Foundation Programme Sharing Event
Holiday Inn, Carburton Street, London
ABSTRACT BOOK
Friday 27th March 2020
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ORALS
1. Balint groups for Foundation doctors: a pilot project
Dr Chris Knight, Dr Emma Salter, Dr Adrian Hayes, Dr Joseph Jameson, Dr Rose–Anne Orrell, Jenny
Pickhaver, Lorna Stewart, Katie Fry and Dr Anna Baverstock
Background:
50% (range: 27%-75%) medical trainees meet burnout criteria whilst 42% trainees take
breaks from training due to poor emotional wellbeing. Physician burnout is associated with
poorer patient care, colleague interpersonal relationships and clinician mental health. Balint
Groups have been proposed as potential interventions to reduce physician burnout.
This project aimed to establish the feasibility of running a foundation doctor Balint group in
a hospital environment as well as ascertaining the effect of Balint groups on junior doctor
burnout, wellbeing, self-reflection and compassion-fatigue.
Method:
The project was initiated by Dr Baverstock, Associate Director of Medical Education
(Support) and Dr Knight, Foundation Programme Director. All authors were involved in
project design, a systematic literature review and monthly project practicality meetings.
Methodology was revised by Jenny Pickhaver, Lorna Stewart and Katie Fry, Trust
Improvement Team.
All foundation year 1 doctors in the Trust (n=22) were invited to attend 10 hour-long
weekly Balint group sessions from November 2018 to March 2019. Sessions were co-
facilitated by Drs Orrell and Jameson, psychiatry core trainees, with supervision by an
accredited Balint group supervisor.
Dr Knight collected questionnaires from all foundation doctors before and after the Balint
series. Abbreviated Maslach Burnout Inventory (AMBI), Self-Reflection and Insight Scale
(SRIS) and General Health Questionnaire (GHQ-12) physician were used to assess burnout,
reflective abilities, and wellbeing.
Post-Balint series focus group with foundation doctors and co-facilitator interviews were led
and analysed by Dr Hayes, medical psychotherapy registrar, with question co-creation, co-
facilitation and transcript collation by Dr Salter, specialty doctor.
Results:
3 (14%) doctors completed pre-questionnaires and 14 (64%) post-questionnaires. AMBI
scores revealed high emotional exhaustion and depersonalization. Mean GHQ-12 score was
11.56. 42% doctors scored at least 12 on GHQ-12, suggesting symptoms of
anxiety/depression. Results of SRIS suggest high reflective ability.
7 doctors attended the focus group. Common themes included high doctor stress levels,
work-related pressures and internalised beliefs of job-role limiting attendance and a reduced
sense of isolation when attending groups. Formal content analysis results are pending and
will be available for presentation at the meeting.
Key Messages:
Balint groups for foundation doctors are feasible and potentially beneficial. Inference from
quantitative results is limited given low questionnaire completion. A further quality
improvement project is underway following adaptations from practicalities gleaned from this
pilot. Outcome measures have been minimised with aim of improving questionnaire
completion. The authors hope ongoing projects will aid in normalising the need for support
by providing a therapeutic space to discuss human aspects of caring.
2. Utilising a Treasure Hunt To Reduce Navigation Anxiety
Dr Laura Horne and Alistair Heath
Working as a junior doctor for the first time is an exciting yet nerve-racking experience.
There are numerous sources of anxiety for new doctors, navigation anxiety being one cause.
Navigation anxiety is a concern held by an individual about their ability to find important
clinical areas, particularly in an emergency.
Within our trust, we found that 70% of new FY1 doctors were anxious about their ability to
navigate around the hospital when on call.
We delivered a ‘Navigation-Busting Treasure Hunt’ to FY1 doctors in their induction week.
The FY1 doctors were presented with the challenge of visiting 14 wards/areas of the
hospital as directed by their ‘on call’ scenarios. Competing against one another, on arrival at
each location the teams collected a alphabetical letter which they pieced together to
discover a welcoming anagram.
Following the treasure hunt, 50% of FY1s reported to be no longer anxious about their
ability to navigate when on call. The average level of navigation confidence increased to 66%
(from 28%). We conclude that our ‘navigation-busting treasure hunt’ is an effective,
enjoyable and inexpensive way to help to welcome and minimise navigation anxiety amongst
new junior doctors.
