Ophthalmology Level 2 visit report

Chair Nabil Habib
Level 2 Visit Date Thursday 11th May 2017
Trust under review Royal Cornwall Hospitals NHS Trust

School/Programme/department under review

Ophthalmology
Grade of trainees under review  
Reason(s) for review

Feedback from previous trainee and Quality Panel had led to the review being proposed.  

Visiting team

Mr Nabil Habib (Head of School)

Mr Roland Ling (Training Programme Director)

Ms Jane Bunce (Quality Manager, HEE)

Mr Neil Squires (Specialty Training Manager, HEE)

Dr Imran Saif (Associate Dean, HEE) 

Trust team

Mr Pierre Rautenbach (College Tutor)

Dr Chris Williams (Director of Medical Education)

Mr Mark Wolf (Divisional Manager, Ophthalmology)

Mr David Jones (Educational Supervisor)

 Action plan to be completed by Mr Pierre Rautenbach (College Tutor)

To be returned to HEE by Saturday 3rd June 2017
To be completed by Mr Pierre Rautenbach (College Tutor)

 

Risk Scores

Scores Prior to review AMBER
Proposed scores following review AMBER

 

1. Executive Summary

Triggered visit to the Royal Cornwall Hospital Ophthalmology department following inadequate rating by the quality panel. The school of Ophthalmology has been reassured that the department including trainers and management is keen to address all the issues raised by the trainees and provide a detailed action plan to ensure high quality training and delivery of the curriculum in a supportive environment.

 

2. Educational Requirements and Recommendations

Educational Requirements

HEE Domain 3 / GMC Theme 3 and 4: HEE to send through an updated list of trained supervisors to DJ and PR.  PR is shortly to complete the training course delivered by the Royal College for College Tutors and this is likely to count towards the agreed training requirements set by HEE in line with GMC requirements.

 

Educational Requirements - Required action

HEE Domains1, 3, 4 and 5 / GMC Theme 1, 3, 4 and 5: PR was asked to provide an action plan and timetable to detail how a future ST1/2 trainee will be managed. This will incorporate how the Curriculum needs will be met and to assure the School that the department is capable and committed to deliver the requirements for that stage of training.  Included within the plan should be details of how DJ will be supported by the Consultant team in future.

 

 

Educational Recommendations

HEE Domain 3 / GMC Theme 3: Subject to trainee agreement, a mentor to be assigned and/or a buddy system to be set up to support the trainee at RCHT..

 

3. Good Practice

Learning Environment Surgical simulation material available. Adequate space and IT facilities.
Developing and implementing curricula Wealth of subspecialty areas in the department to provide wide range of learning opportunities and cover most aspects of the curriculum.



4. Summary of discussions with groups

Trainers

WBAs: It was recognised that the department could make it clearer to trainees, which Consultants or other staff are able to sign off WBAs.  It was agreed a list could be drawn up and the information provided at the first ES meeting and/or during induction.

 

Educational Supervision / accreditation: It was agreed that ideally 2-3 Consultants in the department should be trained as ESs; it was suspected that currently David Jones (DJ) is the only Consultant to have completed all 5 of the HEE Faculty Training courses.  It was unknown how many had completed the training for CSs.  It was confirmed that Consultants have time in their job plans to act as ESs, but not CSs.  PR to brief department to ensure all signed up to being CSs.

 

ACTION: HEE to send through an updated list of trained supervisors to DJ and PR.  PR is shortly to complete the training course delivered by the Royal College for College Tutors and this is likely to count towards the agreed training requirements set by HEE in line with GMC requirements.

 

Competences: Currently DJ supervises the trainee for 6 months and during this time a suitable training list is timetabled to give the trainee a variety of sub-specialty experience.  It was acknowledged that the other 6 months of the year was more problematic in terms of having an adequate training list in place.  Mark Wolf (MW) and PR are committed to putting this in place and ensuring there are adequately trained ES and CS to support this.

