedback for the course has been excellent such as “Thorough hands on from start. Learn
by doing!” In addition, not too surprisingly, the MCQ scores increased from 74% pre-course average to
85% post course (p<0.001).
Key messages: We believe that the success of the course relied on multiple factors, particularly the
enthusiasm of Faculty. However, although less popular than the day itself, we also believe that the MCQs
and pre-read course material prepared trainees with the pre-requisite knowledge base to make the day
“hands on” and “learn by doing”.
- 29 -
Sharing Notable Practice June 2010
Session 2 – E-LEARNING, SIMULATION AND CLINICAL SKILLS
Clinical skills and simulation provision for Foundation trainees in the United
Kingdom
Dr Richard Porter and Dr Alasdiar Strachan
Montagu Hospital, Mexborough
Background: The recent Chief Medical Officers report recommended simulation based training be
integrated within training programmes1, and is supported within the Foundation curriculum. We were
interested to see what current availability for skills and simulation training existed and the perceived
sufficiency of such training.
Methods: The authors designed an on-line electronic questionnaire on Survey Monkey™. The link to
this was emailed to all foundation programme school directors in the United Kingdom. For participants
who were unable to access the on-line questionnaire an attached Microsoft Word™ .doc form was
utilised. The data was analysed using Microsoft Excel for Mac 2008™.
Results: We obtained data for a total of 6273 foundation trainees within the United Kingdom. Of these
4682 (75%) had access to a Clinical Skills Laboratory; 5008 (80%) of foundation trainees had access to
a Clinical Simulation Centre. In the programme directors’ opinion 2455 (39%) of trainees had sufficient
clinical skills training and 2348 (37%) had sufficient clinical simulation training.
Figure 1.Percentage of Foundation Doctors with access to clinical skills labs, simulation centres, clinical
skills tutors, simulation trainers and the percentage of foundation programme directors who feel the time
allocated is sufficient.
Key Messages: The majority of foundation trainees have access to Clinical Skills Laboratories and
Clinical Simulation Centres. Yet, it remains the opinion in the majority of foundation programme
school directors the allocated time is not sufficient.
1.
The Chief Medical Officers (CMO) Annual Report 2008 – Safer Medical Practice
- 30 -
Sharing Notable Practice June 2010
POSTER PRESENTATIONS
1.
F1 Leadership Project
Dr Naomi Brown, Dr Zaynab Baha and Dr Salman Zaman
Leighton Hospital, Crewe
Background: All doctors have to develop leadership skills. This has been formalised within the ‘Medical
Leadership Competency Framework’ (MLCF)(1) to be integrated into undergraduate and postgraduate
curricula. To aid the acquisition of these skills FY1 doctors at Leighton Hospital were given the
opportunity to complete leadership projects. ‘The Challenge’ – Identify a problem (anything at all!) within
the trust, then design and implement a solution.
Methods: Each group was allocated a mentor from within trust management to provide guidance and given
access to resources, including finance.
Results: Four projects are currently ongoing:
1. Redesign of the FY1 medicine rota to include an acute block – the new rota is to be
implemented in April.
2. Review of the FY1 teaching programme – interviews and focus groups with stakeholders to
identify current issues and potential solutions. The outcome will be a report with
recommendations.
3. Handover.
4. Waste disposal and recycling.
Key messages:
 Great opportunity to make a real difference within the trust and see changes actually happen.
 Allows the development of a wide range of skills from several MLCF domains (1) including:
personal qualities, working with others, improving services and managing services.
 Feedback suggests the format needs to be more structured.
References:
1. NHS Institute for Innovation and Improvement Medical Leadership Competency Framework
http://www.institute.nhs.uk/assessment_tool/general/medical_leadership_competency_framework__homepage.html (accessed 11/03/10)
- 31 -
Sharing Notable Practice June 2010
2.
A Guide to the ePortfolio System for F1 Doctors
Dr Toni Bryant
West Midlands Deanery
Background: A junior doctor’s portfolio is an important tool to record career progression, show
evidence of professional development and provide examples that illustrate specific foundation
curriculum competencies. F1 doctors usually attend an extensive induction covering most aspects of
clinical work, however within the West Midlands Deanery no formal induction to the ePortfolio
system is in use. Since portfolios are an important part of medical training and widely used in most
specialties it is vital that doctors learn to use them effectively. Progression in the Foundation Programme is
largely reliant on the evidence provided by the doctor’s portfolio and for that reason I felt it was key that
F1s received formal training on using the ePortfolio system.
Solution/Methods: I have developed an interactive training session for F1 doctors. It is designed to
provide practical information on how to navigate the system as well as explaining the importance of
maintaining an accurate portfolio. I have also produced a summary handbook that allows the new
F1 doctor to refer back to the information at all stages of their F1 year.
Results: The teaching session has been trialled on current F1 doctors with excellent feedback.
There are plans in place for the session to initially be delivered to all F1 doctors commencing work
at Worcester Royal Hospital in August 2010. If it is a success it will then be rolled out to other F1s
in the West Midlands Deanery.
- 32 -
Sharing Notable Practice June 2010
3.
Safe handover from Accident and Emergency to the Emergency Assessment
Unit
Dr Anna-Maria Bielinska, Dr Anita Fernando, Dr Nasri Zreik FY1 Drs & Mr Hugh Millington
Charing Cross Hospital, London
Background: Effective handover during the acute admission is essential, particularly due to shift-based
work and increasing numbers of individuals caring for patients. At Charing Cross Hospital, London, a
computerised emergency admissions written sheet is completed in addition to verbal handover, to facilitate
handover from Accident and Emergency to the Emergency Assessment Unit.
Methods: We retrospectively audited all handover sheets over one week, analysing the quality and
completeness of information. The department has since adapted the way the admission form is completed,
introducing fields which are mandatory and a clearer format with subcategories. We provided feedback
forms for nurses and convened a meeting with emergency doctors to reflect on improvements and attitudes
to handover. Subsequent to introducing the new format we re-audited the quality of handover.
Results: Written handover has improved, with better information on management, teams involved and
nursing instructions. We identified that written handover is crucial for nursing staff and have suggested
improvements on better handover from doctors to the nurses.
Key Messages: The introduction of mandatory fields and subcategories has improved the quality of written
handover. Departmental reflection at meetings and feedback has identified areas of improvement for
handover between emergency doctors and nurses.
