With such high demand on NHS services, how can we protect learning time for doctors in training? Dr Achyut Valluri, Consultant in acute medicine at Ninewells Hospital, shares his team’s bite size solution to a growing problem.
To make sure the doctors in training in our Acute Medical Unit have regular, protected time for learning, we established a daily ’10-minute tutorial’.
Despite organising a weekly, hour-long educational meeting for the staff of our AMU, we have found that attendance by junior medical staff is generally poor. We decided that we should aim for shorter, more frequent sessions, and settled for a time that would maximise the potential for trainee attendance (coinciding with the end of the shift, or just before a natural break for some, and at the start of the shift for others).
Each day one of the Foundation doctors takes their turn to present a case to their peers and a supervising Consultant. The session takes place in a dedicated teaching space, embedded within the unit; it involves a rapid (5 minute) presentation of the key facts, followed by a 5-minute group discussion of any relevant learning points, including a summary of relevant guidance.
Trainees are free to choose any case that ‘interests or intrigues’ them, but over the course of their attachment we aim to cover the ‘Top Medical Presentations’, as defined by the Joint Royal Colleges of Physicians Training Board (JRCPTB).
Besides facilitating and supervising the learning event, the Consultant offers to complete a case-based discussion assessment for the trainee. We also encourage learning points to be shared on the AMU Doctors’ Room ‘Learning Points’ whiteboard, and ask those in attendance to make reflections.
As the timing of these sessions coincided with the junior medical shift handover, this has now benefited from Consultant presence and leadership. We also added a daily end-of-shift debrief to this session – to make sure that we are listening to any clinical and/or non-technical issues arising.
These will then be discussed at the weekly AMU Senior Team meeting, where the only standing agenda items are discussion of clinical incident reports, and a structured discussion about each of our trainees; any general learning is then fed back (anonymised, of course) at the next 10-minute tutorial/handover/debrief session. In this way we have integrated our clinical and educational governance systems.
Dr Achyut Valluri is a Consultant in acute medicine and Clinical Lead for postgraduate training and educational supervision in the AMU at Ninewells Hospital in Dundee.