Executive summary

The results for the 2024 General Medical Council (GMC) National Training Survey (NTS) showed multiple categories where responses were below the national average at Queens Hospital, Burton upon Trent for resident doctors within paediatrics. To better understand their experience of the clinical learning environment, a learner educator meeting was arranged for 21 January 2025.

Overall resident doctors spoke positively about their training and education experience within the trust and the experiences described did not correlate with the negative feedback highlighted in the 2024 GMC NTS. They described working in a friendly, supportive environment with good clinical supervision in and out of hours. Feedback included comments such as ‘one of the best teams I have worked in so far.’

All resident doctors felt comfortable to raise concerns and there is a functioning resident doctor forum in place. They described an adequate induction process, with further work underway to enhance it. Teaching at Queens Hospital was highlighted as a strength and described as ‘better than at other trusts’ with all topics relevant to the curriculum and generally bleep free. 

Resident doctors spoke positively about the learning opportunities and reported no issues with completing work-based assessments. They all felt they were getting a breadth of experience in general paediatrics, the emergency department (ED), neonates, ward work, clinics and the paediatric assessment unit (PAU). Given the lower volume of sick patients, low acuity, and fewer emergencies resident doctors felt this was a good post for initial registrar level and entry-level tier 1 resident doctors to gain experience. 

Workload was described as generally manageable although resident doctors acknowledged that it could be busy particularly on some nights. They described ED as often overstretched, and felt there was a lack of paediatric experience within ED which often impacts their workload. However, they spoke positively about the support provided by site practitioners during nights and weekends although gaps in the rota sometimes meant this coverage was unavailable.

In the educator session we heard about challenges with the consultant rota due to gaps, however, it was reported that a new consultant will soon be in post which they hoped will alleviate some of the rota challenges. 

Overall, we were assured by the feedback and the commitment to provide a good education and training experience was recognised. We also recognised the efforts being made by the college tutor who is currently covering this post on a temporary basis. Based on the review findings the ISF category 1 has been reduced to an ISF category 0.

Review overview  

Who we met with

Learners

• ST1 (Tier 1) Paediatric resident doctors
• ST4 (Tier 2) Paediatric resident doctors

Educators

• Consultant Paediatricians
• College Tutor

Education team

• Director of Medical Education
• Deputy Director of Medical Education
• Education Centre Manager

Review panel

Education Quality Review Lead 

• Dr Joe Fawke, Head of School for Paediatrics

Specialty Expert       

• Dr Louise Wells, Training Programme Director ST4-8 Paediatrics

NHSE Education Quality Representative  

• Sarah Wheatley, Quality Deputy Manager

Review findings

Environment and culture

All resident doctors described a good working environment and a friendly, supportive team with comments such as ‘one of the best teams I have worked in so far’. All felt comfortable to raise concerns and are aware of the guardian of safe working (GOSW). They were all aware of exception reporting but had not had to use this. They described a well-functioning JDF where they felt that issues get actioned when raised. Tier 1 resident doctors also noted the support from the tier 2 resident doctors. 

Induction

Resident doctors described an adequate induction. They reported being familiarised with the department, receiving training on how to use the systems and found the neonate’s SIM session particularly good. The tier 1 resident doctors felt that additional talks on common conditions and more guidance on what to expect would have been helpful. Rotas were sent out in a reasonable timeframe and there had been no issues with booking annual leave or study leave. During the induction resident doctors were informed about a mentoring programme, however, this has yet not been implemented.

In the educator session we heard that they are engaging with another hospital to learn about their induction processes with the aim of enhancing the local induction. There are also plans to gather feedback from resident doctors to find out what else would have been useful to shape the induction. 

Supervision

Resident doctors spoke positively about their clinical supervision within the department. All resident doctors were allocated clinical supervisors at the start of the rotation and had all met with them and reviewed their Personal Development Plans (PDPs). They described their clinical supervisors as supportive, readily available for discussions and familiar with the curriculum. Resident doctors also highlighted the out of hours support, stating that every consultant would be willing to come in if required.   

