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 Hospital for resident doctors within microbiology. To better understand their experience of the clinical learning environment, a learner educator meeting was arranged for 28 January 2025.
Overall resident doctors described a variable training and education experience within microbiology. Whilst some consultants were seen as supportive and approachable, resident doctors perceived a divide between consultants and themselves. They described an environment where certain consultants were unapproachable, making it difficult to raise concerns or receive support for change. One example given of the environment was ‘it has got to the point where it is not a nice place to work’.
Workload was reported as the main challenge for resident doctors and they described feeling that their only role is to keep the service running. They also described being made to feel inadequate by some consultants who imply it is their fault they cannot keep up with the workload. Overall resident doctors felt that the workload is significantly impacting any learning opportunities and the work undertaken significantly lacks training benefits.
Resident doctors reported significant delays with the out of hours rota and delays with the allocation of clinical supervisors when starting the rotation. Applications for study leave were reported to be often over scrutinised with challenges reported in securing study leave prior to exams.
Resident doctors described variable experiences with clinical supervision with some consultants being difficult to access due to them frequently attending other meetings, despite being assigned to supervise clinical duties. Out of hours supervision, particularly at weekends, was described as inadequate with only telephone support available.
Overall resident doctors are very unhappy with the training and education within this hospital and none of the resident doctors we spoke to would recommend it as a place to train.
Based on the review findings, the panel will be recommending this item is increased from an intensive support framework (ISF) category 1 to ISF category 2 and added to the Quality Improvement Register. A trust improvement plan will be required against the mandatory requirements outlined in this report.
Review overview
Who we met with
Learners
- ST3 – ST7 Microbiology
Educators
- Consultants in Microbiology
- Training Programme Director (TPD) for Microbiology
- Head of Service
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 described most of the consultants as friendly and supportive, however, felt that there are some that were less supportive. They reported that for a long time there has been a perceived divide between consultants and resident doctors with resident doctors often being made to feel that their only role is to keep the service running rather than being recognised and valued as learners.
Resident doctors felt that the department did not provide an environment which was conducive to raising concerns and they did not feel supported to make changes. Although there is a JDF in place, resident doctors felt it could be ‘exposing’ to raise concerns in this forum. They reported having raised concerns previously about the training that is offered in the department, however improvements that have been made have not gone far enough to address the unmanageable workload and lack of consultant support in delivering the day-today service.
One example given of the environment was ‘it has got to the point where it is not a nice place to work’. None of the resident doctors we spoke to would recommend their post.
Induction
Resident doctors all reported receiving an induction and had appropriate access to IT systems when starting. There were reports of delays with receiving the out of hours rota and some resident doctors were unsure which hospital they would be based in until a week before starting the rotation. They also reported delays with allocation of clinical supervisors.
Clinical and educational supervision
Some resident doctors described their educational supervisors as supportive and accessible. Most consultants were also reported to be accessible and helpful for clinical supervision. However, some were reported as difficult to access due to them frequently attending other meetings despite being assigned to supervise clinical duties. Resident doctors felt it would be more beneficial to have a clinical supervisor scheduled on the rota specifically to support them rather than one that has other commitments. They also reported that some consultants only offered assistance when asked and were not proactive in offering help, even when aware of the challenging workloads.
Out of hours supervision, particularly at the weekends, was described as inadequate by resident doctors with only telephone support available. They added that they found it overwhelming to be the only microbiology doctor onsite during these times. Trust representatives advised that as part of the curriculum requirements senior resident doctors should be at a level of being entrusted to act with indirect supervision. They also advised that resident doctors only go onto the senior rota after discussion with their educational supervisor and they are also offered simulated sessions prior to going onto the weekend on call rota.
Workload
Resident doctors described a heavy workload and significant challenges in managing the increasing volume of referrals which now take up most of their time. They felt that many of the referrals were often trivial with few complex cases, leading to limited training opportunities
Despite this being recognised by the department, resident doctors felt that no action had been taken to address it. However, it was reported by the department that they have taken action by limiting referral times, lowering the threshold of rejection and requiring all referrals to have prior discussion with seniors.
Some resident doctors reported often not having time to leave their desks and frequently finishing late due to the workload. Despite having access to exception reporting this is not being completed due to resident doctors ‘just wanting to get home’. They also described being made to feel inadequate by some consultants who imply it is their fault they cannot keep up with the workload.
When resident doctors previously raised concerns about the increasing referral workload and difficulties in finishing on time, the response was an audit of their referral numbers which resulted in instructions on how to manage their time more effectively. This made them feel blamed rather than supported.
