Provision of Mentoring for all New Consultant Surgical Appointments

Version / 1
Name of responsible (ratifying) committee / Clinical Governance Meeting Surgery & Cancer CSC
Date ratified / 24 August 2015
Document Manager (job title) / Consultant Surgeon
Date issued / 02 August 2016
Review date / 01 August 2017
Electronic location / Management Policies
Related Procedural Documents / None
Key Words (to aid with searching) / Mentoring

Version Tracking

Version / Date Ratified / Brief Summary of Changes / Author
1 / 14.08.2015 / New Policy / Mr Gibbs

CONTENTS

QUICK REFERENCE GUIDE

1.INTRODUCTION

2.PURPOSE

3.SCOPE

4.DEFINITIONS

5.DUTIES AND RESPONSIBILITIES

6.PROCESS

7.TRAINING REQUIREMENTS

8.REFERENCES AND ASSOCIATED DOCUMENTATION

9.EQUALITY IMPACT STATEMENT

10.MONITORING COMPLIANCE WITH PROCEDURAL DOCUMENTS

QUICK REFERENCE GUIDE

This policy must be followed in full when developing or reviewing and amending Trust procedural documents.

For quick reference the guide below is a summary of actions required. This does not negate the need for the document author and others involved in the process to be aware of and follow the detail of this policy.

  1. Following appointment there must be a meeting between the Clinical Director/ Clinical Lead and the new Consultant.
  1. A mutually agreed document should be drawn up that is specific for the new colleague. It should clearly state the needs of the new colleague to support them at the start of this consultant appointment. The document should clearly state any procedures that one or both parties feel needs to be supervised. It should clearly state the level of supervision required (someone available in the hospital to scrubbed at the table), who will be supervising, for how long and/or how many and what the agreed end point is. This should be documented for each procedure identified. This outcome should all be recorded and the document signed by both parties when agreement is reached.
  1. The patient should ideally be made aware that the operating surgeon is being mentored through the case and what that means. The patient should where possible and practical meet both surgeons pre-operatively and have the opportunity to discuss any issues as part of the consent process.
  2. Any significant points in surgery, such as division of vessels, “point of no return” should be preceded by a “time out” to ensure that all is as it should be. This should also be standard practice outside of the mentoring process.
  3. When the process is complete, this will need to be discussed at a further meeting that will involve the two original parties and any third party that acted as a mentor and was involved in the supervision/coaching process.

1.INTRODUCTION

Following a serious untoward incident during major surgery resulting in a patient death involving a new consultant surgeon being “mentored” by a senior colleague, it was agreed that PHT should formalise the mentoring process for new surgical consultants. This should include established consultants moving to PHT from other hospitals. A mentoris an individual who is tasked with providing personal and/or professional support for a new consultant as a colleague and often outside the line managementsystem. This policy is written primarily with surgeons in mind, but could be adapted for any consultant performing interventional and/or invasive procedures.

This policy is not designed to be overly prescriptive, but to give general principles on the process that should be individualised to suit the department and the consultant as every situation will be different. This allows interpretation of the process from something as simple as introducing a new colleague to the theatre suite and staff to a highly detailed document that states operative numbers, techniques and procedures. The process can vary from supervision to coaching to full mentorship.

2.PURPOSE

The purpose of the policy is to outline the introduction of a formal mentoring process for new consultant surgical colleagues as they adjust to their new role within Portsmouth Hospitals. The ultimate aim is to make sure that all new consultants within surgery have an appropriate period of mentoring tailored to their individual needs.

3.SCOPE

This policy applies to all new consultant surgeons and may be extended to include non-surgical consultants, for example, when the new colleague is performing interventional procedures.

‘In the event of an infection outbreak, flu pandemic or major incident, the Trust recognises that it may not be possible to adhere to all aspects of this document. In such circumstances, staff should take advice from their manager and all possible action must be taken to maintain ongoing patient and staff safety’

DEFINITIONS

Below is a list of definitions for terms used within the document:

  1. Mentor -an individual who is tasked with providing personal and/or professional support and is the overarching umbrella. The individual must be on the Trust Mentor List and can be cross speciality.
  2. Mentoree – an individual who is receiving personal and /or professional support from a mentor.
  3. Mentoring – the process of providing personal and / or professional support.
  4. Supervisor– an individual who is tasked with providing direct oversight of an individual whilst they are performing a procedure. The supervisee is considered competent and the direct oversight of the procedure is for the purposes of “sign-off”. The supervisor must be a Consultant within the same specialty and able to undertake the procedure.
  5. Supervision – is the process where a supervisor oversees the supervisee performs previously agreed procedures to ensure competent and achieve sign off.
  6. Supervisee – an individual who is receiving direct clinical support related to specific pre agreed procedures.
  7. Coaching - the process by which a competent consultant is developed to enable them to expand their surgical portfolio.
  8. Non-surgical – specialties performing interventional procedures outside of a conventional theatre setting. Such as endoscopy and percutaneous interventions.
  9. Time-out – a pause during a surgical procedure to ensure clarity of anatomy and pathology prior to the performing of an irreversible stage of the operation.