The educators reported that they had 0.25 PA allocated time in their job plans for educational supervision, however, highlighted the significant amount of time dedicated to clinical supervision for an increasing number of learners which they felt should also be recognised. 

Workload

Resident doctors described the workload as manageable, noting that it was probably less intense than other district general hospitals due to smaller patient numbers and fewer emergencies and patients often needing to transfer out due to lower thresholds than other hospitals. However, they acknowledged that it could still be busy particularly on nights. They highlighted that the trust is proactive at filling rota gaps and maintaining a regular group of locums which provided good continuity. Handovers were described as well-structured and effective, allowing them to leave on time. 

Discussing their experience in ED, resident doctors described it as often overstretched, and having staff that have a lack of paediatric experience. The ED is used once PAU closes at 10pm and referrals were described as hit and miss depending who was on shift. Nursing experience within ED was described as variable and often a paediatric nurse or a paediatric healthcare assistant is sent from the department to attend ED. Resident doctors noted that site practitioners provide good support during nights and weekends but gaps in the rota sometimes meant this coverage was unavailable. Efforts to have a PAU nurse in ED were appreciated but were often impacted by staff shortages. 

In the educator session we heard about challenges with the consultant rota due to gaps, however, it was reported that a new consultant will soon be in post soon which they hoped will alleviate some of the rota challenges. 

Teaching

Teaching at Queens Hospital was highlighted by resident doctors as a strength and described as ‘better than at other trusts’ with teaching sessions taking place from Monday to Thursday. These include grand round, cased based presentations, audit meetings and radiology meetings. Resident doctors appreciated that the topics were relevant to the curriculum and building on their clinical experience. Tier 2 resident doctors noted that some of the teaching was tailored towards more junior resident doctors, however, still found the sessions useful. Teaching was generally described as bleep free, except during particularly busy periods. 

The educators spoke positively about the opportunities provided by the college and NHS England for supervisor training and educator courses. They also highlighted additional lunch time and evening educational sessions organised by the Director of Medical Education and education team which they found very useful, and these sessions also provided a certificate for their appraisal.  

Learning opportunities

Resident doctors spoke positively about the learning opportunities on offer at Queens Hospital and felt they were getting a wide breadth of experience in general paediatrics, ED, neonates, ward work and PAU. However, it was reported that due to GP resident doctors wanting to do paediatrics as opposed to neonates, this can make the posts neonatal heavy for paediatric resident doctors. They reported no issues with completing work-based assessments. They also highlighted a Case Based Discussion (CBD) rota which is incorporated into the consultants’ calendars, which gives them ample opportunities and was felt to be working well.

Resident doctors also described that due to the ambulance service generally diverting paediatric patients straight to Derby this means that the paediatric caseload in ED is lower than other hospitals. Therefore, due to the lower volume of sick patients, low acuity, and fewer emergencies the post was described as a good initial registrar role for tier 2 resident doctors and a good entry-level position for tier 1 resident doctors. 

Clinic exposure was described a variable. Tier 1 resident doctors reported having one week of clinics every 10 weeks, however, they reported often being called to the ward during busy periods. Tier 2 resident doctors do have set clinics but mainly saw new patients and did not routinely manage complex cases. 

Educators felt that overall training and education at Queens Hospital was going well and even though they felt in-patients was not as busy as other hospitals they still have interesting cases and felt that they try and optimise exposure for trainees. Discussion took place around what extra things they could do for those arriving in the second six months of training such as enhancing the clinic experience, quality improvement opportunities and leading ward rounds.

Good practice

Recommendations

Report approval

Report completed by: Sarah Wheatley, Quality Deputy Manager
Review lead: Dr Joe Fawke, Head of School Paediatrics
Date approved by review lead: 3 February 2025

NHS England authorised signature: Professor Jonathan Corne, Regional Postgraduate Dean
Date authorised: 7 February 2025

Final report submitted to organisation: 19 February 2025