- 33 -
Sharing Notable Practice June 2010
4.
The Multimodel approach to Careers support within the North West
Foundation School,
Dr Eleanor Checkley and Dr Maire Shelly
North Western Deanery
Background: The Foundation Programme gives trainees experience in a wide range of specialities, but
careers choices maybe more difficult as decisions have to be made earlier. As workforce needs change, and
training programmes develop, there is an ever greater need for flexibility and adaptability in careers
planning. Foundation trainees need support in managing their careers 1. They need timely information as
well as guidance and advice 2 . There are a variety of learning styles and a good educational programme
needs to address this 3. We are therefore developing a multimodal package of support.
Methods:
Written information
Internet
1:1
Events
UKFPO publications
Careers books available at education centres
NW deanery website
‘Facebook’ group for timely signposting
E portfolio careers pages for use with educational supervisors
Training for educational supervisors and foundation programme
directors
‘Windmills’ careers support workshops
Deanery careers conference
BMA careers conferences
Results: Some interventions can be directly monitored, and we are recording and collating this
data. A trainee survey will be repeated to monitor effectiveness.
Key messages:
Aims
 Develop a service that is sustainable but responsive to feedback and changing needs of foundation
trainees.
 Training for educational supervisors to deliver
careers guidance.
References:
1. UKFPO; The Foundation Programme Curriculum. Appendix C Appointment to
foundation programmes and career management. April 2010
2. Jackson C, Ball J, Kidd J M, Hirsh W; National Institute for Careers Education and
Counselling. Informing choices – the need for career advice in medical training. Nov 1st 2003. Available
from the Careers research and advisory centre (C.R.A.C.):
http://www.crac.org.uk/CMS/files/upload/nicec_informingchoices_medicaltrainig_re
port.pdf
3. Buisnessballs.com[homepage on the internet]. Kolb learning styles (© David
Kolb). review and diagrams:Alan Chapman, Leicester 2003-2010.
available at:http://www.businessballs.com/kolblearningstyles.htm
- 34 -
Sharing Notable Practice June 2010
5.
The Development of a Foundation Programme Trainee Forum
Dr Marc Davison, L Creasy, S Dunkerley, T McAllister, K Sahota, M Sinczak, S Edmonds, P Lintott
Stoke Mandeville Hospital
Background: Recent documents have highlighted the importance of trainee involvement in their own
education and the requirement for leadership training to be embedded in curricula at the earliest stage. (1,2)
Methods: We devised and piloted a process to combine these needs at foundation level within a DGH
setting.
Results: Personal statements were used to select eight foundation doctor representatives to form a forum
that meets quarterly with programme directors. Representatives developed relevant skills through a specific
monthly, trust funded Management and Leadership Programme. Representatives actively recruited trainees
to form a constituency which they represented throughout the year.
Representatives gained experience in management and leadership skills, enabling them to provide effective,
formalised and structured feedback. By making themselves accessible to all foundation trainees,
representatives provided programme directors with overall insight into the expectations and experiences of
their peers. This has led to the improvement of training provision. Areas of need have been addressed by
creating a handbook of learning opportunities within the trust, organising additional formalised teaching
and improving the supervision and induction processes.
Key Messages: This pilot shows that a foundation trainee forum combining leadership training with a
trainee feedback role can support improvements in training and may create medical leaders of the future.
References:
1. General Medical Council. The new doctor: guidance on foundation training. September 2009
2. Department of Health. High quality care for all: NHS next stage review. June 2008
- 35 -
Sharing Notable Practice June 2010
6.
A snap-shot audit of good inpatient prescribing practice
Dr Catherine Essen
Worcesteshire Royal Hospital
Background: In 2009, the GMC released a report on prescribing errors by foundation trainees 1.
Medication adverse effects cost the NHS over £500 million per year 2 and occur in over 50% of hospital
admissions3. Reason’s ‘swiss cheese’ model describes prescription charts as a key source of prescription
errors4.
Methods: 20 inpatient prescription charts were randomly audited in an English hospital using a 22-point
proforma that incorporated Trust and GMC guidelines. This provided a snap-shot audit of the prescription
practice of both foundation and non-foundation doctors. Partial guideline compliance was deemed ‘noncompliance’.
Results: Overall, compliance was good, with greater adherence by foundation trainees than other grades.
Patient information was universally documented. All prescriptions were signed, legible and had correct
route abbreviations. 50% of charts had a bleep number provided; 45% of charts had allergies documented;
70% of PRN medications had no maximum dose stated; and fewer than 10% of prescriptions were correctly
discontinued.
Key messages:
 Foundation trainees are more accurate in prescription writing than other grades.
 All fields within a prescription must be completed in order to prevent adverse events or errors.
 Doctors need to ensure that they can be contacted by bleep should any problems or queries arise.
1
Dornan T, et al. An in depth investigation into causes of prescribing errors by foundation trainees in
relation to their medical education. EQUIP study. London: GMC; 2009.
2
NHS Audit Commission. A Spoonful of Sugar: Medicines management in NHS hospitals.
London: Audit Commission; 2001, p. 57.
3
Gleason K, Groszek J, Sullivan C. et al. Reconciliation of discrepancies in medication histories and
admission orders of newly hospitalized patients. Am J Health Syst Pharm. 2004; 61: 1689–95.
4
Reason J. Human error: models and management. BMJ. 2000; 320: p. 768-770.
- 36 -
Sharing Notable Practice June 2010
7.
Providing Protected Training Time
Dr Joanne Evans
Homerton University Hospital, London
Context & setting: The National Survey of Trainee Doctors suggests that many F1s find that access to
educational opportunities can be adversely affected when there are increases or changes in service demand.
This careful balance of service level demands and training can be a difficult task but, in spite of such issues,
there is still a requirement to allow Foundation Programme competencies to be met.
Why the innovation was introduced: In order to provide the FY1s within the busy Trauma and
Orthopaedics department with an experience broader than ward based work, a simple timetable was devised
with the aim of providing protected educational clinic and theatre time for trainees, and from which
deviation was only permissible with express consent of the Head of Department.
