Month: August 2013
A short story about our attempts at making life easier for Dr X…..
Dr X has been a clinical supervisor for many years…., more than he cares to remember to be honest and he’s pretty good at it. The trainees like him and he likes the trainees, he’s had a few awards for teaching and he is secretly rather proud of this. In summary he really enjoys teaching and interacting with trainees, loves sharing what he has learned and especially enjoys teaching at the bedside with real patients. This is how Dr X grew up as a doctor and he does it well, but in recent years some aspects of teaching have become burdensome….
In the old days trainees came and went, and sure if there was a problem with one of them Dr X would not sign them off at the end of the rotation and/or have words with the hospital dean, but lately this holistic approach has been replaced by the introduction of the portfolio system, a series of meetings, assessments, checks, balances and development plans that each trainee is required to complete. It’s a significant task for trainee and trainer alike, and while Dr X knows that this is something we are all having to get used to there is one issue that really irritates him…
WHY ARE ALL THESE PORTFOLIOS DIFFERENT?
It’s a good question to be honest, but they are. They all reflect how their particular college and the GMC like to set things out and although there has been a call for more standardisation it seems that we are some way off this. In practice this means that in a speciality such as medicine a department may have a whole range of different trainee types, all with their own particular ‘package’ aimed at supporting their learning and supervision.
As a trainer this can become really confusing as the requirements of junior docs in the same workspace may be very different. A doc working towards GPVTS has different learning needs and a very different portfolio that of a doctor on the same rota embarking on a career in general medicine. The e-portfolios are quite different. They have different logins, passwords, different tutors and different curricula and assessment modes. It’s just too much to keep track of and it leads to poor quality supervision and the possibility of ARCP failure for the trainee.
So, whilst Dr X would like all these e-portfolios to disappear (not going to happen), how can we make life easier for him and the many other consultants in the same position?
THEMATIC SUPERVISION IS THE SOLUTION
In my opinion it is now almost impossible to maintain a good working knowledge of more than one type of trainee portfolio. Some consultants can, but I find it tricky to really understand the detail and specific requirements needed for all the grades and types of staff we get in a place like the ED for example. So, we have moved to the idea of thematic supervision where consultants oversee a group of trainees at the same level/type.
For example, GPVTS trainees on their EM rotation are supervised by me. I’m now much more familiar with their training needs, the GPVTS e-portfolio and the assessments that they need. It has also allowed me to develop contacts with GP trainers in the community. My colleagues in the ED do the same, with themes for foundation, CT1-2, ACCS, SpR, Clinical Fellows etc. so that we all develop expertise and familiarity with our group. We do this for a few years and then have the option to move to a different group (for variety).
This is such an easy thing to do, yet it has a real effect on the quality of educational supervision.
So what of Dr X?
We really want him to continue. We really want him to train all the doctors on the ward, that’s his clinical supervisor role and we are delighted that he will continue. We also know that in his educational supervisor role we need him to reduce any unnecessary repetition and to develop expertise in a group of docs so that he does not have to learn an entirely new portfolio system every 4 months. So Dr X has agreed to look after 3 of the foundation docs on the firm as an Educational Supervisor. He is becoming proficient in the use of HORUS (the e-portfolio for foundation) and is on first name terms with the foundation team.
There is still paperwork, and the process is a bit more onerous than it used to be….., but with thematic supervision it’s at least a little easier, and the trainees do seem to like it when he spends the first 30 minutes of their meetings talking to them rather than trying a series of passwords whilst trying to log on to one of 7 different portfolio systems….
Consultant in Emergency Medicine
NB: Dr X is largely based on me and my past efforts at juggling different trainees on different rotations at different times of the year. Life is so much better now that I just look after the GPVTS docs. I might rotate to a different group in a few years, but for now this is SO much better than it was.
We are delighted to welcome the new foundation dos to CMFT. Forty-Eight new starters across the trust who will be integral to patient care here for years to come. First impressions are that we’ve attracted a bright bunch of enthusiastic and engaging trainees which is fantastic, and having completed 2 weeks of shadowing they are up and running as of this week.
Let’s not forget that the foundation years can be tough though. The first rung of the medical career ladder represents one of the biggest changes to a doctor (the other being the step up to Consultant), and it’s vital that our trainees have great support. Whilst the trust can and will support trainees there is no doubt that your peers in the same grade are really important.
So, to help speed up the bonding process, to learn some leadership skills, to find out more about each other and the foundation teams we spent a day in the Peaks training, running, climbing, paddling and swimming.
Did it work?
In the view of the instructors – absolutely! At the start of the day the 8 teams – well they weren’t really working as teams….. We saw groups working as individuals, but by the end of the day they were clearly working together, supporting each other and achieving their goals. All this will be important in the workplace and especially during those first on calls.
The activities were
- Raft Building
- High ropes
- Low ropes
- Plus, getting there, on time, not getting lost, looking after an egg for the entire day (Ed- Why the egg????)
