Postgraduate School of Obstetrics and Gynaecology Quality Management Visit to Royal Devon and Exeter NHS Foundation Trust

9th May 2014

 

 

Postgraduate School undertaking visit: Obstetrics and Gynaecology (O&G)

Primary author of report (name and job title): Subramanian Narayanan, Training Programme Director

Provider visited: Royal  Devon and Exeter NHS Foundation Trust

Visit team (names and educational job titles)

Chair

Mr Subramanian Narayanan

Panel member 1

Mr Ross Welch

Panel member 1

Miss Susie Bates 

Lay representative

Angela French

Programme

No. of trainees seen

No. of trainers seen

Obstetrics and Gynaecology

6

2

Evidence considered prior to review taking place: 2013 GMC NTS

Date visit report ratified by HESW – Peninsula

17.08.14

Date visit report made available to provider

18.08.14

Date provider ratifies visit report

01.09.14

Circulation of this report: PPME Quality Team, LEP Director of Medical Education, Head of School for O&G

 

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

1

Ensure provision of ultrasound training.

2

Facilitate ATSM training within weekly timetable to ensure that  trainees do not need to take study leave to complete an essential requirement

3

Provision of bleep free local teaching to be prioritised.

4

Consider increasing  the  number of antenatal clinics in order to reduce pressure,

 

5

Formalise Handover in Gynaecology at the end of shifts to enhance patient safety

 

Mr Subramanian Narayanan


  

Areas of good practice

Department / Programme / Specialty

Area of good practice

 

Good Clinical Supervision and one to one teaching

 

Senior input easily available

 

Excellent  multidisciplinary Obstetric Handover

  

Summary of the visit

Patient safety inc. handover and induction

 

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.

Department / Programme / Specialty

Area of development

Obstetrics and Gynaecology

Formalise Gynaecology Handover

Supervision – clinical and educational (inc. career guidance, feedback)

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.

Department / Programme / Specialty

Area of development

Obstetrics and Gynaecology

Trainees to be more pro-active in seeking formal ES meetings.

Training environment (inc. access to educational resources

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.

Department / Programme / Specialty

Area of development

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

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.

Department / Programme / Specialty

Area of development

Obstetrics and Gynaecology

Consideration should be given to allow senior trainees to be able to do theatre lists with remote supervision.

Department / Programme / Specialty

Area of development

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

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

Department / Programme / Specialty

Area of development

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

Excellent one to one teaching and protected SHO teaching. No consultant led teaching for registrars. No difficulty in getting time off for regional teaching.

Department / Programme / Specialty

Area of development

Obstetrics and Gynaecology

Organise protected local teaching for all trainees

Bullying and harassment

Trainees reported no incidences of bullying or harassment.

Department / Programme / Specialty

Area of development

Obstetrics and Gynaecology

 

Additional comments / feedback

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.

Department / Programme / Specialty

Area of development

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.

Chair name:

Subramanian Narayanan             [signature removed for website]

Chair educational role:

TPD

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.

Name:

 

Dr Martin Davis

HESWPPME educational role:

 

Associate Dean for Quality

Date of signature:

 

3rd September 2014