3. Mid-year review of the mandatory teaching log (lessons learned from Horus
ePortfolio)
Ms Kata Varnai
Background:
Foundation doctors (FDs) at the UK Foundation Doctors Advisory Board requested the
counting/recording of mandatory teaching attended to be fairer/more transparent/easier to
manage. Since 2010 the requirement was “[a]n acceptable attendance record at generic
foundation teaching sessions” (“typically 70%”)1.
Methods
Foundation school directors (FSDs) agreed a new requirement, from August 2019, to attend
>60 hours of teaching (>30 hours must be core foundation teaching). All attended teaching
must be logged by FDs. The UK Curriculum Delivery Group operationalized this with e-
portfolio providers (Horus and Turas).
Results:
The new process has launched well in Horus. Many FDs log promptly and helpdesk queries
are consistently low. There has been some confusion, for example about whether FDs have to
upload evidence of attendance. FSDs confirmed this was not required – spreading this
message once the year had started was challenging. In November 2019 1/3 of FDs in England
had not yet started logging – this was concerning as trying to remember what they attended
months later was likely to lead to inaccuracies and increased workload.
Key Messages
FDs appreciate their feedback being used to affect policy. Changing how teaching is logged
has impacted all levels and guidance/reminders are important to ensure FDs meet the
requirement for a successful ARCP.
References:
1. UKFPO (2017). Foundation Programme Reference Guide 2016 - June 2017
Publication, pages 56 and 69
4. Near-peer video tutorials: a novel approach to preparing new doctors for busy
on call shifts
Dr Shriya Kumar and Dr Dowan Kwon
Background:
The transition from student to junior doctor is often stressful and complex. The majority of
anxiety surrounding this is associated with working on acute medical and surgical on call
shifts. The General Medical Council highlight the importance of delivering an effective
induction programme to new doctors.1 Many trusts use electronic learning tools and face-
to-face tutorials to deliver this programme. There is a lack of accessible information to
prepare new doctors for stressful on call shifts; especially for those whose first encounter
with these shifts is several days to weeks following the induction programme.
Methods:
The aim of our innovative online-based YouTube tutorials was to clearly explain the
structure of clinical on call shifts; which was hospital-specific, near-peer, accessible online,
and importantly, could be assimilated by the new starters within their own time. We
created, recorded and distributed these video guides using social media.2,3,4 We used
questionnaires to receive feedback.
Results:
The video tutorials were well received by the new doctors. The overwhelming majority felt
subjectively more confident and prepared for their first on call shift.
Key Messages
By using social media and digital technology, we provided a succinct and valuable learning
resource for preparing new doctors for their new roles within our hospital.
References:
1. Williams M, Mathieu S. Effective departmental inductions for doctors in training. Sharing
good practice. General Medical Council UK.
2. Kwon D, Kumar S. A quick guide to Surgical on calls. 2019.
https://youtu.be/HunkLeIMOPM
3. Kwon D, Kumar S. A quick guide to Medical on calls. 2019.
https://youtu.be/XQa_myYGX9M
4. Kwon D, Kumar S. Weekend Handovers. 2019. https://youtu.be/ACt7TUTufTk
5. Choose Psychiatry: Bristol Autumn School 2019
Dr Stephanie Upton, Dr Sally Stuart and Dr Kate Franklin
Background:
There is a recruitment crisis in psychiatry, with only 82% of core training posts filled in
20181. The
Bristol Autumn Psychiatry School is an event aimed at Foundation doctors to promote
interest in a
career in psychiatry. Since its introduction in 2013, core training fill rates in Severn Deanery
have
increased from 75% to 100%.
Methods:
The event took place on October 10th and 11th 2019. It featured a varied program of
activities
including a communication skills session, a networking event with different sub-specialties, a
drama performance and a museum visit.
Results:
44 people applied for 30 places, 24 attended. 96% of attendees rated the event overall as
“excellent”. There was a significant increase in self-reported likelihood of applying for core
psychiatry training after the event vs pre event and increased likelihood of applying to
Severn
deanery specifically. Qualitative feedback was overwhelmingly positive.
Key Messages
• Psychiatry recruitment is in crisis
• Autumn or summer schools offer an appealing, engaging and effective way to foster an
interest in psychiatry as a career for Foundation doctors
• Attendees to the Bristol School stated they were significantly more likely to apply to core
psychiatry training generally and Severn Deanery specifically after the event.