Impact: In its first three months, the timetable allowed two FY1s to spend a total of 16 hours in clinic and
around 20 hours in theatre. In addition to facilitating work-based assessment and providing different
reflective environments, this innovative yet simple rota also offers added value in providing a means of
career exploration, with direct consultant shadowing. Problems with its implementation have included oncall commitments, annual leave and potentially competing with medical students for exposure.
- 37 -
Sharing Notable Practice June 2010
8.
Foundation Doctors Forum – encouraging trainee lead innovation and
improvement of foundation training
Dr Francesca Garrard
The Great Western Hospital, Swindon
Background: The relationship between a foundation trainee and their employing trust, despite being
relatively short lived, has a significant impact on the trainees’ professional development. As such, it is
crucial to create a dialogue between the trainees and their postgraduate education team, to address training
issues and improve the experience of future cohorts. The Foundation Doctors Forum at the Great Western
Hospital was recently set up to encourage foundation doctor representation and constructive
discussion on training and working practices.
Methods: Part of the forums aim is to identify training challenges, as well as areas of good practice to
emulate across the Trust. In order to objectively identify these, a survey of the foundation year 1 trainees
was conducted. This included questions on educational opportunities and working practices during the
normal working day and on call commitment, of the foundation trainee’s first two rotations.
Results: The survey identified many areas of achievement including the breath of clinical exposure and
clerking by FY1s (particularly on AAU) and the excellent working relationship between them, and their
senior medical and multidisciplinary colleagues. It also identified many suggestions for improvement,
which focused on 5 main domains – Teaching, Educational Supervision, Professional Development,
Working Practices and Multidisciplinary Communication. These areas will be used to set an
objective agenda for the next year of the forum.
Key Messages: The Foundation Doctors Forum allows foundation trainees to become actively involved in
management and the surveys’ objective evidence will make its approach less reactive and more proactive.
The forum encourages reflective practice by challenging doctors to think objectively about their jobs and be
innovative in their solutions to problems. It creates an academic atmosphere by encouraging foundation
doctors and the Trust to value medical education as a method to improve staff morale, patient care and
clinical effectiveness.
- 38 -
Sharing Notable Practice June 2010
9.
The new-2-ICU Course: a novel course preparing Junior Doctors for working
on the Intensive Care Unit
Dr Andrew Georgiou and Dr Migual Garcia Rodriquez
Bristol
Background: Work on the Intensive Care Unit (ICU) requires skills not transferable from other specialties.
Simulation is ideally suited for training in intensive care medicine; this resource is under-used as a tool for
preparing junior doctors for work on the ICU.
Methods: A novel course was developed using pre-course online material formulated from evidenced
based principles. The material consisted of video podcasts, web videos and checklists. Delegates then attend
a one day simulation course. The programme has a high emphasis on safety, teaching delegates how to
manage situations before senior help arrives. Topics covered include airway emergencies, basic use of the
ventilator, the critically ill patient on the ward and insertion of central lines.
Results: Data collected from delegates indicates that the course increases safe practice, familiarity with
ICU equipment, confidence and skill repertoire.
Control data indicate that 94% of junior doctors not attending the course felt under-prepared for working on
ICU.
Key Messages: This course is novel in its design and delivery, with feedback being extremely positive.
Consideration should be given to the provision of the course on a national scale; attendance of all junior
doctors prior to working on the ICU would be desirable.
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Sharing Notable Practice June 2010
10.
Final Year Medical Student Teaching Programme for Foundation Trainees
Dr Michael Glaysher and Dr Simon Donhou
Portsmouth Hospitals NHS Trust
Background: The UKFPO states that a Foundation Trainee must develop the skills, attitudes, behaviours
and practices of a proficient teacher, outlining core competencies that a foundation doctor must obtain
during their FY1 and FY2 posts.1 Within the Portsmouth Hospitals NHS Trust, no official programme
exists to address this curriculum item and formal teaching by foundation trainees is often unrecognised.
Methods: We sought to provide a formal teaching programme for final year medical students during their
rotations at Queen Alexandra Hospital, consisting of weekly two-hour sessions and a mock Objective
Structured Clinical Examination (OSCE) towards the end of their placement. Formal quantitative and
qualitative feedback was collated following each session.
Results: This teaching programme was universally well received by students and trainees, with formal
feedback demonstrating that 100% of students found the teaching beneficial to their undergraduate training.
These sessions allowed Foundation Trainees to gain valuable organisational, teaching and presentation
skills, whilst providing students with core knowledge required for medical finals and better prepare them
for their own foundation training.
Key Messages: A structured teaching programme, such as the one we have introduced within the PHT, is a
simple means of supporting and facilitating the learning and continuing professional development of
undergraduate and postgraduate medical trainees.
References:
(1) The UK Foundation Programme. Curriculum. London: The UK Foundation Programme, June
2007.
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Sharing Notable Practice June 2010
11.
Evaluating Coaching for Foundation Doctors in South Tyneside NHS
Foundation Trust
Mrs Claire Hoy
Northumbria University
Background: ‘Modernising Medical Careers’ is an ongoing project of reform in postgraduate medical
training for Foundation Doctors (FD’s) which is still in its infancy in terms of evaluating its impact. One
element of this reform is the introduction of formal ‘coaching’ into the programme via Educational
Supervisors. This paper discusses the findings from research conducted within South Tyneside NHS
Foundation Trust (STNHSFT) relating to the impact of educational supervision/coaching.
The research assessed strengths and weaknesses of coaching andexamples of good practice and perceived
weaknesses were identified. As a result, coaching is being reviewed in STNHSFT and the implementation
of a homogeneous model of coaching is being considered.
Methods: An epistemological position was adopted, this was supported by an interpretivist philosophy,
utilizing a case study strategy, inductive methodology and qualitative data collection and analysis methods.
Results: The results of the research highlighted key strengths in relationship building. Scope for
improvement exists in relation to utilizing a model to improve the consistency of approach.
Key Messages: There is a need to implement a structured model of coaching to ensure the ES process has a
positive impact on learning, development and performance.
- 41 -
Sharing Notable Practice June 2010
12.
Introducing an Antimicrobial Prescribing Programme – the Sunderland
experience
Dr Daniel Hufton, Dr Ali Hames, Dr Roland Koerner and Dr Anita Jones
City Hospitals Sunderland
Background: National best practice guidance1 suggests that all Trusts should provide appropriate training
in antimicrobial prescribing in line with the Health Act2. Core competencies for the Foundation programme 3
state that antimicrobials should be used appropriately within Trust guidelines but have no requirement for
recognising when these guidelines might not be appropriate, one of the key components of safe prescribing.