4.DUTIES AND RESPONSIBILITIES

The duties and responsibilities are listed below:

4.1 New Surgical Consultants are responsible for:

  • Ensuring they meet with Clinical Lead, Clinical Director or Chief of Service ideally prior to starting in post. If not prior to commencement, the meeting should take place prior to any surgical procedures being undertaken.
  • Ensure there is a written outcome from the above meeting and this is agreed and signed by both parties.
  • Ensuring the discussions about competency and experience are both transparent and honest.
  • Ensure that the sign off meeting takes place after the agreed time period or numbers have occurred.
  • Ensure there is a written outcome from the final meeting agreed and signed by both parties.

4.2 Assigned Supervisors are responsible for:

  • Familiar with the agreed document drawn up between the new consultant and the Clinical Lead / Clinical Director or Chief of Service.
  • Being proactive and ensuring they have direct oversight of the new consultant performing the agreed surgical procedure.
  • Providing timely feedback to the new consultant and the Clinical Lead / Clinical Director or Chief of Service both during the process and prior to the sign off meeting.
  • Signing off the new consultant as competent for each individual procedure they have been tasked with supervising once competency has been demonstrated.

4.3 Assigned Mentors are responsible for:

  • Ensuring they are trained and up to date and on the Trust recognized Mentoring register
  • Providing personal and / or professional support to the new consultant
  • Providing feedback to the new consultant and with agreement providing feedback to the Clinical Lead, Clinical Director or Chief of Service.
  • Provide feedback to the Medical Director with consent for non medical issues if appropriate.

4.4 Clinical Lead / Clinical Director, Chief of Service is responsible for:

  • Ensuring they meet with the new consultant ideally prior to starting in post. If not prior to commencement, the meeting should take place prior to any surgical procedures being undertaken.
  • Ensure there is a written outcome from the above meeting and this is agreed and signed by both parties.
  • Ensuring the discussions about competency and experience are both transparent and honest.
  • Ensure that the sign off meeting takes place after the agreed time period or numbers have occurred.
  • Ensure there is a written outcome from the final meeting agreed and signed by both parties.
  • Allocating the supervisors to each new consultant. This may be a single individual or multiple individuals as agreed by both parties. The supervisors should be competent in the procedures they are supervising and be members of the department.

5.PROCESS

5.1 General Principles

The process should be started at successful interview and explained to the applicant. There will be a meeting between the department Clinical Director and/or Clinical Lead, if more appropriate. This meeting should be confidential, in a suitable location, planned ahead and with appropriate time set aside. It will ideally take place prior to commencement of surgical duties.

The meeting should include discussions on breadth of experience and training and a review of the new consultants’ surgical logbook. The discussion should cover the expected breadth of work to be undertaken by the new consultant both elective and emergency. This should be a two way process. Any areas of perceived weakness or gaps in experience should be discussed in greater detail.

5.2 Meeting outcomes

At or soon after the meeting, a mutually agreed document should be drawn up that is specific for the new colleague. It should summarise the discussion and the agreed outcomes. It should clearly state the needs of the new colleague to support them at the start of this consultant appointment. The document should clearly state any procedures that one or both parties feel needs to be supervised. It should clearly state the level of supervision required (someone available in the hospital to scrubbed at the table), who will be supervising, for how long and/or how many and what the agreed end point is. This should be documented for each procedure identified. A supervisor’srole is to ensure safe practiceand to monitor progress against agreed milestones and report this to clinical director / Chief of Service. There should also be some documentationabout an agreed time to review progress and anunderstanding that the time may need to be extended if progress is not satisfactory as decided by either party, but also shortened if progress is better than expected.

This outcome should all be recorded and the document signed by both parties when agreement is reached.

Examples of possible text:

Mr/Miss X has performed 54 cases of procedure Y with the latter 22 being performed independently with a supervisor only available in the theatre suite. There have been no major complications to date.