Workload at the weekends was described as particularly heavy for resident doctors. They reported that the laboratory has increased its opening times resulting in increased workload. They felt that the increased weekend reporting had not been adequately recognised in the rotas, although senior trust colleagues advised that the rota was changed to reflect this and was confirmed with resident doctors. They reported that the lack of consultant presence onsite at the weekends also adds to these challenges. Additionally, having no lead for infection prevention over the weekend significantly impacts the workload.
The educators acknowledged the workload to be a problem with laboratory work and samples increasing, resulting in the clinical supervision of resident doctors being doubled. They described microbiology as a responsive service to the rest of the trust that cannot just say no to the increased workload but highlighted their attempts to work with management to bring these numbers down. They recognised that due to the increased workload this sometimes results in insufficient time to teach and provide training.
Learning opportunities
Overall resident doctors felt that the workload is significantly impacting learning opportunities and the work undertaken significantly lacks training benefits. Although they recognised the value of experiential learning, they felt the workload was so high it meant learning opportunities were lost. The resident doctors described that they ‘don’t know what they don’t know’ and a lack of consultant supervision means they felt they may be missing things without realising that they are clinically important.
The educators perceived a trend of resident doctors expecting structured training and not engaging in independent learning or viewing service provision as part of their development. They felt that sometimes resident doctors expected training to be delivered to them rather than seeking learning opportunities themselves.
Resident doctors highlighted issues with the trust’s guidelines, describing them as not being specific enough. Despite requesting more detailed guidance from consultants they have been told to write them themselves with consultant support. However, they all felt there was no time to write new guidelines as they are overwhelmed with delivering service. They are also unable to use guidelines from other hospitals, making it challenging when dealing with complex referrals. They felt that clear guidelines would reduce the need for microbiology input reducing the workload and creating more time for learning but reported receiving no support to develop them.
Resident doctors reported that the study leave application process was not as straightforward as it could be, with applications perceived as often being overly scrutinised. This prevented many from using their full allocation. They also reported some challenges in securing study leave prior to exams, finding it challenging to get time away from service.
Teaching
Resident doctors have regional training days and local department teaching which is protected and they are exception reporting if there are any issues with attending.
Areas for improvement
Mandatory requirements
| Review findings | Required action | Reference number and domain(s) and standard(s) |
|---|---|---|
| Culture and environment Resident doctors described a divide between resident doctors and consultants and an unsupportive environment to raise concerns. They also described being made to feel inadequate by some consultants who imply it is the fault of the resident doctors that they cannot keep up with the workload. Resident doctors also described an unsupportive process with requests for study leave.
| The trust and department should ensure that the learning environment is one where education and training is valued and given high priority and learners are treated fairly and not subjected to negative attitudes or behaviours. The department should explore ways of improving communication between consultants and resident doctors and detail how this will be monitored. The trust needs to promote a more positive working environment, ensuring that all colleagues are aware of roles and responsibilities. The trust should ensure that there is a robust mechanism in place for resident doctors to raise concerns. The trust should ensure that concerns raised are supported and investigated. | 1.1, 1.3 |
| Induction Delays with distribution of the out of hours rota and delays with the allocation of clinical supervisors were reported prior to starting the rotation. | The induction process should be reviewed to ensure timely distribution of rotas. | 3.9 |
| Workload Resident doctors described a heavy workload and significant challenges in managing the increasing volume of referrals. They described often not taking breaks and frequently leaving work late. Resident doctors reported that they are often being made to feel that their only role is to keep the service running. | Staffing should be at an appropriate level to ensure safe patient care and a safe environment for resident doctors to be working in. | 1.1, 1.5, 1.6 |
| Clinical supervision Resident doctors reported that the consultant providing clinical supervision is often not accessible due to other commitments. They also raised concerns about the lack of clinical supervision at the weekends with supervision only be available over the telephone. | The trust should ensure that all resident doctors are receiving the appropriate level of clinical supervision. | 3.5 |
Learning opportunities Resident doctors felt that the workload is significantly impacting any learning opportunities and the work undertaken significantly lacks training benefits. | The trust needs to address the imbalance and demonstrate how the post will provide resident doctors with sufficient education and training opportunities. The trust needs to ensure that resident doctors are performing tasks which support their educational needs to meet the requirements of the curriculum. | 1.1, 3.8 5.1 |
| Time for training Educators acknowledged that due to the increased workload this sometimes results in insufficient time to teach and provide training. | The trust needs to ensure that there is time in job plans and the ability to use the time for its intended purpose. The time should match the number of resident doctors. | 4.2 |
Recommendations
| Recommendation | Reference number and or domain(s) and standard(s) |
|---|---|
| Guidelines Resident doctors highlighted issues with the trust’s guidelines, describing them as not being specific making it challenging when dealing with complex referrals. We would recommend support from the consultants in the department in developing the trust guidelines. | 1.1, 1.5 |
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: 28 February 2025
Final report submitted to organisation: 22 April 2025