Methods: An antimicrobial prescribing programme was run over five weeks to supplement the existing
taught programme in prescribing. Four one-hour interactive sessions covering the basic steps in prescribing
(when and when not to prescribe; appropriate empirical choices; circumstances when guidelines are not
applicable; and dealing with healthcare associated infection) were followed by a final assessment session.
Results: Of 40 F1 doctors, all attended at least one session and 31 completed the assessment session.
Feedback immediately after the course showed increased confidence in antimicrobial prescribing. Feedback
at six months revealed sustained confidence, awareness of local policies and an appreciation of the rationale
behind antimicrobial stewardship.
Key messages: The programme was relatively simple to introduce and well received by respondents.
Better understanding of the basic principles underlying antimicrobial prescribing can lead to better
confidence and to better awareness of one’s own limitations.
References:
1. Department of Health. Saving Lives: reducing infection, delivering clean and safe care. Antimicrobial
prescribing: a summary of best practice [Online] 2007. Available at: http://www.clean-safecare.nhs.uk/toolfiles/104_281812ANT_antimicrobial_pres.pdf [Accessed 4th Mar 2010].
- 42 -
Sharing Notable Practice June 2010
13.
The rise of the internet based e-portfolio:” The essential guide to the eportfolio”
Dr Richard James and Dr Jenna Powell
University Hospital Bristol
Background: The Department of Health White Paper recommends that all doctors require a license to
practice, which is then subject to revalidation every 5 years1. The GMC also state that we must maintain a
folder of evidence drawn from our clinical practice2. The e-portfolio allows users to continually update and
record evidence of lifelong learning3. However, many trainees do not see the e-portfolio’s full potential and
only become familiar with it late in their training. To that end, we have written a guide to help trainees get
the most from their e-portfolio and develop a powerful online CV4.
Methods: Our guide is designed to inspire new foundation doctors to use the e-portfolio, not only to
provide evidence of meeting the foundation competencies, but also, to standout from the crowd. It provides
information on what to include, where to store it and how to link their experiences and assessments to the
foundation curriculum.
Results: Our user-friendly guide has been well received by both junior doctors and clinical supervisors. We
hope trainees will now be better equipped to develop an e-portfolio they can be proud of, whilst also
developing skills in reflective practice crucial for continuing professional development, appraisal and
ultimately revalidation.
References:
1. Department of Health. ‘The White Paper trust, assurance and safety: The regulation of health
professionals’. February 2007.
2. Good Medical Practice (GMC 2006) – www.gmc-uk.org
3. www.nhseportfolios.org
4. The essential guide to the e-portfolio. http://foundation.severndeanery.org/parsedownload?docid=710
- 43 -
Sharing Notable Practice June 2010
14.
Assessing foundation doctor career provision and needs within the North
Western Deanery: closing the loop
Dr Kavan Joha & Dr Paul Millel
Univeristy Hospital, South Manchester
Background: In order to assess career support and requirements within the North Western Deanery, a
primary questionnaire-based audit was conducted across all trusts, the results of which were presented at
Sharing Good Practice 2009. To close the audit loop and assess the impact of our interventions we have
repeated the previous audit with the 2010 cohort.
Methods: FY1 and FY2 trainees 6-8 months into their respective programmes completed questionnaires
following up the primary audit. Areas covered included information access/resources, taster sessions,
educational/clinical supervisor competence and local service satisfaction.
Results: Our primary audit determined significant opportunities for career provision/needs within the North
Western Deanery. Knowledge of trust career leads (6%), formal teaching (FY1 7%, FY2 85%), career
portfolio sessions (FY1 41%, FY2 69%) and information accessed (25%) showed significant scope for
improvement. We present our re-audit results to assess the impact of our interventions.
Key Messages: Since our primary audit numerous changes have been implemented to career provision
across trusts within the North Western Deanery, specifically to accessibility of information and provision of
more regular services at an earlier point in the foundation programme. Continued re-audit is recommended
to ensure provision of career guidance continues to progress within our deanery.
- 44 -
Sharing Notable Practice June 2010
15.
Promoting medical education through the Gloucestershire Hospitals NHS
Foundation Trust Medical Journal
Dr Sri Raveen Kandan
Gloucestershire Hospitals NHS Foundation Trust
Background: The inaugural Gloucestershire Hospitals NHS Foundation Trust Medical Journal is a
collection of guidelines, audits and case reports. The impetus for producing this journal was to recognize
the efforts of junior doctors in undertaking various audits and managing challenging cases. The journal
serves as a memoir of their work, an educational resource and an opportunity to promote clinical
governance and medical education within the trust.
Methods: The journal was produced over a 3-month period. An initial email was sent to foundation doctors
and the medical division calling for articles. Doctors were persuaded and solicited to submit reports on
audits and interesting cases. Sixteen articles were received from 21 contributors, including 11 foundation
doctors. Over a two-week period, the articles were edited, formatted and compiled for publication.
Results: The journal was published on the trust’s postgraduate medical education website
www.gloshospitals.org.uk/PGMEC/PDFs/GMJ.pdf. A copy was sent to all contributors, foundation doctors
and the medical division.
Key messages: Audits should be compiled in a database and published to further effect change.
Challenging cases encountered should be recorded and presented to stimulate education. A locally
produced medical journal provides junior doctors with this outlet to promote clinical governance and
medical education within the trust.
- 45 -
Sharing Notable Practice June 2010
16.
Is it time for Nights Out? The role of Junior Doctors
Dr Anji Lee
Stockport NHS Foundation Trust
Background: On reflection - the first experience of working nights in a busy district general hospital could
be regarded as one of the most daunting experiences for a junior doctor.
At Stockport Foundation Trust (SFT), most FY1 doctors work an average of three weeks of nights in total
amounting to 234 hours of experience in medicine/surgery.
Method/Results: A brief email to all FY2’s and a discussion group revealed that all current FY2s at SFT
regard working nights (as an FY1) as an invaluable asset to their training. Despite their initial worry, they
believe that working nights gave them insight into an immense variety of disease and symptoms not seen on
their day job. It helped them to develop skills in the management of acutely ill patients as well as
developing skills of judgement, prioritisation and delegation.
