Postgraduate School of Radiology Quality Management Visit to South Devon Healthcare NHS Trust

15th May 2015

 

Primary author of report (name and job title): Dr Tom Sulkin, Head of School

Provider visited: South Devon Healthcare NHS Trust

Date(s) of visit: 15th May 2015

Visit team (names and educational job titles):

Chair

Dr Tom Sulkin, Head of School

Panel member

Dr William Mukonoweshuro, Consultant Radiologist, TPD

Panel member

Dr Pirya Suresh, Consultant Radiologist, College Tutor in Plymouth

Panel member

Dr Tony Sanderson, Consultant Radiologist, North Devon

Panel member

Panel member

Dr Mark Meller, Consultant Radiologist, College Tutor in North Devon

Mr Joseph Campbell, School Manager HESW

Programme

No. of trainees seen

No. of trainers seen

Paediatrics

7

5

Evidence considered prior to review taking place: Feedback questionnaires from some of the trainees and trainers

2014 GMC national training survey

Date visit report ratified by HESW – Peninsula

24th September 2015

Date visit report made available to provider

24th September 2015

Date provider ratifies visit report

9th October 2015

Circulation of this report: Peninsula Postgraduate Medical Education Quality Team

Director of Medical Education, SDHCT

 

Executive Summary

 

 

 

Key recommendations

1

Torbay provides excellent training in clinical radiology.

2

Some aspects of subspecialty training would benefit from review. Provision of an additional work station in MRI would improve training opportunities in all aspects of MRI. An additional US machine would improve opportunities for ‘hands on’ ultrasound training. Both should be considered in 2015 given the recent increase in the number of trainees in Torbay. 

3

Participating in a network for provision of on call radiology services would increase learning opportunities; especially in the subspecialties of radiology. This proposal should be evaluated before the start of the next academic year on 7/9/15.

Dr Tom Sulkin – Head of School


 Areas of good practice

Department/ Programme/ Specialty  Area of good practice
  The trainers are flexible in their approach to the trainees learning needs and there is a good exposure to radiology across the curriculum.
  The rotation is well organised and delivers effective training with excellent feedback from trainees
  Excellent communication between all members of staff and the trainees.
  Excellent provision of timely feedback on clinical work
  Including trainees in the Troubleshooting rota
  Provision of case archives
  Support from medical secretaries
  The enthusiasm and effectiveness of the College Tutors

 

Summary of the visit

Patient safety inc. handover and induction

The induction pack is very good. Circulating photographs of the trainees is a particularly good idea.

There are robust systems for handover at the beginning and end of on call shifts.

No patient safety issues were raised.

Department / Programme / Specialty

Area of development

 

None

 

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

Torbay offers an excellent training environment for all levels of trainee. The rotation is well organised by the two College Tutors working as a team with the medical secretaries and PACS Team.

The teaching is provided by enthusiastic clinical supervisors who check reports in a timely manner, both during the working day and out of hours. There is good experience of general acute radiology provided by the 'Troubleshooting' sessions.

There is an enthusiastic team of educational supervisors who are all appropriately trained. Educational supervision is effective and targeted against trainees’ learning needs.

There is good engagement with the requirements of the curriculum including use of the e-portfolio and WPBAs.

ES have limited feedback on Academy blocks.

The College Tutors share 1 PA in their job plan.

ES are allocated 0.25 PA in their job plan

CS have no allocation

 

Area of development:

Ensure that initial CS meetings take place before, or at the start of an attachment. 

Improve links with the Academy between Academy and Clinical blocks. 

Training environment (inc. access to educational resources

The trainees have access to reporting work stations, either in communal reporting areas or consultants’ offices.

The trainee’s timetables include protected teaching in preparation for the FRCR exams.

Nuclear Medicine and MRI are geographically remote from the rest of the department. This can act as a barrier to exposure to the practical side of training in these modalities.

There is adequate access to educational resources.

 

Area of development:

An additional workstation in MRI would be beneficial. It would facilitate ‘hands on’ training in the MRI department and would improve learning opportunities in all aspects of MRI.

Work load

There is an appropriate balance between service and training (6 training + 4 service sessions per week)

The workload on call can be light, limiting learning opportunities.

Compensatory days off after on call shifts can limit learning opportunities for some trainees. This is more of a problem for senior trainees whose focus is on subspecialty training.

Trainees are offered locums to cover gaps in the on call rota.

 

Area of development:

Review the impact of on call on learning opportunities. Networked on call should address the problem.  Trial is currently underway.

Adequate experience / achievement of curriculum competencies

The placement in Torbay offers excellent general radiology training at both core (ST1-3) and post FRCR (ST4-6) levels. Trainees undertake themed blocks based on the RCR curriculum. For core trainees, as far as is possible these are linked to the Academy Blocks and the FRCR IIa exam modules.

The trainees have the opportunity to adapt their timetable to meet their educational needs. This process is extremely flexible. Training in Torbay is supported by the medical secretaries who take responsibility for administration of the trainees’ rotations. The medical secretaries are particularly enthusiastic and supportive. As the number of trainees increases however the administration of training in Torbay is becoming increasingly complex and time consuming.

The trainees like the modular style of their training. If they take leave or attend courses during a particular block there is opportunity to make up for missed sessions.

Supervision of trainees and film checking is particularly well organized and effective.

Provision of training for ST1 trainees works well. Particular strengths are plain film reporting, 1:1 teaching and consultant supervision.

Breast training, is particularly good with good feedback from trainees and a number of requests for more of this training.  These sessions are also deemed valuable for improving ultrasound training and communication skills.

IR training is also deemed to be good although this may be threatened by the imminent retirement of one of the three IR consultants.

MSK and GI radiology are also strengths of the Torbay department.

In common with many radiology training schemes exposure to general MRI is a little limited. Also the training in paediatric radiology and nuclear medicine could be improved.

Some learning opportunities in US are limited by availability of machines. Trainees may have to ‘double up’ with consultants. This is an increasing problem as the number of trainees in Torbay increases.

 

Area of development:

The panel recommends a review of the provision of training in paediatric radiology, NM and MRI to ensure trainees are aware of any competencies they may have to acquire on placements at other training centres.

An additional US machine would improve provision of US training

Ensure the medical secretaries have sufficient resource to continue providing their excellent support framework.

Teaching – local, regional and study leave

Trainees rotate between the Radiology Academy in Plymouth and the clinical department in Torbay during the course of the year.

All trainees have free access to study leave.

There are good case archives available for trainees to work through.

Limited exposure to aspects of radiology department management.

 

Area of development:

Consider establishing some management/teaching sessions for post FRCR trainees (either in Torbay or at the Academy) and also consider inviting them to the routine consultants meeting.

 

   

Bullying and harassment

None reported or observed

Additional comments / feedback

There is a standing agenda item at the departmental consultants meeting to discuss all trainees and grade them on a 3 point system, where;

1 = Improvement required

2 = Performing satisfactorily

3 = Good performance

The results of this are then fed back to the individual trainees by their educational supervisors with appropriate advice and guidance where required.

Comments from the panel

Overall there is a very good feel about the department in this trust with the consultants and trainees working equally hard, to ensure the trainees get the best possible training available to them.  This is aided by the enforced structured nature of the way training is planned and appears to be appreciated by all the trainees.’

In summary - very good and would definitely pass my 'Family and Friends' test.

 

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:

Dr Tom Sulkin

Chair educational role:

Head of School, SW Peninsula Post-Graduate School of Paediatrics

Date of signature:

30/06/2015 

 

 

 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:

 

PPME educational role:

 

 

Date of signature: