Executive summary
Overall, the resident doctors reported the radiology department as a challenging training environment. While some consultants provide excellent support, generally supervision and teaching opportunities are limited. Resident doctors have expressed reservations about recommending the department for training or patient care. The review indicates significant concerns alongside areas for improvement in the training programme.
Areas working well include:
- The department benefits from a small but highly engaged group of consultants who demonstrate significant commitment to training and education.
- The trust has developed plans to outsource overnight reporting between midnight and 4am, which should help reduce workload pressures on resident doctors.
- Study leave and training opportunities are managed flexibly to accommodate resident doctors’ needs.
- The College Tutor provides responsive and supportive leadership, actively addressing concerns raised by resident doctors.
Significant concerns requiring attention include:
- Issues have emerged regarding weekday evening on-call workload, where resident doctors are working additional unpaid hours to maintain service safety.
- The portable ultrasound daytime on-call rota lacks structured supervision, with resident doctors sometimes being asked to perform examinations at a complexity level above their current training. There is no named supervisor for the rota, creating uncertainty about escalation pathways; the Clinical Director made a commitment to naming a supervisor immediately.
Additional areas requiring attention for improvement include:
- Variation in engagement with training across the consultant body, affecting the consistency of educational experiences.
- Face-to-face training opportunities and feedback mechanisms need development to ensure effective educational engagement across all supervisors.
- Challenges for resident doctors in progressing their ultrasound skills beyond basic competencies due to limited access to supervised training opportunities.
- The working environment and facilities for resident doctors require improvement to ensure appropriate conditions for reporting and learning.
Areas that would benefit from further attention:
- The Resident Doctor’s Forum would benefit from more regular meetings to provide consistent opportunities for feedback and discussion.
- Local teaching sessions should be reviewed to ensure they effectively complement the Academy teaching programme.
Based on these findings and areas of concern identified, 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 quality intervention follows a previous review in 2023 which had demonstrated significant improvements in the training environment. Recent 2023 National Education and Training Survey and 2024 GMC National Training Survey results indicated a decline in resident doctor satisfaction, prompting this follow-up visit to review progress and identify any new challenges.
Who we met with
Learners
Clinical Radiology resident doctors, ST2-3
Educators
- Clinical Director for Radiology
- College Tutor and Deputy College Tutor
- Clinical Radiology consultants involved in training
Education team
- Director of Medical Education
- Clinical Director for Radiology
- College Tutor
- Postgraduate medical education department representatives
Review panel
Education Quality Review Lead
Dr Shahid Hussain, Head of School (Radiology)
Specialty Expert
Dr Caron Parsons, Training Program Director (Radiology)
Dr Gareth Lewis, Training Program Director (Radiology)
NHSE Education Quality Representative(s)
Kalpesh Thankey, Quality Deputy Manager
Review findings
Training environment and culture
Resident doctors reported variable experiences within the department. They identified a small group of highly engaged consultants who provide excellent training opportunities and support. However, they described challenges in engaging with the larger consultant body, particularly around obtaining feedback and supervision. Resident doctors reported variable responses to requests for training opportunities. They described instances where consultants declined requests to join lists or limited report numbers that could be checked, citing time constraints and reporting pressures. Some resident doctors reported being informed that productivity metrics influenced consultants’ availability for training activities. The education team advised that these metrics have been amended to incorporate capacity for training however trainers reported that the current allocation of 10 minutes per hour for supervision is insufficient to provide meaningful supervision and support for resident doctors.
The department has recently moved to new hospital facilities. While this has provided improved equipment and working conditions in certain areas, resident doctors reported ongoing challenges with the working environment, particularly regarding appropriate seating and workspace arrangements. Trainers reported the workspace arrangements are temporary due to flooding of the magnetic resonance imaging (MRI) scanner and surrounding rooms. The education team acknowledged these concerns and reported that measures have been taken to supply alternative seating and that resident doctors can choose workstations to suit their needs; further plans are in place to address the concerns following the initial settling-in period.
Resident doctors indicated they would not recommend the department to their peers as a place to train. They also expressed hesitation about recommending the hospital to friends and family requiring treatment, particularly for overnight care, citing concerns about workload and supervision arrangements.
Rota
Resident doctors reported variable experiences with clinical lists. Whilst some consultants permitted them to perform ultrasound scans, the majority limited their involvement to observation only. Resident doctors reported weekly timetables had occasional discrepancies with actual clinical sessions. They noted the ST1 rota structure was good.
Teaching and training opportunities
Resident doctors reported that while some subspecialties provide regular teaching sessions, there is variation across the department. Trainers reported that weekly teaching sessions are scheduled however engagement from resident doctors is poor and they typically do not to attend these sessions. Trainers reported that the Academy’s role in delivering teaching has impacted local teaching arrangements, though the education team confirmed that plans are in place to reinstate regular departmental teaching sessions.
Supervision and feedback
Resident doctors described variable experiences with supervision. While some consultants provide regular face-to-face feedback and training, others primarily provide feedback through report verification rather than direct discussion. Educational supervisor meetings occur, though some resident doctors reported delays in initial meetings.
