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Executive summary
Overall, resident doctors were overwhelmingly positive about the support they receive from both the department and the trust.
Positive feedback was identified during the visit within the following areas:
- Resident doctors reported feeling well-supported and shared that they enjoy working with the consultants.
- All resident doctors shared that the environment was welcoming and safe for training. Those that had experienced working at the trust previously shared that they had noticed a positive shift in attitudes and the culture of the department, recognising the work of the senior team to implement these changes.
- Generally, resident doctors praised the department for the opportunities available for learning. They also reported that the workload of the unit was balanced which supported them with completing tasks aligned to their curriculum requirements.
- All resident doctors were aware of the mechanisms to raise concerns, sharing that the process was covered during their induction.
- Consultants who are also educational supervisors reported having allocated time within their job plans to undertake their roles.
- The trust shared an ongoing, robust, multidisciplinary programme of improvement to strengthen the culture within perinatal services at the trust.
A recommendation for improvement was identified in the following area:
- Resident doctors reported that there is not consistently a second ward round of the day undertaken after the evening handover within the department. This has the potential to impact on patient care as well as providing a valuable teaching opportunity for resident doctors.
Based on the feedback provided during this visit, it was evident that the trust has taken proactive measures to address the concerns raised within the survey outcomes. As a result of the work delivered by the trust, all resident doctors recommended the department as a place to train and would recommend obstetrics and gynaecology services at the trust to friends and family.
To ensure that the improvements are sustained, the Intensive Support Framework (ISF) Category 1 rating for this concern will currently be maintained.
Review overview
Background to the review
This intervention was held to explore the quality of the training environment within obstetrics and gynaecology following outcomes received within the 2024 General Medical Council National Training Survey (GMC NTS). Outcomes from the survey highlighted a number of indicators which were below the national average score, and were identified as outliers.
In addition, the Postgraduate School of Obstetrics and Gynaecology had been made aware of feedback from resident doctors that the culture of the training environment was poor, with allegations of bullying raised.
Who we met with
Learners
- Resident doctors within obstetrics and gynaecology at Foundation, General Practice and Higher Specialty level
Educators
- Consultants within obstetrics and gynaecology
Education team and senior team
- Managing Director
- Interim Chief People Officer
- Deputy Foundation Programme Director
- Head of Midwifery
- Postgraduate Centre Manager
- Head of Medical Education
- College Tutor
- Medical and MAPS Manager
Review panel
- Associate Dean, Ellen Knox, Education Quality Review Lead
- Training Programme Director, Tony Thomas, Specialty Expert
- Quality Deputy Manager, Amelia Harbon, Education Quality Representative
Review findings
Supportive training environment
The resident doctors were overwhelmingly positive about the support they receive at George Eliot Hospital. It was shared that they felt welcomed from the beginning, workload is at an appropriate level, and they enjoy working in the department describing it as a great learning environment.
There appeared to be an active involvement of resident doctors in driving improvements to the quality of the training environment. Resident doctors explained how the senior team had listened to their feedback when developing actions to improve O&G training. This was supported by the education team, who discussed an ongoing multi-disciplinary programme of improvement to strengthen the culture within perinatal services across the trust. It was shared that resident doctors were encouraged to share their feedback and identify solutions to any issues. It was reported by the education team that this gave resident doctors additional leadership opportunities to support their learning needs with appropriate oversight from the senior team.
All resident doctors were aware of the mechanisms to raise concerns, sharing that both the College Tutor and Guardian of Safe Working attended their induction to discuss the process. Whilst resident doctors reported not having any concerns to raise currently, they were confident that if they did have issues to speak up about, they would be taken seriously. Similar comments were given by the consultant body, who advised that they always try to facilitate a safe environment for resident doctors to feel that they can raise concerns openly.
Learning opportunities
The department was reported to enable the delivery of relevant parts of the curriculum through good exposure to a range of procedures. Resident doctors shared that they had not been allocated tasks which were outside of their level of confidence or clinical competency. Despite the trust being a smaller unit by comparison to others in the region, there was good access to opportunities to assist in gynae theatre and labour ward exposure reported.
Resident doctors shared that regular cardiotocography sessions had previously been available at the trust. It was felt that these were beneficial to their learning, and they would appreciate the sessions being restarted. Furthermore, it was recognised by the Education team that opportunities for research would support learning needs. This was following the positive outcomes from the research work being undertaken by the Midwifery team in the department.
Feedback was shared by resident doctors that there is not always consistency with holding a second ward round of the day after the evening handover. Whilst we recognise that, due to being a smaller unit, consultants within the department will cover both obstetrics and gynaecology, we would strongly recommend that a second ward round is held to support continuity of care management for patients. In addition, it was felt by resident doctors that there is a missed opportunity for teaching because of the inconsistencies around conducting the second ward round.
Clinical and educational supervision
All resident doctors reported that clinical supervision was good during the day and at night. Consultants that were educational supervisors also shared that they have allocated time within their job plans to undertake their roles, and that they were able to use this time for its intended purpose.
In addition, resident doctors shared that the consultants were conscious of the feedback from the GMC NTS, and were actively trying to address the concerns to improve the learning experience. This was echoed by the consultant body, who shared that they are constantly trying to change and improve the experience within the department.
Resident doctors also highlighted teamwork as an area that is working well. The trust has recruited new consultants who were reported by resident doctors to be approachable, helpful, and working cohesively with the longer standing consultants in the department.
Areas that are working well
| Description | Reference number and or domain(s) and standard(s) |
|---|---|
| Supportive training environment The resident doctors praised the department and the trust for the support they receive. Those that had been at the trust for previous rotations/training shared that they had noticed a positive shift in attitudes and the culture. All resident doctors were aware of the mechanisms to raise concerns, sharing that the process was covered during their induction. | 1.1 |
| Clinical and educational supervision Clinical supervision during the day and night was reported to be ‘good’ with resident doctors praising the support from consultants. All shared that they enjoyed working with the consultants in the department. | 4.2 – 4.5 |
| Multi-disciplinary teamwork- quality improvement We recognised that there is a clear and visible Senior team which is joined up, promotes a positive culture and has adopted a multi-professional approach to improving the quality of education and training. Resident doctors have been encouraged to actively participate in the process by sharing their feedback and suggesting solutions. | 1.9 / 2.1 |
Areas for improvement
Recommendations
| Recommendation | Reference number and or domain(s) and standard(s) |
|---|---|
| Learning opportunities- CTG sessions Resident doctors reported that the department previously offered CTG training sessions however, these appear to no longer be available. It was shared by resident doctors that these sessions were a useful learning opportunity, and they would benefit from the sessions being implemented again. | 1.12 / 5.1 |
| Second ward round Resident doctors shared that there is not always consistency with holding a second ward round of the day after the evening handover. It was also felt by resident doctors that there is a missed opportunity for teaching due to the inconsistency in holding the second ward round of the day. The more senior resident doctors also felt it would be helpful as a learning opportunity if they led the handover on occasion. Whilst we recognise that consultants within the department will cover both obstetrics and gynaecology, we would strongly recommend that a second ward round is held to support continuity of care management for patients. This will also provide opportunities for resident doctors to take part in the multi-disciplinary ward round, which can be utilised as a teaching experience. | 1.12 / 5.1 |
Report approval
Report completed by: Amelia Harbon, Quality Deputy Manager
Review lead: Ellen Knox, Associate Dean
Date approved by review lead: 5 December 2024
NHS England authorised signature: Prof. Andy Whallett, Postgraduate Dean
Date authorised: 2 January 2025
Final report submitted to organisation: 20 January 2025