Natioal traier survey 2011 Key fidigs
Natioal traier survey 2011 Key fidigs
Published by: Geeral Medical Coucil 3 Hardma Street Machester M3 3AW Telephoe: 0161 923 6602 Website: www.gmc-uk.org This iformatio ca be made available i alterative formats or laguages. To request a alterative format, please call us o 0161 923 6602 or email us at publicatios@gmc-uk.org. Published February 2012 2012 Geeral Medical Coucil The text of this documet may be reproduced free of charge i ay format or medium providig it is reproduced accurately ad ot i a misleadig cotext. The material must be ackowledged as GMC copyright ad the documet title specified.
Cotets Foreword 02 Itroductio ad scope of report 04 Summary of chapters 06 Chapter 1: Survey overview 08 Chapter 2: Supervisio ad assessmet 14 Chapter 3: The Workig Time Regulatios 26 Chapter 4: Preparedess 30 Refereces 36 Ackowledgemets 37 Geeral Medical Coucil 01
Foreword This report sets out the key fidigs of the 2011 atioal survey of medical traiers. It gives a overview of the experieces ad perceptios of over 15,000 seior doctors who supervise, assess ad otherwise support postgraduate traiees from the iitial foudatio stages through to the poit they become GPs ad cosultats. It complemets the report o traiees published i November 2011. We are very grateful to have had feedback from 15,000 traiers but the fact is that the respose rate was very low i some deaeries makig it difficult to be as clear about the fidigs as i the case of the traiee survey. Nevertheless, although impressioistic rather tha comprehesive, this report is a helpful cotributio to our uderstadig of the challeges ad opportuities we face. Traiers play a pivotal role i makig sure that the curret geeratio of doctors is equipped for their role i a moder health service. It is essetial that traiers are well prepared for the roles they play. Equally, they eed support from their departmets, employers ad deaeries if they are to be effective i deliverig high quality educatio ad traiig ad i supportig those traiees who are performig poorly. A key issue for us is how we recogise ad approve traiers to uderlie the importace of their cotributio. We already formally approve geeral practice (GP) traiers of GP registrars ad we ow eed to move towards the same kid of system for those workig outside geeral practice ad i udergraduate medical educatio. We are ow cosultig o how to take this forward ad urge you to take part i this importat piece of work before the closig date of 30 March, 2012 02 Geeral Medical Coucil
Foreword http://www.gmc-uk.org/educatio/10264.asp. We wat to use this as a opportuity to idetify the traier populatio more accurately. That is why we are ot ruig the traier survey i 2012. 2011 was the fourth year of the traier survey, which was itroduced by the Postgraduate Medical Educatio Board (PMETB) ad the Coferece of Postgraduate Medical Deas (COPMeD). It was the secod year the Geeral Medical Coucil (GMC) had ru the survey. This year we are thoroughly reviewig the survey ad questios for 2013 ad beyod. We will eed to take accout the outcome of our cosultatio o the recogitio ad approval of traiers as well as make sure that the questios are closely aliged with our stadards. We are eormously grateful to all those who gave their time to take part i this year s survey ad to all those who have cotributed to the desig ad success of this project. This feedback makes a crucial cotributio to our uderstadig of the traiig ladscape i the UK, ad what eeds to be doe to raise stadards further. We would very much welcome commets o the report ad i particular ways that future surveys ca be improved. Geeral Medical Coucil 03
Itroductio ad scope of report For the past four years, the GMC or PMETB (ow merged with the GMC) has worked with COPMeD to survey those who trai doctors across the UK. This report highlights key fidigs from the 2011 traiers survey ad commets o treds over time. The respose rate to the traiers surveys have always bee lower tha for the traiees surveys ad this limits the coclusios that we ca draw. Eve so, it will help iform the developmet of a framework for recogisig ad approvig traiers, which we are curretly cosultig o. The surveys of traiers have helped us to make sure that medical traiig meets the stadards we set. They are a importat part of the evidece base we use to moitor stadards i medical educatio, to support our ispectios ad to provide feedback to those resposible for educatio delivery. They provide a basis for further aalysis ad actio, both by us ad by those o the frotlie. I 2011, as i previous years, we asked about: how effectively traiers feel they perform their duties. how these duties are recogised i their job plas. the level of support they feel they receive. I 2012 we will be reviewig the survey of traiers i light of the ew framework for recogisig ad approvig traiers to make sure it stays relevat. You ca keep up to date about our plas for the traiig surveys at www.gmc-uk.org/educatio/surveys.asp. I may areas, the 2011 surveys of traiers ad traiees provide a cosistet view of the quality of traiig, despite comig from differet perspectives ad aswerig differet questios. Traiees satisfactio about the quality of the traiig they receive remais high ad is icreasig year o year, ad traiers are clear about their traiig roles ad resposibilities, ad feel supported by their departmets ad employers. Broadly speakig, the impact of the workig time regulatios (WTR) remais a cocer for some traiers, as it did for traiees i the 2011 survey, especially surgery ad foudatio traiees. Similarly, there is more evidece that workplace based assessmet (WPBA) is widely perceived by traiers ad traiees to be a tick-box exercise that ca mask performace problems. Despite idetifyig multiple barriers to carryig out WPBA, traiers make time to do it ayway. 04 Geeral Medical Coucil