References:
1) Health Education England North West (2018) CT1 Psychiatry fill rates 2018. Available
at: https://www.nwpgmd.nhs.uk/sites/default/files/Round 1 %26 R1 Re-advert Aug 2018 -
CT1 Psych Fill Rates - For Web Site.pdf (Accessed: 9 December 2019)
6. Non- Clinical Masterclass on ‘Quality Improvement’ for Foundation Doctors
within the EOE Foundation School
Dr Zilley Khan, Fiona Greenfield, Dr H Barker, Dr H Johnson, Dr R Banerjee
Background:
Keeping the focus on Quality Improvement (QI) at a time of transformation is vitally
important. The national framework ‘Developing People – Improving Care1’ emphasises the
delivery of continuous improvements in health care services ie build cultures of continuous
improvement. The Academy of Medical Royal colleges also state QI should be put at the
heart of medical training.2 Limb’s report revealed ‘all doctors should have access to training
in QI, which should be made “part of the mindset”.3 QI has at least as much potential to
improve outcomes for patients as cardio-pulmonary resuscitation, was highlighted. 3
It sets out how the General Medical Council, medical schools, and medical royal colleges
should make the necessary changes in undergraduate and postgraduate education to
incorporate QI. Among the key recommendations is a “progressive curriculum” in QI
activity which should underpin all training stages of a doctor and all trainees should have
access to QI training. 3
All Foundation Programme doctors are expected to participate and complete a QI project
for their sign off. 4 Strong evidence reveals that junior doctors may face a number of
problems and barriers in doing worthwhile QI projects. Some of these include lack of
understanding by more senior medical staff of the QI methodology 5 and lack of effective
formal training. 5,6,7
Since September 2017 Royal Papworth Hospital has been offering QI masterclasses to
foundation trainee enrolled with the East Anglia foundation School. These masterclasses
have been delivered by QI fellows who undertook a two year fellowship programme offered
by HEEOE and delivered by the ‘King Fund’.
Methods:
Since 2017 to date we have ran an average of 3 workshops per year. Feedback in the form
of surveys post masterclass have been collated and reviewed.
Results:
There is clear evidence from the feedback that these masterclasses are very well received
and those that attend appreciated the learning. A detailed breakdown of the results will
follow in the oral or poster presentation.
Key Messages:
QI methodology masterclasses needs to be a mandatory part of junior doctors teaching
programme.
7. Careers promotion events for Foundation Doctors
Dr Preethi Gopinath, Mrs Judith Butcher and Mrs Margaret Short
Background:
Many foundation doctors are not applying for specialty training resulting in applications being
at an all-time low in the UK. There are numerous reasons for this including the current
political climate, NHS resources and ‘burn out’. Princess Alexandra Hospital developed
several careers afternoons promoting the range of specialities using different methods to
engage trainees.
Methods:
A doodle poll was carried out for all foundation doctors within the trust asking about which
specialities they were interested in. From that information, trainees from 12 different
specialities were invited to talk. A speaker on taking a non-training year. There were 5
rooms being used with simultaneous presentations occurring at the same time.
Results:
We received 40 feedback forms. 100% of doctors found the afternoon useful. 95% of
doctors felt that all their questions had been answered and 100% of doctors would
recommend the afternoon to a peer. Doctors were asked to rate the afternoon on a scale
from 1 to 5, with 5 being excellent. The mean average rating was 4.88.
Key Messages:
Career afternoons can provide a great way of providing information. Feb 2020 Careers
Hub day is planned using a “speed dating” method to improve exposure to lesser known
specialties, data will follow in presentation if successful.
8. “Virtual Oncall” – innovative virtual patient simulation training for
Foundation doctors
Dr Junaid Fukuta, Alan Coombs and James Dalton
Background
Anxiety amongst new F1 doctors is high and the unfamiliarity in the management of acute
medical conditions contributes to this (Tallentire et al, 2012). NHS Trusts utilise simulation
training to better prepare F1s, but requires huge resources in faculty, cost and time. We
looked for a technology based solution to help reduce the resources required, the result is
our virtual patient simulations (VPS): “Virtual On call.”
