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 Leicester Royal Infirmary (LRl) for resident doctors within histopathology. To better understand their experience of the clinical learning environment, a learner educator meeting was arranged for 28 January 2025. 

Resident doctors reported mixed experiences with their overall education and training. Whilst many described a positive experience and felt well supported and supervised, it was recognised that some had received fewer positive experiences. Feedback about consultant support was mixed with some resident doctors feeling listened to and well supported, while others found some consultants dismissive and rude and reported often feeling undermined.

Resident doctors reported an ‘astronomical’ increase in workload which they felt had impacted consultants’ availability for teaching and getting assessments completed and signed off. They described no structured system in place to facilitate supervised activities and work between less than full time consultants and resident doctors. Time for subspecialty work which had previously been allocated in the rota is now being organised by resident doctors which they found challenging. It was also felt that there is no clear pathway to raise concerns.

The educators reported a good supportive environment amongst the consultant team but acknowledged that the extensive workload puts pressure and time constraints on how they can provide education. Although they have time in their job plans, they felt this did not reflect the true workload.

Based on the review findings we will be recommending that the Intensive Support

Framework (ISF) category 1 remains. A trust improvement plan will be required against the mandatory requirements in this report.  

Review overview  

Who we met with

Learners

• ST1 – ST5 Histopathology

Educators

• Consultants in Histopathology
• Head of Service
• Education Lead Pathology

Education team

• Head of Medical Education Management

Review panel

Education Quality Review Lead 

• Dr Somaia Elsheikh, Head of School for Pathology

Specialty Expert       

• Dr Lina Kayali, Training Programme Director, Chemical Pathology
• Dr Susan Snape, Training Programme Director, Microbiology, East Midlands North

NHSE Education Quality Representative  

• Sarah Wheatley, Quality Deputy Manager

Review findings

Environment and culture

Resident doctors reported mixed experiences regarding the overall training environment. Whilst many described a positive experience and felt well supported and supervised, it was recognised that some had received fewer positive experiences. Whilst some found the department friendly, others found the working environment to be hostile at times. 

The experiences with consultant support were also mixed. Some resident doctors felt listened to and well supported, while others found certain consultants dismissive and rude and often felt undermined. Staffing levels and workload sometimes impacted on supervision activities especially for less than full time resident doctors, although most felt well supervised and well supported clinically. 

The educators reported a good supportive environment amongst the consultant team but acknowledged that the extensive workload puts pressure and time constraints on how they can provide education. They expressed disappointment with the survey results and felt that there was a general lack of recognition for their efforts. In particular, the significant amount of work carried out outside of normal working hours to support training. They felt that job planning had been a ‘paper exercise’ and did not reflect the amount of work being delivered in terms of service and training. Although they have time in their job plans, they felt this did not reflect the true workload. They also reported a lack of support from both the trust and the Postgraduate School of Pathology, with no funding for additional posts or essential equipment.

There was mixed feedback on whether resident doctors would recommend histopathology at LRI as a place to train. Some felt it would be a good place for general histopathology training but noted a lack of support for engaging with any of the subspecialties. 

Induction

All resident doctors agreed that the induction process was thorough, comprehensive, and there were no issues reported when starting the rotation. The more junior resident doctors particularly praised the ‘heavy supervision’ until they became competent with what they were doing. 

Clinical and Educational Supervision

Resident doctors were allocated educational supervisors at the start of their rotation and found them to be accessible and knowledgeable about the new curriculum. Overall clinical supervision was also found to be accessible. However, some resident doctors reported difficulties in arranging specific clinical supervision, such as for double reporting, although they acknowledged this was largely due to consultants’ workload. They also found it challenging to get consultants to attend cut-up sessions, with some feeling a nuisance when asking for support.

Workload

Resident doctors reported an ‘astronomical’ increase in workload and a shortage of consultants in some subspecialties which they felt had impacted consultants’ availability for teaching. 

They noted that most resident doctors and some consultants in the department are working less than full time and consultants also have designated work from home days included in their rota. They felt that these working patterns have caused additional challenges with no structured system in place to facilitate supervised activities and work between less than full time consultants and resident doctors. Handover arrangements were described as effective, with the use of the ILAB reporting system which enables them to be aware of who the supervising consultant is for each case. 

The cut-up workload was reported to have increased significantly, with the more junior resident doctors often feeling pressured by some specialties to take more than they can manage, leading to a lack of time for learning opportunities. There were mixed experiences reported with the pressures of the workload, with some feeling that they had to frequently stay late to complete cases whilst others did not feel obliged to do so. It was highlighted by the trust following the report that resident doctors are never asked to clear the cases on specialty cut up or stay late. Trust colleagues advised that resident doctors could communicate more effectively with the specialty consultant to discuss what they can do and want to do at the beginning of their specialty attachment. 

Resident doctors working less than full time highlighted the challenges of managing the workload with reduced hours. They also described instances where communication between colleagues could be more compassionate. 

Learning opportunities

Resident doctors reported difficulties with getting assessments signed off, particularly with the new curriculum in place, due to the busyness of the department. They reported that previously there had been allocated time in their rota to do subspecialty work. However, this time has now been removed from the rota and must be organised by the resident doctors themselves which they struggle to find time for. Due to the lack of organisation they felt that dedicated weeks would work better. It was felt that autopsy was a particular concern, and resident doctors were struggling to pick up cases, however, this has been fed back to supervisors, and it was reported that there are plans in place to have a specific allocation for autopsy.

Teaching

It was reported by resident doctors that there has been no formal local teaching, however, a session is being arranged on a weekly basis which is due to start soon. Resident doctors did highlight that the consultants are generally happy to teach anything required if they are approached. Overall, apart from isolated cases, there were no issues reported with study leave. 

Raising concerns

There was mixed feedback about the ability to raise concerns. Resident doctors felt there was no clear pathway to raise concerns, apart from a twice-yearly resident doctor’s feedback meeting which provided opportunities to raise issues. It was reported that although some felt comfortable approaching their supervisor, this was reported to be highly dependent on the individual consultant. There were examples of concerns being raised, addressed and resident doctors being listened to. However, there were also reports of consultants responding dismissively or rudely, with some making unkind remarks. 

Areas for improvement

Mandatory requirements

Report approval

Report completed by: Sarah Wheatley, Quality Deputy Manager
Review lead: Dr Somaia Elsheikh, Head of School Pathology
Date approved by review lead: 19 February 2025

NHS England authorised signature: Professor Jonathan Corne, Regional Postgraduate Dean, Midlands
Date authorised: 27 February 2025

Final report submitted to organisation: 24 April 2025