As this year’s national training survey has launched, Janet Gray, Head of North of England and a former nurse, reflects on some of the innovative examples of good practice that the last survey highlighted. And discusses why the survey is so important for doctors in training.

Having practised as a nurse, I know only too well the strains and stresses our healthcare services face, particularly during the annual ‘winter pressures’ period. But I can only imagine the physical challenges and the emotional toll working during a pandemic must have on those working on the medical frontline.

Through my role I have been fortunate enough to hear first-hand how, despite the exceptional challenges and intensity of the past year, some pioneering advances have been made in medicine and that the wellbeing of these valuable workers is being considered. I wanted to highlight some of the impressive changes borne from new ways of working I have heard from the frontline, as well as from trainees and trainers who left a free text comment about new or innovative working practices in last year’s NTS.

Telemedicine

Many trainees used the survey to reflect on the use of telemedicine and how it has improved work-life balance. We received many positive comments from trainees who had used telephone and video software to carry out patient consultations and clinics, access educational opportunities and communicate with each other.

Some trainees believed this form of consultation to be a way to reach out to a diverse range of patients who may otherwise be reluctant to attend an appointment. Others reported that less time was lost because of no-shows for appointments.

These findings echo what I have been hearing from the frontline in the north and from colleagues across the country. Many trusts switched training to virtual learning very early on in the pandemic, using a mixture of programmes depending on the learning. We’ve heard trusts comment on how online learning has allowed for a greater range of speakers and more flexibility in scheduling.

Rotas

The pandemic has seen some positive shifts in staffing of rotas. From colleagues I speak to I was impressed with how staff at hospital in the north adapted to the challenges they faced by moving to a whole-hospital rota, where foundation doctors were included to ensure all wards were covered when staff were shielding or self-isolating. The innovative way of working was presented at an NHS Provider Conference last year. Although the rota has now been stepped down it can be reinstated within 48 hours.

Rota shifts are always a common theme in the NTS; from 2017 to 2019 trainees have reported year-on-year improvements in opportunities not being lost to rota issues. And lots of trainers and trainees used the free text options in the 2020 survey to say they’d experienced some positive changes during the spring peak of the pandemic, such as better staffing, more flexible rotas and more senior staff available out of hours.

Wellbeing

When I was practising, the doctors’ ‘mess’ was always a place where doctors in training could have some time out away from the wards, have their meals and a bit of down time to speak to colleagues. This idea has been replicated but with a touch of luxury, namely Project Wingman. The scheme, run by aircrew who have been furloughed, grounded or made redundant due to COVID-19, gives NHS staff a place to de-stress and unwind before, during and after hospital shifts. It has been introduced to a catalogue of trusts across England and in Scotland. This initiative has undoubtedly given frontline staff a much-needed moment to recharge and feel appreciated. It was also referenced in both surveys as a highlight.

One trust told us it had seen a shift in attitude towards wellbeing. The new focus, with the message ‘it is ok to not be ok’ freed trainees who may have previously been reluctant to admit defeat to accept it is natural to be upset, seek support or take time out.

In the 2020 NTS free text comments, trainees and trainers discussed similar positive moves to consider wellbeing. Initiatives to support staff included rest areas with free food and hot drinks, access to mental health support, buddy systems, the introduction of ‘wobble rooms’ where staff could take some time out, along with mindfulness and meditations sessions. We hope many of these selfcare options continue beyond the pandemic.

Teamwork

One of the real highlights we have been hearing time and time again is the exceptional teamworking – with staff pulling together throughout the pressure. In the 2020 NTS, some trainees and trainers commented upon the camaraderie between staff, flattened hierarchies and increased cooperation between departments and specialities.

Results

My message for all doctors in training and trainers is to please take the time to respond to the national training survey as each voice really does matter.

The results this year will still be impacted by the pandemic, and we’ll have to take that context into account when analysing the data.

Survey results will help us identify issue and good practice. We will review any poor survey results alongside a range of other sources of information. It will also give us vital data to understand the impact of the pandemic on training and help us pinpoint where support needs to be focused.

The NTS adds value to the work of the GMC. But it is dependent on as many doctors as possible completing it and sharing their honest experiences.

More information can be found on this National training survey page.