Methods:
Virtual On call utilises an innovative first-person perspective to mimic the viewers’
experience of actually seeing and managing acutely unwell patients. To add realism, we used
video and embedded decision making points that alter the patient’s outcome, allowing the
viewer to experience the visual, audio and emotional impact managing these patients
involves.
Results:
We carried out a randomized controlled trial between our VPS against standard simulation
training (n=40). We found no significant difference in subsequent clinical performance but an
increased knowledge gain with our VPS. With these results they are now embedded in four
hospitals F1 teaching programmes.
Key Messages:
Virtual On call is a low resource educational tool that is comparable to traditional
simulation training. It helps prepare Foundation doctors for the management of acute
medical conditions and is now being used in their training.
References
Tallentire VR, Smith SE, Skinner J and Cameron HS (2012) The preparedness of UK
graduates in acute care: a systematic literature review. Postgraduate Medical Journal. 88: 365 –
371.
9. Near-Peer Mentorship Scheme for Foundation Doctors: How to Increase
Engagement using the PDSA Cycle
Dr Jordan Moxley, Dr Samuel Haynes and Dr Huma Naqvi
Background
The transition from medical student to doctor is associated with increased stress, with new
doctors feeling unprepared and unsupported.1,2 We established a Near-Peer Mentorship
(NPM) Scheme in 2017/18 between Foundation Year 1 and 2 (FY1/FY2) doctors to provide
additional support. NPM is highly effective but associated with challenges such as lack of
engagement.3,4 To increase engagement, we made improvements to the scheme using the
Plan-Do-Study-Act (PDSA) cycle5.
Methods
17 FY2 mentors were recruited to participate in the 2019/20 NPM Scheme. Mentors were
matched to FY1s on concurrent rotations and asked to meet approximately twice per
rotation. Improvements included use of an application process, formal training through E-
Learning and reallocation of groups to address non-engagement. Qualitative and quantitative
data were collected through face-to-face meetings and online surveys.
Results
Questionnaire data showed increased engagement, with 88% of FY1s in contact with their
mentor, compared to 40% in the previous year. FY1 experiences on the Scheme improved;
100% of FY1s who met their mentors found the experience helpful, compared to 92%
previously.
Key Messages
NPM is an effective way of providing support for FY1s. Introducing an application process,
formal training and group reallocation increases engagement and improves FY1 experiences
on the Scheme.
References
[1] Brennan, N., Corrigan, O., Allard, J., Archer, J., Barnes, R., Bleakley, A., Collett, T. and
de Bere, S. (2010). The transition from medical student to junior doctor: today’s experiences
of Tomorrow’s Doctors. Medical Education, 44(5), pp.449-458.
[2] Kellett, J., Papageorgiou, A., Cavenagh, P., Salter, C., Miles, S. and Leinster, S. (2015).
The preparedness of newly qualified doctors – Views of Foundation doctors and supervisors.
Medical Teacher, 37(10), pp.949-954.
[3] Peterson A., Monaghan H. (2019). Near-peer mentorship: a pilot programme to improve
support for new doctors. BMJ Leader 2019;3:11-14.
[4] Srinivasan A, Tadros M, Nelson I, et al. (2019). Foundation mentorship scheme pilot
programme: is near-peer mentorship an effective way to look after incoming FY1s? BMJ
Leader 2019;3:A6.
[5] NHS Improvement. (2019). Plan, Do, Study, Act (PDSA) cycles and the model for
improvement, [online] Available at https://improvement.nhs.uk/documents/2142/plan-do-
study-act.pdf. [Accessed 5 Dec. 2019]
Posters
1. 60 hours taught programme: a chance for change
Dr H Johnson, Dr H Barker, Dr R Banerjee, Dr Z Khan, Dr C Lui, Mr M Bullock, Dr E Boddy
Background:
At school visits to local trusts, trainee mixed feedback around generic teaching was
common with themes of the teaching subject and quality, the type of teaching, being
predominantly lecture based with a preference for interaction and simulation, and the
difficulties in attending and then returning to the ward to catch up on missed time.
Methods:
In 2018-2019 we implemented a 60 hour taught programme pilot where having listened to
feedback, we increased our simulation and interactive elements, created half day
masterclasses sub regional teaching, though the generic training programme still made the
majority of the hours.
