Andrew Long

Peer mentoring: evaluation of a novel programme in paediatrics

Background Mentoring is important for personal and professional development of doctors. Peer mentoring is a core skill in the UK paediatric postgraduate curriculum. However, there is a paucity of peer mentoring programmes aimed at postgraduate doctors in training (postgraduate trainees), and there are no such schemes within paediatrics described in the literature. We developed a regional peer mentoring programme for postgraduate trainees in paediatrics to assess demand and need for peer mentoring and to explore the benefits for both peer mentees and mentors. Programme design Junior postgraduate trainees, randomly selected from volunteers, received peer mentoring from more senior trainees for 1 year. Peer mentors were selected by competitive application and undertook tailored training followed by an experiential learning programme. The programme was evaluated using structured questionnaires. Results 90% (76/84) of first-year postgraduate trainees in paediatrics applied to participate, demonstrating high demand. 18 peer mentor–mentee pairs were matched. Peer mentors and mentees reported high satisfaction rates, acquisition of new and transferable skills and changed behaviours. All peer mentors intended to use the skills in their workplace and, later, as an educational supervisor. Conclusions Our programme represents a novel approach to meeting the demonstrated demand and the curriculum requirement for peer mentoring, and enabled peer mentors and mentees to develop a valuable and versatile skill set. To our knowledge, it is the first such programme in paediatrics and provides a feasibility model that may be adapted locally to allow education providers to offer this important experience to postgraduate trainees.

Trainees in difficulty

There are many reasons why the term “trainee in difficulty”, or perhaps even worse “problem doctor”, strikes fear into the hearts of consultant trainers. It may be because of issues around patient safety or how to manage the on-call rota, but Richard Smith, former Editor of the British Medical Journal , would have us believe that, at least in part, it is because all doctors are “problem doctors”, or at least have the potential to become so.1 In September 2005, the Medical Defence Union (MDU) and the National Patient Safety Agency (NPSA) produced a document entitled “Medical error” in which 14 distinguished senior doctors admitted to making significant clinical errors in an attempt to encourage openness as part of organisational risk management.2 In his foreword,3 the Chief Medical Officer promotes the “new (Foundation) curriculum” for Modernising Medical Careers (MMC) as an opportunity for doctors in training to learn from their mistakes which mostly happen “because systems are not working as they should” rather than because doctors are careless. This view is supported by Wu and colleagues,4 whose anonymous survey of junior doctors identified a large number of errors, many of which were attributable to inexperience and lack of supervision as well as trainee exhaustion. On re-publication in 2003, the accompanying commentary5 suggested that new methods of working and changes in organisational culture were needed rather than the NHS “blame culture” which often led to individuals being inappropriately sacrificed as the organisational scapegoat. However, it is rarely a single error of judgement that identifies a doctor who is “failing”. In the National Clinical Assessment Service (NCAS) review of the first 50 cases referred to their service,6 over half had a history of concerns stretching back more than 2 years before referral. It is sadly often …

Child health in low-resource settings: pathways through UK paediatric training

UK doctors training in paediatrics benefit from experience of child health in low-resource settings. Institutions in low-resource settings reciprocally benefit from hosting UK trainees. A wide variety of opportunities exist for trainees working in low-resource settings including clinical work, research and the development of transferable skills in management, education and training. This article explores a range of pathways for UK trainees to develop experience in low-resource settings. It is important for trainees to start planning a robust rationale early for global child health activities via established pathways, in the interests of their own professional development as well as UK service provision. In the future, run-through paediatric training may include core elements of global child health, as well as designated ‘tracks’ for those wishing to develop their career in global child health further. Hands-on experience in low-resource settings is a critical component of these training initiatives.

