Judy Wakeling

Factors influencing the effectiveness of multisource feedback in improving the professional practice of medical doctors: a systematic review

BackgroundMultisource feedback (MSF) is currently being introduced in the UK as part of a cycle of performance review for doctors. However, although it is suggested that the provision of feedback can lead to a positive change in performance and learning for medical professionals, the evidence supporting these assumptions is unclear. The aim of this review, therefore, was to identify the key factors that influence the effectiveness of multisource feedback in improving the professional practice of medical doctors.MethodRelevant electronic bibliographic databases were searched for studies that aimed to assess the impact of MSF on professional practice. Two reviewers independently selected and quality assessed the studies and abstracted data regarding study design, setting, MSF instrument, behaviour changes identified and influencing factors using a standard data extraction form.ResultsA total of 16 studies met the inclusion criteria and quality assessment criteria. While seven studies reported only a general change in professional practice, a further seven studies identified specific changes in behaviour. The main professional behaviours that were found to be influenced by the feedback were communication, both with colleagues and patients and an improvement in clinical competence/skills. The main factors found to influence the acceptance and use of MSF were the format of the feedback, specifically in terms of whether it was facilitated, or if narrative comments were included in the review, and if the feedback was from sources that the physician believed to be knowledgeable and credible.ConclusionsWhile there is limited evidence suggesting that MSF can influence professional performance, the quality of this evidence is variable. Further research is necessary to establish how this type of feedback actually influences behaviours and what factors have greatest influence.

Asking the right questions and getting meaningful responses: 12 tips on developing and administering a questionnaire survey for healthcare professionals

Questionnaires provide a useful and versatile tool for new and occasional researchers, and can be applied to a wide range of topics. This paper provides simple guidance on some of the potential pitfalls in developing and running a questionnaire study, and how to avoid them. Each tip is illustrated with a real-life example from the development of a UK-wide questionnaire survey of trainee doctors and their educational supervisors.

Enhancing the Effectiveness of Significant Event Analysis: Exploring Personal Impact and Applying Systems Thinking in Primary Care

Introduction: Significant event analysis (SEA) is well established in many primary care settings but can be poorly implemented. Reasons include the emotional impact on clinicians and limited knowledge of systems thinking in establishing why events happen and formulating improvements. To enhance SEA effectiveness, we developed and tested “guiding tools” based on human factors principles. Methods: Mixed-methods development of guiding tools (Personal Booklet—to help with emotional demands and apply a human factors analysis at the individual level; Desk Pad—to guide a team-based systems analysis; and a written Report Format) by a multiprofessional “expert” group and testing with Scottish primary care practitioners who submitted completed enhanced SEA reports. Evaluation data were collected through questionnaire, telephone interviews, and thematic analysis of SEA reports. Results: Overall, 149/240 care practitioners tested the guiding tools and submitted completed SEA reports (62.1%). Reported understanding of how to undertake SEA improved postintervention (P < .001), while most agreed that the Personal Booklet was practical (88/123, 71.5%) and relevant to dealing with related emotions (93/123, 75.6%). The Desk Pad tool helped focus the SEA on systems issues (85/123, 69.1%), while most found the Report Format clear (94/123, 76.4%) and would recommend it (88/123, 71.5%). Most SEA reports adopted a systems approach to analyses (125/149, 83.9%), care improvement (74/149, 49.7), or planned actions (42/149, 28.2%). Discussion: Applying human factors principles to SEA potentially enables care teams to gain a systems-based understanding of why things go wrong, which may help with related emotional demands and with more effective learning and improvement.

Is Foundation training producing competent doctors? What do Foundation trainees, educational supervisors and nurses in Scotland have to say?

The aim of this paper is to examine perceptions of Foundation Year trainees, consultants and senior nurses about the introduction of the Foundation Programme. Specifically, to examine whether Foundation trainees acquire appropriate skills, experience and responsibility. Semi-structured interviews were conducted with 23 F1 doctors, 22 F2 doctors, 23 consultants and 25 nurses from across Scotland in a broad range of specialties. In the summer of 2007 trainees, consultants and nurses broadly agreed that Foundation offers good experience but some issues were highlighted. Certain specialties were seen as offering insufficiently generic experience and consultants, in particular, were concerned that four-month rotations are too short. Frequent moving around for trainees was seen as detrimental for seeing cases through and continuity of care was now perceived to be provided by nurses and consultants rather than junior doctors. Levels of responsibility could vary widely from post to post and tended to be specialty-dependent. As a result, some F2s reported frustration that they were not given sufficient responsibility for their stage of training. Nights were recognized as a valuable learning opportunity and most trainees were supportive of night work being made available in F1 and F2. In conclusion, in order to maximize the possibilities of the Foundation years and ensure that trainees can meet the required Foundation competencies, specialties that offer narrow experience need to be matched with ‘busy’ specialties that can offer broader experience. Night work should be retained, but perhaps not introduced right at the start of F1. Trainees feeling that they are being given insufficient experience, particularly in the F2 year, need to be proactive in addressing this if possible. There is a perception among some consultants and nurses that a process of ‘delayed skilling’ is taking place, attributable more to reduced hours than Foundation per se. There is a need to follow trainees through to specialty training to ascertain if Foundation has adequately prepared them for run-through training.

