Feedback Received from Trainees Unable to Attend Visit

Feedback received from Trainees unable to attend visit

Catherine Lloyd (CT 2 Trainee)

Areas for exploration with specialty trainees in Hospital posts

Any concerns about patient safety related to the working environment/s

Educational / Clinical supervision appropriate /competent for level of responsibility

Yes usually no problem.

Any examples of good educational / clinical supervision arrangements

My personal experience is that my educational supervisor always makes time to have necessary meetings.

When help is required, is it easily available?

Yes

Do the working hours/shift patterns allow adequate rest?

No. Rota shifts from long days to nights frequently over the course of a couple of weeks. single rest day after 4 nights then back on 2 long on call days. only reason rota is EWTD compliant is because of the 1 week out of 8 when we only do 3 days, so it evens it out. But on average the rota leaves most of us feeling very tired. exacerbated by the fact there is no on call room or even common room for us to use. the on call rooms are supposedly available after a night shift if we are too tired to drive home, but in reality security either refuse to give out the key or say that they haven’t had the keys returned yet or keys are with cleaners. So lots of trainees forced to drive long commutes back to their homes without opportunity for adequate rest. Most trainees would like a change in the rota but it can only be changed in august when new intake can decide, otherwise people book off their leave etc.

How often do you work beyond rostered hours?

Usually work till 6 as natural end of day although i believe hours are till 5.30. other than that shifts particularly on calls usually finish promptly. we do usually one late trauma shift a week as well as an on call evening. this is meant to be last patient in recovery by 7.30 but often overruns till 8.

Is the appropriate information about individual patients easily available?

Not always. often patients come down with only temporary notes from last 24 hours of admission. rarely opportunity to look at old anaesthetic charts for emergency operations.

Do the patient records allow effective and safe management of every patient?

No. see above. need old notes should be sent to patients ward as soon as decision to admit from A+E made. I think it should be reasonable to have old notes present before anaesthetising patients for major emergency surgery particularly on weekdays when ward clerks etc are on duty.

Are shift/patient handovers adequate?

Yes.

Is there a hospital at night process? If so, how does it work?

Yes. don’t know as it doesn’t include anaesthetic team.

Any concerns about patient safety in the out of hour’s placements

Don’t think single rooms are optimum for treatment particularly on geriatric/orthopaedic wards because it can make the nursing job very difficult with staffing levels particularly at night. don’t see how this can be resolved though without knocking a few walls down or miraculously increasing nursing staff levels however!

Taking consent appropriate to level of experience.

No concerns

HushamAlshather (ST5 Trainee)

Life in the anaesthetics department at Tunbridge Wells Hospital

We have felt very welcomed from the first day we started in tunbridge wells.

We had two well-organized induction days (general hospital induction and anaesthetics induction). During the anaestheic one, we have been given a booklet that contains all the important information. We had a tour in both hospital, role as a registrar and rota explained appropriately. Educational supervisors have been allocated for each one of us. And all our questions have been answered.

The rota have been sent to us in advance, most of trainees are happy with the rota, although some of us feel doing a two-week on calls rota is inappropriate and very tiring. CLWRota is very helpful as well.

We have teaching and journal club every Wednesday. The topics covered are excellent and related to the aesthetic exams. We also attend the regional teaching (either ITU or anaesthetics). We have also had simulation teaching in anesthetic emergencies. We had a change to teach other trainees and doctors as well.

The level of supervision is very good. A consultant supervises most of our list. The case mix we see in both hospitals is excellent, especially in TW. We have gained excellent practical and non-practical skills in both anaesthetic (Trauma, CEPOD, Gyne, Paeds, Orthopedics, obstetrics and genral surgery) and ITU. The feedbacks and the teaching we get from the consultants are very constrictive and helpful.

I never have a problem in organising a leave (study or annual leaves). And the anesthetic secretory (Lesley) is fantastic lady and very helpful.

We have been allocated to modules we have chosen according to our requirement. The trainees also encouraged doing their exams and have been given teaching by the consultants in the exam technique.

All in all, in my opinion, the training we are getting in MTW is very good and we feel very supported and welcomed. This trust would be my first choice when I start looking for a consultant job in the future.

Best regards

Dr.HushamAlshather

ST5 trainee in Anaesthetics and intensive care

Higher trainee representative in MTW

NabeelAmiruddin (ST5 Trainee)

Domain 1 – Patient safety

No concerns about patient safety
Appropriate supervision
Regular weekly teaching
Help always available
On-call rota requires us to finish night shift 24 hours before starting 12 hour day shift the following day – not enough rest
Infrequently working beyond rostered hours
Adequate info about patients available

Locality training:

Well supported training
Difficulties: Distance for travel when residing in London/2 hospital site 35 minutes drive apart/Often more than 1 trainee with consultant for list

Domain 2 – Quality Management

Local education provider

EWTD complaint
LFG meetings take place

Specialty Trainers and Programme Directors

I’m unfamiliar with GMC Generic Standards for Training/GEAR
LFG good practice: open culture/willingness to change and compromise

Domain 3 – Equality/Diversity

No discrimination seen
I was well supported for paternity leave
I’ve had NO training in equality and diversity

Domain 4

Domain 5 – delivery of curriculum

Assessments are carried out effectively by supervisors
Formal feedback collected
Best part of educational process is developing clinical skills
Study leave is supported

Domain 6 – Support and development of training

Induction: Should begin with obtaining car park permits/ID badges/Pathology and Radiology passwords before anything else. I didn’t receive paperwork for registration for payroll/Occupational health long enough in advance
Well introduced to clinical team/on-calls
Educational supervisors nominated in advance
Meetings occurring
E-portfolio being used
Weekly teaching in place – very consistent
No pressure or bullying

Domain 7 – Management of education/training

Domain 8 – educational resources

Appropriate learning opportunities available
Enough supervisors present
Access to internet/eportfolio available
NOTE ON LIBRARY: I did not find library staff helpful in obtaining Athens password and getting it to work

David Hutchinson (ST 3/4 Trainee)

Below is my feedback for the 6th of June visit to Maidstone/Tumbridge Wells. Apologies that I could not attend the visit in person. I had booked a holiday way in advance. My feedback in response to some of the question prompts is below. In general I have no concerns and have had a great experience so far. I hope this is helpful.