Itroductio ad scope of report I some areas, perceptios diverge. Traiees rate their practical experiece highly ad cotiue to feel cofidet about meetig their required competeces. However, cosultats report that the service demads made of traiees ofte mea that they miss out o learig opportuities, ad a majority of traiers thik traiees are less cofidet ad less able to work idepedetly tha whe they were traied. The survey was t madatory, but deaeries strogly ecouraged traiers to take part. 15,062 traiers respoded to the survey. However, for techical reasos data from 669 GP traiers were icomplete. We have oly icluded complete resposes i this aalysis, givig a total dataset of 14,393 traiers for 2011 compared to 17,264 i 2010. Traiers were able to add their free text commets, ad 2,630 did so. We selected the commets used i this report from these ad used them to illustrate the fidigs of the mai aalysis. They were ot selected usig ay objective method but were chose to reflect the geeral views expressed overall. Who was surveyed ad whe? The survey took place betwee 2 May ad 22 July 2011 ad icluded: all cliical ad educatioal supervisors as idetified by deaeries (for ease of readig, we ve referred to this group as cosultats, although a miority will have bee associate specialists). all approved GP traiers all GPs with foudatio traiees. The full results ca be accessed through our reportig tool, http://gmc-olieeducatioreports.org, where they ca be viewed by local educatio provider, specialty ad deaery. You ca view our report o the key fidigs of the 2011 Natioal Traiee Survey here http://www.gmcuk.org/nts_traiee_survey_2011.pdf_45270429.pdf. Geeral Medical Coucil 05
Summary of chapters Chapter 1: Survey overview This chapter reports o the umber of traiers aswerig the survey ad provides data o what roles they udertake, how log they have bee traiers, whether they have bee appraised for their educatioal resposibilities ad how clear they are about their roles ad resposibilities. It also looks at their perceptios of the degree to which they are supported i their traiig work ad at the service demads made of their traiees. Key fidigs Cosultats report that service demads ofte mea traiees miss out o learig opportuities. Traiers are clear about their traiig roles ad resposibilities. Traiers feel supported by their departmets ad employers. Chapter 2: Supervisio ad assessmet This chapter reports o traiers perceptios of supervisio ad assessmet, icludig WPBA. It provides data o the roles they udertake, how well prepared they are for these roles ad the umber of traiees they supervise. It also looks at issues to do with workload ad supervisio. Key fidigs The proportio of cosultats traied to carry out WPBA has rise slowly sice 2007 ad most traiers have received formal traiig for their roles. Traiers make time for supervisio ad ofte work beyod their cotracted hours to do so. Traiers idetify multiple barriers to carryig out WPBA but make time to do it. 06 Geeral Medical Coucil
Summary of chapters Chapter 3: The Workig Time Regulatios This chapter looks at how traiers have adapted to the 48-hour workig week icludig whether they have bee able to deliver traiig to the same stadards ad, if so, whether this was by makig chages. It also looks at traiers perceptios of whether their traiees work beyod the WTR limits. Key fidigs Traiers have made chages to the way they trai i order to maitai stadards. Some traiers remai cocered that the WTR are havig a egative impact o traiig. Traiers report that traiees rarely work beyod the WTR limits. Chapter 4: Preparedess for practice This chapter reports o traiers perceptios of how well traiees are prepared for the ext stage of their traiig ad how traiers view traiees cofidece. It also looks at the availability of structures for supportig poorly performig traiees. Key fidigs A miority of traiers report beig aware of traiees who were siged off a stage of traiig whe traiers did ot thik they were competet. A majority of traiers thik traiees are less cofidet ad less able to work idepedetly tha they were i their day. Service pressures are leadig traiers to restrict the activity of traiees. Geeral Medical Coucil 07
Chapter 1: Survey overview This chapter looks at which traiers aswered the survey i 2011 ad at their perceptios of how well supported they are i their traiig work ad at the service demads made of their traiees. It covers the overall respose rate, what roles traiers have, how log they have bee i traiig roles, whether they have bee appraised for their educatioal resposibilities ad how clear they are about their roles ad resposibilities. Key fidig: Cosultats report that service demads ofte mea traiees miss out o learig opportuities. Traiers are clear about their traiig roles ad resposibilities. Traiers feel supported by their departmets ad employers. 8 Geeral Medical Coucil
Chapter 1: Survey overview Who aswered the survey? I 2011, we received completed surveys from 15,062 traiers, of which 12,839 were cosultats ad 2,223 were GPs. However, techical issues meat that we had complete data from oly 1,554 GPs. The data preseted here take ito accout oly those completed questioaires. Respose rate by deaery The total respose rate was 44.6% ad this varied by deaery from almost eight i te i the Sever ad the South West Peisula Deaery to a quarter i Yorkshire ad Humber Postgraduate Deaery. Table 1.1 gives more detail. Table 1.1 Respose rate by deaery Deaery All resposes (=33,905) Cosultats (=29,750) GPs (=4,155) East of Eglad Multi-Professioal Deaery 1,968 (68.9%) 1,714 (70.2%) 254 (61.5%) Ket, Surrey ad Sussex Deaery 1,161 (56.7%) 670 (47.3%) 491 (77.9%) Lodo Deaery 810 (13.9%) 810 (13.9%) o data Mersey Deaery 687 (49.7%) 684 (50.0%) 3 (23.1%) North Wester Deaery 1,090 (38.6%) 1,090 (38.7%) 0 (0.0%) Norther Deaery 1,426 (60.0%) 1,266 (60.6%) 160 (55.8%) Norther Irelad Medical ad Detal Traiig Agecy 370 (36.0%) 337 (38.3%) 33 (22.3%) NHS Educatio for Scotlad (East Regio) 229 (62.9%) 188 (63.3%) 41 (61.2%) NHS Educatio for Scotlad (North Regio) 263 (64.2%) 190 (66.0%) 73 (61.3%) NHS Educatio for Scotlad (South-East Regio) 511 (42.1%) 433 (42.0%) 78 (42.6%) NHS Educatio for Scotlad (West Regio) 514 (40.6%) 413 (41.5%) 101 (37.4%) Wales Deaery 821 (45.3%) 676 (43.7%) 145 ((54.5%) NHS West Midlads Workforce Deaery 1,634 (51.48%) 1,502 (54.3%) 132 (32.4%) Defece Postgraduate Medical Deaery 7 (14.0%) 1 (100.0%) 6 (12.2%) Oxford Deaery 555 (54.8%) 458 (55.2%) 97 (53.0%) Wessex Deaery 698 (55.7%) 563 (54.5%) 135 (61.6%) East Midlads Healthcare Workforce Deaery 389 (28.3%) 291 (28.0%) 98 (29.5%) South West Peisula Deaery 444 78.0%) 324 (78.8%) 120 (76.0%) Sever Deaery 1,054 (79.3%) 832 (79.6%) 222 (77.9%) Yorkshire ad the Humber Postgraduate Deaery 431 (25.7%) 397 (25.6%) 34 (27.2%) Faculty of Pharmaceutical Medicie 42(65.6%) 42 (65.6%) Total 15,104 (44.6%) 12,881 (43.3%) 2,223 (53.5%) Geeral Medical Coucil 9