So, here are a selection of photos from the day. If you want more then get in touch. As you can see…..some rafts were better than others!!!
I’d like to personally thank all the trainees who showed willing to take part and get stuck in, but especially to the instructors and organisers of what turned out to be a fantastic day.
Sharon Gibbs gets top marks for once again organising the day beautifully.
I’ve recently been forced to consider the longevity of the SHO grade. This is not an idle pursuit but a requirement as over the last few years there have been a number of patient safety reports highlighting the difficulties in the use of the term SHO, or ‘senior house officer’. The title has not existed as a training grade for many years (2005?? if I remember rightly), but the term remains in common parlance.
Is this a problem?
Well, if usage is anything to go by, then to some it isn’t. It appears to be widely used by a variety of different staff perhaps having become one of those terms that is difficult to define, but seemingly everyone knows what it means….
Or do they?
We have pretty much disbanded the term house-officer in favour of foundation doctor (although some die-hards do remain), but SHO seems more sticky. It is an all encompassing term that links years 1-3 core/specialist training posts. FY2 docs, clinical fellows, trust fellows and a bunch of other trainees into one amorphous mass which belies the variability in experience and skill within. There is clearly a significant difference in experience (and ability) between an FY2 and an ST3 so it is disingenuous and potentially dangerous to consider them to be all the same….., a nurse (for example) requesting an ‘SHO’ to see a patient may get a doctor with wildly different levels of experience and that can’t be good. So why does the term continue? I think it is a mixture of convenience and history. SHO rolls off the tongue in a way that ‘core trainee, year 1, Acute Common Care Stem (Emergency Medicine)’ does not. It just does. and there is little we can do about this, but that does not mean that it is unimportant. The question has been raised as a patient safety concern by the deanery and by national bodies for good reason, so we must do what we can to change the current custom and practice. Here at CMFT we are going to try the following.
- Stop the issue of ID cards with ‘SHO’ on them.
- Stop doctors from trying to choose their own titles for ID cards.
- Don’t advertise any job as an SHO post.
- Change rotas to reflect true grade and not ‘HO’ or ‘SHO’
- Use alternative grading systems. For example In the ED and medicine we use different coloured lanyards to designate roles and responsibilities (so the whole team can see who is operating at whichever level in the clinical setting).
Will this work? We hope so as we’d like to think that the term ‘SHO’ is dead….., my concern is that it might only be resting unless we take steps to make sure that he not just (as Monty Python might say) pining for the Fjords……
Having been through revalidation this year I can instantly sympathise with any colleague who may be putting together the evidence to ensure that we can keep working. For the vast majority of consultants the process should be fairly straightforward as it is largely based on the annual appraisal process which is well embedded in the trust. This process should cover all aspects of practice and for clinical and educational supervisors this means that appraisal (and thus revalidation) should address how you perform as a supervisor.
So what does this mean in practice?
Essentially, it means that consultants who are working as clinical and educational supervisors will need to demonstrate that they are up to speed and developing in this area of their practice. In the web based system (currently Equiniti as used by many trusts including CMFT), there is a specific section that collates and maps evidence around educational activities and the expectation is that if you are working as a CS/ES then you will be able to show continuing professional development in this area.
So who decides on what constitutes evidence?
A good question as there are a whole range of activities that colleagues undertake to ensure that they become better supervisors over time. The current recommendation from the deanery (who monitor and approve the trust in this area) is that a CS/ES will show evidence of CPD in one of the 7 domains as defined by the Academy of Medical Educators.
We would also like to encourage as many consultants as possible to join the Academy and this would be a strong evidence of your development as an educator. Remember that you get a discount on membership and fellowship if you work for the trust.
OK, but how do I know if the level of training is ‘enough’? What about quality?
We have taken a pragmatic approach to this as we want to encompass a range of skills/courses/activities that embrace the diversity of specialities that we have at CMFT. Some activities will be generic (e.g. completing a Postgraduate Certificate in Education), whereas others may be speciality specific (e.g Ophthalmology college trainers day). Most will be self evident, but advice should be sought from divisional leads if an appraiser or appraisee is in doubt.
Hmm, I teach undergraduates and postgraduates – do I have to do this twice?
Nope. Again, we know that our education team is busy and duplication upsets everyone. We have come to an agreement with the undergraduate team that generic teaching skills are exactly that – generic! So, if you completed a course on examining in undergraduate medicine that would be great evidence for development in ‘assessment’ for both your undergraduate and postgraduate roles.
So how will you know if this is working?
We are required to keep a log of who is and who is not accredited and that information will come through the appraisal system. We will sample the quality of evidence on an annual basis to ensure that clinicians are only accredited when it is valid to do so.
So in summary we are working to make the process of accreditation as easy, reliable and as valid as we can. If you have any questions or concerns then please get in touch with the team in postgrad or undergrad.