NHS GRAMPIAN

2015 GMC National Trainee Survey

1.  Actions Recommended

The 2015 General Medical Council (GMC) National Trainee Survey and the actions progressed by the Director of Post-Graduate Medical Education team are submitted to the Board for discussion and appropriate oversight.

2.  Strategic Context

Every year, the GMC undertakes a comprehensive survey of all Doctors in Training in the UK for their views about the training they are receiving. This is called the National Trainee Survey (NTS) and the results presented here are those for NHS Grampian.

The 2015 and 2014 GMC NTS for NHS Grampian are included in Appendix One. NHS Education for Scotland (NES) requires each Board to respond to the GMC National Trainee Surveys and the Director of Post-Graduate Medical Education leads the process of educational governance oversight for NHS Grampian. This is summarised in the annual report of the Director of Post-Graduate Medical Education which is available to Board members.

This report focuses on the Healthcare Improvement Scotland (HIS) report[1] Staff Governance recommendation Number 11.

3.  Key matters relevant to recommendation

One of the recommendations of the HIS report under Staff Governance was that “NHS Grampian should ensure that the training of trainee medical staff is given a sufficiently high priority, ensuring that the General Medical Council and National Training Survey results are reviewed by the Board.”

The HIS recommendation number 11 further stated that adverse trainee surveys results should be noted; action plans produced to address them in line with the GMC mandatory regulatory standards; the progress of such action plans monitored. HIS recommended that particular attention was paid to the training experience in general surgery and emergency medicine to ensure that the trainees’ rotas were monitored and valid returns were produced.

In the HIS report, the following three specialties had their 2014 GMC National Trainee Survey results extensively reported: Emergency Medicine, General Surgery and Obstetrics and Gynaecology.

NTS Survey Analysis by programme

The NTS survey results are categorised to reflect the views of the trainees. Where the results are ‘flagged’ as green, the response to the Board’s performance is regarded as good. Where the survey results are below an acceptable level or an outlier, the result is reported as a red flag; where the results are in the bottom quartile, but not outside 95% confidence limits of the mean, a pink flag is reported; and where the results are within the middle quartile, the results are reported as White. For articulation, attention is paid to those results reported as red or pink and action plans are required to address these.

The results for particular specialities are discussed below.

Emergency Medicine

In 2014, the Emergency Medicine Programme at Aberdeen Royal Infirmary was either a statistical outlier within the bottom quartile, or was within the bottom quartile for 9 of the 12 indicators (reflected as either “red” or “pink “ flags in the survey, respectively) for foundation and/or core and/or specialist trainees.

In 2015, significant improvements were reported, with no red or pink flags. This was confirmed by the recent report of the Deanery Quality Management Visit to the Emergency Medicine Department (June 2015).

General Surgery

In the 2014 survey, the General Surgery Programme at Aberdeen Royal Infirmary showed 8 of the 12 indicators as red or pink for foundation and/or core and/or specialist trainees. For two of these 8 indicators (clinical supervision, adequacy of experience) this poor rating has persisted for three successive years.

By 2015, the performance had improved with only two pink flags reported for induction and clinical supervision out of hours. All other flags are now white. These include: overall satisfaction; clinical supervision; adequate experience; workload; access to educational resources; feedback and local teaching.

However in the Surgery FY2 programme for Aberdeen Royal Infirmary, of which General Surgery is part, there are red flags with 5 of the 12 indicators within the bottom quartile. This is being addressed.

Obstetrics and Gynaecology, Aberdeen Maternity Hospital

According to the HIS report in 2014, the Obstetrics and Gynaecology Programme in Aberdeen Maternity Hospital (AMH), 6 of the 12 indicators were either red or pink for foundation and/or core and/or specialist trainees. In 2015, the survey reported that 2 of the 12 indicators were pink in the domains of: induction and supportive environment. Whilst this is an improvement, work remains to be done.

Within the GP programme in Obstetrics and Gynaecology at Aberdeen Maternity Hospital, 6 of the 12 indicators were red or pink flags in the 2015 survey and 4 of the 12 indicators for the FY2 programme were also red or pink. Further action is required to address these.

Other departments

Analysis using the HIS report methodology suggests the following specialties should also be highlighted and improvements sought.

The Anaesthetics Programme at Aberdeen Royal Infirmary reports red or pink flags for 4 of the 12 indicators in the 2015 Survey in the following domains: supportive environment; access to educational resources; local teaching and induction.

The Haematology Programme at Aberdeen Royal Infirmary reports red or pink flags for 4 of the 12 indicators in the 2015 Survey for handover; educational supervision; access to educational resources and induction.

The Paediatrics Programme (Neonatal Medicine) at Aberdeen Maternity Hospital had 7 of the 12 indicators reported as red or pink in the 2013 GMC National Trainee Survey. These were: overall satisfaction; clinical supervision; induction; adequate experience; access to educational resources; local teaching and study leave.