Key Messages: The FY2s at SFT believe working nights helped to develop their confidence as a doctor,
gaining knowledge and experience they would otherwise not have.
Due to changes to the foundation structure, some junior doctors in clinical posts do not and will not have
the opportunity to work at night, regarded by many as an unfortunate loss for prospective foundation year
doctors.
- 46 -
Sharing Notable Practice June 2010
17.
Intravenous Fluid Prescribing by Foundation Year 1 Doctors during on-calls
and out-of-hours ward covers
Mr Chung Thong Lim, Mr Michael Dunlop and Mr Chung Sim Lim
London
Background: Foundation Year 1 (FY1) doctors are often required to prescribe intravenous (iv) fluid to
patients not under their regular care during on-call or out-of-hours ward cover. This questionnaire survey
aimed to investigate FY1s’ practice of iv fluid prescribing to these patients.
Methods:A questionnaire survey on practices important for prescribing iv fluid to patients was distributed
to FY1s of five NHS hospitals in England and Scotland.
Results: All 149 FY1s responded to survey. 86% have been taught iv fluid prescribing during medical
school, compared to only 48% in FY1 induction. More than half always/often checked the patient’s U&E
(72%), read the fluid balance (58%) and observation charts (80%), discussed case with nursing staff (75%),
enquired about oral status (82%), identified the main diagnosis/operation (75%) and indication for iv fluid
(72%) of the patient when prescribing iv fluid. However, less than half often/always read the medical notes
(43%) or performed clinical examinations on patients (16%). Most FY1s (94%) always/often checked
patient’s U&Es when prescribing potassium.
Key Messages: There were variations among FY1s in the practice of iv fluid prescribing to patients
unknown to them during on-calls or out-of-hours ward covers. Such variations should be addressed to
improve patient care.
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Sharing Notable Practice June 2010
18.
Foundation Trainee Welfare
Dr Kate Marflow and Dr Sebastian Pillon
Trafford General Hospital, Manchester
Background: Medicine can be stressful leading to suicide and parasuicide amongst trainees (1). With
recent changes to training and working hours Foundation doctors should be less stressed than their
predecessors? Anecdotal evidence does not support this.
Methods: Through attending deanery led seminars on trainee welfare, internet research and questioning our
colleagues we looked for answers to: why should trusts worry about trainee welfare? What is making
trainees stressed? What systems are currently in place? What do trainees want?
Results: We identified several stressors to today’s junior doctors. One will always be the nature of the
work, our hours may be less but our work is more intense. Another is the pressure to make a career decision
early and the professional development needed. Also we feel the loss of free accommodation and the unity
of the doctors’ mess has left some trainees feeling isolated. The quality of clinical supervisors is vital and
their role in welfare, as well as education, emphasised. Trainees need to be aware of what support is
available if they have financial, emotional or physical problems.
- 48 -
Sharing Notable Practice June 2010
19.
Qualitative assessment of consent forms in the Endoscopy Unit, Royal
London Hospital: how can we improve our performance?
Dr Faidon-Marios Laskaratos and Dr Sean Preston
Royal London Hospital
Background:The aim of this audit was to improve the quality of the consent forms in the Endoscopy Unit,
Department of Gastroenterology at the Royal London Hospital. An initial audit in July 2009 had shown that
the quality of the consent forms was poor.
Methods: Methods used to address this issue included discussion at our Clinical Governance meeting and
an email sent by the Head of the Endoscopy Unit to staff performing endoscopies, emphasizing the
problem. The results were statistically analyzed with Chi-square and a p<0.05 was considered statistically
significant.
Results: Our initial audit in July 2009(62 consent forms) had shown that only 1(1.6%) consent form was
completed perfectly. After introducing our interventions(Governance meeting and email) we re-audited our
performance in November 2009(50 consent forms). Interestingly, in this audit 39(78%) consent forms were
perfect (p<0.0001). In more detail, all the consent forms(100%) had patient details (DOB,p<0.05 and
hospital number,p<0.01). Significant improvement was also noted in the anaesthesia/sedation field (86% vs
52%,p<0.0001), in the healthcare professional signature (100% vs 90%,p<0.05) and name (100% vs
79%,p<0.001) fields, as well as the date of the procedure (98% vs 87%,p<0.05)
Key messages: The audit cycle was completed demonstrating significant improvement in the quality of the
consent forms.
- 49 -
Sharing Notable Practice June 2010
20.
Audit of the Bristol Paediatric Early Warning Tool Observation Charts
Dr Kiera Meade and Dr Natalie Quinn, Royal Victoria Hospital
Newcastle-upon-Tyne
Background: The Bristol Paediatric Early Warning Tool Observation Chart is a systematic clinical tool
that can be used to facilitate the detection of antecedent signs of critical illness, in order to alert ward staff
to communicate with, and make appropriate referrals to medical teams. This aims to prevent cardiac or
respiratory arrests, and aids in early identification of the seriously ill child.
Methods: Data was collected from 160 observation charts in use within the Newcastle Trust between
August and November 2009. This assessed if the charts were being accurately completed, and therefore
correctly detecting and triggering the early warning tools to initiate treatment of the seriously ill child.
Results: Results demonstrated that the Bristol Charts were being inadequately completed. None of the
observation parameters reached the standard of 100% completion. The most fulfilled parameter was the
“consecutive dates and times” category, achieving 81.25% completion.
Key messages:
 Bristol Paediatric Early Warning Tool Observation Charts were not being appropriately completed;
hence the early warning systems to prompt management of the seriously ill child were not being
initiated.
 We have designed a new Paediatric Early Warning Score Chart to be piloted Trust-wide, with the
aim of appropriately triggering essential clinical treatment.
- 50 -
Sharing Notable Practice June 2010
21.
Re-Audit of Venflon Insertion and Documentation at the Royal Victoria
Hospital, Newcastle-upon-Tyne
Dr Kiera Meade, Dr Kate McVeigh and Dr Najibah Mahtab
Royal Victoria Hospital, Newcastle-upon-Tyne
Background: Intravenous cannulation is an invasive procedure predisposing patients to an increased risk of
infection. The use of the Visual Infusion Phlebitis (V.I.P) score is an important tool to provide a record in
relation to peripheral venous access. This re-audit reassessed compliance with this tool, following
interventions that took place after the initial audit in 2008.