Chapter 1: Survey overview The mai reaso for the differet respose rate is difficulty idetifyig precisely who should be asked to complete the survey. Our work this year to develop a framework to recogise ad approve traiers will provide us with better data about this populatio, ad should mea that whe we ext survey traiers i 2013 the data will be more comprehesive, reliable ad useful. Cosultats ad GPs held a variety of traiig roles Respodets held a variety of roles, ad may had more tha oe role, but most were cliical ad/or educatioal supervisors or GPs traiers (tables 1.2 ad 1.3). Table 1.2: Traiig roles carried out by cosultats Cliical supervisor 10,548 (82.2%) Educatioal supervisor 9,232 (71.9%) Foudatio or Specialty Traiig 1,068 (8.3%) Programme Director (TPD) I do ot have a desigated title for this role 623(4.9%) Other 868 (6.8%) Total 12,839 Table 1.3: Desigated titles of GP traiers Foudatio Tutor 128 (5.8%) GP Traier 1,433 (64.5%) Traiig Programme Director 128 (5.8%) Other 123 (5.5%) Total 1,554 Most cosultats ad GPs had a log experiece of traiig roles, with just over half havig six or more years experiece ad oly oe quarter three years or fewer. Traiers are mostly clear about their traiig roles ad resposibilities Almost all (91.8%) cosultats said they were mostly or very clear about their traiig roles ad resposibilities. 30.1% were very clear. 61.7% were mostly clear. Similarly amog GPs, 95.6% were mostly clear or very clear, with early half very clear. 49.1% of GPs were very clear. 46.5% of GPs were mostly clear. Half of cosultats have bee appraised for their traiig role Just over half (50.5%) of the cosultats had bee appraised for their educatioal resposibilities i the previous 12 moths. There were some specialty differeces. Fewer tha half of cosultats workig i cardiothoracic surgery, cardiology, cliical ocology, medical ocology, histopathology, geeral surgery ad trauma ad orthopaedic surgery had bee appraised i the previous year. GPs reported higher rates of appraisal tha cosultats, with three quarters (73.2%) havig bee appraised i the previous 12 moths. 10 Geeral Medical Coucil
Chapter 1: Survey overview Cosultats feel more supported i their traiig roles tha do GPs By ad large, cosultats reported both that their employig orgaisatio ad their departmet supported traiig. 88.1% agreed or strogly agreed that they work i a departmet that is supportive of traiig. 68.3% agreed or strogly agreed that their employig orgaisatio is supportive of traiig. GPs reported feelig less well supported by primary care trusts (PCTs), with 48.2% sayig their PCT was supportive of traiig. Cosultats are more likely to opt to have traiees tha GPs The survey asked if, give the choice, cosultats would opt to have traiees ad whether GPs would opt to have more tha oe traiee. 92.6% of cosultats said yes, they would opt to have traiees. 44.5% of GPs said they would opt to have more tha oe traiee *. I wat to be more ivolved with traiig. My curret colleagues do t kow who is the curret traiig lead for my speciality (whe I asked). We do t host ay regioal traiig days. We wat to. I believe cosultats i our departmet are committed to traiig, ad mostly deliver it above their job plaed commitmets. Very high service pressures impact o traiig. Traiig remais a vocatio for me. I have bee ivolved i traiig for a log time. Registrars work hard ad are by ad large excellet. The greatest problems lie i recruitmet whe a iappropriate cadidate is appoited who is ot traiable. GP traiig has become more time cosumig tha ever before. I would evisage a retiremet of may GP traiers if we did ot receive full salary reimbursemet for traiees i practice i the future! Traiig is less ejoyable tha it was. It requires far more time completig forms tha actually preparig traiees to become GPs. The quality of the product (ew GPs) is worse for the chages. Free text commets idicated a rage of views. Some were committed to ad passioate about traiig but felt that service demads were compromisig traiig; others felt it had become too oerous ad time cosumig. * I the Key Fidigs report 2010, this questio was icorrectly reported as whether GPs would opt to have traiees whe i fact they were asked whether they would opt to have more tha oe traiee. Therefore this data caot be compared to that reported i 2010. Geeral Medical Coucil 11
Chapter 1: Survey overview Service demads i hospitals prevet traiees takig advatage of learig opportuities Nearly half of cosultats reported that service demads regularly meat that their traiees were ot able to take advatage of either cliical learig opportuities or formal teachig sessios (table 1.4). Oe i te said that service demads meat traiees missed out o cliical learig opportuities o a daily basis. The curret traiig is a shambles. They do ot atted my teachig opportuities because they are ot workig or coverig for someoe else who is abset. Targets (service) do ot allow adequate time to trai the juior. I feel our etire dept is uder costat pressure, this impacts o the more juior traiee. Uless the four hour target i A&E is chaged traiig of doctors i A&E will collapse. Table 1.4 Cosultats reportig that service demads prevet traiees takig advatage of learig opportuities* Formal teachig sessios Cliical learig opportuities Never 991 (7.7%) 695 (5.4%) Rarely 6,395 (49.8%) 5,588 (43.5%) Mothly 2,662 (20.7%) 2,379 (18.5%) Weekly 2,289 (17.8%) 2,826 (22.0%) Daily 502 (3.9%) 1,351 (10.5%) The same was ot true of geeral practice. Amog GP traiers, 79.3% either disagreed or strogly disagreed that service demads mea that traiees i their practice do ot always have the opportuity to take advatage of learig opportuities such as study leave, tutorials or case based discussios. Oly 14.5% said this happeed regularly. May of our stadards are beig met but traiers are cocered about the impact of service demads o traiig These data are closely aliged with the fidigs from 2010. While there is much that is positive, the data also idicate some ogoig areas of cocer: appraisal of traiers the degree to which employig orgaisatios support traiig the impact of service demads o traiees. O a positive ote, the data cotiue to show that most traiers i hospitals ad i geeral practice are clear about their roles ad resposibilities. This is a core stadard set i The Traiee Doctor 1 : Traiers must uderstad the structure ad purpose of, ad their role i, the traiig programme of their desigated traiees. However, oe i te is ot clear. Deaeries have take steps to address this. For example, Yorkshire ad the Humber Postgraduate Deaery ad Sever Deaery have each developed materials to support traiers o their websites that iclude defiitios of differet roles, clear descriptios of resposibilities ad guidace o job plaig. 12 Geeral Medical Coucil
