Immunology - Level 2 visit report

 

Local office name: Health Education England, working across the South West

Organisation under review: University Hospitals Plymouth NHS Trust

Placements reviewed: Immunology

Date of Review: 6th August 2019

 

BACKGROUND

Reason for Review

The Review was organised in response to adverse feedback received from a trainee previously in post.  The Review was undertaken in order to assure HEE that the current learning environment within the department complies with the GMC standards and requirements stated in Promoting Excellence.  

No. of Learners met

 3

No. of Supervisors/Mentors met

 2

Other Staff members met

-

Duration of review

2.5hrs

Intelligence sources seen prior to review

N/A

 

PANEL MEMBERS

 

Name Job Title
Dr Martin Davis Head of Quality, HEE (Chair)
Dr Siraj Misbah Consultant Immunologist, Oxford and External SAC Representative
Mr Bill Wylie Lay Representative
Ms Jane Bunce Quality Lead, HEE

 

EXECUTIVE SUMMARY

The Review was organised in response to adverse feedback received from a trainee previously in post.  The Review was undertaken in order to assure HEE that the current learning environment within the department complies with the GMC standards and requirements stated in Promoting Excellence. Our usual processes of providing evidence such as the GMC NTS and Quality Panels were in this instance unable to provide sufficient data.


Given the small number of trainees placed in the department the panel chose to see all learners rather than limit itself to postgraduate medical trainees. The lines of enquiry were topics that highlight the learning environment, these included: Induction, Rotas, Clinical Supervision, Handover, Raising Concerns, Educational Supervision, Assessments, Feedback and Educational Leave.

 

The feedback received from learners and supervisors in the department provided assurance that the requirements and standards contained within Promoting Excellence and the HEE Quality Framework are currently being met. There were areas of good practice which is highlighted in the body of the report.

 

REPORT SIGN OFF

Outcome report completed by (name) Jane Bunce / Dr Martin Davis
Chair's signature Dr Martin Davis
Date signed 3/9/2019
 
HEE authorised signature Dr Martin Davis
Date signed 3/9/2019
Date submitted to organisation 3/9/2019

 

 ORGANISATION STAFF TO WHOM REPORT IS TO BE SENT

Job title Name
Mr Matthew Bowles Director of Medical Education
Dr Lucy Leeman Consultant Immunologist, University Hospitals Plymouth
Dr Andrew Whyte Consultant Immunologist, University Hospitals Plymouth
Dr Clare Bethune Consultant Immunologist, University Hospitals Plymouth

  

PATIENT/LEARNER SAFETY CONCERNS

Any concerns listed will be monitored by the organisation. It is the organisation's responsibility to investigate/resolve.

Were any patient/learner safety concerns raised at this review?  NO

 

EDUCATIONAL REQUIREMENTS - NO

EDUCATIONAL RECOMMENDATIONS - NO

 

GOOD PRACTICE

Learning environment / Prof. group / Dept. / Team  Good practice Related Domain(s) & Standard(s)
Immunology Dept

A multi-professional briefing that takes place at 9am each day. 

  • The meeting was set up to improve handover and thereby patient safety.
  • The clinical team, including admin, are participants.
  • Handover occurs but in addition a de-brief from the previous day is on the agenda.
  • The plan for the day ahead is discussed.
  • The Registrar and Consultant on-call for that day is confirmed.
  • Meetings last 10-20 minutes.
  • The meeting enhances team working

 A twice weekly team meeting also takes place to discuss broader issues and agenda items come out of the daily briefing.

1, 2, 3, 4

 

 

Summary of discussions with groups

Learners

The panel met with 3 learners – 1 non-training doctor; 1 ST4 doctor; and 1 Clinical Scientist.

 

Induction: 

  • All learners had received an induction relevant to their role. Due to the small number of learners involved this may be less formal than in departments with larger numbers of staff.
  • All had enhanced supervision on starting in post.
  • All were aware of who to go to escalate clinical concerns – all the team were described as being approachable
  • Medical learners described being able to sit in clinics when they started in post and being gradually exposed to their own independent but supervised workload.

 

Working Environment: 

The visiting panel heard about a morning multi-professional briefing that takes place each day at 9am. 

