Executive summary
All resident doctors that we met with spoke positively about the culture and learning environment within Anaesthetics and ITU (Intensive Therapy Unit). Those with prior experience of the training environment recognised notable improvement over the last few years. The below are highlights of areas that are working well:
A friendly and supportive environment with positive working relationships. Consultants are approachable, always happy to help and willing to come in out of hours if requested. Resident doctors reported that consultants are all accommodating with training lists and good at conducting supervised learning events (SLEs).
All resident doctors particularly credited the College Tutor for driving positive change within the department.
Resident doctors spoke positively about the Rota Coordinator highlighting their flexibility with swaps and efforts to align resident doctors with consultants in line with individual learning goals.
Bleep free and protected local teaching is taking place and resident doctors described all consultants as keen to teach.
The College Tutor was specifically commended for delivering an effective departmental induction.
Areas in need of further improvement were also identified as listed below, however, we were assured that the department and trust would take this feedback onboard and work in collaboration with resident doctors to further improve the experience:
There were some mixed experiences with induction including some delays with IT systems access.
Space for teaching within the department was described as an issue and the off-site residence for on calls was highlighted as in need of some improvement.
There are some issues with the rota system and resident doctors reported frequently being changed between clinical areas due to high service demands, inadequate staffing levels and session cancellations. The level of disruption was perceived as a major barrier to achieving structured training.
There were also concerns raised by educators around the imbalanced allocation of resident doctors to critical care making it difficult to support the experience required.
Concerns were raised with regards to the range of learning opportunities available to resident doctors. Limited case variety, low case numbers and list cancellations are significantly impacting access to training.
Review overview
Background
The results for the 2024 General Medical Council (GMC) National Training Survey (NTS) and the National Education and Training Survey (NETS) showed multiple categories where responses were below the national average at Lincoln County Hospital for resident doctors within Anaesthetics. To better understand their experience of the clinical learning environment, a virtual learner educator meeting was arranged for 16 June 2025.
Who we met with
Learners
Resident doctors in Anaesthetics (Stage 1, 2 and 3)
Educators
Clinical and Educational Supervisors in Anaesthetics
College Tutor
Education team
Director of Medical Education
Deputy Directors of Medical Education
Medical Education Liaison Officer
Other
General Manager for Theatres and Critical Care
Clinical Lead for ITU
Clinical Lead for Anaesthesia
Director of Surgery
Review panel
Education Quality Review Lead
Dr Sujata Handa, Training Programme Director for Quality, School of Anaesthesia
Specialty Expert
Dr Nicola Hickman, Deputy Head of School Anaesthesia
NHSE Education Quality Representative
Sarah Wheatley, Quality Deputy Manager
Review findings
Learning environment and culture
Stage 1 resident doctors described the working environment in Anaesthetics and ITU as supportive and friendly with positive working relationships with consultants and more senior resident doctors. They reported receiving good supervision during in and out of hours shifts and highlighted some valuable learning opportunities. All stage 1 resident doctors are aware of the exception reporting process, though none had felt the need to use it. They all felt comfortable raising concerns, and a well-functioning junior doctor forum is in place.
Stage 2 and 3 resident doctors described the working environment as friendly and supportive, with consultants encouraging appropriate levels of solo working with distant supervision. Resident doctors who had previously worked at the Trust, recognised notable improvements over the past few years. They particularly credited the College Tutor for driving positive change and felt empowered to raise concerns. Several resident doctors shared examples of how the College Tutor had personally supported them, with one commenting that ‘she has been the most positive outcome in this hospital over many years.’
All resident doctors that we met with said they would be happy to recommend Anaesthetics and ITU as a place for patient care and no concerns were raised around patient safety. All Stage 1 resident doctors said they would recommend the department as a place to train describing it as a good place to gain experience. However, Stage 2 resident doctors were less positive about recommending due to the lack of sufficient training opportunities.
Stage 2 and 3 resident doctors also reported consultants to be supportive and approachable providing the appropriate levels of supervision. There was an observation that another person on ICU overnight would be helpful and there could be some improvements made to the way the calls are distributed.
Rota
Stage 1 resident doctors reported receiving the weekly rota a week in advance, with the final iteration being available on a Friday for the following week. They described frequent changes being made to the rota during the week. They spoke positively about the rota coordinator highlighting their flexibility with swaps and efforts to align resident doctors with consultants in line with individual learning goals. Despite this, they felt that receiving the rota further in advance would be beneficial particularly for planning personal and professional commitments. Additionally, they felt a more bespoke on call rota system would be beneficial.
Stage 2 and 3 resident doctors expressed more significant concerns regarding weekly rota stability and its impact on training. They reported frequently being moved between clinical areas throughout the week due to high service demands, inadequate staffing levels and session cancellations. These changes often limited their ability to access appropriate and planned training opportunities. Examples were given of resident doctors planning their weekly activities only to experience multiple rota changes followed by further changes on the day. This level of disruption was perceived as a major barrier to achieving structured training.