Chapter 1: Survey overview As i 2010, eight i te cosultats report that their departmets support traiig but oly two thirds say the same of their employig orgaisatio. Overall, the data idicate that may orgaisatios are meetig the GMC stadard set out i The Traiee Doctor: Orgaisatios providig medical educatio ad traiig must esure that traiers have adequate support ad resources to udertake their traiig role. But may are ot. Agai as i 2010, less tha half of GPs report that their PCT is supportive. While worryigly low, it is at least ecouragig that i a time of flux for PCTs this figure has t dropped further. The picture is also mixed whe it comes to appraisals with half of cosultats ad three quarters of GPs reportig that they had bee appraised i the previous 12 moths. There is o madatory obligatio for may traiers to udergo appraisal for their educatioal role; The Traiee Doctor requires it oly of those with additioal educatioal roles, such as traiig programme director or director of medical educatio. However, several deaeries have recogised the importace of appraisal ad have developed madatory traiig programmes for cliical ad educatioal supervisors that iclude review ad appraisal although ot o a aual basis. It is worth otig that GP traiers, who are already approved by the GMC, report higher rates of appraisal tha cosultats. This is a area that will be cosidered i more detail durig the cosultatio o recogitio ad approval of traiers. The coflict betwee high quality traiig ad service demad is a ogoig theme ad was highlighted i our 2011 report, The state of medical educatio ad practice i the UK: 2011 2. This flagged cocers raised by medical royal colleges, faculties ad by traiees themselves about the tesio betwee the eed to provide immediate care ad the eed for traiees to have dedicated time to lear ad be supervised. The data preseted here provide yet more evidece this time from traiers ad our positio remais uchaged: Usig traiees to respod to today s service pressures may compromise the competecy ad cofidece of tomorrow s medical professio. Takig steps to remedy this is ot a issue the GMC ca, or should, address o our ow. The orgaisatio of rotas is a matter for employig orgaisatios. They may eed to fid alterative solutios, for example by aligig cosultat ad traiee rotas so that the impact o traiig becomes less acute. However, the GMC does expect deaeries to act if they believe traiees are ot beig give the educatioal experiece they eed to meet curricula requiremets ad to develop. We will withdraw approval for traiig programmes where we are ot satisfied that traiees are beig adequately supported. * Roudig error meas that some results do t add to 100% This cosultatio is ope util 30 March 2012 ad is available at www.gmc-uk.org/educatio/10264.asp#stadards Geeral Medical Coucil 13
Chapter 2: Supervisio ad assessmet This chapter looks at supervisio ad assessmet from traiers perspectives. It examies their roles, how well they are prepared for them ad how much time they sped o them. It also looks at how may traiees they supervise ad whether their workload allows them to provide appropriate cliical supervisio. Fially, it looks at traiers experieces ad perceptios of WPBA ad how this has chaged over time. Key fidig: The proportio of cosultats carryig out WPBA ad who are traied to do so has icreased slowly sice 2007. Traiers are makig time for assessmet ad ofte work beyod their cotracted hours to do so. 14 Geeral Medical Coucil
Chapter 2: Supervisio ad assessmet The proportio of cosultats carryig out WPBAs has icreased over time Nearly all the cosultats i this survey are ivolved i cliical supervisio, providig formal feedback o work i the cliical eviromet ad carryig out WPBAs. May also carry out a rage of other roles ad resposibilities (table 2.1) icludig iductio, selectio ad ivolvemet i college exams. The proportio of cosultats carryig out WPBAs i 2011 was 92.5%. This is a marked improvemet o the positio i 2008-09 whe 83% (=10,331) of cosultats did so. GPs are approved traiers ad so are assumed to be carryig out WPBAs. For that reaso, we did t ask them this questio. Table 2.1 Cosultats roles ad resposibilities Roles / resposibilities (=12,839) Supervise cliical work i the cliical eviromet 12,470 (97.1%) Provide formal feedback o cliical work i the cliical eviromet 11,969 (93.2%) Perform WPBA 11,877 (92.5%) Review traiees learig portfolios 10,170 (79.2%) Deliver formal teachig to groups of traiees away from the cliical eviromet 10,079 (78.5%) Hold regular meetigs with idividual traiees away from the cliical eviromet 10,066 (78.4%) Provide formal feedback o cliical work away from the cliical eviromet 9,689 (75.5%) Deliver ad mediate feedback usig results from formal assessmets 8,940 (69.6%) Have direct ivolvemet i the iductio of traiees to your ward/departmet 7,976 (62.1%) Have ivolvemet i the selectio process 6,475 (50.4%) Ivolvemet with college exams 2,765 (21.5%) Other 491 (3.8%) Noe of the above 51 (0.4%) Geeral Medical Coucil 15
