Postgraduate School of Pathology Quality Management Visit to the Department of Histopathology at the Royal Devon and Exeter NHS Foundation Trust

 

27th June 2014

  

Postgraduate School undertaking visit: Pathology

Primary author of report (name and job title): Dr Mark Smith (Consultant Histopathologist, Derriford Hospital) (Histopathology TPD)

Local Education Provider visited: Royal Devon and Exeter NHS Foundation Trust (RDE)

Visit team (names and educational job titles)

Chair

Dr Mark Smith (Histopathology TPD, Peninsula Programme, HESW)

Administration

Ms Carla Miners (Manager, Pathology School, HESW)

Medical external

Dr Vipul Foria (Histopathology TPD, HE Wessex, Consultant Histopathologist, Southampton General Hospital)

Lay representative

Mr Bill Wylie

Programme / Specialty

No. of trainees seen

No. of trainers seen

Histopathology

One

Two

Evidence considered prior to review taking place: none

Date visit report ratified by SWPPME

7th October 2014

Date visit report made available to provider

16th October 2014

Date provider ratifies visit report

17th October 2014

Circulation of this report: PPME Quality Team, RDE Director of Medical Education, RDE Medical Education Manager

 

Executive Summary

Following the LEP visit, the Department of Histopathology at Royal Devon and Exeter Foundation Trust is considered to provide high quality histopathology teaching (histology, cytology and autopsy pathology) to its histopathology STs.  The histopathology ST who was questioned had had appropriate and detailed induction.  Exeter STs can access large quantities of very diverse pathology, much of it of a specialized nature.  All the histopathology consultants participate in teaching at local and regional levels.  They are enthusiastic about teaching and provide access to much specialist pathology expertise.  There was no report of bullying or harassing behavior.  The Department was described as a pleasant place to work.  The consultants are approachable and provide apprentice-type training for STs in which there is considerable one-to one ST/consultant contact.  The ‘registrar’ training room is large and light with windows; altogether a pleasant place to work.  The Library was described as limited but plans are in place to improve it.  Educational supervisor meetings occur regularly.  The two trainers who were interviewed both considered that the training process did not lead to patient harm or to any unsatisfactory standard of reporting.

It was acknowledged that the monthly SW regional training days were presently less good than they have previously been. Partly this was due to difficulty in identifying consultants to teach.  However, it should be noted that Exeter consultants have been exemplary within the region in stepping forward to volunteer to teach at these regional days.  Though provision of the regional training days isn’t any more an Exeter role than it is a Plymouth or Bristol One, Dr Manish Powari (RDEH) has stepped forward to join Dr Mark Smith (TPD) in trying to improve the standard of regional training day teaching.

Exeter traditionally has been more cautious than some other centres in advancing trainees in independent reporting and in participating in MDTs.   In the recommendations below they are encouraged to consider advancing these practices in an appropriately safe and staged manner.    

Dr Mark Smith

(Peninsula Histopathology TPD)

 

 

 

Key recommendations

Ref

Department / Programme / Specialty

Key recommendation(s)

1

Exeter Histopathology.

(Exeter Departmental response required by 1st December 2014)

Give consideration to more trainee participation at MDTs.  This might be started by taking the form of a trainee presenting one or several cases at the MDT and handling questions with the supervising consultant histopathologist (who will already have reviewed the case with the trainee) in attendance.

The Department is encouraged to permit trainee independent reporting appropriate to trainee stage and the department’s assessment of trainee competence (in accordance with the RCPath guideline document, which will soon be updated).

The Exeter Department (through Dr Manish Powari) to participate in reviewing the delivery of regional training which is to be led from the Peninsula side by Dr Smith (Peninsula TPD). 

 

Areas of good practice

Department / Programme / Specialty

Area(s) of good practice

Exeter Histopathology

Use of ‘black box sessions’ in making available diverse and difficult histology to trainees.

 

Exemplary participation of Exeter Histopathology Consultants in the regional training days.

 

Appropriate and useful departmental induction

 

Provision of excellent ‘apprentice-style’ training with much 1 to 1 consultant teaching of trainees.

 

 

Summary of the visit

Patient safety including handover and induction

Both trainers had no patient safety concerns.  This was especially the case since at present both trainees based at Exeter (one an ST1, the other an ST4) do not independently report, so all their reporting is supervised by a consultant.  Trainees undergo RDEH medical staff induction, though much of this is not relevant to histopathologists.  The trainee considered the local induction to be satisfactory and appropriate.  Handover is not generally applicable to Histopathology.

