Dr Jonathan Round, former Director of Medical Education at St George’s University Hospitals in London, reflects on his experiences of using the national training survey results to identify and address issues with medical education and training.

I used to open the email with the national training surveys results with trepidation – afraid possibly that my team’s efforts to improve training had been in vain, or that I had misread the educational climate in the trust. Most frightening was the prevailing colour – just where on the green-red spectrum was it? Now, I’m happy to see the blood red boxes. It might mean more work, but now there is fuel in the tank! I’ll explain.

This is a typical year’s GMC survey output. I’ve ordered it based on the scores, so the lower scoring departments are at the bottom, better scoring at the top:

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This is a nice way to look at it, because doctors like tables, and don’t like being low down in any competition. It also tells me where I will be able to make a difference. The graph below explains why:

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*source: personal impression

This chart maps the engagement with matters educational and training to the average colour of the department’s GMC output. Those getting lots of greens are already really focused on training, and will try to improve. Most other departments are just relieved it’s adequate. Struggling departments are often struggling in other ways too, buffeted by targets, vacancies, morale, poor facilities, budgets and retention issues. So it is not until something bad is threatened – such as the removal of trainees – that attention switches to education. A flush of red on the GMC survey is that threat.

Now, I strongly believe, and there is lots of evidence to back this up, that attention on education and training is probably the cheapest way to improve quality, safety, recruitment, retention and even the finances of a department.

The reds, and their potential to mean a loss of trainees, are a wake-up call. And that wake-up call means that I, as well as the college tutor and the postgraduate department, will be listened to.

Below is my over-simplification of what makes for a good training department and, consequently, a green survey:

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Without the ears, let alone hearts and minds of the management team in a department, I can really only affect the brown boxes – faculty development of the supervisors. But, with the attention of the management team, it’s all possible: change in clinic sizes, clinics with consultants alongside, better and consistent ward supervision, appropriate office and IT support, more realistic job plans, and time for the educational supervisors to meet the trainees. Bring on those reds – they make it all possible.

Here’s an example from one of the departments in the trust. First, this is the year on year GMC output:

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No one was interested up until 2016. But suddenly there was interest in education and training as they saw their internal difficulties presented at trust board, discussed at Health Education England visits and debated in consultant meetings. Something could change now there was interest. It wasn’t rocket science – this is the list the department itself drew up of what was needed to be addressed:

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Well, with all this red energy focusing the management team, much was done, and quickly. The senior staff were reorganised to allow better access to educational opportunities, better supervision, an actual teaching programme, and there was an impetus to not accept the lack of a departmental teaching room as a barrier to local teaching. See how quickly this changed the GMC results:

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The department is now thought of as a good place to train and often selected as the place to come to. It also has some of the best clinical outcomes in the country.

Bring on the reds.

The 2019 national training surveys results are now live and you can check the results and read the summary report via the GMC’s website here.

*This blog was first published via InsightsHealth on 8 March 2019