Chapter 2: Supervisio ad assessmet Table 2.2 Number of traiees for whom cosultats are resposible Cliical supervisor Educatioal supervisor Traiig programme director Director of medical educatio Tutor Other Number of traiers i role 10,551 9,231 1,068 179 1,237 870 Average umber of traiees 4.2 2.7 36.1 172.9 16.6 61.2 Media 3.0 2.0 21.0 120.0 10.0 5.0 Table 2.3 Number of traiees for whom GP traiers are resposible Foudatio tutor GP traier Traiig programme director Number of traiers i role 128 1,433 128 Average 1.1 1.8 42.2 Media 1.0 2.0 36.0 Traiers are resposible for differet umbers of traiees i differet roles (tables 2.2 ad 2.3). Typically, cliical supervisors are resposible for three traiees ad educatioal supervisors for two. GP traiers are typically resposible for two traiees. Supervisors do betwee oe ad two hours of supervisio a week beyod their cotracted hours We asked traiers to tell us how may hours a week they were cotracted to sped supervisig traiees ad how may they actually spet. Just over half (65 out of 128) of the GP foudatio tutors had o cotracted hours for supervisio but were typically spedig three hours a week. While GP traiers, traiig programme directors ad those i other roles were spedig two hours a week more tha they were cotracted for. I other words, most traiers were carryig out a extra half-day to oe day s work a moth tha their cotracts allowed. The hours are broadly the same as those reported i 2010. Typically, cliical ad educatioal supervisors had a hour a week i their cotract but reported spedig two hours (tables 2.4 ad 2.5). 16 Geeral Medical Coucil
Chapter 2: Supervisio ad assessmet Table 2.4 Cosultats cotracted hours spet o supervisio ad the actual hours spet o supervisio Cliical supervisor Educatioal supervisor Traiig programme director Director of medical educatio Tutor Other Number i role 10,548 9,226 1,068 179 1,237 869 Average umber of hours cotracted a week 1.5 1.3 2.9 7.4 2.3 2.9 Media 1.0 1.0 3.0 8.0 2.0 1.0 Average umber of hours actually worked a week 3.4 2.5 5.5 7.4 2.3 5.4 Media 2.0 2.0 4.0 8.0 2.0 3.0 Table 2.5 GPs cotracted hours spet o supervisio ad the actual hours spet o supervisio Foudatio tutor GP traier Traiig programme director Other Number i role 128 1,432 128 123 Average umber of hours cotracted a week 3.6 4.1 7.7 7.0 Media 0.0 3.0 8.0 4.0 Average umber of hours actually worked a week 4.8 5.8 10.8 10.2 Media 3.0 5.0 10.0 6.0 Icreasig demads of geeral practice mea it is icreasigly difficult to do traiig work. I ofte fid there is pressure to do traiig work/preparatio at home, upaid, itrudig ito persoal time. This is ot recogised ad is usatisfactory ad uacceptable. Traiig with the itroductio of the e-portfolio ad assessmets has become much more labour itesive ad much less ejoyable. I am usure as to whether the chages have made ay differece i churig out better doctors. I cotiue to feel the stadards expected of us are becomig icreasigly demadig ad professioal but we are treated as hobbyists. For example the sessioal fees ad mileage paid beig less tha the cost icurred by us. Geeral Medical Coucil 17
Chapter 2: Supervisio ad assessmet The umber of cosultats who report that their workload does ot allow them to provide appropriate supervisio has dropped over time We asked traiers whether their workload allows them to provide appropriate cliical supervisio. More tha half said yes, but may said it did ot. GPs were more likely to say yes. However, this was fewer tha i 2007. Cosultats i some specialties were more likely to disagree tha others. Emergecy medicie, occupatioal medicie ad medicie traiers were the most likely to report that their workload did ot allow them to provide appropriate supervisio; psychiatry, aaesthetics ad public health traiers were the least likely. Whe this is compared to 2007, the same specialties top the list but overall fewer cosultats disagree or strogly disagree (table 2.6). 29.7% of cosultats said their workload did ot allow them to provide appropriate supervisio, compared to 39.7% i 2007. 50.7% said it did. 17.2% of GPs said their workload did ot allow them to provide appropriate supervisio. 66.7% said it did. I love beig a traier but the govermet seem to forget that traiees lear o the job ad the pressure of tryig to provide support i a pressurised workplace with targets/demads is hard. We eed better time recogitio for traiig. At preset we rely too much o the goodwill of a ethusiastic group of cosultat traiers. Service pressures will start to erode this. Table 2.6 Traiers who disagree or strogly disagree that their workload allows them to provide appropriate cliical supervisio for their traiees, 2010 compared to 2007 Specialty group Strogly disagree ad disagree 2010 Strogly disagree ad disagree 2007 Emergecy Medicie 524 (50.8%) 316 (57.9%) Occupatioal Medicie 22 (40.9%) 21 (47.6%) Medicie 3,358 (36.2%) 2,022 (46.0%) Paediatrics ad Child Health 1,136 (35.4%) 679 (46.5%) Ophthalmology 297 (34.7%) 145 (48.3%) Radiology 680 (33.7%) 349 (45.9%) Obstetrics ad Gyaecology 763 (33.0%) 436 (47.3%) Surgery 2,234 (31.2%) 1,286 (42.8%) Pathology 409 (24.2%) 262 (32.4%) Psychiatry 1,360 (17.6%) 964 (24.7%) Aaesthetics 1,360 (16.2%) 1,046 (25.2%) Public Health 142 (11.3%) 103 (19.4%) All 12,695 (30.1%) 7,629 (39.7%) 18 Geeral Medical Coucil
Chapter 2: Supervisio ad assessmet Table 2.7 Cosultats traiig to trai profile (=12,839) How to support traiees learig WPBA How to give feedback to traiees Equality ad diversity Never 1,569 (12.2%) 1,451 (11.3%) 1,275 (9.9%) 1,019 (7.9%) Yes i last three years 9,435 (73.5%) 9,505 (74.0%) 9,670 (75.3%) 10,354 (80.6%) Yes over three years ago 1,835 (14.3%) 1,883 (14.7%) 1,894 (14.8%) 1,466 (11.4%) Table 2.8 GPs traiig to trai profile (=1,544) How to support traiees learig WPBA How to give feedback to traiees Equality ad diversity Never 18 (1.2%) 19 (1.2%) 12 (0.8%) 70 (4.5%) Yes i last three years 1,464 (94.6%) 1,475 (95.3%) 1,440 (93.0%) 1,406 (90.8%) Yes over three years ago 66 (4.3%) 54 (3.5%) 96 (6.2%) 72 (4.7%) I feel icreasigly pressured due to work load i that I am ot as egaged ad proactive about traiig as I should be. My traiees seem less self motivated tha they should be. The departmet is too busy to give adequate time to the traiees. The traiees are very iexperieced which meas they require cosiderable supervisio. This makes the departmet ru slowly ad cliics over ru o a daily basis. This chage came about after MMC. Most traiers have received recet formal traiig i their role as traiers I the past three years, aroud three quarters of cosultats ad more tha ie i te GPs had received formal traiig i: how to support traiees learig WPBA how to give feedback to traiees equality ad diversity. Aroud oe i te cosultats ad oe per cet of GPs had ever had formal traiig i these areas (tables 2.7 ad 2.8). The umbers of cosultats who have received traiig i WPBA has improved markedly over the years of the traier survey. I 2007, oly 67% of cosultats had bee traied to carry out WPBAs; by 2008/09 this had rise to 80%. It ow stads at early 85%, with most of them receivig traiig i the past three years. Most traiers feel they have adequate traiig to give useful feedback to traiees based o the WPBA structures. 74.9% of cosultats said yes, compared to 77% i 2010 91.5% of GPs said yes, compared to 88% i 2010. Geeral Medical Coucil 19
