Executive summary
Overall, resident doctors were overwhelmingly positive about the support they receive at the 3 different sites through which they rotate: Good Hope Hospital, Solihull Hospital, and Heartlands Hospital. They reported feeling well-supported, they enjoy working with the consultants, and appreciate the flexibility and learning opportunities provided.
All resident doctors reported that they would recommend the department to colleagues as a place to train and, they would recommend the use of anaesthetic and intensive care services at these hospitals to friends and family.
Areas working well and good practice identified during the review:
- The introduction of the CLWRota system was seen as beneficial, providing resident doctors with quick access to supervising consultant contact details and improving communication.
- Advanced critical care practitioners (ACCPs) were commended for their support in training practical procedures in the ITU, particularly when consultants were busy with sick patients.
- The introduction of a flexible registrar rota tier was seen as a positive addition, helping to support busy areas in the daytime and night-time.
- Resident doctors reported getting more time in their allocated modules with ICM being covered and backfilled, allowing for better training experiences.
- The departmental induction was reported to be good, providing all necessary information about roles, responsibilities, and orientation.
- Resident doctors appreciated the opportunity to move between different sites, recognising the importance of gaining varied clinical exposure and making use of different learning opportunities. Anaesthetic associates were commended for being helpful in identifying and supporting regional anaesthesia training opportunities.
In addition to the above, items for improvement were noted in the following areas:
- Resident doctors reported challenges in achieving their Initial Assessment of Competence in Obstetric Anaesthesia (IACOA).
- Resident doctors reported difficulties with the rota swap process, finding it complicated and cumbersome.
- There is a lack of quiet workspace for resident doctors in the Intensive Treatment Unit (ITU).
- Some resident doctors experienced difficulties with badge activation when moving between sites, with one instance of a resident doctor being unable to access an area to treat a critically unwell patient.
- Ongoing challenges with the educational supervisor processes, including allocation and evidence tracking.
There were no significant concerns, and the trust has shown commitment to enhancing the training experience meaning NHS England is assured that the areas for improvement highlighted in this report will be keenly reviewed and explored by the trust.
To ensure that the improvements made to date are embedded and sustained, and the identified requirements are addressed, it will be recommended that this item remains at intensive support framework (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 was held as a follow-up to the 2022 learner educator meeting to test the trust’s improvement plan and receive assurances following below national average outcomes for anaesthetics at BHH in the 2023 National education and training survey (NETS).
Who we met with
Learners
- Anaesthetics resident doctors of various grades
- ICM resident doctors
Educators
- Educational and clinical supervisors
Education team
- Director of medical education
- Deputy director of medical education
- College tutors
- Postgraduate medical education department representatives
Review panel
- Dr Catherine Brennan – Head of School of Anaesthetics, ACCS and ICM.
- Dr Elin Jones – Quality Lead for School of Anaesthetics, ACCS and ICM.
- Dr Ranvir Cheema – Trainee Quality Representative for School of Anaesthetics, ACCS and ICM.
- Kalpesh Thankey – Quality Deputy Manager, NHS England (Midlands).
Review findings
Supportive training environment
The resident doctors were overwhelmingly positive about the support they receive at Good Hope, Solihull, and Heartlands Hospitals. They reported feeling well-supported and enjoy working in these departments.
Resident doctors reported that the workload was appropriate, and they were able to take breaks as needed. The department was reported to be helpful in allowing study leave and giving time back when resident doctors completed mandatory training on their off days.
Advanced critical care practitioners (ACCPs) were commended for their support in training practical procedures in the ITU, particularly when consultants were busy with sick patients.
The introduction of the CLWRota system was seen as beneficial, providing resident doctors with quick access to supervising consultant contact details and improving communication. The introduction of a flexible registrar, present 24/7, was seen as a positive addition, helping to support in busy areas, as and when required. Resident doctors who had undertaken this role reported that it was a valuable learning opportunity and helped provide resilience in the event of staff sickness.
Training provision
Resident doctors appreciated the opportunity to move between different sites, recognising the importance of gaining varied clinical exposure and making use of different learning opportunities.
Resident doctors reported getting more modular time with ICM being covered and backfilled during daytime hours, allowing for better training experiences.
Resident doctors receive appropriate educational supervision, with increased access to solo lists and training days for ITU on-call shifts, though capacity issues in obstetric anaesthesia training have been noted.
