Postgraduate School of Obstetrics and Gynaecology Quality Management Visit to Royal Devon and Exeter NHS Foundation Trust
9th May 2014
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Postgraduate School undertaking visit: Obstetrics and Gynaecology (O&G) |
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Primary author of report (name and job title): Subramanian Narayanan, Training Programme Director |
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Provider visited: Royal Devon and Exeter NHS Foundation Trust |
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Visit team (names and educational job titles) |
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Chair |
Mr Subramanian Narayanan |
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Panel member 1 |
Mr Ross Welch |
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Panel member 1 |
Miss Susie Bates |
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Lay representative |
Angela French |
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Programme |
No. of trainees seen |
No. of trainers seen |
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Obstetrics and Gynaecology |
6 |
2 |
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Evidence considered prior to review taking place: 2013 GMC NTS |
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Date visit report ratified by HESW – Peninsula |
17.08.14 |
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Date visit report made available to provider |
18.08.14 |
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Date provider ratifies visit report |
01.09.14 |
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Circulation of this report: PPME Quality Team, LEP Director of Medical Education, Head of School for O&G |
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Executive Summary
The panel met with 6 trainees: 2 at ST1-2 level, 2 at ST3-5 level and 2 at ST 6 level. The others were either on call or off after nights or on leave. We also met with 2 trainers, one of whom was also the College Tutor. The department was universally perceived to be very friendly and had a very good training environment. The senior trainees had some difficulty accessing training at the appropriate level due to competing non-training grade doctors. But overall it was a good place to work and every trainee would recommend this department to a colleague.
Key recommendations |
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1 |
Ensure provision of ultrasound training. |
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2 |
Facilitate ATSM training within weekly timetable to ensure that trainees do not need to take study leave to complete an essential requirement |
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3 |
Provision of bleep free local teaching to be prioritised. |
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4 |
Consider increasing the number of antenatal clinics in order to reduce pressure,
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5 |
Formalise Handover in Gynaecology at the end of shifts to enhance patient safety |
Mr Subramanian Narayanan
Areas of good practice
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Department / Programme / Specialty |
Area of good practice |
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Good Clinical Supervision and one to one teaching |
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Senior input easily available |
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Excellent multidisciplinary Obstetric Handover |
Summary of the visit
Patient safety inc. handover and induction |
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A multidisciplinary handover takes place for Obstetrics at 0800 hours and 2000 hour and is considered by the panel as an area of good practice. Handover in Gynaecology was less formal and trainees verbally handed over patients that they felt needed review rather than all the patients. All trainees had received a departmental induction and felt that it was adequate. |
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Department / Programme / Specialty |
Area of development |
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Obstetrics and Gynaecology |
Formalise Gynaecology Handover |
Supervision – clinical and educational (inc. career guidance, feedback) |
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Excellent one to one Clinical supervision. All trainees could access their supervisors when required and felt that they received easily accessible and excellent one to one supervision. Trainees regularly meet with their Educational Supervisors, although these meetings are not always conducted in a formal manner. Trainers aware of where to signpost trainees for guidance. |
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Department / Programme / Specialty |
Area of development |
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Obstetrics and Gynaecology |
Trainees to be more pro-active in seeking formal ES meetings. |
Training environment (inc. access to educational resources |
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Trainees very happy in general. The ultrasonographers seem to be under pressure to deliver service requirements and hence feel under even more pressure to deliver training. This has impacted on the trainees not being able to access ultrasound training. |
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Department / Programme / Specialty |
Area of development |
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Obstetrics and Gynaecology |
Formal provision of Ultrasound training. Efforts to be made to facilitate training provision for trainees doing ATSM within the day to day timetable. Reducing the ultrasound clinic numbers by one and then funding as additional clinic could provide adequate buffering to provide training. |
Work load |
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Trainees report their responsibilities are appropriate for their level of training. However the senior trainees did express some concern that they did not get adequate training opportunity because of the post CCT fellows in theatre. Concern expressed by senior trainees about lack of theatre opportunity because of Post CCT Fellows. |
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Department / Programme / Specialty |
Area of development |
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Obstetrics and Gynaecology |
Consideration should be given to allow senior trainees to be able to do theatre lists with remote supervision. |
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Department / Programme / Specialty |
Area of development |
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Obstetrics and Gynaecology |
Resolve conflict between providing training opportunity for trainees and providing career enhancing opportunity for post CCT fellows. |
Adequate experience / achievement of curriculum competencies |
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Core trainees felt that the posts offered very good training opportunities. . Advanced trainees report difficulty accessing ATSM training sessions. The barriers are service pressures and the trainees therefore need to take study leave to be able to access training opportunity |
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Department / Programme / Specialty |
Area of development |
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Obstetrics and Gynaecology |
Priority to be given to senior trainees able to access ATSM training opportunities within weekly timetable |
Teaching – local, regional and study leave |
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Excellent one to one teaching and protected SHO teaching. No consultant led teaching for registrars. No difficulty in getting time off for regional teaching. |
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Department / Programme / Specialty |
Area of development |
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Obstetrics and Gynaecology |
Organise protected local teaching for all trainees |
Bullying and harassment |
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Trainees reported no incidences of bullying or harassment. |
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Department / Programme / Specialty |
Area of development |
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Obstetrics and Gynaecology |
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Additional comments / feedback |
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Trainees considered the department as a really good place to work. All trainees were very happy and would recommend the post to a colleague. The trainers were described as all very approachable and supportive. Overall the panel considered the department to be very well-adjusted, , provides very good training opportunities and all the consultants, and in particular tutor, to be commended on this. Trainees too are taking their responsibility seriously and amenable to constructive feedback. |
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Department / Programme / Specialty |
Area of development |
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Obstetrics and Gynaecology |
To organise Ultrasound training better i.e. formalise arrangements and ensure delivery of ATSM training within day to day activity. |
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.
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Chair name: |
Subramanian Narayanan [signature removed for website] |
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Chair educational role: |
TPD |
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Date of signature: |
09/05/2014 |
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.
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Name: |
Dr Martin Davis |
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HESWPPME educational role: |
Associate Dean for Quality |
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Date of signature: |
3rd September 2014 |