Steven Agius

A solid grounding: prescribing skills training

Prescribing is an error‐prone process for all doctors, from those who are newly qualified through to those at consultant level. Newly qualified doctors write the majority of in–patient prescriptions and therefore represent an opportunity for safety improvement. Attention to prescribing as a patient‐safety issue and potential educational interventions to help improve the situation have been published, but offer little to inform educators why and how any interventions may succeed. In order to identify areas of good practice, and to provide evidence of areas requiring further investigation and innovation, we aimed to ascertain the full range of prescribing practices for final‐year medical students and newly qualified doctors across a large geopolitical region of the UK.

Clinical teaching: widening the definition

In all medical specialities, trainees are increasingly encouraged to develop teaching skills alongside their clinical professional development. However, there have been few empirical UK‐based studies that have examined trainees’ attitudes and understanding of their own engagement with educational activities. This study therefore aimed to explore this in the context of general practitioner (GP) training using a qualitative approach.

Managing change in postgraduate medical education: still unfreezing?

Background: Modernizing Medical Careers (MMC) is an ambitious project to change the training of UK doctors. A key to its successful implementation is the ways that MMC is perceived and operationalized by senior doctors who act as local educational leaders and supervisors. Aims: To analyse hospital consultants’ perceptions of the modernization process and its impact on their role as the primary educators of Senior House Officers (SHOs), using Scheins extended model to explain their stage in the process of change. Methods: We interviewed medical directors, College and clinical tutors and education supervisors at 6 Trusts. The transcripts were analysed using Scheins change model to explore the perceptions and assumptions of senior medical staff and to determine their stage in the process of change. Results: 12 tutors, 12 supervisors, and 4/6 medical directors approached agreed to participate (28/30). Nine themes emerged from transcript analysis. These were related to the three-stage model of change. Most participants were at the stage of ‘unfreezing’, expressing views around disconfirmation of expectations, guilt and anxiety and feelings of some psychological safety. A smaller number were at the stage of ‘moving to a new position’. There were limited examples of ‘refreezing’. Conclusions: At the local delivery level, most senior doctors were aware of the need to review their current position and alter their approaches and assumptions about postgraduate medical education. Yet only a minority were moving forward. Considerable work remains for successful implementation of MMC.

Value of supervised learning events in predicting doctors in difficulty.

In the UK, supervised learning events (SLE) replaced traditional workplace‐based assessments for foundation‐year trainees in 2012. A key element of SLEs was to incorporate trainee reflection and assessor feedback in order to drive learning and identify training issues early. Few studies, however, have investigated the value of SLEs in predicting doctors in difficulty. This study aimed to identify principles that would inform understanding about how and why SLEs work or not in identifying doctors in difficulty (DiD).

Educator appraisal—occurrence and experience of hospital consultants in North-West England

Background: It is recommended all hospital consultants with educational responsibilities undergo appraisal of their educational role by their employer: a key component of revalidation. To support this process locally, the North Western Deanery developed guidance on educational appraisal. We wished to establish the frequency and perceived value of educator appraisal. Methods: A web-based questionnaire of 605 hospital consultants with educational responsibilities in North-Western England was conducted to collect data. Results: Only 17.7% had been appraised for their educational responsibilities in the previous 36 months despite 92.7% undergoing appraisal of clinical work. Educational leads were statistically more likely to have had educational appraisal than Educational supervisors (ES), similarly ES were more likely to have had appraisal than Clinical supervisors (CS). Clinical specialty does not appear to be a major determining factor. The majority found the supporting documentation helpful in guiding data collection and subsequent recording of evidence. All respondents felt appraisals were conducted in a supportive manner with 76.6% stating appraisal had reassured them they were fulfilling their educational roles and helped 78.5% to identify an education personal development plan. Conclusions: The incidence of educator appraisal remains low but the experience is considered valuable and contributes effectively to educators’ professional development.

Supporting dental registrants in difficulty.

Over the past few years there has been a significant increase in the number of dentists and dental care professionals (registrants) having conditions placed on their practice either by the General Dental Council or NHS area teams. There are a number of reasons for this including the fact that patients complain more often, colleagues are now expected to alert the authorities if poor practice is detected and the demographics of the dental profession in the UK are changing. Steps have already been taken to prevent dentists getting into difficulty, such as the development of requirements for continued professional development by the GDC and past initiatives at a local level set up to assist dentist in difficulty. The regional offices of Health Education England and equivalent organisations in Wales and Scotland assist registrants in difficulty in meeting these conditions. Little published research has been carried out into this important service which has had to develop rapidly over the past few years. There is a need to investigate the current service, the views of those dental professionals being assisted and those providing the support to inform the further development of the service. This paper provides an introduction to a planned series of research papers reporting on our investigation into the service provided by HEE teams.