Resident doctors reported difficulties with the rota swap process, finding it complicated and requiring multiple conversations to gain assurance that the swap had occurred. Blocks of days, including the off days, had to be swapped rather than one day. It was reported the swap process used MS Excel spreadsheets rather than the CLWRota system.
Induction and access
The departmental induction was reported to be good, providing all necessary information about roles, responsibilities and orientation. Resident doctors suggested the need for site-specific departmental inductions when working at different hospitals within the Trust, such as Solihull Hospital.
Some resident doctors experienced difficulties with badge activation when moving between sites, with one instance of a resident doctors being unable to access an area to treat a patient.
The onus of responsibility appeared to be on the resident doctors to individually request access to areas that they required, instead of this being done in advance.
Facilities and rest areas
Resident doctors reported that some rest facilities were far from clinical locations, particularly in the ITU and for supporting maternity in the event of an emergency. While the review team found the facilities to be comparable to other trusts in the region, there is a lack of quiet workspace for doctors in training in the ITU.
Resident doctors reported difficulties accessing food out-of-hours, with vending machines often out of order or empty.
Parking between sites
Resident doctors reported difficulty in accessing on-site parking when moving between trust sites on the same day.
Clarity of roles
The department is working to balance service provision with training needs, particularly with the integration of anaesthesia associates. Clarity of roles and who is responsible overall for the patient in theatre, especially between resident doctors and anaesthesia associates, needs improvement to enhance learning experiences.
Developing and supporting supervisors
The department acknowledges the importance of educational supervisor (ES) roles by allocating appropriate time in job plans. However, there is ongoing work to clarify the requirements and process for becoming an ES to ensure all supervisors are appropriately trained.
College tutors face high workloads managing both resident doctors and trust-grade doctors, including international medical graduates, indicating a need for additional support or resources.
While the department strives for quality improvement, challenges exist in the distribution of resident doctors grades, creating bottlenecks for competency sign-offs, particularly in specialised areas like obstetric anaesthesia.
A need for a clearer contact list for educators has been identified to improve communication channels with the Postgraduate Education Centre. The role of tutors for locally employed doctors requires definition and support, especially in terms of curriculum sign-offs.
Curriculum coverage
The department generally enables the delivery of relevant parts of the curriculum through good exposure to a range of specialties and procedures.
However, working in partnership with other specialties to plan and deliver curricula faces challenges, such as accessing specific training opportunities when surgical specialties relocate between sites.
The development of innovative methods of education delivery was hindered by issues with simulation training funding.
Resident doctors reported challenges in achieving their Initial Assessment of Competence in Obstetric Anaesthesia (IACOA) due to high numbers of both resident doctors and trust-grade doctors competing for opportunities.
Areas that are working well
| Description | Reference number and/or domain(s) and standard(s) |
|---|---|
Supportive training environment The resident doctors were overwhelmingly positive about the support they receive at Good Hope, Solihull, and Heartlands hospitals. They reported feeling well-supported and enjoying working with the consultants in the department. | 1.1 |
Improved ICM training Resident doctors reported getting more modular time with ICM being covered and backfilled during daytime hours, allowing for better training experiences. | 1.1 |
Effective departmental induction The departmental induction was reported to be good, providing all necessary information about roles, responsibilities, and orientation. | 3.9 |
Good practice
| Description | Reference number and/or domain(s) and standard(s) |
|---|---|
Support from ACCPs ACCPs were commended for their support in training practical procedures in the ITU, particularly when consultants were busy with sick patients. | 1.1, 1.12 |
Flexible workforce The introduction of a flexible registrar tier was seen as a positive addition, helping with support in the daytime and on-call at night. | 1.1 |
Improved communication tools The introduction of the CLWRota system was seen as beneficial, providing resident doctors with quick access to supervising consultant contact details and improving communication. | 3.8 |
Multi-site training opportunities Resident doctors appreciated the opportunity to move between different sites, recognising the importance of gaining varied clinical exposure and making use of different learning opportunities. | 3.7 |
Areas for improvement
Mandatory requirements
| Review findings | Required action | Reference number and/or domain(s) and standard(s) |
|---|---|---|