Chapter 2: Supervisio ad assessmet Most traiers kow eough about traiees performace to give a reliable ad valid assessmet The data show a large majority of traiers feel they kow eough about traiees to give a reliable ad valid assessmet of their performace (table 2.9). Cosultats spet o average 2.1 hours givig feedback (media 1.0) givig feedback. GPs (=1,543) spet a average of 3.9 hours (media 2.0 hours) carryig out assessmets. GPs spet o average 3.3 hours givig feedback (media 2.0) givig feedback. 84.2% of cosultats agree or strogly agree that whe they assess traiees, they kow eough about their performace to give a reliable ad valid assessmet, compared to 78% of cosultats i 2010. 93.3% of GPs agree or strogly agree, compared to 87% of GPs i 2010. Table 2.9 Traiers kow traiees well eough to provide reliable ad valid assessmets of performace Cosultats (=12,839) GPs (=1,554) Strogly agree 3,752 (29.6%) 668 (43.6%) Agree 7,060 (55.7%) 776 (50.7%) Neither agree or disagree 1,039 (8.2%) 50 (3.3%) Disagree 604 (4.8%) 26 (1.7%) Strogly disagree 228 (1.8%) 11 (0.7%) Not applicable 156 (1.2%) 17 (1.1%) GPs sped twice as much time carryig out WPBAs as cosultats We asked traiers to estimate roughly how much time they spet o WPBA ad providig feedback i the four weeks before the survey. Cosultats (=11,865) spet a average of 2.4 hours (media 2.30 hours) carryig out assessmets. Traiers idetify multiple impedimets to usig WPBA but make time to support it Most traiers say they had ot tured dow a traiee s request for iput ito a WPBA because of work pressure. Cosultats were more likely to have tured dow a request tha GPs. I the four weeks before the survey, oe i te cosultats had tured dow oe traiee. 79.8% of cosultats had ot tured dow a request i the last four weeks, compared to 78% i 2008/09. 93.1% of GPs had ot tured dow a request, compared to 90% i 2008/09. Traiers also reported that there were may impedimets to usig WPBA i their departmets ad practices. The most commoly cited reaso was lack of time a factor that has remaied uchaged sice 2008 3. Traiers could tick more tha oe aswer ad provide their ow free text to aswer other (table 2.10). The free text commets from cosultats highlighted a umber of themes icludig difficulties withi some small specialties, lack of access to IT, problems with the e-portfolio, admiistrative obstacles ad lack of plaig by traiees. 20 Geeral Medical Coucil
Chapter 2: Supervisio ad assessmet Table 2.10: Which of the followig impede the use of WPBA i your departmet? Cosultats sayig yes (=12,839) GPs sayig yes (=1,544) Lack of time durig the workig day 8,416 (65.6%) 778 (50.1%) Traiee disegagemet 3,228 (25.1%) 431 (27.7%) Difficulties i recordig (eg e-portfolio) 2,829 (22.0%) 305 (19.6%) Lack of facilities (eg a room) 2,346 (18.3%) 55 (3.5%) No impedimets 2,229 (17.4%) 440 (28.3%) Seior cliicia disegagemet 1,871 (14.6%) 67 (4.3%) Other 1,191 (9.3%) 143 (9.2%) Lack of suitable traiig opportuities 937 (7.3%) 52 (3.3%) Carryig out the assessmet i the cliical settig but the PC for recordig is i a office i a completely separate buildig. Cadidates come at the last miute askig oe to fill a WPBA ad cite a recet iteractio. They are ot orgaised eough to war oe that they wat a formal assessmet. Disorgaised traiees who assume that they ca ask you to drop everythig ad do a W[P]BA there ad the. I will ofte ask traiees to sed me a request for a WPBA but they ofte do ot seem to be very proactive to do it or request them themselves. But some cosultats were positive about WPBA or recogised they eed to be more proactive. They are made a priority, so are ot impeded. Other forms of traiig may suffer through lack of time. I firmly believe that the use of WPBAs is etirely dow to traiee/er egagemet. The e-portfolio is ot a problem except to disegaged idividuals (or worse groups). I sometimes forget to prompt the traiee to do a WPBA ad oly remember afterwards whe the opportuity s goe. Last week I bleeped a differet cosultat s traiee whe a opportuity relevat to him arose, but o aswer. I have to say that I MAKE this happe. I arrive for work a hour earlier tha my o traiig parters ad leave later ad work eveigs ad weekeds o the e-portfolio ad tutorial plaig. I do ot mid this but reset the erosio of my icome. All the above improvig ad WPBA becomig part of everyoe s life. E-portfolio is still a uacceptably slow website which could be upgraded. Geeral Medical Coucil 21
Chapter 2: Supervisio ad assessmet More tha half of workplace based assessmets are scored retrospectively The survey asked traiers whether, i geeral, they scored assessmets retrospectively ad more tha half said they did with cosultats more likely tha GPs to do so (table 2.11). 15% of cosultats say they ever score retrospectively, compared to 20.4% i 2010. 43.8% of GPs say they ever score retrospectively, compared to 46.1% i 2010. Table 2.11 How frequetly do traiers score WPBAs retrospectively? Cosultats (=11,877) GPs (=1,549) Never 1,778 (15.0%) 678 (43.8%) Less tha 25% of the time 3,734 (31.4%) 531 (34.3%) 26% to 50% of the time 2,334 (19.7%) 173 (11.2%) 51% to 75% of the time 2,118 (17.8%) 107 (6.9%) 76% to 100% of the time 1,913 (16.1%) 60 (3.9%) Some of the commets shed some light o why WPBAs are scored retrospectively. Reasos iclude lack of time durig busy cliics ad lack of access to IT. But this traier added aother commet: I am sad that traiees usually ask for the forms to be filled out retrospectively, rather tha at the time - I ecourage them to do so cotemporaeously. All WPBA tools are perceived to have gaps whe it comes to providig meaigful data about traiees competecy We asked traiers for their perceptios about the usefuless of the various WPBA tools available to them: mii cliical evaluatio exercise (mii-cex) directly observed procedural skills (DOPs) case based discussio (CBD) multi-source feedback (MSF) cosultatio observatio tool (COT). All were perceived to have gaps (table 2.12 ad 2.13). GPs overall gave higher ratigs tha cosultats. Overall, MSF received the least favourable ratigs. There were a large umber of commets about WPBA, with may regardig it as a time cosumig tick-box exercise. There were several commets otig that WPBA was useful to support uder-performig traiees. The assessmet tools for traiig waste a eormous amout of time, they are absurdly process drive ad dimiish traiig. The poorly performig traiee ca be helped by this process but it is a hidrace to adequately performig doctors. 22 Geeral Medical Coucil