Methods:This prospective re-audit was completed by inspection and examination of V.I.P score
documentation in a central Newcastle hospital. The audit was conducted weekly, for eight weeks in
October and November 2009, recording V.I.P score presence, inspection, indication and completion.
Results:A total of 482 venflons were audited. An average of 63.9% of V.I.P scores were present in the
correct location (patients’ drug kardex). A further 43.7% were fully inspected, 93.5% had a known
indication and 72.4% were fully completed.
Key messages: This completed audit cycle has demonstrated improvements in compliance with Trust
policy, except in V.I.P score location. We believe that this generally improved practice is secondary to our
raising awareness campaign following the initial audit. This re-audit will be presented to healthcare
professionals to show that standards have improved but to be aware of the correct site to document the V.I.P
score.
- 51 -
Sharing Notable Practice June 2010
22.
Curriculum Mapping Project for the Foundation Programme with the
London Deanery
Dr Daniel McGuinness
London Deanery
Background: Foundation Training is based on a defined curriculum and Training Providers are required to
demonstrate that all of the Curriculum can be delivered to trainees through direct patient contact or formal
teaching sessions.
Summary of Work:The London Deanery developed an automated Curriculum Mapping Matrix, dividing
the curriculum into 59 sections. Supervisors and FDs within all Foundation Training Providers rated the
ability of their post to deliver the competencies for each section of the curriculum on a four point scale,
ranging from no opportunities to plenty of opportunities.
Summary of Results: There was an 86% response rate from supervisors accounting for 2105 foundation
programmes. Of these, 1721 (82%) programmes could access all the competencies, with 384 (18%) unable
to access components of the curriculum. The commonest deficit was in the Epidemiology and Screening
component of the curriculum where 205 (10%) programmes had inadequate exposure, other gaps were less
frequent, but common across providers. FD responses suggested access to curriculum competencies within
their posts was less than identified by their supervisors.
Conclusions: This curriculum mapping process revealed access to all parts of the curriculum may not be
universal for all programmes.
Take Home Messages:
This process provides a method to meet the regulator requirement to quality manage curriculum delivery.
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Sharing Notable Practice June 2010
23.
Foundation Year 1 Clinical Induction Programme
Mrs Helen Melville and Dr Colin Melville
ERMEC, Hull Royal Infirmary, Yorkshire
Background: Clinical induction for F1 doctors remains a challenge, and is not met by the shadowing
process, particularly as students are increasingly less likely to work in a trust local to their medical school.
The previous programme was delivered throughout August, but this created challenges in finding faculty
and in releasing trainees form clinical duties. New doctors express anxiety about commencing in their new
role in spite of the supportive processes within the Foundation Programme.For these reasons it was decided
to provide a two day focussed clinically oriented programme aimed specifically at the new F1 doctor
delivered immediately prior to commencement of work on the first Wednesday in August and the doctors
were paid to attend as part of their contract.
Methods: Two one day programmes were run in parallel for 70 doctors. Day one included a half day on
Acute Care (ACID), together with prescribing and pharmacy related workshops. The other day included
transfusion, X-Ray interpretation, clinical skills and discussion with outgoing F1s. Trainees completed both
programmes.
Results: Written feedback from trainees identified that they found it to be useful timely revision, made
them feel more confident, and outlined the expectations of the year. It is recommended for delivery at all
trusts within this foundation school from August 2010.
Key Messages: Doctors about to start as F1s find such a programme to be relevant, timely and useful.
- 53 -
Sharing Notable Practice June 2010
24.
Integrating Clinical Governance into the Educational Arena for Junior
Doctors
Dr Victoria Naunton & Julie Oakley, Head of Medical Education
North Tees & Hartlepool NHS Trust
The aim of the project was to implement a system to ensure clinical governance issues were integrated into
the education system by ensuring that lessons were learnt by individuals, the organisation and the relevant
remedial support is given.
A system has been implemented to ensure that when a junior doctor is involved in a DATIX incident they
learn from their mistakes. This involves informing the doctor’s Supervisor to meet with the doctor to
discuss and ensure they do a reflective statement.
After reviewing previous incidents, trends were analysed and clinical skills stations were decided upon to
competency test junior doctors starting in the Trust. A Safe Prescribing test was also implemented to reduce
repeated incidents.
We have complimented this work by implementing an easier system of reporting concerns. An Effective
Feedback form was launched which allows staff to report positive or negative comments about a junior
doctor. An In-Training Reference form has also been introduced as a method for Clinical Supervisors to
pass on feedback about Foundation Programme doctors as they rotate from placement to placement.
The Educational Governance system adopted allows junior doctors to make a mistake in a safe environment
before being involved in a patient safety incident.
- 54 -
Sharing Notable Practice June 2010
25.
What is the impact of remote and rural training during the Foundation
Programme?
Dr Suzanne Nabavian, Ms Fiona French and Ms Mari Todd
NHS Education for Scotland
Foundation Programmes in the North of Scotland Deanery include a remote and rural placement. Each
year, around 60 Foundation Doctors spend four months in a remote location and a further six spend one
year.
Trainees’ expectations of remote working were sought by postal questionnaire prior to the start of their
placement/year. Their experiences and long-term career plans were explored by interview at the end.
Educational Supervisors were also interviewed to ascertain if additional support was required.
Most trainees approached their placement with a positive attitude but some were ambivalent. All valued the
experience and training they had been given. Very few who had not previously considered a career in
remote and rural medicine had changed their minds as a result. Educational Supervisors thought the
benefits for trainees in working in these posts included: close supervision, a wide variety of different
cases,working across specialities, and greater development of decision making abilities.
Early exposure during postgraduate training may result in some trainees considering a long-term career in
remote and rural medicine.
Although some trainees interviewed decided to develop their careers in remote and rural posts, all trainees
found these posts to be rewarding, enjoyable and valuable parts of their training programme.
- 55 -
Sharing Notable Practice June 2010
26.
Venous Thromboembolism prophylaxis in the Acute Medical Unit
Dr Amina Rezgui and Dr Nick Rhodes
Stepping Hill Hospital, Stockport
Background: There are 30000 deaths each year from venous thromboembolism (VTE) acquired following
hospital admission. I audited the use of prophylaxis in my acute medical unit.
