Postgraduate Medical Education Meeting

Held on 22nd August 2013 at 12.30 p.m.. in the CSB

Present

Ed Simmonds Chair/Clinical Tutor Sailesh Sankar Lead Endocrine/CMT Shabin Joshi Lead Neurosurgery Marie Midgley Secretary/Manager Medical Education Maggie Allen Director of Education, Training and Professional Development M. Christie-Large Lead Radiology Emma Helm Lead Radiology Ausama Alaani Lead ENT Shirish Dubey F1 Deputy Clinical Tutor W. Ayub Lead Nephrology Asad Ali Lead Respiratory Chris Bassford Lead ITU Matt Rogers Lead Pathology Chris Harmston Lead Surgery Simon Darlow Lead Gastroenterology Kavi Goswami Lead Obs & Gynae

Apologies

David Bennett-Jones F2 Deputy Clinical Tutor Andreas Ruhnke Lead Anaesthetics Kim Neuling Lead Paediatrics Andrea Lindahl Lead Neurology Dawn Adamson Lead Cardiology Dorothy Apakama Lead A&E Harpreet Ahluwalia Lead Opthalmology

Minutes of previous meeting

It was noted that the minutes on consent need amending before they are approved.

Apologies were given to those who had not received the draft minutes, MM agreed to update the circulation list. ACTION MM

Matters arising

Ausama Alaani was welcomed and thanked for agreeing to become the Educational lead for ENT. He has taken over from Peter Dekker who was thanked for all his support.

Waqar Ayub was welcomed and thanked for agreeing to be the Educational lead for Renal.

It was noted that Christopher Bassford and Nikkil Bhasin have agreed to become joint leads for ITU. They were both thanked for agreeing to undertake this responsibility. ES agreed to send the Educational Lead roles and responsibilities document to the new Educational leads for them to sign and return to Marie Midgley (Medical Education dept, CSB)

ACTION ES, AA, WA, CB and NB

GMC Survey 2013

ES presented a summary of the GMC survey results to the group. The following highlights were noted:-

Foundation and Core trainees – Overall there are a lot of greens which indicates high levels of satisfaction with training when compared to national averages (i.e. the Trust was rated in the top five percentile on a number of indicators). The reds (i.e. rated in the lowest five percentile nationally) for surgery have already been discussed by ES and CH. ES will circulate the Deanery Level 1 document to request feedback on departments analysis of the potential causes for trainee “dissatisfaction” and action to address these. This will assist him in responding to the next ‘Deanery’ report which will be circulated in October.

ACTION ES and CH

Specialty trainees – It was noted that there has been an overall improvement in the satisfaction ratings compared with the previous couple of years. However, Acute Internal medicine reported poor levels of satisfaction with several areas of training and this needs urgent attention – a matter discussed at length later in the meeting. Also there were areas of concern in Plastic surgery which came as a surprise and needs investigation.

ACTION ES and MA

All trainees – Overall the results are very pleasing because this year the ratio of red to green flags has been reversed which indicates a significant shift in trainees overall satisfaction with the training provided by the Trust. In particular credit goes to Neurosurgery for turning around their results, to Obs and Gynae for their progress and to Cardiothoracic for obtaining predominantly green flags which indicates that trainees were particularly satisfied with the training they are receiving in that specialty.

GP trainees – The results for this group indicate that they are generally pleased with the training that is being provided for them.

Overall

Generally the survey shows progress in the right direction and the Trust is now comparable with it’s peers across the West Midlands. The committee members were thanked for all their hard work which has helped to achieve this result. There are two areas requiring further work. Members were asked to look at any pink areas (i.e. where satisfaction falls in the lowest 25th quartile) for their specialty and seek to improve on these areas particularly by establishing with trainees what has led to the concerns and then seeking to rectify them. Members were advised to dig into the survey results to find out exactly which questions have led to the lower scores as sometimes this is not necessarily what would be expected from looking at the indicator title.