 

The rota is currently based on a 4-weekly cycle meaning that theatre times change and complicates facilitation of training lists.  PR committed to resolving this as much as possible.

 

Training Environment: The trainers explained that it can be difficult for a single ST1/2 as they don’t get the peer support that they would receive in another more central training center.  In addition there is no registrar to help teach and RCHT is 2 ½ hours from the Simulation facilities at Torbay Hospital.

 

PR raised concerns that from an emotional/social perspective the training environment can be an issue for ST1/2 and as a result it could be easier to have a more experienced trainee.  However, from a School perspective, this was unlikely to change until other improvements are evident.

 

ACTION: NH suggested that, subject to trainee agreement, a mentor be assigned and/or a buddy system be set up to support the trainee at RCHT.

 

Teaching: Since the feedback received through the 2016 Quality Panel, teaching had been resumed twice a month on a Friday afternoon.  Weekly teaching was not feasible due to clinical commitments.  Regional teaching takes place every third Friday. Links to Exeter/Plymouth for teaching have been established where necessary.

 

In the last 2 months a dedicated room and work space for trainees has been reinstated.

 

It was confirmed that the whole department is committed to training however PR acknowledged that there were steps which could be taken to create a more trainee centered department. 

 

ACTION: PR was asked to provide an action plan and timetable to detail how a future ST1/2 trainee will be managed. This will incorporate how the Curriculum needs will be met and to assure the School that the department is capable and committed to deliver the requirements for that stage of training.  Included within the plan should be details of how DJ will be supported by the Consultant team in future.

 

Trainee (ST7)

The department had not been allocated an ST1/2 in 2016/17 and as a result the current ST7 trainee had requested a placement at the Trust.  Due to being a fairly independent learner at this stage in training, his experience differed from the usual ST1/2 placed at the Trust however useful feedback was gained as follows.

 

Educational supervision: The trainee had received good supervisory support from DJ.  A consultant was always available in clinic and on-call.

 

Competences: The trainee described experience of complex cases and different case mix to satisfy his training requirements. However, also felt there would be enough straightforward cases to satisfy the needs of a more junior ST1/2 trainee.  In terms of casualty experience, the training environment was considered good and comparable to Exeter and Plymouth.

 

Training Environment: The trainee described his time at RCHT as a good experience during which his needs had been well met.  Nursing support was in place.

 

Ophthalmology trainees undertake a survey within the School each year and feedback had suggested that trainees in RCHT can feel lonely and exposed, due to having no senior trainee to go to.  In addition the Trust feels fairly remote due to its geography.  There are 8 Consultants within the department but they work across 12 sites.  This means that the trainee can also feel remote from the Consultant team. The team ethos was described as being equitable with other Trusts but they don’t see each other often due to working across the 12 sites.  They do have a Governance meeting once a month and come together for teaching. Due to these reasons the trainee believes that a more senior trainee doctor may get more of the experience at RCHT.

 

Teaching: This was described as variable and the new programme had been set up since January.  A video link to teaching sessions in other Trusts had been tried but had not been deemed successful.

 

When asked if he would recommend the job, the trainee agreed that he would.

 

4. Quality Process

Once the panel Chair has shared and agreed this report with all attendees for factual accuracy, it should be sent to the relevant Quality Manager (see below).

The final report will be issued to the DME by the Quality Team, as appropriate.

 

Quality Managers:

Peninsula: Jane Bunce (jane.bunce@southwest.hee.nhs.uk)

 

The Quality Team will review and update the quality register and report to the General Medical Council (GMC), as appropriate.

 

5. DECLARATION BY CHAIR

I confirm this completed report is a true and accurate account of the level 2 visit. The key recommendations have been identified within this report in good faith.

I confirm that any significant areas of concern e.g. trainee safety or patient safety concerns have been brought to the attention of the relevant Director of Medical Education (or equivalent) and Medical Director for immediate attention.

 

Name:  Dr Martin Davis (Associate Dean for Quality)                               Date: 19th June 2017