We asked one of our foundation fellows to review our foundation trainee feedback on the
generic teaching they received from local trusts.
Following the national roll out of the 60 hours taught programme, and based on our
education fellow feedback, we decreased the local generic teaching element, increased the
trainee choice options, further increased simulation opportunities.
We are now evaluating both feedback of individual events, and trainee overall satisfaction.
Results:
Our foundation trainees wished for valued high quality teaching, aligned to their curriculum
and career needs choice and autonomy in attendance. Interim results suggest our new
programme is valued by trainees.
Key Messages:
Bold changes to foundation teaching increase trainee satisfaction.
References:
1. Junior doctors don’t get enough teaching BMJ 2011; 342 :d2246
2. https://heeoe.hee.nhs.uk/sites/default/files/taught_programme_3030_final_2019_1.pdf
3. What do doctors value from generic teaching in the uk foundation programme?
Eleanor Boddy, Alex Rowland, Helen Johnson AMEE Vienna 2019 poster
presentation
4. Bellman L. A qualitative evaluation of senior house officers’ teaching and learning:
towards sharing good practice. Med Teach. 2004;26(4):313–20.
5. Oliver J. Ziff & Monica Samra (2016) Junior doctor led teaching programme provides
insight for incoming Foundation doctors, Medical Teacher, 38:1, 105, DOI:
10.3109/0142159X.2015.1056128
6. Paul S. Richman, Doreen M. Olvet, Sahar Ahmad & Latha Chandran (2019) Use of
student feedback to drive quality improvement (QI) in a preclinical U.S. medical
school course, Medical Education Online, 24:1, DOI:
10.1080/10872981.2019.1583968
2. Psychiatry teaching for Foundation doctors on placement.
Dr Stephanie Upton and Dr Alice Pitt
Background:
Almost 50% of doctors will complete a psychiatry placement during their Foundation
Programme1. This is a valuable opportunity to improve knowledge of mental health and
encourage interest in a career in psychiatry. Crucial to these aims is ensuring adequate
opportunities for learning. Psychiatry-specific teaching is one possible way of facilitating this.
Methods:
Two cohorts of Foundation doctors (15 in total) on psychiatry rotations in Bristol received
biweekly hour-long small group teaching sessions. Topics were decided via focus groups and
included mental state examination, common psychiatric presentations, and
psychopharmacology. Pre and post questionnaires measured teaching quality, self-rated
knowledge and confidence on psychiatry topics and attitudes towards a career in psychiatry.
Results:
100% of cohort 1 respondents strongly agreed the teaching was useful and relevant to their
current role and that it made them think more positively about a career in psychiatry. Free
text feedback praised the informal nature of the sessions, that the topics were chosen by
the learners themselves and the level of interactivity. Cohort 2 results are awaited.
Key messages:
• Small group teaching improved self-rated knowledge and confidence in dealing with
mental health issues
• Foundation doctors felt more positive towards a career in psychiatry after receiving
teaching
References:
1) Health Education England Broadening the Foundation Programme:
Recommendations and Implementation Guidance. HEE, 2014.
3. Professional and cultural integration of overseas doctors into NHS practice; a
qualitative study
Dr Joe Wild, Dr Sophie Lightbody, Bruce Kerr, Dr Ratna Makker
Background:
A third of UK doctors trained overseas (Jalal et al, 2019). Recruiting bodies are responsible
for ensuring they receive sufficient support to adapt to working in the NHS. To help
improve the existing induction programme, we analysed the experiences of a sample of
newly recruited overseas doctors in the East of England.
Methods:
The doctors were offered two training days prior to starting their Foundation Year One
(FY1) posts in 2019, including simulation based education preceded by a human factors
workshop (skills in adaptability, proactivity, optimism and empathy). Four months later they
were invited to participate in a focus group to assess the impact of the training on their new
role.
Results:
Many reported challenges of high workloads and task prioritisation, compounded by
pressure from colleagues to perform tasks efficiently. The majority felt underprepared for
their FY1 role and shared experiences of cultural, social and language barriers.
Key messages:
Commencing work as an FY1 is daunting for any newly qualified doctor. Those who trained
overseas face additional challenges to apply their training and navigate an unfamiliar system.
Feedback from these doctors is an invaluable resource which we are examining to further
improve the programme.
