Postgraduate School of Paediatrics Quality Management Visit to Royal Devon and Exeter NHS Foundation Trust

29th June 2014

 

Postgraduate School undertaking visit: School of Paediatrics

Primary author of report (name and job title): Dr Y Kumar

Provider visited: Royal Devon and Exeter NHS Foundation Trust (RDE)

Visit team (names and educational job titles)

Chair

Dr Yadlapalli Kumar

Panel member 1

Dr Dermot Dalton

Panel member 1

Dr Simon Bedwani

Lay representative

Ms Jenny Cooper

Programme

No. of trainees seen

No. of trainers seen

Paediatrics

Ten

Three

Evidence considered prior to review taking place: Total number of WPBAs undertaken by each trainer (submitted by Dr David Bartle, College Tutor)

Date visit report ratified by HESW – Peninsula

01.09.14

Date visit report made available to provider

01.09.14

Date provider ratifies visit report

22.09.14

Circulation of this report: PPME Quality Team, RDE Director of Medical Education

 

Executive Summary

 

The Royal Devon and Exeter has 14  trainees enrolled in the Paediatric training programme, 6 in level 1 training (ST1 – 3), and 8 in level 2 and 3 training (ST4 – 8). On the day of the visit the panel saw 5 level 1 trainees and 5 level 2 and 3 trainees.

All trainees were informed of the purpose of the visit and were open and spoke freely when answering the questions put to them by the panel. During a separate interview with the trainers, they were equally open and honest in their responses.

During the visit it became clear that there is a marked difference in the training experience when working in neonatology as compared to general paediatrics. All trainees enjoyed the experience and training gained during their rotation in neonatology where rota’s are appropriately staffed and teaching is run on a very structured basis.

There were no safety concerns raised during this visit. However the trainees were unhappy about taking consent for general anaesthetic for MRI as they believe this is something their anaesthetist colleagues should be taking as they are responsible for administering the general anaesthetic.

Teaching was generally assessed as good in particular the simulation training in both neonatology and general paediatrics. However the Wednesday and Thursday morning local teaching sessions wereless favourably received. They are perceived as being conducted on an ad hoc basis with little structure and poor trainee attendance.

The trainee experience of getting work place based assessments (WPBA’s) signed off was reported as variable.This is supported by statistical information provided by the chair of the panel where it was apparent that one supervisor has completed 43% of all WPBAs signed off for the trainees & another 20% by a second educational supervisor.

In general paediatrics (Bramble Ward), the trainees reported a perceived lack of training opportunities. This was reported as being due to service pressures caused by a shortfall of staff and consequent rota issues.  This is having an impact on the trainees ability to identify and have signed off training opportunities, and to take study leave.

The main concern of the senior trainees  was the lack of opportunities to attend out-patient clinics.

As a group the trainees felt very well supported by their senior colleagues, who the trainees felt were all very approachable and willing to offer advice and guidance when required.

All trainees would recommend this trust as a good place to train.

Key recommendations

1

Improve Rota’s on General Paediatric Ward with the September 2014 intake of new junior doctors at both ST1 and at middle grade level.

2

Improve attendance and structure of local teaching on a Wednesday and Thursday morning with Consultant and middle grade doctor presence and supervision by March 2015

3

Improve access to study leave for those trainees on the General Paediatric Ward by March 2015

4

More parity in consultant activity regarding the completion of WPBAs by July 2015 when the next round of ARCPs would be completed.

5

Ensure those who start outside of the September handover get a formal induction by March 2015 (next changeover).

6

Seek clarification on who is responsible for taking consent for GA for MRI by March 2015.

 

Yadlapalli Kumar

Head of School of Paediatrics

 

 

Areas of good practice

Department / Programme / Specialty

Area of good practice

Neonatology

Neonatal and General Paediatric simulation teaching which occurs on a regular basis with Consultant supervision and active junior doctor involvement.

 

 

Summary of the visit

Patient safety inc. handover and induction

This was generally a very positive experience for all trainees who particularly liked the electronic staff handbook.  It was agreed that the induction in neonatology was much more comprehensive and useful than that in general paediatrics.  With regards to patient handover this occurs in a standard format and at shift change overs.  Another aspect of induction is that those trainees who start outside of the September changeover did not receive a formal departmental induction.

Department / Programme / Specialty

Area of development

General Paediatrics

Induction experience in general paediatrics.

Ensure those who start outside of the September handover get a formal induction.

Supervision – clinical and educational (inc. career guidance, feedback)

The trainees feel fully supported by their seniors and receive adequate career guidance and feedback

Training environment (inc. access to educational resources

Nothing to report.

Work load

The trainees are currently under pressure due to staff shortages on the General Paediatric ward, and this is having an adverse impact on their ability to take study leave.

Department / Programme / Specialty

Area of development

General Paediatrics

Improve rota’s in particular for the junior trainees.

Adequate experience / achievement of curriculum competencies

All trainees reported they were gaining adequate experience and achieving curriculum competencies in the main.  The senior trainees however need more exposure to outpatient clinics

Department / Programme / Specialty

Area of development

 

Improve accessibility to outpatient clinics for senior trainees.

Teaching – local, regional and study leave

Neonatal and General Paediatric simulation training is well structured and well attended.  The local teaching on a Wednesday and Thursday morning is not well structured nor well attended by trainees and appears to be an ad hoc arrangement.

Department / Programme / Specialty

Area of development

 

Re-structure General Paediatric teaching on a Wednesday and Thursday morning and consider making it a consultant led event to improve attendance.

Bullying and harassment

Nothing to report

Additional comments / feedback

The trainees were uneasy about having to obtain consent for GA for MRI, as they feel this should be the responsibility of their anaesthetist colleagues, despite having a guideline to follow and the appropriate documentation provided to enable them to do this.

Department / Programme / Specialty

Area of development

 

Seek clarification on who is responsible for taking consent for GA for MRI.

 

 

 

Visit Panel Chair Declaration

This completed report is a true and accurate account of the discussion that I participated in or that were reported to me from this visit.

The key recommendations identified within this report have been identified with good faith.

I can confirm that any areas of significant concern that have a direct impact upon patient safety have been brought to the attention of the relevant Director of Medical Education (or equivalent), responsible Medical Director and Executive Lead for Quality at Health Education South West Peninsula Postgraduate Medical Education.

Chair name:

Yadlapalli Kumar

Chair educational role:

Head of School, SW Peninsula Post-Graduate School of Paediatrics

Date of signature:

28.6.2014

 

 

 

 

 

 

 

Health Education South West Peninsula Postgraduate Medical Education Declaration

I as signatory on behalf of Health Education South West, Peninsula Postgraduate Medical Education can confirm that the information and associated recommendations provided via this report have been reviewed and deemed appropriate for the purpose as stated.

The recommendations contained within this report have been documented as part of the quality management processes of Health Education South West, Peninsula Postgraduate Medical Education and where appropriate, will be reported to the General Medical Council (GMC) as required.

Name:

 

Dr Martin Davis

HESWPPME educational role:

 

AD for Quality

Date of signature:

 

1st October 2014