Resident doctors have identified issues with obtaining appropriate sign-offs from clinical supervisors.
Of particular concern is the supervision of daytime portable ultrasound on-call services. Resident doctors reported occasionally being expected to perform portable ultrasound examinations in the Intensive Care Unit (ICU), at a complexity level above their current training. There is no named consultant supervisor for this rota, making it difficult for resident doctors to seek guidance when faced with challenging cases, though they noted help is available when requested. The education team acknowledged this creates particular difficulties for more junior resident doctors who require additional support when performing complex examinations and the Clinical Director committed to immediately naming a consultant supervisor for the rota.
On-call arrangements
Resident doctors raised significant concerns about weekday on-call workload. They reported that the workload was unmanageable for a single doctor, particularly affecting more junior resident doctors (ST2). This had led to resident doctors voluntarily working unpaid additional hours (8pm-midnight) to support their colleagues, raising concerns about service sustainability and reporting capacity. The education team confirmed that plans to mitigate the concerns are in the advanced stages, having secured funding to outsource reporting between midnight and 4am to help manage workload.
Resident doctors and trainers reported weekend on-call arrangements provided more appropriate consultant support than weekday evenings for resident doctors.
Curriculum delivery
Resident doctors reported challenges in meeting curriculum requirements, with concerns about accessing appropriate ultrasound training opportunities. While basic ultrasound training is provided, resident doctors reported difficulty in building on these skills and accessing appropriate supervision for progression. The education team has identified this as an area for development and is working to implement protected training lists with appropriate supervision.
Areas that are working well
| Description | Reference number and or domain(s) and standard(s) |
|---|---|
| Supportive College Tutor The College Tutor was consistently praised for being approachable, responsive to concerns, and proactive in supporting training needs. | 1.1 |
| Flexible approach to training Resident doctors reported good flexibility in accessing study leave and training opportunities, with support for attaining specific curriculum requirements. | 1.13, 3.2 |
| Weekend on-call consultant support Weekend on-call arrangements provide appropriate consultant support and supervision for resident doctors. | 3.5 |
Good practice
| Description | Reference number and or domain(s) and standard(s) |
|---|---|
| Workload management initiative The development of plans to outsource overnight reporting demonstrates commitment to addressing workload challenges and supporting resident doctors’ wellbeing. | 1.5, 5.6 |
Areas for improvement
Mandatory requirements
| Review findings | Required action | Reference number and or domain(s) and standard(s) |
|---|---|---|
| Evening on-call coverage Resident doctors reported weekday on-call workload is unmanageable for a single resident doctor, leading to voluntary unpaid additional working from the resident doctor peer group to support the on-call resident doctor. | Review weekday evening on-call arrangements and implement appropriate staffing solutions. Implement the planned outsourcing of overnight reporting and consider double-tier coverage for weekday evenings. | MR1 – 1.5, 1.6, 5.6 |
| Portable ultrasound supervision Resident doctors reported a lack of supervision for portable ultrasound service with resident doctors working beyond competency levels and no named supervisor for daytime on-call rota. | Implement clear supervision arrangements for on-call portable ultrasound services, including named consultant supervisors for each session and clear escalation pathways. | MR2 – 1.5, 3.4, 3.5 |
| Workspace health & safety Resident doctors reported challenges with workspace ergonomics and appropriate seating arrangements in the temporary reporting areas, impacting their physical health, e.g. neck and back pain. | Conduct a review of workspace arrangements and implement appropriate solutions to ensure safe working conditions. | MR3 – 1.6, 1.11 |
| Consultant engagement Resident doctors and trainers reported variable engagement in training across the consultant body, affecting access to feedback and teaching opportunities. | Review barriers to engagement in training resident doctors, e.g., familiarity with e-portfolio system, performance calculations. Develop and implement a framework for consistent consultant engagement in training, including structured feedback processes. | MR4 – 1.1, 3.5, 3.6 |
| Ultrasound skills development Resident doctors report difficulty progressing their ultrasound skills beyond basic competencies. | Review ultrasound training opportunities to ensure appropriate progression of skills with adequate supervision for all levels of training. | MR5 – 3.5, 3.7, 5.1 |
Recommendations
| Recommendation | Reference number and or domain(s) and standard(s) |
|---|---|
| Resident Doctor’s Forum Consider implementing more regular Resident Doctor’s Forum meetings to provide consistent opportunities for feedback and discussion. | 1.7 |
| Local teaching programme Review arrangements for local teaching sessions to complement Academy teaching. | 5.1, 5.4 |
| Consultant productivity metrics Review productivity metrics and consider whether these are required. Resident doctors and trainers reported that the metrics appear to have a negative effect on consultants’ willingness to teach. | 1.1, 4.2 |
Report approval
Report completed by: Kalpesh Thankey, Quality Deputy Manager
Review lead: Dr Shahid Hussain, Head of School (Radiology)
Date signed: 4 February 2025
NHS England authorised signature: Prof. Andy Whallett, Postgraduate Dean
Date signed: 13 February 2025
Final report submitted to organisation: 16 April 2025