Mr/Miss X uses a similar technique to that used by the existing surgeons and has requested that a colleague is available in the hospital for the first 5 cases performed at QA.

Mr/Miss X has performed 54 cases of procedure Y with the latter 22 being performed independently with a supervisor only available in the theatre suite. There have been no major complications to date. Mr/Miss X uses a different technique to that used by the existing surgeons and it has been discussed and agreed that colleague Z will be scrubbed with Mr/Miss X for the first 5 cases performed at QA. If these proceed uneventfully, colleague Z will be available for the next 5, but for support only.

Mr/Miss X has very limited experience of procedure Y and will need a formal period of training with colleague Z. Progress will be assessed after 10 cases and a further plan formalised.

5.3 Before each case

The patient should ideally be made aware that the operating surgeon is being mentored through the case and what that means. The patient should where possible and practical meet both surgeons pre-operatively and have the opportunity to discuss any issues as part of the consent process.

Both surgeons should review all relevant investigations before the start of the anaesthetic and highlight any areas of concern, anatomical variation or potential difficulty. If there are possible variations in operative method and/or technique, these should also be discussed pre-operatively so both parties are aware of the method/technique being used. This should also be discussed at the theatre Team Brief. This should be standard practice outside of the mentoring process.

Any significant points in surgery, such as division of vessels, “point of no return” should be preceded by a “time out” to ensure that all is as it should be. This should also be standard practice outside of the mentoring process.

5.4 Conclusion of the process

When the process is complete, this will need to be discussed at a further meeting that will involve the two original parties and any third party that acted as a mentor and was involved in the supervision/coaching process. Again, there should be an agreed written documentation of the meeting, signed by all present. It will be expected that the documentation, process and outcome will be discussed at the new consultant’s first appraisal.

Examples of possible text:

Mr/Miss X has completed the agreed number of cases of procedure Y and all parties feel that progress has been goodand Mr/Miss X is deemed suitable to proceed independently with this procedure.

Mr/Miss X has completed the agreed number of cases of procedure Y. All parties feel that progress has been good but it has been mutually agreed that Mr/Miss X needs a further period of supervision in theatre for procedure Y by colleague Z for an additional 5 cases. A further review will take place when these have been completed.

Mr/Miss X has completed the agreed number of cases of procedure Y. All parties feel that progress has been slow. It has been mutually agreed that Mr/Miss X needs a further period of mentorship for procedure Y by colleague Z. Progress will be reviewed in the future at a time to be determined.

5.5 Grievances

If there is a disagreement between the parties about the process and/or its outcome this should be escalated to the Chief of Service first, and only to the Medical Director if resolution is not achieved.

6.TRAINING REQUIREMENTS

No specific training requirements identified.

7.REFERENCES AND ASSOCIATED DOCUMENTATION

Nil to note

The following referencing format must be used:

8.EQUALITY IMPACT STATEMENT

Portsmouth Hospitals NHS Trust is committed to ensuring that, as far as is reasonably practicable, the way we provide services to the public and the way we treat our staff reflects their individual needs and does not discriminate against individuals or groups on any grounds.

This policy has been assessed accordingly

Our valuesare the core of what Portsmouth Hospitals NHS Trust is and what we cherish. They are beliefs that manifest in the behaviours our employees display in the workplace.

Our Values were developed after listening to our staff. They bring the Trust closer to its vision to be the best hospital, providing the best care by the best people and ensure that our patients are at the centre of all we do.

We are committed to promoting a culture founded on these values which form the ‘heart’ of our Trust:

Respect and dignity

Quality of care

Working together

Efficiency

This policy should be read and implemented with the Trust Values in mind at all times.

9.MONITORING COMPLIANCE WITH PROCEDURAL DOCUMENTS

This document will be monitored to ensure it is effective and to assurance compliance.

Minimum requirement to be monitored / Lead / Tool / Frequency of Report of Compliance / Reporting arrangements / Lead(s) for acting on Recommendations
Audit of new consultants having a signed document outlining supervision requirements / Senior Business Manager for Service / Audit Document / 6 Monthly / Policy audit report to:
  • CSC Board
  • CSC Clinical Governance Meeting
/ Chief of Service
Clinical Director or Clinical Lead for each Surgical Specialty

Provision of Mentoring for all New Consultant Surgical Appointments
Version: 1

Issue Date:02 August 2016
Review Date: 01 August2017 (unless requirements change)Page 1 of 9