Department / Programme / Specialty

Area(s) of development

Exeter histopathology

None advised

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

As mentioned above, the present trainees do not report independently but are very closely supervised.  Clinically this takes the form of the supervising consultant meeting twice a day with trainees to analyse, discuss and report cases. All consultants teach and there is no problem accessing them and their areas of expertise.   Formal educational supervisor meetings take place four times a year.  Career guidance is not particularly relevant to Histopathology as it provides run-through training with a single outcome (i.e. qualifying to be a consultant histopathologist).

Department / Programme / Specialty

Area(s) of development

Exeter histopathology

None

Training environment (including access to educational resources)

The training environment is a pleasant one.  Two trainees occupy a large trainee room possessing windows.  The Trainee thought that the departmental library was limited and could be improved.   This was discussed with the training consultants who said that further books were presently being purchased.

Department / Programme / Specialty

Area(s) of development

Exeter Histopathology

None

Work load

All trainees are managing to report case numbers in excess of the RCPath minimum recommendations for cytology, histology and autopsy pathology.  They are exposed to a very wide variety of pathology.  At Exeter, trainees have relatively little experience of presenting cases at MDTs, which is a forum at which they might gain confidence in discussing cases with their clinical colleagues. 

Department / Programme

Area(s) of development

Exeter Histopathology

Give consideration to more trainee participation at MDTs.  This might be started by taking the form of a trainee presenting one or several cases at the MDT and handling questions with the supervising Consultant Histopathologist (who will already have reviewed the case with the trainee) in attendance.

Adequate experience / achievement of curriculum competencies

Work place based assessments are undertaken in the numbers required but there was a general feeling that they were of relatively little value in this speciality given that Histopathology training is essentially an apprentice style training with every-day continuing consultant assessment of trainees outside of WPBAs.

In the past at Exeter, trainees have not reported independently until they have passed the FRCPath examination.

Department / Programme / Specialty

Area(s) of development

Exeter Histopathology

The Department is encouraged to permit trainee independent Reporting appropriate to trainee stage and the Department’s assessment of trainee competence (in accordance with the RCPath guideline document, which will soon be updated).

Teaching – local, regional and study leave

The Department has recently instituted a regular weekly ‘black box’ teaching event at which trainees are exposed to and are required to comment on many interesting and sometimes difficult cases.

There was general acknowledgement that the regional teaching programme that is shared between the Peninsula and Severn programmes is presently sub-optimal.  Some of this is due to the geography of the region but, in addition, it has become increasingly difficult to identify Consultants throughout the region to teach.  This general criticism of the region does not extend to Exeter consultants who have been exemplary in their participation.  The trainee also considered that there is sometimes not enough teaching content to justify a whole training day. The trainee suggested that it might be good to have a fuller programme but at less frequent intervals (perhaps one every two months instead of monthly).  Also, delivery of the regional programme by video conferencing might be considered. 

Department / Programme / Specialty

Area(s) of development

Exeter Histopathology

The Exeter Department  (through Dr Manish Powari) to participate in reviewing the delivery of regional training which is to be led from the Peninsula side by Dr Smith (Peninsula TPD). 

Undermining, bullying and harassment

No evidence of undermining, bullying and harassment was reported

Department / Programme / Specialty

Area(s) of development

Exeter Histopathology

none

Additional comments / feedback

The Department provides a pleasant working environment for the delivery of training.  It does an excellent job in providing apprentice style training.  It provides excellent resources in the quantity and diversity of pathological material available for teaching.

Department / Programme / Specialty

Area(s) of development

Exeter histopathology

None

 

 

 

Visit Panel Chair Declaration

This completed report is a true and accurate account of the discussion that I participated in or were reported to me from this visit.

The key recommendations have been identified within this report have been identified with good faith.

I can confirm that any areas of significant concern and that have a direct impact upon patient safety has 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:

 

 

Dr Mark Smith

Chair educational role:

 

 

Peninsula Histopathology TPD

Date of signature:

 

 

 

 

 

 

 

 

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 has been reviewed and deemed appropriate for the purpose as stated.

That 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:

 

AD for Quality

Date of signature:

 

30th  October 2014