The weekly rota was discussed amongst the educators and education team including the multiple benefits of CLWRota, a web based electronic system for Anaesthetics, in comparison to a manual rota fill, including the significantly reduced administrative burden. It was advised by the school that this is being used very widely across Anaesthetics in the East Midlands and would highly recommend that the implementation of this is considered.
Induction
Stage 1 resident doctors spoke positively about their induction experience and felt it was well organised and welcoming. They all reported receiving their rotas and IT systems access in a timely manner. The College Tutor was specifically commended for delivering an effective departmental induction. Discussions took place regarding the structure of the mandatory training which was described as ‘tiresome’ with up to five in person sessions of four hours each, some of which were perceived as not relevant to their roles. They expressed a preference for e-learning alternatives and questioned why completed e-learning modules could not be transferred between Trusts to reduce duplication.
Stage 2 and 3 resident doctors described a good departmental induction and those resident doctors that were unable to attend the scheduled induction were supported by the College Tutor whose efforts again were positively acknowledged for the departmental induction. There were some examples given of delays with receiving access cards preventing a resident doctor from being able to enter labour ward, and log in credentials that failed to work during a first on call weekend shift. These were acknowledged as IT system issues rather than departmental issues.
Facilities
Stage 1 resident doctors described the on-site facilities as adequate with the availability of a rest area, however, Stage 2 and 3 resident doctors described the facilities at Hazel House for on calls as easily accessible but in need of some improvement.
The educators reported that space within the department is an issue with no provision for any face-to-face meetings. Although the weekly teaching takes place in the education centre, for shorter meetings such as journal clubs, there is no space, and the education centre is located too far away to enable attendance.
Supervision
Stage 1 resident doctors spoke positively about the supervision they received in and out of hours. They confirmed that they have never been asked to work outside of their competence and that consultants are always happy to help and willing to come in out of hours if requested. They felt that everyone was accommodating with training lists and supportive with supervised learning events (SLEs). They also reported their educational supervisors are supportive and available.
Learning opportunities
Overall, Stage 1 resident doctors spoke positively about the learning opportunities at Lincoln. They described the whole team as being very supportive and they felt there was a focus on education. They also described the team as good at facilitating exposure in certain areas when requested. They highlighted that emergency anaesthetics had been particularly valuable and noted good exposure to a variety of clinical areas including Paediatrics which was noted as an area that offered more opportunities than other Trusts.
However, concerns were raised regarding the ability to achieve required obstetric competencies particularly in relation to the number of epidurals. While the team was described as supportive and proactive in trying to facilitate opportunities, resident doctors reported significant difficulty in meeting the required targets. One example given was the domain lead’s requirement to complete 20 epidurals in 6 months and reports of only having completed 8 over 5 months. This was described as a juggling act and very stressful. It was confirmed that the issue is known to the School of Anaesthesia and the Training Programme Director is actively working with the department to identify a solution.
Stage 1 resident doctors also expressed the view that the number of learners rotating through Obstetrics may be too high to ensure adequate opportunities for everyone.
Stage 2 and 3 resident doctors expressed concern about the overall quality and range of training opportunities due to limited case variety and low case numbers. Specifically, they reported reduced exposure to Paediatrics and more complex or challenging cases, as well as fewer opportunities to engage in regional anaesthesia. Cancellations were reported as a common occurrence due to staffing issues with one example noted that 11 sessions had been cancelled for the following week. This was seen as significantly impacting access to training.
Stage 2 and 3 resident doctors also highlighted the high number of the learners in the department comparing it to the number of available training opportunities. Regional anaesthesia lists were described as limited, and it was noted that a substantial number of consultants do not routinely perform regional anaesthesia which further restricts opportunities. They described only one upper limb list shared between six resident doctors and a single shoulder list running once a week at an alternative site. This was all described as having an impact on logbook numbers and there was an example given of a comparison of 69 cases over a 3-month period at this site to 130 cases in the same period at a different hospital. They all agreed that there was insufficient exposure to a diverse range of anaesthetic procedures beyond routine cases.
The experience in ITU from all resident doctors was described as good. Stage 1 resident doctors described a friendly department with approachable and supportive consultants that are proactive in doing CPDs. They found being paired up with an ITU registrar extremely beneficial in terms of learning.
The educators did raise concerns around the allocation of resident doctors to critical care, describing having an influx of learners or at times having none. With no pattern to how they are allocated this is making it very difficult to support the experience they need. There was an example given that sometimes they have significantly more medical staff than patients.
The educators also discussed the difficulties with planning training opportunities due to staffing issues, cancellations, staff being moved around and consultants being moved between sites at short notice all making any planning extremely labour intensive to organise. They reported that most of the low-risk surgery happens in the hub at Grantham and sending resident doctors to Grantham can be problematic due to most lists being run by specialist doctors and therefore a lack of clinical supervision. In addition, resident doctors must agree to travel and have found it difficult to claim travel expenses.
The availability of a consultant trouble shooter to support lists was also discussed and although it was confirmed that the Trust is working towards the model of one extra, and it is in the workforce review, the pressure in the system means they are unable to provide this every day. It was advised by the school that this is widely practiced throughout the region with significant benefits.