Whither mentoring in training

In Homers poem The Odyssey , ‘Mentor’ was a trusted friend of Odysseus who was charged with caring for his son, Telemachus, when Odysseus departed for the Trojan War. In this role, he served as role model, encourager, counsellor, teacher, guardian, protector and ‘kindly parent’. He was a ‘trusted adviser’, and shared wisdom, challenged and promoted Telemachus’ career and actively engaged him in a deep, personal relationship. In their article, Mellon and Murdoch-Eaton1 draw parallels between the educational supervisor role, which has been brought into sharp focus by new General Medical Council (GMC) Standards,2 and the process of mentorship for doctors in training. Their article highlights the challenges of newer models of training with shorter training in reduced hours, lack of an apprenticeship model and loss of a traditional ‘firm structure’ with opportunities for extended informal observation. They address the potential confusion in nomenclature between ‘clinical’ and ‘educational’ supervision and the responsibility for goal setting and ‘competence-based assessment’. They acknowledge that useful feedback may be compromised by a broad curriculum requirement and greater content expertise. However, the professional development of trainees is dependent on effective educational supervision, and trainees’ value less task-focused supervision and more time available for informal feedback from a trusted, experienced colleague. Much has been written about the importance of good role modelling—appropriate intervention and a supportive learning environment to facilitate a safe environment for patient care and security for doctors in training. It is, therefore, timely that this paper focuses on the development …

How can general paediatric training be optimised in highly specialised tertiary settings? Twelve tips from an interview-based study of trainees

Objectives Both general and subspecialty paediatric trainees undertake attachments in highly specialised tertiary hospitals. Trainee feedback suggests that mismatches in expectations between trainees and supervisors and a perceived lack of educational opportunities may lead to trainee dissatisfaction in such settings. With the ‘Shape of Training’ review (reshaping postgraduate training in the UK to focus on more general themes), this issue is likely to become more apparent. We wished to explore the factors that contribute to a positive educational environment and training experience and identify how this may be improved in highly specialised settings. Methods General paediatric trainees working at all levels in subspecialty teams at a tertiary hospital were recruited (n=12). Semistructured interviews were undertaken to explore the strengths and weaknesses of training in such a setting and how this could be optimised. Appreciative inquiry methodology was used to identify areas of perceived best practice and consider how these could be promoted and disseminated. Results Twelve best practice themes were identified: (1) managing expectations by acknowledging the challenges; (2) educational contracting to identify learning needs and opportunities; (3) creative educational supervision; (4) centralised teaching events; (5) signposting learning opportunities; (6) curriculum-mapped pan-hospital teaching programmes; (7) local faculty groups with trainee representation; (8) interprofessional learning; (9) pastoral support systems; (10) crossover weeks to increase clinical exposure; (11) adequate clinical supervision; and (12) rota design to include teaching and clinic time. Conclusions Tertiary settings have strengths, as well as challenges, for general paediatric training. Twelve trainee-generated tips have been identified to capitalise on the educational potential within these settings. Trainee feedback is essential to diagnose and improve educational environments and appreciative inquiry is a useful tool for this purpose.

E2.1 Using appreciative inquiry to explore the factors which contribute to a positive educational environment in a tertiary paediatric setting

Background In the UK both general and subspeciality paediatric trainees undertake attachments in highly-specialised tertiary hospitals. The cases, investigations and procedures here may be unfamiliar to the general trainee. This may lead to trainee dissatisfaction, mismatched trainee-trainer expectations and a perceived lack of educational opportunities. With the “Shape of training” review (reshaping postgraduate training in the UK to focus on more general themes) this issue may become more prominent. We wanted to explore the factors that contribute to a positive educational environment and training experience and how this could be improved in our tertiary setting. Methods GMC and London school of paediatrics survey data was examined to find areas of practice where our organisation received less-than optimal scores. These areas were then explored using observational work and semi-structured interviews with trainees. Appreciative inquiry methodology (Cooperrider 1990) was used to identify areas of perceived best practice and consider how these could be promoted and disseminated to build on the potential of the organisation (4D Model: Discover, Dream, Design, Deploy). Results Twelve best-practice themes were identified (1) Manage expectations by acknowledging the challenges (2) Educational contracting to identify learning needs and opportunities (3) Creative educational supervision (4) Centralised teaching events (5) Signpost learning opportunities including non-clinical (6) Curriculum mapped pan-hospital teaching programmes (7) Local faculty groups with trainee representation (8) Inter-professional learning (9) Pastoral support systems (10) Cross-over weeks to increase clinical exposure (11) Adequate clinical supervision (12) Rota design to include teaching and clinic time. Conclusions Through appreciative inquiry, trainees identified methods of best practice which have the potential to enhance their educational environment and training experience. These included trainee, trainer and organisational factors.

