Executive summary
Overall, resident doctors shared a variable experience regarding their training within the department.
Positive feedback was identified during the visit within the following areas:
- Resident doctors reported that they feel safe to raise concerns and share feedback with the department.
- The consultant body were described by resident doctors as supportive and approachable. Consultants are visible to resident doctors and check-in with them regularly whilst they are on shift.
- Praise was shared by resident doctors for the teaching provided by the Gynae Oncology team, who were reported as being keen to provide learning opportunities.
- Handover was reported to be a good opportunity for learning, with members of the multidisciplinary team in attendance, and roles and responsibilities for the shift being clearly defined.
The following areas were identified as requiring improvement:
- Whilst the induction was described positively overall by resident doctors, it was reported that those who have started their rotation out of sync with the wider group had not received a trust induction. This has impacted on their ability to prepare for their roles.
- Although resident doctors felt comfortable to raise concerns, they reported that they are not aware of the formal processes to do so.
- Concerns were raised by resident doctors about the poor behaviours being displayed towards them by the Midwifery team. This was felt to be due to high workloads and a number of vacancies within the Midwifery team structure.
- There is a perceived lack of training and teaching opportunities for resident doctors due to upholding service provision.
- Resident doctors shared challenges with high workloads during on call shifts. This was linked to known gaps within the on-call rota.
- There was an identified disconnect between the feedback shared by consultants and that of the resident doctors.
- It was highlighted that the number of Educational Supervisors appears limited when compared to other units of a similar size, with 1 supervisor supporting 4 – 5 resident doctors during a rotation. Educational Supervisors also appear to be receiving less than the expected allocation of programmed activities to undertake their role.
It should be noted that generally, attendance during this visit was suboptimal. On further discussion with the trust, it was not clear how they had facilitated team members to join the sessions and share their experiences with us.
Following the feedback provided by trust colleagues at this visit, it was evident that the concerns raised within the survey outcomes have been recognised and that the trust is trying to address them. Currently, of the 14 resident doctors that we met with, only 2 would recommend the post for training.
Based on these findings and to ensure that improvements are delivered, the panel will be recommending this item is increased from an Intensive Support Framework (ISF) category 1 to ISF category 2.A trust improvement plan will be required against the mandatory requirements outlined in this report.
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 both the 2023 National Education and Training Survey (NETS) and the 2024 General Medical Council National Training Survey (GMC NTS). Outcomes from both surveys highlighted a number of indicators which were below the national average, and were identified as outliers.
Who we met with
Learners
- Resident doctors within obstetrics and gynaecology
Educators
- Clinical and Educational Supervisors in obstetrics and gynaecology
Education team
- Director of Medical Education
- Clinical Directors
- Clinical Tutors
- College Tutor
- Medical Education Manager
- Chief Medical Officer
Review panel
- Deputy Head of School and Training Programme Director (Quality) within Obstetrics and Gynaecology, Jane Panikkar Education Quality Review Lead
- Foundation Programme Director, Julian Chilvers, Specialty Expert
- Training Programme Director within Obstetrics and Gynaecology, Tony Thomas, Specialty Expert
- Deputy Foundation Programme Director, Mihaela Chirita, Observer
- Quality Deputy Manager, Amelia Harbon, Quality Representative
Review findings
Induction
Resident doctors that had experienced the local induction shared that they felt it was extensive. It was reported that during the induction, the consultant body met and welcomed resident doctors into the department, and that appropriate teaching and shadowing time was provided to adequately prepare them for their roles.
A concern was raised that resident doctors who have started their rotation out of sync with their wider peer group had not received a trust induction, and therefore did not have an equitable start to their post within the department.
Raising concerns
Whilst it was reported by resident doctors that they felt comfortable to raise concerns within the department, they were not aware of the formal mechanisms to do so. This included the process for exception reporting, which resident doctors advised was not covered as part of the induction and is not routinely discussed within the department.
Those that had raised concerns shared that they had approached their Clinical Supervisors and received good levels of support in return. Resident doctors shared that future rotations would benefit from both processes being covered as part of the induction and at the junior doctor’s fora.