References:
1. Jalal M, Bardhan KD, Sanders D, Illing J. INTERNATIONAL: Overseas doctors of
the NHS: migration, transition, challenges and towards resolution. Future Healthc J.
2019;6(1):76–81. doi:10.7861/futurehosp.6-1-76
4. Using Balint Groups to encourage reflection in F1 doctors
Dr Francesca Crawly, Mrs Kate Read, Dr Alexandra Rowland
Background:
Reflection is paramount to good medical practice. The GMC state that ‘reflecting (on these
experiences) is vital to personal wellbeing and development, and to improving the quality of
patient care’ and that ‘group reflection often leads to ideas or actions that can improve
patient care’. 1
It is recognized, particularly following the Bawa Garda case in 2018, that trainees are
anxious about written reflection.2
Methods:
Following a study in 2018-19 involving foundation trainees in the East of England, we
established many prefer informal reflection with an experienced facilitator over formal
written reflection. The FT felt that discussion with more experienced doctors stimulated
higher levels of thought processing and appeared to achieve deeper learning, yet they
struggled to recognise that these encounters formed an important part of the authentic
learning process.3
From October 2019 we have offered all F1 in a DGH the opportunity to participate in
monthly Balint groups. These are facilitated by two senior educators in the trust. Following
each session all participants are sent an electronic certificate which they were encouraged
to upload to eportfolio, acknowledging their participation in a reflective group.
Results:
Ongoing feedback is universally positive and will be collated and presented.
5. Teaching Foundation Doctors a new way of communicating with vulnerable
patients.
Dr Adrian Marsh, Ms Mary Johnson and Dr Jenni Rowlands
Background:
Foundation doctors need to demonstrate understanding of safeguarding principles, manage
situations where safeguarding concerns exist, communicate in challenging circumstances and
facilitate patients making informed decisions.
Methods:
The Joint Training Team at Shropshire Council facilitated “My Enquiry and Safety Plan cards”
training. The cards were co-produced with individuals who have care and support needs in
Shropshire, in conjunction with advocacy services and independent organisations. Training
was delivered in small groups using the cards and “four and one questions”. Teaching
included; Mental Capacity assessment, Best Interest Decisions, RESPECT and group work on
case based discussions exploring safeguarding concerns in different circumstances. In
particular, teaching focused on words and phrases that individual patients understand,
therefore meeting the objective of making safeguarding personal and empowering the
patient.
Results:
Feedback demonstrated whilst this was a new way of communicating, it was critical in
ensuring that the conversation and outcome should be based around that person’s needs.
This approach will change how Foundation Doctors have conversations with vulnerable
groups.
Key Messages:
Patient centred communication training is essential, enjoyable and deliverable using an
innovative card based system, improving patient centred outcomes in vulnerable groups.
6. The Empathy, Resilience and Self-Compassion Study: a longitudinal cohort
study of Foundation Doctors
Dr Daniel Turton and Dr Bill Kawai-Calderhead
Background:
The GMC National Trainee Survey shows that amongst doctors-in-training, Foundation
Doctors (FDs) have the highest level of burnout. This may partly explain the ever-falling
number that progress directly into speciality-training. It is debatable whether doctors
protect themselves from burnout by adopting a position of ‘detached concern’ or,
conversely, whether resilience is enhanced by encouraging more empathic behaviours. This
study aims to elucidate this issue; and see whether self-compassion – a trainable quality – is
correlated with either empathy or resilience.
Methods:
Longitudinal cohort study of Foundation Year 1 doctors (F1s). Three validated self-reporting
tools administered with demographic survey. Repeat surveys to be carried out at six and
eleven months. Analysed in Excel using Spearman’s rank-order correlation.
Results:
189 F1s at participating Trusts completed initial surveys (response rate 96.4%). Positive
correlation demonstrated between resilience and self-compassion (r=0.507, p<0.001); and a
statistically significant, albeit weak, positive correlation between empathy and resilience
(r=0.197, p<0.01).
Key Messages:
This appears to be the first study demonstrating positive correlation between empathy and
resilience in UK doctors. Interventions that promote empathic behaviours may, therefore,
not only improve patient safety but also improve doctors’ resilience. Furthermore, the
results provide evidence that interventions to increase self-compassion may also increase
resilience.