Facilities and rest areas Resident doctors reported that some rest facilities were far from clinical locations, particularly in the ITU and for supporting maternity in the event of an emergency. While the review team found the facilities to be comparable to other trusts in the region, there is a lack of quiet workspace for doctors in training in the ITU. Resident doctors reported difficulties accessing food out-of-hours, with vending machines often out of order or empty. | Provide a dedicated room in the ITU for quiet workspace, which could also be used flexibly for seminar teaching and short rest periods. Review and improve out-of-hours food facilities, ensuring reliable access to food and drinks for resident doctors on night shifts. | MR1 |
Badge activation and access Some resident doctors experienced difficulties with badge activation when moving between sites, with one instance of a resident doctors being unable to access an area to treat a patient. | Review and streamline the process for badge activation and access rights for resident doctors moving between sites. Implement a system to ensure all resident doctors have appropriate access from their first day at each site. | MR2 |
Rota swaps process Resident doctors reported difficulties with the rota swap process, finding it complicated and requiring multiple conversations to gain assurance that the swap had occurred. Blocks of days had to be swapped rather than one day. | Review and simplify the rota swap process, creating clear guidelines and a streamlined electronic system for resident doctors to request and implement swaps. | MR3 |
Obstetric anaesthesia training capacity Resident doctors reported challenges in achieving their IACOA due to high numbers of both resident doctors and trust-grade doctors. | Review the capacity for obstetric anaesthesia training and implement a fair and efficient system for allocating training opportunities. Consider the impact of recruitment on training capacity. | MR4 |
Educational supervisor processes There are ongoing challenges with the educational supervisor processes, including allocation and evidence tracking. The present setup in ICM, whereby 1 consultant supervises 8 resident doctors, is not sustainable long term. | Implement the new Tracker2 system to streamline evidence collection and improve communication about the educational supervisor process. Provide clear guidance to all consultants about becoming an educational supervisor and remove the potential barriers of local requirements, such as, must be a consultant for several years, and shadowing an experienced ES prior to becoming an independent ES. Support newly qualified consultants to be ESs for both anaesthetics and ICM. | MR5 |
Recommendations
| Recommendation | Reference number and/or domain(s) and standard(s) |
|---|---|
ITU rest facilities usage Encourage a discussion among the ITU team about the optimal use of the 2-bedded ICU room for rest periods, considering the needs of different grades of doctors and proximity to clinical areas. | 1.11 |
Parking between sites Review the current parking arrangements for resident doctors moving between sites on the same day and consider implementing a system to facilitate easier parking access. | 1.11 |
Simulation training funding Review the breakdown of the education tariff to ensure continued support for simulation training, and if necessary, discuss alternative funding options with the senior education team. | 1.1 |
Contact list for educators Develop and distribute a clear contact list or flow chart for educators, detailing who to contact within the education centre for various queries or issues. | 4.2 |
Expanded role for locally employed doctors and their tutors Explore locally employed doctors being encouraged and supported to become educational supervisors. The RCoA Regional Advisor to explore with the RCoA how experienced tutors at the trust, who are not formally recognised as tutors by the RCoA, could review LED portfolios and undertake their IAC/ IACOA sign-offs. | 4.2 |
Distribution of resident doctors grades Educators raised concerns about the distribution of resident doctors grades at Heartlands, Good Hope and Solihull Hospitals, with a perceived imbalance towards more junior resident doctors. Trust to work with the training programme director to review the allocation of resident doctors across sites and develop strategies to attract more senior resident doctors to HGS. | 4.4 |
Clarity of roles in theatre There is sometimes a lack of clarity regarding the roles of resident doctors and anaesthesia associates (AAs) when working together in theatre. Develop and implement a system for consultants to clearly define and communicate the roles and responsibilities of all team members at the start of each theatre list. | 1.12 |
Site-specific inductions Resident doctors suggested the need for site-specific departmental inductions when working at different hospitals within the trust. Develop and implement brief site-specific induction materials or sessions for resident doctors who primarily work at one site but occasionally work at others. | 3.9 |
Report approval
Report completed by: Kalpesh Thankey, Quality Deputy Manager
Review lead: Dr Catherine Brennan, Head of School of Anaesthetics, ACCS and ICM
Date approved by review lead: 31 October 2024
NHS England authorised signature: Prof. Andy Whallett, Postgraduate Dean
Date authorised: 27 November 2024
Final report submitted to organisation: 10 January 2025