Supportive environment
The resident doctors that we met with described the consultant body as approachable and welcoming. We heard of consultants regularly checking in with resident doctors throughout their shifts and that they always attend where clinical support is needed. However, resident doctors gave several examples where poor behaviours were being displayed by midwives within the department, advising that there is a general theme of ‘hostility’ and ‘rudeness towards them. These behaviours were attributed to high workloads and stress levels for the Midwifery team.
Resident doctors reported that the Midwifery team are frequently running shifts with several rota gaps and are carrying a number of vacancies within their team structure. When we spoke with the Education team, the Clinical Director shared that they were aware of these concerns and had shared the feedback with the Midwifery team for further action.
Learning opportunities
Resident doctors reported challenges with accessing learning opportunities to support their curriculum requirements due to the need to sustain service provision. It is felt that there is a breadth of learning opportunities available within the department, but accessing these is difficult due to high workloads, particularly within obstetrics. Resident doctors shared that often, when they are rostered for a shift within gynaecology, they will be pulled to support obstetrics services due to a shortage of senior specialty doctors. Resident doctors felt that this is impacting on their ability to receive hands on gynae experience, including the opportunity to go to theatre.
Praise was shared by resident doctors for the teaching provided by the Gynae Oncology team, who were reported as being keen to provide learning opportunities. In addition, resident doctors shared that handover is a good opportunity to learn, with members of the multi-disciplinary team in attendance and roles and responsibilities clearly allocated and defined.
Rotas
All resident doctors reported concerns about high workloads during on-call shifts due to regular gaps within the rota. It was felt that, upon reviewing the on-call rota, these gaps are anticipated in advance, as the trust will issue locum requests to cover the shifts, but these will regularly go unfilled. Resident doctors feel that where there are gaps, there is an expectation for them to provide the relevant cover as well as undertaking their allocated duties on shift. As a result of this, resident doctors routinely feel ‘exhausted’ after their on-call shifts.
Disconnect between feedback from consultant body and resident doctors
We identified during this review that there appears to be a disconnect between some of the feedback shared by resident doctors, and that of the consultant body. When asked about access to learning opportunities, consultants shared that resident doctors are provided with a wide range of experiences to support their curriculum requirements. This was in contrast to the feedback provided by resident doctors, who felt opportunities were limited due to supporting the department to maintain service provision.
In addition, when asked about the relationship between resident doctors and the Midwifery team, consultants shared that they had not come across significant issues with midwives’ behaviour towards resident doctors. This feedback was not shared by the resident doctors, who had reported ongoing concerns about the behaviours of midwives towards them.
Consultant support – planned activities (PAs)
Consultants who are also acting as Educational Supervisors shared with us that they are allocated 0.5 PAs per week to support 4 – 5 resident doctors during a rotation. This is under the typical allocation of 0.25 PAs per week per resident doctor. When this was raised, the Education team advised that Educational Supervisors should be receiving more PAs, with the Trust confirming that they have a detailed Job Planning Policy which attributes PA time allocation to each consultant activity. 0.25 PAs are allocated for the educational supervision of resident doctors on the NHS England training pathway. It has been advised by the trust that this Job Planning Policy was not sufficiently understood internally, leading to the incorrect allocation of time to Educational Supervisors within obstetrics and gynaecology.