7. Increased Resilience In Foundation Doctors Through The Nation’s First
Clinical Leadership Apprenticeship. Can This Be True?
Capt Bill Kawai-Calderhead RAMC and Roddy Christie
Background:
Clinician resilience and wellbeing is a national focus1,2. Over 25% of foundation doctors
(FDs) exhibit pathological anxiety3. FDs have the highest level of trainee burnout4; this
‘occupational phenomenon’5 significantly increases patient safety events6. Locally provided
FD-supporting initiatives are needed to reduce this burden.
Methods:
Foundation Leadership and Management (FLM), England’s first clinical leadership
apprenticeship7, is sustainably funded through trusts’ Apprenticeship Levy. Enrollment is
voluntary. The 12-month modular, spiral curriculum includes self awareness, emotional
intelligence and quality improvement. Enrolled and non-enrolled FDs receive module
workshops, however, enrolled FDs meet monthly with a dedicated leadership coach and
receive a national qualification on completion. Impact evaluation includes measuring FDs’
resilience
Results:
2018-19 FDs’ resilience (Brief Resilience Scale8) prior to starting clinical practice was
compared to 5-7 months after. Resilience increased in 70% of enrolled FDs (n=17) whilst
decreased in 70% of non-enrolled (n=10) and military FDs (n=8)9,10.
Key messages:
Supporting FDs’ and their resilience locally is a national focus. Resilience increased in 70%
of FDs enrolled in the FLM apprenticeship. Given all FDs receive workshops, could the
difference be the leadership coach? The 2019-20 FD cohort (n=198), including a control
group (n=51), will offer greater statistical power in time for the conference.
References:
1. BMA. (2018). Supporting health and wellbeing at work. London: BMA.
2. BMJ. (2019). Wellbeing campaign. [Internet]. Available from
https://www.bmj.com.wellbeing [Accessed 01/12/2019].
3. Van Hamel, C. and Jenner, L. (2015) Prepared for practice? A national survey of UK
foundation doctors and their supervisors. Medical Teacher 37:181-88.
4. General Medical Council. (2019) National training surveys 2019: initial finding report.
London: GMC.
5. WHO. (2019). Burn-out an “occupational phenomenon”: international classification of
diseases. [Internet]. Available from https://www.who.int/mental_health/evidence/burn-
out/en/ [Accessed 18/11/2019].
6. Panagioti, M., Geraghty, K. and Johnson, J. et al. (2018). Association between physician
burnout and patient safety, professionalism, and patient satisfaction: A systematic review and
meta-analysis. Journal of the American Medical Association Internal Medicine
178(10):1317-1330.
7. Skills For Health. (2018). Can a doctor be an apprentice? [Internet]. Available from
https://haso.skillsforhealth.org.uk/wp-content/uploads/2018/12/2018.12.05-South- Tees-case-
study-v2.pdf [Accessed 14/12/2018].
8. Smith, B.W., Daley, J., Wiggins, K., Tooley, E., Christopher, P. and Bernard, J. (2008).
The Brief Resilience Scale: assessing the ability to bounce back. International Journal of
Behavioural Medicine 15:194-200.
9. Kawai-Calderhead, B. and Christie, R. (2019). Doctors As Apprentices. In ASME ASM
2019: sustainability, transformation and innovation in medical education. Glasgow,
04/07/2019.
10. Kawai-Calderhead, B. and Christie, R. (2019). You’re hired! Clinical leadership
apprenticeships: a national first at South Tees. In Royal College of Physicians presidential
visit to South Tees. Middlesbrough, 29/11/2019.
8. £200 million of apprenticeship funding available - use it or lose it! 3 years of
clinical leadership and management apprenticeships, and still going.
Capt Bill Kawai-Calderhead RAMC and Roddy Christie
Background:
Medical leadership and management (LM) is core to clinical practice1,2; poor application
causes poor patient outcomes3-5. Standardised, sustainable training is lacking whilst clinician
burnout, which increases patient safety incidents6, is a national concern7,8. Burnout in
foundation doctors (FDs) is the highest amongst trainees9. NHS England trusts, through the
apprenticeship scheme, can access ring-fenced funding for wokplace-based, nationally
benchmarked LM training. £200million remains unspent and some trusts are now losing
funding back to government monthly10.
