Executive summary
The review has identified several areas of good practice alongside aspects requiring further development. Notable improvements and areas working well include:
- Changes to the on-call structure, with the resident doctor providing on-call coverage being supported by increased consultant involvement. This has enhanced the balance between service provision and training opportunities.
- The ST1 ultrasound training programme, delivered through the Academy, has received positive feedback, and there is evidence of good exam preparation support, particularly for FRCR (Fellowship of the Royal College of Radiologists) 2B candidates.
- The trust has demonstrated commitment to addressing challenges through various initiatives, including plans for a reporting hub, weekly teaching sessions, and increased outsourcing support to create capacity for training.
- The Clinical Director for Imaging and education team are actively engaged in implementing improvements, whilst acknowledging the need to balance service demands with educational requirements.
Areas that require further attention:
- A key priority is addressing the working environment within the A&E reporting room, where resident doctors have reported concerns regarding interrupted working, inappropriate access, and occasions of challenging interactions with colleagues.
- The variation in face-to-face training opportunities and feedback mechanisms across the department suggests scope for more structured approaches to supervision and teaching.
- The review identified gaps in ultrasound training opportunities for ST2-3 resident doctors, though plans are in development to address this through protected training lists and increased consultant supervision.
Areas that would benefit from further attention:
- The trust’s educational governance arrangements, particularly the 0.5 PA cap for educational supervisors, may benefit from review to ensure sustainable delivery of training.
It is evident that progress has been made to date and there is a commitment from the trust to further develop the training environment. Continued focus on the areas for improvement identified will help ensure sustainable improvements in training quality.
Based on the overall review findings, it will be recommended that this item remains at Intensive Support Framework (ISF) category 1. A Trust improvement plan will be required against the mandatory requirements outlined in this report.
Review overview
Background to the review
This review follows an initial site visit that was conducted in February 2022. Following implementation of an improvement plan, the 2023 NETS and 2024 NTS outcomes indicated additional opportunities for improvement in both trainee and trainer experiences.
The intervening time has seen implementation of several changes to address previous feedback, particularly regarding on-call arrangements and training opportunities. Whilst there was evidence of progress in certain areas, the recent surveys indicated that several aspects would benefit from further development and a follow-up site visit was arranged for November 2024.
Who we met with
Learners
- Clinical Radiology resident doctors, ST2-5
Educators
- Clinical Director for Imaging
- College Tutor
- Radiology consultants involved in training.
Education team
- Associate Medical Director, Postgraduate Dental and Medical Education
- Deputy Associate Director of Medical Education
- Clinical Director for Imaging
- College Tutor
- Medical Education Manager
- Deputy Medical Education Manager
Review panel
- Dr Shahid Hussain, Head of School (Radiology),
- Dr Caron Parsons, Training Program Director (Radiology),
- Kalpesh Thankey, Quality Deputy Manager.
Review findings
On-call arrangements/responsibilities
Resident doctors advised recent modifications to the on-call rota utilise a single resident doctor system and core hours feature consultant-led reporting. The second resident doctor supports routine daytime work until 16:00 and outsourcing support enables these arrangements. The modified rota allows more structured daytime training and resident doctors report improved break arrangements with the new system. Night shifts maintain two-person coverage, but sickness absence can affect rota arrangements.
Teaching programme
The musculoskeletal (MSK) specialty provides evening teaching sessions from 17:00-19:00.
Plans exist for weekly case-based teaching implementation. The Academy delivers structured ST1 ultrasound training. Resident doctors reported that teaching arrangements vary across subspecialties. Trainers reported disengagement with the training programme from some consultants due to a loss of teaching opportunities now being undertaken by the Academy, resulting in no formal teaching being undertaken other than FRCR2B.
Examination support
Trainers reported the department offers FRCR preparation guidance and additional support is available for resident doctors undertaking 2B examinations. The department demonstrates positive examination outcomes compared to national averages.
Reporting room arrangements
Resident doctors advised that the location and access arrangements of the A&E reporting room warranted review. They reported instances of unauthorised access, e.g., by patients or their relatives, and communication challenges with clinical colleagues. The workspace situation impacted upon reporting activities, and they felt alternative locations merit consideration.
Clinical workload
Resident doctors reported that the introduction of a second ED CT scanner has increased scanning volumes, and they can be managing 40-50 scans per 12-hour session. Service demands were affecting opportunities for face-to-face teaching and some resident doctors described challenges in achieving curriculum requirements alongside service provision.
Training facilities
Resident doctors reported that sonographer teaching commitments affected training availability.
The senior team stated that the department had appointed a clinical lead for ultrasound. Opportunities exist to enhance ultrasound training access for ST2-3 grades and ST4-5 grades receive weekly lists with indirect supervision.