What do GP educators perceive to be the opportunities and challenges of introducing revalidation

The Chief Medical Officer’s (CMO’s) paper on the future of medical regulation, Trust, Assurance and Safety, set out the need for a process to revalidate the competence of practising UK doctors. The UK has in excess of 41 000 general practitioners (GPs), therefore the prospect of revalidation presents considerable logistical problems. It raises questions about the most effective approach to demonstrating competence of GPs, ensuring they are fit to practise, as well as presenting an opportunity to review the educational needs and provision for GPs. Revalidation will need to consider GPs across a range of performance, to both encourage high performance and enable the identification of GPs with performance problems. The introduction of revalidation is more likely to secure the positive engagement of the medical community if it can be shown to support their professional development and effective working practices. This research was commissioned by the United Kingdom Conference of Educational Advisors (UKCEA) as part of a larger study to explore the context for revalidation and a consideration of the possibilities for the process. We sought to capture the perceptions of GP educators on the key opportunities and potential challenges of implementing a revalidation system. Education for Primary Care (2011) 22: 386–92 # 2011 Radcliffe Publishing Limited

Is the support that dental registrants in difficulty receive from postgraduate dental teams and other sources adequate

Objective The aim of this research was to investigate the views of dental registrants in difficulty (DRiDS) on the support they received from postgraduate dental teams (PgDT) in Health Education England (HEE) and other sources. These data were complemented by the views of those appointed from the PgDT to support them on the service they provide.Method Qualitative data were collected by recording one-to-one semi structured telephone interviews, lasting approximately 30 minutes, with registrants in difficulty and supporters purposefully sampled from across England and Wales. Recordings were transcribed and the interview data analysed for recurring discourses and themes using thematic framework analysis.Setting and subjects All regional leads for DRiDs services in PgDT across the UK were asked to invite the DRiDs they were in contact with and the supporters they had appointed to contact the research team. Attempts were made to contact all who returned consent forms and six DRiDs and 11 supporters were eventually interviewed.Results Overall the DRiDs thought that the PgDT were very helpful. They were in many cases the only source of expert support and advice, particularly with regard to developing a personal development plan and collecting evidence about their practice to present to the regulator. There was a good match between the qualities that DRiDs wanted their supporters to have and the strengths supporters felt they brought to the role. The DRiDs had mixed views about the support provided by their indemnifiers and could not identify any other organisations that provided support once conditions had been imposed. Some had the support of peers; but both DRiDs and supporters felt there was a need for further support in addition to the educational support provided by PgDT and legal support provided by the indemnifier.Conclusion The DRiDS regarded the PgDT as their primary source of support and, in general, were very satisfied with the character and competence of the service.

Supporting dental registrants in difficulty: the service provided by postgraduate dental education teams.

The number of dental registrants in difficulty (DRiDs) has increased significantly in recent years and the General Dental Council or National Health Service organisations tasked with the management of dental services will, if appropriate, instruct the registrant to contact postgraduate dental teams (PgDT) based in regional offices of Health Education England and equivalent postgraduate deaneries in Wales and Scotland for assistance in meeting their conditions for continued registration. We surveyed DRiDs Leads within the PgDT with a view to understanding the current development of this important service. Results revealed that these managers had considerable relevant previous experience which underpinned their responsibility for DRiDs. Their responses indicated that there were notable differences between PgDT in the number of DRiDs seeking their help and that the development of the service and the resources deployed to help DRIDs also differed significantly. Those responsible were generally happy with the service they were providing and all were able to see DRiDs for an initial interview within four weeks of being contacted. However, weaknesses were identified such as insufficient time to support individual registrants, lack of consistent process across PgDT teams and a need for clinical training facilities.

Why do medical trainees take time out of their specialty training programmes

Postgraduate medical trainees may take time out of programme for personal or professional reasons which can delay completion of training. This survey of out of programme trainees in England explores a phenomenon that impacts significantly upon medical careers and workforce planning.