Areas that are working well
| Description | Reference number and or domain(s) and standard(s) |
|---|---|
| Supportive environment – consultant support The consultant body were described by resident doctors as supportive, approachable and will check in with resident doctors regularly whilst they are on shift. | 3.5, 3.6, 3.8 |
| Learning opportunities – Gynae oncology Praise was shared by resident doctors for the teaching provided by the Gynae Oncology team, who were reported as being keen to provide learning opportunities. | 1.1, 1.4, 5.1 |
| Handover Resident doctors shared that handover is a good opportunity for learning. Members of the multi-disciplinary team are reported to be in attendance and roles and responsibilities for shifts are clearly defined. | 1.12, 5.1 |
Areas for improvement
Mandatory requirements
| Review findings | Required action | Reference number and domain(s) and standard(s) |
|---|---|---|
| Training engagement- attendance at feedback sessions It was identified that the number of resident doctors and consultants who joined the feedback sessions was lower than expected, with no clear encouragement or facilitation of attendance made by the trust. | The trust needs to evidence how it will facilitate the active engagement of all relevant team members in quality assurance processes. Evidence should include how the trust will ensure appropriate participation at future quality visits, and how both resident doctors and consultants will be part of the actions to improve the quality of the training environment within the obstetrics and gynaecology department. | MR1 1.1, 1.9 |
| Induction It has been reported that resident doctors who began their rotations at the trust at different times from their peers are not receiving a trust induction. This is impacting on them receiving an equitable start to their rotation and being prepared for their roles within the department. | The trust must ensure that all resident doctors receive an appropriate, effective and timely induction into the obstetrics and gynaecology department. | MR2 3.9 |
| Raising concerns Resident doctors shared that they were not aware of the formal mechanisms to exception report or raise concerns within the department. Resident doctors suggested that this could be improved by including an overview of the processes as part of the local induction. | The trust needs to ensure that all resident doctors are aware of the processes for exception reporting and raising concerns. | MR3 1.6, 1.7 |
| Supportive environment Resident doctors reported a general theme of poor behaviours being directed towards them by midwives within the department, which is impacting on their training experience. Resident doctors felt this was due to stress, high workloads and vacancies within the Midwifery team. | The trust needs to ensure that there is a culture where all team members are valued and where a compassionate and supportive approach is embedded. While we acknowledge that the Education team is aware of the reports from resident doctors regarding the conduct of midwives, we request formal assurances regarding the actions being taken to address these concerns. This needs to include clarification on the multidisciplinary approach being implemented to support and resolve these issues effectively. | MR4 1.1, 1.3, 2.1 |
| Learning opportunities Resident doctors shared that they are missing valuable learning opportunities due to upholding service provision. There were reports of resident doctors regularly being moved from shifts within gynaecology to support the obstetrics service. This was reported to be impacting on the ability to gain hands on experience in gynaecology and to evidence curriculum competencies. | The department needs to review its rota to ensure that the work of resident doctors contributes positively towards their training and not solely to maintain service provision. | MR5 5.1 |
| Rotas Resident doctors shared concerns about high workloads during on-call shifts due to regular gaps within the rota. It was felt that the department is aware of these gaps in advance, as they will issue locum requests to cover the shifts, but these will often go unfilled. Resident doctors felt that there is then an expectation for them to cover the gaps in addition to undertaking their designated role on a shift. | In addition to the actions within MR4, the department needs to review its on-call rota in advance and agree mitigations for any regular gaps. | MR6 1.6 |
| Disconnect between feedback from consultant body and resident doctors There was an identified disconnect between some of the feedback shared by resident doctors, and the feedback given by the consultant body that we met with. This related to concerns raised by resident doctors regarding access to learning opportunities and the reported poor behaviours of the Midwifery team. | The trust needs to undertake further work with the consultant body to recognise where concerns have been identified with education and training. Consultants should be appropriately sighted on and involved in any quality improvement work being undertaken to encourage a more collaborative approach which has a focus on teamwork. | MR7 1.1, 3.4 |
| Consultant support – planned activities (PAs) It was identified that consultants are not receiving the typically allocated PA time to undertake their educational roles. Consultants who are acting as Educational Supervisors shared that they are allocated 0.5 PAs per week to support 4 – 5 resident doctors during a rotation. The typical allocation is 0.25 PAs per week per resident doctor. | The trust needs to ensure that formally recognised educational supervisors are being appropriately supported, with the correct time allocated in their job plans to undertake their roles. Revisiting the number of consultants undertaking the Educational Supervisor role could help address some of the issues potentially stemming from one supervisor being responsible for 4 – 5 resident doctors during a rotation. | MR8 3.6, 4.2 |
Report approval
Report completed by: Amelia Harbon, Quality Deputy Manager
Review lead: Jane Panikkar, Deputy Head of School and Training Programme Director (Quality), Postgraduate School of Obstetrics and Gynaecology
Date approved by review lead: 31 December 2024
NHS England authorised signature: Prof. Andy Whallett, Postgraduate Dean
Date authorised: 9 January 2025
Final report submitted to organisation: 26 February 2025