Face-to-face training
Resident doctors report variable experiences of face-to-face interaction with consultants. Current feedback often occurs through report verification rather than direct discussion. Some subspecialties, particularly neuroradiology, demonstrate regular face-to-face training sessions. The department has outlined plans for a reporting hub to improve exposure to interactive teaching.
Supervision experience
Resident doctors describe the quality of supervision to be consultant-dependent, although the neuroradiology team provides consistent supervision arrangements. Some resident doctors reported delayed initial educational supervisor meetings and an overall variation in subspecialty training experiences.
Supervisor allocation
Trainers advised that current educational supervisor arrangements allocate a maximum 0.5 PA, and some supervisors oversee multiple resident doctors. Senior educators noted that small subspecialties faced supervision challenges, and the senior team confirmed that trust-wide policies influence PA allocation.
Trainer development
The department encourages trainer engagement and resident doctors identified specific consultants who regularly provided teaching. The trust supports development of teaching skills and regular trainer feedback mechanisms are under development.
Cross-site working
Resident doctors reported that some subspecialties operate across multiple sites and arrangements for subspecialty training require travel between locations, however, remote reporting systems supported cross-site working.
Radiology fellows
Trainers reported that Clinical Fellows, often international trainees with limited NHS experience, require substantial support. Currently, there are 10 Clinical Fellow posts on a 1-year training programme, and trainers reported having limited time allocated to teach them. Trainers reported that allocating adequate time for training and support for Fellows is important for their development and supporting them as potential future trainers and consultants in the department.
Areas that are working well
| Description | Reference number and or domain(s) and standard(s) |
|---|---|
|
On-call rota arrangements The department has successfully transitioned to a single resident doctor for on-call coverage. Consultant-led reporting has been introduced during core hours. These changes have resulted in an enhanced balance between service provision and training opportunities. |
1.5, 5.6 |
|
ST1 ultrasound training The Academy-based training programme has demonstrated effectiveness through positive learner feedback. The structured approach to early ultrasound experience provides appropriate foundation training for ST1 doctors. |
5.1, 5.2 |
|
Examination preparation support The department provides comprehensive support for FRCR examination preparation. This is particularly evident in the support offered to resident doctors approaching their 2B examinations. |
3.6, 3.7 |
Good practice
| Description | Reference number and or domain(s) and standard(s) |
|---|---|
|
MSK teaching programme |
1.4, 5.1 |
|
Regular evening teaching sessions are held between 17:00-19:00. The programme demonstrates a structured approach to specialty training. |
|
|
Departmental culture development Regular collaborative gatherings have enhanced department cohesion. Resident doctor participation in directorate planning has increased, fostering engagement in departmental development. |
1.1, 1.2, 1.3 |
Areas for improvement
Mandatory requirements
| Review findings | Required action | Reference number and or domain(s) and standard(s) |
|---|---|---|
|
A&E reporting room The current A&E reporting room requires attention regarding access arrangements and workplace security. Resident doctors reported frequent interruptions to clinical work. The location has led to challenging interactions with clinical colleagues; some resident doctors reported A&E consultants being overly assertive, which they perceived as bullying. |
A comprehensive review of the reporting room location and access arrangements should be undertaken. This should include consideration of appropriate security protocols. |
MR1: 1.6 |
|
Face-to-face training and supervision |
A framework for consultant engagement in training should be established and include structured feedback processes. |
MR2: 3.5, 3.6 |
|
Current arrangements present opportunities to enhance consultant interaction during reporting sessions. Teaching engagement varies amongst supervisors. |
Expedite plans for a reporting hub. |
|
|
Ultrasound training for ST2-3 The current ultrasound training arrangements require review. Access to supervised lists is limited. |
Protected training lists should be developed. Consultant time for supervision requires formal allocation; the balance between service provision and training should be reviewed. |
MR3: 5.1, 5.6 |
Recommendations
| Recommendation | Reference number and or domain(s) and standard(s) |
|---|---|
|
Educational supervisor arrangements The allocation of educational supervisors would benefit from review. Current arrangements of a maximum 0.5 PA for educational responsibilities warrant consideration. |
4.1, 4.2 |
|
Teaching programme enhancement It is recommended that weekly case-based teaching sessions be implemented as planned. Structured feedback mechanisms require development to support educational delivery. |
1.4, 5.4 |
Report approval
Report completed by: Kalpesh Thankey, Quality Deputy Manager Review lead: Dr Shahid Hussain, Head of School (Radiology)
Date approved by review lead: 4 December 2024
NHS England authorised signature: Prof. Andy Whallett, Postgraduate Dean
Date authorised: 11 December 2024
Final report submitted to organisation: 5/ January 2025