  • The meeting was set up to improve handover and thereby patient safety.
  • The clinical team, including admin, are participants.
  • Handover occurs but in addition a de-brief from the previous day is on the agenda.
  • The plan for the day ahead is discussed.
  • The Registrar and Consultant on-call for that day is confirmed.
  • Meetings last 10-20 minutes.
  • The meeting enhances team working

 

A twice weekly team meeting also takes place to discuss broader issues and agenda items come out of the daily briefing.

 

Medical trainees described a process whereby they receive feedback from consultants.  All letters sent to GPs and patients from the trainees are countersigned by a consultant.  This was viewed as a useful form of supervision and enabled constructive feedback to take place.  This was described as a supportive process that gave trainees additional confidence.

 

Learners are able to bring other issues to MDT meetings as necessary.

 

Rotas are not an issue as no learners within Immunology do out of hours work.

 

The Clinical Scientist learner welcomed autonomy within the laboratory which aids learning.  Any problems can be raised through quality meetings or more informal routes.

 

Raising concerns:

All learners were comfortable raising concerns.  These may be discussed at the morning briefing or individually.  All learners felt well supported in this respect.  The department process for managing Datix was described as supportive and the individual who manages them, as approachable.

 

Assessments:

Learners had not experienced any issues getting assessments completed.

 

Exams and Curriculum coverage:

The Clinical Scientist had completed and passed part 1 of the RCPath exam last year and had felt very supported.  The Trust doctor had taken PACES and had been supported.  The ST4 had yet to take any exams but confirmed that their supervisor had been very proactive in terms of suggesting access to additional opportunities e.g. Vasculitis experience at RD&E and attendance at specialist clinics in London.

 

All learners confirmed that they had been supported to attend ‘Hitchhikers’ national training programme in Immunology.

 

Medical learners confirmed they attend clinic but have 2 days a week allocated to laboratory work, which is protected time.

 

Learners were asked if they would recommend the department for training and they confirmed that it was a ‘great department to work in’ and felt fortunate.

 

No bullying and undermining was reported.

 

The learners could not think of anything that they would change to make the department better in terms of education and training.

 

Consultants

The panel met with 2 of the 3 consultant immunologists.

 

Induction:

The consultants described induction which includes a tour of the department, introductions to staff and the departmental schedule.  In addition, the general ethos of the department is covered.

 

Day to day working of department:

The consultants described wanting trainees to come to them with queries etc. 

 

They described the process of countersigning letters as a way to feedback; and MDTs as a learning opportunity.  The number of patients has increased since this process was originally introduced which means it has become more difficult to manage but still takes place.

 

There is a good relationship with the admin team and the consultants are able to discuss clinic format, capacity and trainee allocation with them on a regular basis. 

 

There are departmental away days which learners also attend.

 

The consultants described patient management as interactive but as trainees progress, they obviously ask less and there is less of a need for countersignature on letters.  Letters can however be electronically marked if learners want consultants to look at something in more detail.

 

The department undertakes an educational activity whereby they put scenarios to the team and through this process can learn what others do and compare practice.

 

The consultants described the daily briefing sessions which started as a way to improve communication.  There is a set agenda and the meeting covers safety issues, job allocation, challenging clinical scenarios.  Everyone has a voice.

 

There is currently only one approved educational supervisor (ES) within the department but the longer-term plan is for all consultants to become ESs. 

 

Assessments:

Both consultants confirmed they are happy supporting assessments and approve and support learner attendance at external educational opportunities.

 

Exams and Curriculum coverage:

Exam support was described as trainee led.  They are advised to look at past papers and complete practice answers which can be shared with consultants for comment.  Mock exams have taken place in the past.

 

A regular schedule is produced to ensure equitable clinic/lab time and the department has worked hard to ensure this is protected wherever possible.

 

There is a cohort due to attend the annual ESID meeting (European Society for Immunodeficiencies meeting) and another to attend an Auto Inflammatory Training Day.  The Department also sends attendees to a network meeting which takes place between Plymouth, Bristol, Southampton and Cardiff.

 

The department aims for a flat hierarchy and tries to take a coaching approach to training.

 

The department is QPID and IQAS Accredited.

 

The Consultants were asked if there was anything they would do to improve training within the department and they described aspiring to a better journal club.

 

Date of report: 7th August 2019

Author: Jane Bunce/Dr Martin Davis

Job Title: Quality Lead / Head of Quality