Chapter 2: Supervisio ad assessmet Table 2.12 Cosultats views o whether WPBA tools provide a meaigful ad sufficiet dataset about traiees competecy Mii-CEX DOPs CBD MSF Nothig meaigful 658 (6.1%) 453 (4.2%) 366 (3.2%) 784 (7.0%) Isufficiet 1,707 (15.8%) 1,137 (10.6%) 1,223(10.6%) 1,606 (14.3%) Sufficiet with mior gaps 5,902 (54.7%) 5,043 (46.9%) 5,466 (47.3%) 4,687 (41.8%) Sufficiet 2,513 (23.3%) 4,118 (38.3%) 4,490 (38.9%) 4,146 (36.9%) Total ratig tool 10,780 10,751 11,545 11,223 Table 2.13 GPs views o whether WPBA tools provide a meaigful ad sufficiet dataset about traiees competecy CBD COT Mii-CEX DOPS Nothig meaigful 21 (1.4%) 9 (0.6%) 17 (2.4%) 119 (7.9%) Isufficiet 71 (4.6%) 31 (2.0%) 81(11.2%) 120 (8.0%) Sufficiet with mior gaps 716 (46.5%) 497 (32.7%) 379 (52.4%) 671 (44.6%) Sufficiet 732 (47.5%) 984 (64.7%) 246 (34.0%) 595 (39.5%) Total ratig tool 1,540 1,521 723 1,505 Traiig MUST become less tick-box. Most of the W[P]BA s I feel are fairly worthless except the 360 feedback ad there HAS to be less paperwork as it is disegagig a great may good idividuals. Mii-CEX are completely impractical. If I sat ad watched my juior work durig a cliic o-oe would go home util mid eveig. The juiors are already so slow they see tiy umbers of patiets. Oe cosultat commeted that they were better tha othig. The WPBA ad e-portfolio tools are overly bureaucratic but better tha the complete absece of structured assessmet which I had i my traiig. WPBA s are traiig tools NOT assessmets of competece. Their use to defie competece/ icompetece should be limited. Their utility is i the documeted improvemet i cliical skills ad as a mechaism for improved traiig. Geeral Medical Coucil 23
Chapter 2: Supervisio ad assessmet The proportio of traiers meetig our stadards is gradually icreasig despite the heavy workload ivolved The stadards we set for traiers explicitly state that supervisig ad assessig the progress of traiees is cetral to their role; they also make clear that traiers must be traied to do this 1. The data from the traier survey datig back to 2007 show a gradual improvemet i the proportio who have received this traiig ad the proportio of cosultats who carry out WPBA. It also shows a improvemet i the proportio who feel their workload allows them to provide appropriate supervisio for their traiees. That matters are improvig is a tribute to traiers. As the data here show, most traiers work beyod their cotracted hours to fulfil their traiig obligatios. Although may cosultats ad GPs do ot like WPBAs (as evideced by their commets), they cotiue to carry them out. They are usig tools that may regard as iadequate ad a system that may view as simply a tick-box exercise. Assessmet is a key part of learig i the cliical eviromet. We have edorsed ad published proposals for discussio aimed at achievig a better balace betwee helpig traiees lear ad develop, ad to provide evidece for their progress i the competecies required, http://www.gmc-uk. org/learig_ad_assessmet_i_the_cliical_ eviromet.pdf_45877621.pdf. 24 Geeral Medical Coucil
Chapter 2: Supervisio ad assessmet Deaeries ad the medical royal colleges have also played their part by developig material to support traiers. Ket, Surrey ad Sussex Deaery, for example, hosts e-learig material available through its website for the estimated 500 to 1,000 assessors of traiees i each trust. They developed this iitiative i partership with South Thames Foudatio School o behalf of the NHS ad other parter orgaisatios. * The Royal College of Ophthalmologists has developed WPBA hadbooks for traiers, traiees ad assessors for each idicative year of traiig. Cocer about whether traiers have eough time to trai has bee a cosistet theme throughout the life of the survey. I 2007, PMETB s report cocluded that traiers require more recogitio for traiig, i the form of icreased protected time i their job plas or through remueratio, for example. 4 Little seems to have chaged. I 2011, oe third of cosultats ad early oe fifth of GPs say that their workload is so demadig that they caot provide appropriate supervisio. This will be importat evidece i the debate o the recogitio ad approval of traiers ow uderway. * The e-learig material is available at http://kssdeaery.org/etft These are available at http://www.rcophth.ac.uk Geeral Medical Coucil 25
Chapter 3: The Workig Time Regulatios The Workig Time Regulatios itroduced ito UK law a 58-hour workig week for juior doctors i 2004, reducig to a 56-hour week i 2007, ad to a 48-hour week from 1 August 2009. This chapter looks at how traiers have respoded over time to the shorteig workig week. It examies the impact of the 48-hour week o traiers compared to the 56-hour week icludig whether they have bee able to deliver traiig to the same stadards ad, if so, whether this was by makig chages. It also looks at traiers perceptios of whether their traiees work beyod the WTR limits. Key fidig: Traiers have chaged the way they trai to maitai stadards but cocers remai amog a large miority that the WTR are havig a egative impact o traiig. Traiers report that traiees rarely work beyod the WTR limits. 26 Geeral Medical Coucil