A review of further training for GP appraisers in Scotland.

A one-day further intensive skills (FIS) course has been developed to provide additional training for existing general practitioner (GP) appraisers in Scotland. The course focuses on skills in developing the appraisees personal development portfolio (PDP) and skills in responding to significant issues (with emotional content) presented by appraisees - both key areas for effective appraisals. The course is briefly described. An initial pilot of the course led to some changes being made to the content, as it was discovered that the inclusion of training on Summary Form completion in the pilot made the course too dense and distracted from the experiential elements of the training. Two subsequent course deliveries were evaluated by conducting semi-structured interviews with over 40% of the participants from these two courses. The main purpose of the evaluation was to discover to what extent the participants felt they had benefited from the training and whether they felt the training had led to any changes in their practice as appraisers. Secondary aims were to discover the acceptability of the use of video recording as a training technique and views regarding a reaccreditation process for appraisers. Key findings were that almost all participants found this training beneficial and judged it to have led to positive changes in their practice, as well as reassuring them that their skills were up to scratch. Some appraisers felt that it had encouraged a slightly more challenging approach. The acceptability of the use of video recording during the training, as a means of allowing participants to gain further benefit from the work undertaken after the course was finished, was tested. This technique received a mixed response, with opinion divided as to whether it added value. Opinion amongst the participants was also mixed regarding whether this training should contribute towards their reaccreditation as appraisers. However, a number of participants felt this could be a valid element in an appraiser reaccreditation process.

What Factors Impact on General Practitioners’ Engagement with Appraisal? A Qualitative Evaluation In Scotland

Although appraisal has gained acceptance as a supportive and developmental process, it has been proposed that it should become an explicitly summative element of revalidation. This study aimed to explore the views of general practitioners (GPs) in Scotland about appraisal in the light of the proposed changes. The method used semi-structured interviews with a sample of 18 GPs who have undergone appraisal at practices throughout Scotland. The interviews were transcribed in full and a thematic analysis conducted. The study showed that the majority of interviewees derive some benefit from appraisal – mostly in planning learning needs and through the support provided by a confidential discussion with Education for Primary Care (2008) 19: 615–23 # 2008 Radcliffe Publishing Limited

An enhanced induction programme for general practice specialty training: a qualitative study of trainee perceptions and experience

Abstract Background: Following a Judicial review brought by the British Association of Physicians of Indian Origin, greater expectation is now being placed upon Health Education England Local Offices and Deaneries across Scotland, Wales and Northern Ireland to identify doctors who may go on to experience difficulties in general practice specialty training – and who may benefit from educational support at an early stage. NHS Education for Scotland West region has offered an enhanced induction programme for trainees who were identified as being at risk of difficulty in training. Aims: To capture the experience of an enhanced induction programme; exploring insight towards potential difficulties in training; and the feelings relating to being identified as a trainee at risk of difficulty. Method: Interviews with trainees who attended the enhanced induction programme. Transcripts were analysed by a basic thematic analysis approach. Results: All non-UK Doctors completed 17 interviews. The term ‘at risk’ was accepted and the intervention was well received. Participants showed insight into the common areas of difficulty in trainees. The workshops helped to develop understanding of cultural differences, use of the ePortfolio, and gave participants an opportunity to practice their communication skills. Conclusions: This enhanced induction programme has provided targeted training to a group of trainees identified at risk of difficulty.

A one-year practice-based learning programme for new general practice nurses in Scotland: evaluation of the pilot.

Abstract This paper summarises the evaluation of a pilot programme introduced by NHS Education for Scotland to provide education and skills training for nurses new to general practice. The programme was developed through extensive consultation with existing general practice nurses and was educationally accredited by the Royal College of General Practitioners and the Royal College of Nursing in 2013. Twelve nurses embarked upon the programme 2012–2013 and nine completed it. The programme was extensively evaluated through questionnaires (with supervisors, practice staff and participants), analysis of programme documentation and interviews with participants. Based on the evaluation feedback, alterations have been made to subsequent deliveries of the programme. These include removing some topic areas and lengthening the programme by three months. The programme continues to be successfully delivered and evaluation is ongoing to ensure it continues to meet nurses’ needs.

General practice training in Scotland: the views of GP trainers and educators.

What is already known in this area At present, training does not equip all GPs to be confident independent practitioners. Fewer medical students and newly qualified doctors envisage a career in general practice. There is much discussion about lengthening GP training and situating it more in general practice. Extended GP training pilots have been well received. What this Study adds GP trainers and educators in Scotland considered that training had changed in recent years with more workload related to assessment. There is a consensus that training should be longer and based in general practices. Trainees should have time to experience different types of general practice and to gain further and wider skills and knowledge. GPs have diverse careers, and training and career advice needs to recognise this. Suggestions for future work or research Longitudinal and qualitative studies of extended training programmes would evaluate the recommendations suggested by this study. It would be useful to evaluate programmes where trainees spent the majority of their time in general practice, and those where trainees were placed in contrasting practices.