All grades of resident doctors also expressed a view that the number of learners in the department may be too high to ensure adequate opportunities for everyone.
Teaching
Stage 1 resident doctors have access to teaching every other Wednesday which is led by a consultant and senior registrar and consists of presentations on specific topic areas. They described the teaching as bleep free and protected time in the rota. They described the consultants as keen to teach with an example given of consultants staying late to help with exam preparation.
Stage 2 and 3 resident doctors described the local teaching as good and automatically rostered every other week. A quality improvement project (QIP) teaching session is scheduled in also an hour before teaching. This was highlighted as working well and beneficial for module sign off.
All resident doctors highlighted an issue with the East Midlands School of Anaesthesia (EMSA) calendar invite coming very late for a recent regional teaching session and although the department tried to accommodate, not all resident doctors were able to attend. The school confirmed that this would be highlighted to all teaching leads to ensure the EMSA teaching events are visible on the EMSA calendar.
Areas that are working well
| Description | Reference number and or domain(s) and standard(s) |
|---|---|
| College Tutor All resident doctors particularly credited the College Tutor for driving positive change, delivering an effective departmental induction and personally supporting them. | 1.1, 1.7 |
| Support and Supervision All resident doctors spoke positively about the support and supervision they receive in and out of hours noting that consultants are approachable, always happy to help and willing to come in out of hours if requested. | 1.1, 3.5 |
| Culture and environment All resident doctors described the working environment as friendly and supportive with positive working relationships. Notable improvements had been recognised over the past few years. | 1.1 |
Areas for improvement
Mandatory requirements
| Review findings | Required action | Reference number and or domain(s) and standard(s) |
|---|---|---|
| Learning opportunities Stage 1 resident doctors raised concerns regarding the ability to achieve the required obstetric competencies particularly in relation to the number of epidurals reporting significant difficulty in meeting the required targets which they found stressful. Stage 2 and 3 resident doctors raised concerns about insufficient exposure to a diverse range of anaesthetic procedures beyond routine cases. The allocation of resident doctors and other learners to critical care is impacting the ability to provide the experience required. | The department to continue to review all learning opportunities for all grades of resident doctors with the School of Anaesthesia. The trust should address the arrangements to improve list utilisation and minimise patient cancellations. The streamlining of this pathway will be crucial in improving learning opportunities for all resident doctors. Explore the use of other sites to maximise exposure to up to date and best practice anaesthetic techniques. Liaise with the EMSA TPD to establish training capacity in ICU for each stage of training. | 3.7, 5.1 |
| Rota All resident doctors reported frequent changes being made to the rota due to staffing issues, high service demands, cancellations and consultant movement between sites. The instability of the rota is limiting their ability to access appropriate and planned training opportunities. | The Trust to review the rota and staffing levels. Ensure that there is a robust mechanism in place to manage rotas. Rotas to be written which are consistent with training provision. | 1.1, 2.4, 5.6 |
| IT system issues There were examples given of delays with receiving access cards preventing a resident doctor from being able to enter labour ward, and log in credentials that failed to work during a first on call weekend shift. | The Trust to communicate with their IT department to ensure that the Clinical Systems within Anaesthetics are effective and reflect the requirements of the specialty. The level of IT support available should be reviewed to ensure the appropriate level of access is given to all resident doctors as required. | 3.9 |
Recommendations
| Recommendation | Reference number and or domain(s) and standard(s) |
|---|---|
| Rota Resident doctors and educators discussed the impact of last minute rota changes impacting the planning of educational activities and felt that short notice of the rota and multiple rota changes negatively impacted the planning for personal and professional commitments. We would highly recommend the implementation of CLWRota which is used in most Trusts across the East Midlands. We would recommend that incoming resident doctors are offered the option of a more bespoke on call rota system. This could be facilitated with the use of software such as DBrota. | 1.1, 2.4 |
| Facilities Resident doctors described the residence at Hazel House for on calls as easily accessible but in need of some improvement. The educators reported that space within the department is an issue with no provision for any face-to-face meetings. Although the weekly teaching takes place in the education centre, for anything else such as journal clubs, there is no space. The Trust should review access to appropriate space. Plan to improve facilities available to resident doctors in accordance with British Medical Association (BMA) recommendations and the BMA Fatigue and Facilities Charter. | 1.11 |
| Mandatory training Discussions took place regarding the structure of the mandatory training which was described as ‘tiresome’ with up to five in person sessions of four hours each, some of which were perceived as not relevant to their roles. We would recommend that mandatory training requirements are reviewed and e learning packages are considered where possible. | 1.1, 2.4 |
Report approval
Report completed by: Sarah Wheatley, Quality Deputy Manager
Review lead: Dr Sujata Handa, Training Programme Director for Quality
Date approved by review lead: 21 June 2025
NHS England authorised signature: Professor Jonathan Corne, Regional Postgraduate Dean
Date authorised: 26 June 2025
Final report submitted to organisation: 11 July 2025