In 2014, 6 indicators were red or pink. These were overall satisfaction; induction; adequate experience; access to educational resources; feedback and local teaching. In 2015 there were 3 indicators as red or pink. These were: overall satisfaction; adequate experience and supportive environment. This suggests the need to pay attention to these aspects of the training programmes.

In Dr Gray’s Hospital there were 8 red or pink flags reported in the 2015 survey for the GP programme in Paediatrics and Child Health. These were overall satisfaction, clinical supervision out of hours, induction; supportive environment; educational supervision; access to educational resources; local teaching and study leave.

In previous years, 2013 and 2014, the programme was reported as having one red or pink flag respectively in regional teaching and educational supervision.

Key actions from the Director of Post-Graduate Medical Education team

The Director of Post-Graduate Medical Education (DME) team have undertaken work across the system to support the governance of medical education, including quality improvement of medical education, where there are adverse trainee survey results.

A new committee, the Medical and Dental Educational Governance Group (MDEGG) has been established as a sub-group of the Staff Governance Committee to formalise the links to NHS Grampian’s Board. This committee will ensure oversight and implementation of educational governance processes across the organisation, including monitoring and performance management of improvement plans.

The role of MDEGG and the medical education team are to continually ensure that local quality control of NHS Grampian Postgraduate Medical Education meets the GMC draft standards[2].

The new processes seek to foster an improved medical education environment and culture. The approach incorporates a number of strands, including improvements in both the resources and capacity to support the development of trainees, trainers and the faculty. Progress is being made with the review of training capacity within the Board, including the establishment of a reliable database of trainers; the induction of new trainers; and improved ‘train the trainer’ training, with four workshops having been delivered in recent months and a further three scheduled in the coming months. These actions are required to ensure that the Board meets the more robust requirements for recognition of trainers introduced by the GMC.

Another example of improved educational capacity is the establishment of a trainers’ self facilitated group learning project (Grampian Learning Initiative GLINT) which is currently in the pilot phase.

Several “road-shows” have taken place across NHS Grampian to inform current trainers on the proposed changes within medical education and the potential opportunities and issues. Around 120 consultants and Specialty and Associated Specialist (SAS) doctors have attended these sessions.

A new role of Head of Performance Governance has also been established within the Acute Sector to support medical education governance at ARI and Dr Gray’s.

A Primary Care Education, Training and Workforce Group has also been established with a remit to address workforce, training and education issues in Primary Care. This includes relevant stakeholder engagement from all organisations that have an interest and remit in education, training and workforce management in Primary Care.

Formative reviews of all departments are being carried out by the DME team. Eight departments have been visited thus far and more are scheduled. These face to face meetings have involved trainers and trainees, with the aim to improve the educational quality and culture and troubleshoot any areas of concern.

Further actions include developing a business case to expand the DME team and a medical education symposium for trainers will take place in November 2015.

4.  Risk Mitigation

The GMC National Trainee survey is an indicator of the quality of medical education and training within NHS Grampian. As such, it has an influence on perceptions of the quality of the working environment and culture which ultimately impacts on recruitment and retention of Doctors in Training as future consultants within NHS Grampian.

In order to address the risks identified within the GMC 2015 National Trainee Survey the following actions have been taken:

·  The establishment of a Medical and Dental Education Governance Group, as a formal sub group of the Staff Governance Committee (SGC). This group will ensure that there is an appropriate governance framework for medical and dental education within NHS Grampian and provide regular oversight and monitoring of performance and improvement requirements.

·  The 2015 GMC National Trainee Survey requires triangulation with the NES Scottish Trainee Survey and any relevant information from the NES Quality Management processes. A detailed response and action plan has recently been submitted to NES which will drive the improvement work, led by the Director of Medical Education over the next year.

·  The Director of Post-Graduate Medical Education progresses discussion with local services and provides an overview of the actions and progress undertaken by the Director of Medical Education team over the past year in partnership with local services.

·  Deanery Quality Management Visit Reports to NHS Grampian for various specialties are required to be scrutinised at the Medical and Dental Education Governance Group with appropriate high-level scrutiny and action plans to be presented to the Staff Governance Committee.

5. Responsible Executive Director and contact for further information

If you require any further information in advance of the Board meeting please contact:

Responsible Executive Director
Annie Ingram
Workforce Director
/ Contact for further information
Gerry Lawrie
Deputy Director of Workforce

Date 3rd September 2015

Additional supporting information

The GMC 2015 and 2014 National Trainee Surveys are included in Appendix One.

·  The methodology incorporated in the narrative is HIS methodology and that presented in Appendix One is the GMC methodology. Therefore, flags may not be comparable across these different methodologies.

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·  Appendix One

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[1] Healthcare Improvement Scotland (2014) Aberdeen Royal Infirmary – Short life review of quality and safety http://www.healthcareimprovementscotland.org/our_work/governance_and_assurance/programme_resources/ari_review.aspx

[2] General Medical Council (2014) Draft Education and Training Standards www.gmc-uk.org/education