Chapter 3: The Workig Time Regulatios Traiers ad departmets have made chages to the way they teach Just over half of all traiers say their departmet delivers traiig to the same stadard i the 48-hour week compared to the 56-hour week, although may had made chages to do so (table 3.1). Just uder oe third of cosultats say they are ot deliverig traiig to the same stadard, compared to oe i te GPs. The data are broadly similar to 2010 but slightly fewer cosultats say they are ot traiig to the same stadard (34.5% i 2010 compared to 30.8% i 2011) 5. Whe asked whether they had made chages to the way they teach i respose to the shorter workig week ad the resultat chages i the rota: 59.3% of cosultats said yes, compared to 52% i 2010. 38.2% of GPS said yes, compared to 30% i 2010. Table 3.1 Is your departmet able to deliver traiig to the same stadard i the 48-hour week as i the 56-hour week? Cosultats (=12,839) GPs (=1,549) Yes 3,030 (23.6%) 706 (45.6%) Yes, with chages to the traiig Yes, with chages to the rota 1,349 (10.5%) 73 (4.7%) 1,981 (15.4%) 101 (6.5%) Yes, with other chages 270 (2.1%) 15 (1.0%) No 3,948 (30.8%) 157 (10.1%) Do t kow 2,261 (17.6%) 497 (32.1%) Table 3.2 What chages have traiers made i respose to the shorter workig week ad chages to the rota? I have restructured the traiig I have take o fewer traiees I have ecouraged more self-directed learig amog my traiees Cosultats (=12,839) GPs (=1,554) 3,691 (28.7%) 331 (21.3%) 907 (7.1%) 21 (1.4%) 4,134 (32.2%) 248 (16.0%) I have delegated traiig 1,741 (13.6%) 130 (8.4%) I made some other chages 1,415 (11.0%) 137 8.8%) Table 3.2 outlies the chages made; traiers were asked to tick all optios that applied. Cosultats were most likely to say they had ecouraged more self-directed learig by their traiees or had restructured the traiig. GPs were also most likely to say they had ecouraged more self-directed learig. A miority had either take o fewer traiees or delegated traiig. I believe that because with EWTD * there is more time available for private study, that traiig withi workig hours should be more directed to cliical issues rather tha lectures/tutorials. I feel that for surgical traiees, availability for 56 hours a week would ehace traiig sigificatly. There is a real risk of producig uder traied ad uder cofidet cosultats i the future. I spite of traiig beig restructured I still feel the EWTD does ot give traiees adequate experiece to feel 100% cofidet eve at accreditatio. * I free text commets, traiers usually referred to the WTR as the EWTD Europea Workig Time Directive Geeral Medical Coucil 27
Chapter 3: The Workig Time Regulatios GPs are more likely to feel that their traiees eeds are met withi the 48-hour week GPs were more likely to say that their traiees eeds were met withi the 48-hour week tha were cosultats. 56.4% of cosultats said yes, their traiees eeds were beig met. 89.8% of GPs said yes. GPs are more likely to feel that traiees rarely or ever work beyod their WTR limits 60.9% of cosultats say ever or rarely. 28.2% say weekly or daily. 88.2% of GPs say rarely or ever. 6.7% say weekly or daily. Table 3.3 outlies how ofte traiees work beyod their WTR limits. These data are broadly similar to 2010. However, they differ from the data provided by traiees, two thirds of whom report workig beyod their rotas o a daily, weekly or mothly basis 5. As i previous years, there were may commets from traiers about the impact of the 48-hour week. The followig are typical: Please ca the GMC take a lead i articulatig the pressures o traiig created by EWTD. This is the greatest threat to our professioal itegrity over the ext 10 years ad it worries me hugely. Traiees eed dedicated time to trai o sufficiet cliical volumes o elective cases (expesive i time/ resources) ad emergecies but this is ot always betwee 9-5 ad must be recogised. EWTD ad full shift rota s have ruied the juior doctor experiece to the detrimet of their traiig ad hece to their experiece of cotiuity of care. Table 3.3 How ofte do your traiees work beyod their WTR limits? Cosultats (=12,839) GPs (=1,554) Never 1,754 (13.7%) 688 (44.4%) Rarely 6,054 (47.2%) 678 (43.8%) Mothly 1,417 (11.0%) 80 (5.2%) Weekly 2,939 (22.9%) 88 (5.7%) Daily 675 (5.3%) 15 (1.0%) Traiees are volutarily comig i o EWTD days off to get experiece of operatios they would otherwise miss. There is a geeral cocer amog themselves that they will be less experieced whe reachig cosultat level tha their predecessors. 28 Geeral Medical Coucil
Chapter 3: The Workig Time Regulatios Traiers are maagig the impact of the WTR but cocer remais about its log-term impact o traiig The data preseted here are broadly similar to last year: GPs report better progress with implemetig the WTR tha cosultats. They are more likely to report beig able to achieve the same stadard of traiig as i the 56-hour week, ad more likely to report that their traiees eeds were beig met. There are also some sigs of progress i secodary care with fewer cosultats reportig that they are ot able to maitai stadards i their departmets. But there are may cosultats whose traiees are still workig beyod their rostered hours ad may cosultats who feel that the stadard of traiig is beig compromised by the shorter workig week. Take as a whole, the evidece from this survey sice 2009 idicates that may traiers, providers ad deaeries are maagig the implemetatio of the WTR well. Traiers ad departmets are adaptig their traiig styles to take accout of the shorter workig week, as opposed to reducig the umber of traiees they take o. But may traiers remai to be coviced that high quality traiig ca be delivered i the 48-hour workig week. We have commissioed research ito the impact of both the WTR ad the steps take to comply with them o the quality of traiig i the UK, as part of our commitmet to work with the royal colleges, postgraduate deaeries ad the service to improve what is clearly a uacceptable situatio. Also, as we move forward with developig ad improvig this survey for 2013 ad beyod, we will work with postgraduate deaeries ad royal colleges to look at ways of securig a outcome-based assessmet of the impact of reduced workig hours o traiig. Geeral Medical Coucil 29
Chapter 4: Preparedess This chapter examies traiers perceptios of how well traiees are prepared for the ext stage of their traiig ad how traiers view traiees cofidece. It also looks at the structures available for supportig poorly performig traiees. Key fidig: A miority of traiers report beig aware of traiees who were siged off a stage of traiig whe traiers did ot thik they were competet. A majority of traiers thik traiees are less cofidet ad less able to work idepedetly tha they were i their day. Service pressures are leadig traiers to restrict the activity of traiees. 30 Geeral Medical Coucil