Methods:
In partnership with a trust, Foundation Leadership and Management (FLM) FD programme
was launched in 201711. Believed to be a national first, FLM lasts 12 months, is mapped to
FDs’ clinical curriculum and offers a nationally recognised LM qualification11.
Results:
FLM-enrolled FDs show statistically significant increased confidence in LM domains and 70%
show increased self-rated resilience12. FLM is now delivered in three trusts, and adapted
trust-grade, core trainee, consultant and ward manager programmes are delivered13.
Key messages:
FLM proves apprenticeship scheme adaptability in providing clinical LM programmes which
positively impact on learners’ LM skills and resilience. With £200million unspent, and funding
being taken back, there exists a time-pressured opportunity to establish local LM initiatives
bespoke to support staff of any profession and level.
References:
1. General Medical Council. (2018) Outcomes for graduates. London: GMC.
2. Faculty of Medical Leadership and Management. (2018) Medical Leadership and
management: an indicative undergraduate curriculum. London: Faculty of Medical
Leadership and Management.
3. Berwick D. (2013) A promise to learn – a commitment to act: improving the safety of
patients in England. London: Department of Health.
4. Francis R. (2013) Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry.
London: The Stationary Office.
5. The King’s Fund (2013). Patient-centred leadership: rediscovering our purpose. London:
The King’s Fund.
6. Panagioti, M., Geraghty, K. and Johnson, J. et al. (2018). Association between physician
burnout and patient safety, professionalism, and patient satisfaction: A systematic review and
meta-analysis. Journal of the American Medical Association Internal Medicine
178(10):1317-1330.
7. BMA. (2018). Supporting health and wellbeing at work. London: BMA.
8. BMJ. (2019). Wellbeing campaign. [Internet]. Available from
https://www.bmj.com.wellbeing [Accessed 01/12/2019].
9. General Medical Council. (2019) National training surveys 2019: initial finding report.
London: GMC.
10. Unison. (2019). Apprenticeship restrictions mean hundreds of millions of NHS funds
going to waste, says Unison. [Internet]. Available from
https://www.unison.org.uk/news/press-release/2019/10/apprenticeship-restrictions-mean-
hundreds-millions-pounds-nhs-funds-going-waste-says-unison/ [accessed 01/11/2019].
11. Skills For Health. (2018). Can a doctor be an apprentice? [Internet]. Available from
https://haso.skillsforhealth.org.uk/wp-content/uploads/2018/12/2018.12.05-South- Tees-case-
study-v2.pdf [Accessed 14/12/2018].
12. Kawai-Calderhead, B. and Christie, R. (2019). Doctors As Apprentices. In ASME ASM
2019: sustainability, transformation and innovation in medical education. Glasgow,
04/07/2019.
13. Kawai-Calderhead, B. and Christie, R. (2019). You’re hired! Clinical leadership
apprenticeships: a national first at South Tees. In Royal College of Physicians presidential
visit to South Tees. Middlesbrough, 29/11/2019.
9. Laying the Foundation for Foundation Programme Directors.
Ms Lynn Wilson, Dr Lorraine Parks, Ms Karen Moore
Background:
Foundation Programme Directors (FPDs) are responsible for ensuring that Trust
Foundation Training meets the quality standards set by the General Medical Council (GMC)
and the UK Foundation Programme Curriculum. In Northern Ireland we had no formal FPD
induction via the Foundation School. We therefore developed a regional induction
programme for new appointees and established FPDs.
Methods:
The content of the induction programme was developed, based on the standards outlined in
the GMC Promoting Excellence document [GMC] (2015). Areas covered included
recruitment, portfolio completion, study leave and ARCPs. This was delivered to the new
appointees in a small group setting and feedback was collated using a questionnaire with a
Likeart scale. Feedback was used to improve the content of the induction for subsequent
delivery.
Results:
All new FPDs have completed the induction and it has been rolled out to established FPDs.
Feedback is overwhelmingly positive with minor areas for change. All aspects were rated as
either very useful or extremely useful. Ongoing feedback will be used to develop updates
and an educational programme of relevance to the FPD role.
Key messages:
All FPDs found the induction content relevant and beneficial. We recommend a formal
induction and educational program for all FPDs.
References:
General Medical Council., (2015). Promoting excellence: standards for medical education and
training. Manchester: General Medical Council.
