Dr Achyut Valluri, Consultant and Clinical Lead for Postgraduate Training and Educational Supervision in Acute Medicine at Ninewells Hospital, shares his thoughts on the national training surveys and why it is so important that the voice of the trainer is also heard.
Supporting learners and educators
At the start of last year I made the transition from doctor in training to consultant. With it came the move from trainee to trainer, and for me, the added responsibility of becoming Clinical Lead for Postgraduate Training and Educational Supervision in our department.
Luckily, day one of the new job coincided with the release of Promoting excellence the new GMC standards for medical education and training. These would prove to be an excellent roadmap for finding ways of better supporting our learners AND our educators. Of course, any improvement effort must involve the people affected; and the first step is to gain a better understanding of the situation on the ground.
As a trainee, I saw the national training survey (NTS) grow and evolve. Yes, it was always a useful platform for raising important issues, like bullying and undermining, but over the years the questions it started to ask were actually allowing people to paint a picture of the learning environment and culture.
As a trainer I realised there were other pieces missing from the puzzle. If we wanted to really see the bigger picture – to try and understand how service and training can be properly integrated, and not be seen as competing demands – then our trainers’ voices also needed to be heard. In 2016 the GMC provided this opportunity, by reintroducing the survey of trainers.
Dedicated time for training is vital
It’s clear from this year’s survey results that many trainers are stretched, and struggling to balance service provision with their education and training responsibilities. Taking time to train doesn’t just mean integrating teaching into the way we conduct ourselves in clinical practice at the bedside – taking time to think out loud, encouraging ‘noticing’ of clinical signs and having clinical conversations are all things that make us better doctors. But it’s also the time needed to debrief, provide feedback, discuss our doctors in training at a departmental level; and then complete those all-important workplace-based assessments that need to be recognised in our job plans.
I strongly believe that every department needs to have someone responsible for promoting and coordinating education and training. These educational governance/leadership roles take time, as does reviewing how we are doing using data from the NTS, cross-referencing with more local surveys (such as the Scottish Trainees Survey), and then engaging with our trainees and trainers to move things forward.
Having agreed ‘tariffs’ for the educational and clinical supervision of doctors in training is helpful. Trainers can get an hour per week per trainee accounted for in their job plan, and I am fortunate that our organisation supports this. But I know that achieving this at a departmental level, where services are often stretched to the limit, can be challenging. Having data from the NTS can help inform those difficult conversations. Clearly where concerns are being raised by both trainees and trainers our boards/trusts MUST take heed to protect their doctors and patients. The safety and quality of our learning environments is inextricably linked with the safety and quality of our care.
Keeping up with an evolving profession
But any one of the canaries can be the first to show signs of distress. I was interested to read about the difference in workload between our GP trainers and GP trainees: though their efforts and commitment is clearly laudable, is this sustainable? Are there lessons we can learn from specialties where things seem to be working well?
Perhaps more importantly, are we training our doctors of tomorrow for the right thing? There’s much discussion about what’s in store for the future of the profession. As we move more fully into a technology-based internet society, will traditional roles and responsibilities still be relevant for the doctors of the future? I watch with interest how the GMC’s current consultation on Outcomes for graduates pans out.
But come what may, as Charlie Massey said in his foreword to this year’s NTS report, “Valuing training, a cornerstone of any workforce strategy, starts with valuing trainers”.
Back in 2015 I encouraged my fellow trainees to take a little time to fill in the NTS; in 2017 I’m pleased to be asking a wider group of you to be doing the same.