Areas for exploration with specialty trainees in Hospital posts

Any concerns about patient safety related to the working environment/s  No concerns. The layout of the hospital is well designed so that there is a logical movement from A&E resus to emergency theatre, emergency recovery and ICU. As these are all in the same area it groups together staff so more people are close in the case of an emergency. I have not found a proplem in elective theatres and people are easily available. The single pt rooms are inherently problematic but spacious enough in an arrest situation for resuscitation. Trauma calls and peri-arrest calls are well attended. Note significant consultant presence from ICU and anaesthetics at these calls .

Educational / Clinical supervision appropriate /competent for level of responsibility  Supervision has been excellent and numerous educational opportunities on a daily basis.

Any examples of good educational / clinical supervision arrangements  The CEPOD list is overseen by an anaesthetic consultant who is local and immediately available but allows independent practice wherever possible. Also, as ICU is in close proximity staff on the unit and the covering consultant are easily available and in general take a keen interest.

When help is required, is it easily available?  Yes no issues at all.

Do the working hours/shift patterns allow adequate rest?  Yes. No issues.

How often do you work beyond rostered hours?  Fairly regularly, approx. once per week but I have rarely been expected to. Often I have been keen to “see a case through” or leave at a time when I feel confident things are under control, so usually by choice not a necessity.

Is the appropriate information about individual patients easily available?  Yes notes in the main are present and some letters are available online, plus PACS for radiology.

Do the patient records allow effective and safe management of every patient?  Usually.

Are shift/patient handovers adequate?  Depends on the colleague handing over but this has recently been improved and formalised so is now much better.
Is there a hospital at night process? If so, how does it work? Yes. There are site nurse practioners who have been very usefull, another staff grade anaesthetist on obstetrics who are available and good contact with medical and surgical teams is usually established early in the night.

Any concerns about patient safety in the out of hour’s placements  No

Taking consent appropriate to level of experience.  I have not been asked to consent for any procedure that I am not confident to do.

Areas for exploration with Trainees (NBindividuals may not wish to disclose personal details)

Seen/ experienced discrimination in the workplace?  No

Have full information about posts, the job description, and the content and purpose of the posts?  Yes thorough induction and info available beforehand.

Know about, or how to get information about:

Planned absence
Unplanned absence
Training at less than full-time
Level of support offered for any disability or special needs? No issues.

Areas for exploration with trainees

How Educational or Clinical Supervisors carry out assessments.  Standard process as per elsewhere.

How Educational or Clinical Supervisors input to Trainee Portfolio / ePortfolio.  Either sat together at a computer or sometimes after a list it may be done in the next couple of days via e-mail submission.

How their progress is discussed with Trainees – formal feedback from Educational Supervisor; informal feedback  Informal feedback is daily and ongoing. Formal feedback has been at educational supervisors meetings.

What areas of your work do you consider to be training? The vast majority if lists I have been on have been training lists with very few a service provision. Lots of support and informal discussion with opportunities whilst on-call to try new techniques and procedures with the support of the consultant mentor. I have been impressed in this regard!

Best part of the educational process.  Very flexible and my training so far seems to have been exactly tailored to my needs and changed when needed.

How NHS appraisal is carried out  Not sure

Support / encouragement to take study leave; any difficulties. Only if I have not been able to provide sufficient notice.

Areas for exploration with trainees

The process for induction:

To the Trust
To the clinical team
In the context of on-call No issues. Done well

Nominated Clinical Supervisor/s?  No issues

Nominated Educational Supervisor?

Planned or achieved Educational Supervision meetings?  Yes
Use of portfolio / ePortfolio?  Could do with some more training on this myself.

Content and location/s of Specialty training programme  No issues

Access and provision of career advice Readily available but not especially formalised. However I have not sought any.

Relevance of posts for GP training [if appropriate]  N/A

Any concerns about quantity or kind of work  No

Quality of bedside teaching – business / teaching rounds  usually excellent

Examples of particularly good training  CEPOD list as above

Weekly protected teaching time:

Trainee voice in choice of subjects
Consistency of attendance of teachers
Consistency of attendance of learners No concerns

Learning experience in Outpatients – quantity/ quality – how easy is it to attend clinics  Access to pain clinic and CPET possible

Awareness of study leave support for trainees  No concerns

Experienced of undue pressure or bullying  Nil experienced or witnessed

Opportunities to learn from, or with, professionals other than doctors  Possible especially on ICU but good ODP support and help with some aspects of equipment etc.

Areas for exploration with trainees

Appropriateness of learning opportunities and experience required for your specialty training  Very appropriate. Missing some areas eg vascular, neuro

Training or educational support from non-doctors.  usually very forthcoming

Enough Supervisors (consultants, middle grades, and other professionals) to provide appropriate levels of educational support.  Yes

Information resources:

library
internet
access to portfolio / ePortfolio Easily accessible from any computer, of which there are many

Perception of the learning environment in the Specialty/ LEP  Fine

Kind regards,

David Hutchinson