In general there are two areas across the specialties where the Trust has scored a number of pinks, these are clinical supervision and feedback. In discussion it was noted that trainees may not be responding to difficulties within their own specialties when grading these indicators but rather problems with the acute take and overnight supervision are likely to be contributing to these poorer scores, particularly in the medical specialities, so a more generic Trust approach is needed to address these areas of concern.

For specialty trainees it was noted that the feedback is generally very good. The vast majority of trainees would recommend the post to a friend. It was noted that the JEST and GMC survey results don’t always correlate.

In Obs & Gynae there has been a big turnaround in the results and the specialty was congratulated on all the hard work and changes they have made to the training programme to bring about this result. The recent ‘Deanery’ visit responded to these results, rather than the more negative GMC results when commenting on the service improvements. Further improvements and satisfactory completion of the action plan is required before the specialty will be signed off from its current level of scrutiny but the personal efforts of staff particularly Kavita, Stephen Keay and Anne O’Leary were acknowledged and applauded.

For Plastic surgery the results were again not good (which correlates with the GMC results). ES has asked Alan Parkes what the particular problems are for trainees. ES will work with Alan to resolve these concerns.

ACTION ES

There have been problems with downloading the Foundation trainee JEST results. Bogdan Tanea is working on this and the results will be circulated to the committee as soon as they are available.

ACTION ES

Misallocation of trainees in ‘Deanery’ database – CAE

One of the difficulties with the JEST survey is the misallocation of some trainees SS noted that he has advised the ‘Deanery’ and will advise them again – this same error has caused problems with the allocation of trainees to posts in the August rotation which caused significant service problems at Rugby. There was no SHO at Rugby for 2 days and an emergency locum was required to cover the wards at nights. DA has asked for a CAE to be raised about this matter, SS will try again to get the errors amended.

ACTION SS

Next ‘Deanery’visiting dates

Acute Medicine – 19th September 2013 – it was noted that this is likely to be a very challenging visit. The Committee members discussed their deep concerns about the current problems in Acute medicine both in terms of the lack of provision of a satisfactory training experience but also because of significant concerns that the trainees are being required to work in a way which is likely to adversely affect patient safety e.g. they are not being adequately supervised, the service is not clearly structured therefore trainees are not clear about how to escalate concerns or who to.

It was noted that Helen Pickard, Nurse Consultant, had provided those trainees who joined the service on the 7th August with an orientation to the department during their induction which was organised by Nick Balcombe. However, trainees also rotate into the service every four weeks and with the current lack of adequate permanent consultant staffing it was not clear whether they were being provided with a local induction. This was seen by the Committee as potentiallydangerous and inadequate for the training and service needs of the specialty. For CMT it was noted that Helen has been asked to provide an induction and also for the Foundation trainees during their teaching programmes. MA has strongly represented concerns about the provision of training in Acute Medicine to the Executive team and has advised them of the risk that the ‘Deanery’ will withdraw the training posts until a more adequate training structure can be supplied. In the past when concerned about particular specialties the Dean has noted that it is not just the particular specialty within the Trust that can be adversely affected by its poor reputation. When making decisions about posts in other specialties the failure of one specialty can influence the outcome for another.

Committee members expressed very strong concerns about patient safety and a couple of specific issues which have gone to the Patient safety committee were discussed. The committee asked that ES write formally to the Executive team to express their concerns. It was suggested by some that the committee should advise the 'Deanery’ not to send trainees to these posts until the training structure and system is improved. The group noted that there is a lack of communication about what is happening which is potentially dangerous and undermines confidence in the service. ACTION ES

EJS addendum – Since the meeting it is clear that the executive team are very concerned about the non elective pathway. Professor Ian Sturgess presented his findings at a meeting of senior managers and clinicians after being invited in a consultancy role to look at this. His overview was clear - UHCW does not have good processes in place to manage non elective attendances to the Trust and that patient safety is of concern as a consequence.

The senior management team (including Meghana Pandit) has also heard the concerns of some of the trainees within the medical specialities including Acute Medicine in a very recent meeting.