G264 Mentoring for Paediatricians – need and support for a National Framework

Aims Mentoring has been shown to be important for personal and professional development of doctors. This study aimed to assess the current awareness of and demand for mentoring amongst paediatricians in the UK. This will enable appropriate development and targeting of resources and support, in addition to assisting paediatricians in training to meet curriculum requirements in this area. Methods A survey was circulated via institutional communication tools to all members and fellows of the RCPCH, seeking views on interest in, and provision and experience of, mentoring and related activities. The responses were analysed and results used to develop recommendations and strategies to improve RCPCH support of mentoring in the UK. Results 312 paediatricians responded. Findings showed that the majority of respondents are “mentoring naive” in a formal sense but reported some informal experience of delivering mentoring (19% formally, 44% informally). There is a perception that existing local support for formal mentoring is limited, and exists either via mentoring schemes or training courses (33% aware of a local scheme, 69% perceived local provision to be inadequate). RCPCH support for mentoring is welcomed by trainees, SAS doctors and consultants (71–79% supported RCPCH provision of support; 32–45% supported signposting to non-RCPCH provision). In addition, there is pan-region support for increasing emphasis on and availability of mentoring schemes and resources (high interest (68%) in attending RCPCH blended mentoring courses). There is interest in both hierarchical and peer-to-peer mentoring relationships. Concerningly, there is poor knowledge about trainee mentoring curriculum requirements (only 16% aware) across all grades. Conclusion There is limited experience of formal mentoring, and poor awareness of mentoring-related curriculum requirements amongst paediatricians in the UK. RCPCH support of mentoring activities is welcomed by all grades of paediatricians. This data will be used to inform development of future resources and support, including specific standards to support delivery of effective mentoring schemes. Future possibilities include development of a RCPCH-led mentoring scheme (with the potential for training courses and an accredited mentor register) in addition to increasing awareness of mentoring related curriculum requirements for all grades of paediatricians.

G05 A Paediatric Peer Mentoring Programme Offers Significant Benefits to Both Junior and Senior Trainees

Aim Mentoring has been identified as an important process in personal and professional development for doctors. Peer Mentoring is a core skill specified within the RCPCH curriculum. We developed, implemented and evaluated a Programme for provision of Peer Mentoring within our School of Paediatrics. Methods 18 junior trainees received individual Peer Mentoring from a specifically trained senior trainee over a one year period. 18 Peer Mentees were randomly selected from volunteers recruited at the regional ST1 Induction. 18 Peer Mentors of ST5 level upwards were recruited and selected by anonymised competitive application. Peer Mentors undertook a tailored programme of training, with defined learning objectives, mapped against established standards. This was subsequently reinforced by experiential learning which included regular meetings with the Peer Mentee, completion of a reflective portfolio and attendance at facilitated Action Learning Sets. Results 90% of ST1 trainees expressed interest in participating in the Programme. We recruited to capacity and 16/18 pairs successfully completed the Programme. Satisfaction was high: 100% of Peer Mentors and 82% of mentees enjoyed the experience of participating in the Programme. 100% of Peer Mentors and 94% of mentees felt the Programme to be useful. Subjects discussed in sessions were predominantly work-related; professional development and accessing learning opportunities were discussed by 94% of pairs, followed by work-life balance and performance issues (both 82%). Both Peer Mentors and Mentees reported acquisition of a wide range of skills useful for a range of applications. 94% of Peer Mentors wished to continue in this role and all intended to use the skills in their workplace and, later, as an Educational Supervisor. 77% of Peer Mentees reported greater proactivity in seeking new learning opportunities and improved decision-making skills. Improved stress management was also mentioned. 75% reported enhanced ability to deal with new situations and 88% reported improved self-confidence. 76% reported a positive change in their overall outlook and approach to their professional lives. Conclusion Our successful Programme represents a novel and sustainable approach to meeting both the demonstrated demand and the RCPCH curriculum requirement for Peer Mentoring. Both Peer mentors and mentees developed versatile and sustainable skills for the future.