Methods: 100 patients were audited post consultant ward round assessing their risk factors for VTE and
whether they were being prescribed prophylaxis appropriately. A re audit was carried out which introduced
a stamp in the clerking proforma highlighting the need for risk assessment and prophylaxis.
Results: In the first audit only 39% of patients with 2 or more risk factors and no contraindications received
prophylaxis. After the stamp was introduced of the patients suitable for prophylaxis 58% received it. If the
stamp was present and completed 71% of these patients were prescribed prophylaxis. The presence of the
stamp increased prescribing even it was not always completed
Key messages: The stamp worked as a memory aid improving prescribing of VTE prophylaxis.Education
improved understanding of indication and contraindications improving prescribing. Since the audit major
developments have occurred, a VTE nurse is in post, a risk assessment form is now part of the clerking, a
VTE box is currently being printed onto the drug kardexes and a VTE committee is being set up.
- 56 -
Sharing Notable Practice June 2010
27.
Providing a valuable teaching experience for Foundation Trainees
Dr Amit Sud, Dr Olivia Clancy, Miss Louise Turner, Dr Constantinos Papoutsos, Dr Lolita Chan, Miss
Judith Hadfield and Prof Simon Carley
Manchester Royal Infirmary
Background: Participation in teaching is an integral component of foundation training and constitutes good
medical practice.[1, 2] Prior to sitting objective structured clinical examinations (OSCE), many medical
students attend revision courses. Final OSCEs place emphasis on foundation trainee skills. With these two
requirements in mind, foundation trainees and the undergraduate department at Central Manchester
University Hospitals NHS Foundation Trust (CMFT) organised a revision course for finalists.
Methods: Topics were derived from consultation with students. Foundation trainees were self-nominated
to lead particular sessions. 8 topics were taught each day and repeated the following day with different
students attending to ensure small group sizes. Individual feedback of teacher performance was collected.
Results: Attendance over the weekend was 88.5% (101/114). 100% of students felt like this revision
weekend meet their requirements (101/101). 93% (94/101) of students felt confident with the OSCE topics
after the revision weekend vs 33% (33/101) prior to the revision course.
Key Messages: Foundation trainees will support students whom did not meet final examination
requirements and will utilise the feedback received from the course. At CMFT we have demonstrate an
effective revision programme for students can be delivered in addition to providing valuable teaching
experiences and feedback for foundation trainees.
[1] The Foundation Programme. The Foundation Programme Curriculum. 2007.
[2] General Medical Council. Good Medical Practice, GMC/GMP/1109. 2006.
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Sharing Notable Practice June 2010
28.
Drug prescribing in older hospitalized patients
Dr Amy Talbot, Dr Sam Atherton and Dr Anna-Louise Day
Manchester
Medication prescribing errors are common and can have serious consequences. Clear and correct
prescribing is vital to minimise the risk to patients. Various guidelines for good prescribing have been
established, and this audit aimed to evaluate drug prescribing among hospitalised older patients and to
assess if these standards were being met.
An initial audit was carried out followed by intervention and two further short-cycle audits. The audit was
undertaken on a busy acute medical ward for older patients, and assessed the prescription chart of every
patient.
Following the initial audit, further education was introduced including presentations in medical meetings
and pharmacist-led training. The short-cycle audits subsequently showed an overall improvement in
prescribing. Patient details were well recorded, with 100% allergy documentation. Nearly all prescriptions
were signed, but signatures were almost exclusively unidentifiable. The discontinuation of medication was
poorly carried out, and although antibiotic prescribing practice had improved, it remained suboptimal.
In conclusion, the ongoing education of prescribers needs further improvement, and should include all
doctors. The trust is therefore introducing hospital-wide short-cycle prescribing audits as a compulsory
element of FY1 training, in order to help junior doctors identify the key aspects of safe prescribing and
improve their own practice.
- 58 -
Sharing Notable Practice June 2010
29.
Can Foundation Doctors participate in ‘on-the job’ educational research
without compromising their clinical roles?,
Dr Simon Tso, Dr Gaggandeep Singh Alg and Dr Eleanor Wood
Homerton University Hospital, London
Background: Junior doctors are encouraged to develop their research skills. However, only those in the
academic training programmes have time allotted for research. This case study looked at whether junior
doctors can participate in ‘on-the-job’ research without compromising their clinical roles.
Methods: Two foundation year one doctors participated in the conduction of two research projects over an
eight month period. Their jobs were full-time posts with no time allotted for research activities. Project one
looked into the use of the ‘Virtual Continuity in Learning Programme’ to support foundation doctor
learning1. Project two looked at shadowing experiences for third year medical students2. They evaluated
their experiences through reflective practices and small group discussion.
Results: The majority of research activities took place outside work. They perceived ‘on-the-job' research
had little impact upon their clinical roles as clinical work always took priority. They gained teaching and
research skills. However, time factors limited the role they could play. The good practices employed by
their hospital to support their research activities were discussed. Other ways for junior doctors to build
research skills during their training were suggested.
Key messages: It is possible for foundation doctors to gain research experiences without compromising
their clinical roles.
References:
1. Wood E, Virtual Continuity in Learning Programme – ‘on-the-job’ learning for foundation doctors. The
Clinical Teacher, 6 (4): 233-236
2. Graham P, Wood E, ‘Shadowing a Foundation Year 1 Doctor’ – A Third Year Medical Student’s
Perspective. Abstract – Submitted to ASME and AMEE Conference 2010
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Sharing Notable Practice June 2010
30.
“They didn’t teach us that in medical school”. Evaluating the role played by
junior doctors in preparing new trainees for professional practice
Dr John Williamson, Dr Jonathan Pesic-Smith and Dr Kobika Sritharan
Hornchurch, Essex
Background: Our educational innovation concerns the induction period of FY1 doctors and the role of
inducting Junior Doctors.
The transition between medical student and Junior Doctor requires the FY1 to acquire new skills and
knowledge in a short period. The Dr Foster report (1) highlights the importance of this time and analyses
mortality rates. Our innovation analyses the role of Junior Doctors in inducting the next generation of
FY1’s.
Methods: A questionnaire, ‘What you now know you needed to know’, was circulated to FY1 trainees
currently employed in an outer London DGH. It evaluated: how prepared junior doctors felt following the
induction period, how useful and effective the induction offered by previous Junior Doctors was, which
areas required development and which learning methods were most useful in preparing new trainees.
Results: Our questionnaire highlighted key areas for improvement. We aim to use these areas to deliver a
more topic focused and structured induction to the new Juniors beginning work in 2010. We will then reevaluate this induction period to assess the impact of our innovation and suggest further improvements.
Key message: FY1 training is too important to be left to ‘chance’. Analysis of current practice will ensure a
more effective transition between generations of FY1s
- 60 -
Sharing Notable Practice June 2010
31.
Fluid Balance knowledge in Medical Students can be improved using Multidimensional Teaching intervention
Dr Jamie Wilson and Dr Matthew Taylor
Southampton University Hospitals Trust
Background: Undergraduate experience in practical fluid prescribing is variable and frequently suboptimal. Many junior doctors are ill prepared at the start of their FY1 year, and consequently, many perioperative fluid prescriptions are inappropriate1;2. Our objective was to design a teaching programme to
improve knowledge of fluid physiology and to provide practical experience of fluid prescribing for final
year medical students.
Methods: A portfolio of case summaries (i.e. fluid overload, septic shock etc) were used together with
extended-matching questions to assess knowledge at the start of the programme. Students were taught about
aspects of evidence-based fluid balance using interactive lectures, course materials and small group
teaching sessions. Students were then re-assessed at the end of the programme.
Results: Students demonstrated a 17% improvement in mean assessment scores between assessments,
(60±4% to 77±4%; p = 0.00001). 100% reported an improvement in knowledge.
Key Messages: Junior doctors often have sub-optimal knowledge and experience of fluid prescription when
they start clinical practice. We have demonstrated that a targeted teaching module incorporating practical
experience can improve peri-operative fluid balance knowledge. The programme could be developed into a
universal tool for students and foundation trainees, which could lead to a reduction in patient harm 2.
References:
1. Lobo DN, Dube MG, Neal KR, Simpson J, Rowlands BJ, Allison SP. Problems with solutions: drowning
in the brine of an inadequate knowledge base. Clin.Nutr. 2001;20:125-30.
2. Walsh SR,.Walsh CJ. Intravenous fluid-associated morbidity in postoperative patients.
Ann.R.Coll.Surg.Engl. 2005;87:126-30.
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Sharing Notable Practice June 2010
32.
Regional Public Health teaching days: mutual benefits for tutors and learners
Dr Sid Wong, Dr Catherine Goodall and Dr Veena Rodriques
Public Health StR, NHS Bedford
Background: Each cohort of Foundation year 2 (FY2) doctors undergoing Public Health (PH) placements
in the East of England receives a set of four teaching days, coordinated by PH higher specialist trainees.
These aim to improve knowledge of key PH concepts, address core FY2 competencies, enable sharing of
placement experiences and offer peer support.
Methods: Teaching is delivered through a mixed model of didactic teaching, worked exercises and
facilitated group discussions. Formal lectures cover key topics such as basic epidemiology, critical appraisal
and population screening. Exposure to health protection is offered through an interactive outbreak
management simulation. FY2 trainees also deliver presentations on current work projects.
Results: In addition to learning received, there are opportunities for peer feedback, sharing of work
experiences, and facilitated discussion. On-going evaluation and timely feedback has enabled continuing
improvements to this programme which is highly rated by FY2 trainees and continues to be an integral part
of FY2 PH training. An added benefit is the reinforcement of learning for the tutors and an opportunity for
tutor teaching skills development.
Key Messages: FY2 PH learning can be enhanced by using a variety of teaching methods.
There is mutual benefit to tutors and learners.
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Sharing Notable Practice June 2010
33.
Improving the timing of CT brain requests in stroke patients at Salisbury
District Hospital
Dr Andrea Yap
Salisbury District Hospital
Background: The NICE guideline CG68 (1) states that all patients with a suspected stroke should have
brain imaging within 24 hours from symptom onset to confirm diagnosis. Data from a previous audit
revealed that only 55% of patients had their CT scan completed within 24 hours.
Method: Data was collected from patient notes, arrival tables and radiology computer systems.
Results: Thirty four patients were admitted during the month of October 2009. Fourteen patients were seen
during working hours (between 8.30am and 5.30pm), six at the weekend and fourteen out of hours on
weekdays.
There was a reduction in the number of delayed scans by 30% when compared to the previous audit. It was
found that doctors took an average of 9 hours to request a CT scan. The radiology department then took an
average of 54 minutes to complete the scan and a further 14 minutes to report it.
Key Messages: To increase efficiency, every patient triaged as a stroke should have their CT scan done
before a direct admission to a stroke ward regardless of the time or day. This will improve compliance with
the CG68 NICE guideline, maximise patient care and reduce the length of inpatient stay.
1. National Institute of Clinical Excellence. CG68 Stroke: NICE guideline, Stroke: Diagnosis and
initial management of acute stroke and transient ischaemic attack. London: NICE, July 2008.
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Sharing Notable Practice June 2010
34.
The FOOT Scheme: a near peer approach to undergraduate education
Dr Stuart Younie and Dr Richard Jones
Nottingham
Background:Traditionally clinical teaching is delivered by senior doctors; the FOOT (Finals Orientated
OSCE Teaching) Scheme utilises foundation doctors to optimise final year medical student teaching.
Methods:
1. Scheme Delivery
Teachers were recruited based on their access to clinical signs and acceptance of FOOT teaching criteria.
54 medical students randomly allocated to the pilot site by the university were offered the opportunity to
partake in the scheme.
2. Summative Evaluation
Feedback forms evaluated the impact of the scheme.
A retrospective analysis of pass rates from the FOOT cohort were compared with the rest of the year.
Results:
Qualitative
Students unanimously agreed that the FOOT Scheme was a useful addition to the undergraduate
curriculum, teaching was of a high standard, and it increased their participation in the clinical environment.
Teacher feedback highlighted an improvement in their clinical and teaching skills.
Quantitative
OSCE failure rate: FOOT group 5.5%
Control group 10.2%
Key Messages: The results from this innovative teaching scheme provide evidence that foundation doctors
have a valuable role in facilitating undergraduate education benefitting both students and teachers.
This has led to endorsement of the scheme by Nottingham University and it is now delivered across all
teaching hospitals in the deanery.
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