It is my assessment that presently (11th September) correspondence from me on PMEC’s behalf will not be helpful. The Trust senior team share many of our concerns and are actively engaged in seeking solutions to address these. Their strategy will be presented at the Grand Round on 13th September.

The visit on 19th September to Acute Medicine is also likely to bring additional focus on the issues and will mandate an action plan to address these.

It was suggested that Paul Martin should be invited to the next Deanery visit ACTION MM

It was noted that the current problems in Acute medicine were adversely affecting the training experience for trainees from other specialties as they are being pulled in to support the service.

GMC Patient safety concerns

It was noted that the latest list of patient safety concerns which arose from the GMC survey will not require a response to the ‘Deanery’ until October however they should be responded to and an action plan developed. CH reported that the three concerns raised in Surgery had all gone to their QUIPPs meeting and will be responded to formally by that group. The items had also been reported to Paul Martin as chair of the Patient Safety Committee.

2013 August Induction

1. E-Handover tool – ES asked the specialties if trainees were now using this tool as they were expected to. Most members of the group (where the tool had not previously been adopted) advised that their practice had not changed. The E-handover training module had not been made part of the compulsory pre joining group of modules (as it should have been) and this needs to be rectified for future inductions. ES agreed to raise this with Bogdan Tanea. However, it is part of the second group of compulsory training modules that trainees are required to complete within the first four weeks of joining the Trust and therefore by now most trainees should be familiar with the tool and ready to use it. If the training has not been completed by the end of the month ES will ask the trainees why not. ACTION ES

The limitations of the system were discussed by the committee members but it was acknowledged that it is still better and safer than the current paper based ad hoc systems adopted by some specialties. It provides a traceable system, it addresses the acknowledged lack of adequate handover from nights to the morning team and the Deanery is expecting the Trust to be using it in all specialties. It was agreed that completion of this package should be be made part of the Consultants mandatory training programme. Consultants need to adopt the approach and demand it from their trainees in order to ensure that the system is fully implemented and used. The Trust needs a communication campaign to re-launch the system. ES agreed to discuss this with Collette Marshall.

ACTION ES

2. Informed consent training

Obtaining blood transfusion, general and endoscopy consent – S Dubey reported that Janine Beddows (blood transfusion) and Simon Darlow (endoscopy) had provided the F1s with training which had gone very well. The training on obtaining general consent had not gone as well as the Defence Society who volunteered to do this withdrew at the last minute.. Ideally, it was agreed that trainees should now be observed obtaining consent for these procedures and then be signed off as competent in their eportfolio.

With respect to other procedures the ideal would be that trainees should not be asked to obtain consent on any of these until they have been trained and signed off as competent. Currently , the sign off can be added to the E-portfolio as a Dops but it was suggested that the ‘Deanery’ should be asked to add the procedures to the E-portfolio in an identified area for ease of access and auditing.

There will be need to be a register for more specialist consents which should be electronic for ease of access. ACTION S. Dubey

Simon Darlow noted that he was having trouble registering his training presentation on E-Library and it was agreed that he would send it to Amanda Gould who would place it on the Medical Education website.

ACTION S Darlow

It was noted that the training needs to rolled out to the F2s and to higher training grades

ACTION S Dubey and ES

3. Medical Staffing concerns

It was noted that for the August intake a number of the rotas were incorrect and the trainees got them late. There were particular problems with part time trainees. These trainees need to have their rotas to reflect the right hours and days because of the clashes and concerns errors create for their personal commitments. It was noted these errors create a very poor impression of the Trust and some Educational leads feel that they are constantly apologising and trying to correct a poor first impression.

A second concern was that at the last minute a senior trainee had not turned up which caused service issues – the failures in communication need investigating and measures put in place to improve for future rotations.

ACTION ES

Dates of the next two meetings

Tuesday 15th October evening 5.30 p.m.

Wednesday 11th December lunchtime 12.30 – 1.30 p.m. (lunch provided)