Working with doctors Working for patients

Theme 1: Learning environment and culture

Purpose

This theme is about making sure that the environment and culture for education and training meets learners’ and educators’ needs, is safe, open, and provides a good standard of care and experience for patients.

Education and training should be a valued part of the organisational culture. Learners will have a good educational experience and educators will be valued where there is an organisational commitment to, and support for, learning. High quality organisations will promote excellence in education.

The clinical learning environment is multiprofessional, so an effective learning culture will value and support learners from all professional groups.

Responsibility

Local education providers (LEPs) – specifically the leadership at board level or equivalent – provide the learning environment and culture. They are accountable for how they use the resources they receive to support medical education and training. They are responsible for taking action when concerns are raised that impact on patient safety. They work with postgraduate deaneries, local education and training boards (LETBs) and medical schools in recognising and rewarding trainers.

Postgraduate deaneries, LETBs and medical schools make sure that medical education and training takes place in an environment and culture that meets these standards, within their own organisation and through effective quality management of contracts, agreements and local quality control mechanisms. They work together to respond when patient safety and training concerns are associated.

Standards

S1.1 The learning environment is safe for patients and supportive for learners and educators. The culture is caring, compassionate and provides a good standard of care and experience for patients, carers and families.

S1.2 The learning environment and organisational culture value and support education and training so that learners are able to demonstrate what is expected in Good medical practice and to achieve the learning outcomes required by their curriculum.1

Requirements

R1.1 Organisations2 must demonstrate a culture that allows learners and educators to raise concerns about patient safety, and the standard of care or of education and training, openly and safely without fear of adverse consequences.

R1.2 Organisations must investigate and take appropriate action locally to make sure concerns are properly dealt with. Concerns affecting the safety of patients or learners must be addressed immediately and effectively.

R1.3 Organisations must demonstrate a culture that investigates and learns from mistakes and reflects on incidents and near misses. Learning will be facilitated through effective reporting mechanisms, feedback and local clinical governance activities.

R1.4 Organisations must demonstrate a learning environment and culture that supports learners to be open and honest with patients when things go wrong – known as their professional duty of candour – and help them to develop the skills to communicate with tact, sensitivity and empathy.

R1.5 Organisations must demonstrate a culture that both seeks and responds to feedback from learners and educators on compliance with standards of patient safety and care, and on education and training.

R1.6 Organisations must make sure that learners know about the local processes for educational and clinical governance and local protocols for clinical activities. They must make sure learners know what to do if they have concerns about the quality of care, and they should encourage learners to engage with these processes.

R1.7 Organisations must make sure there are enough staff members who are suitably qualified, so that learners have appropriate clinical supervision, working patterns and workload, for patients to receive care that is safe and of a good standard, while creating the required learning opportunities.

R1.8 Organisations must make sure that learners have an appropriate level of clinical supervision at all times by an experienced and competent supervisor, who can advise or attend as needed. The level of supervision must fit the individual learner’s competence, confidence and experience. The support and clinical supervision must be clearly outlined to the learner and the supervisor.

Foundation doctors must at all times have on-site access to a senior colleague who is suitably qualified to deal with problems that may arise during the session.3 Medical students on placement must be supervised, with closer supervision when they are at lower levels of competence.

R1.9 Learners’ responsibilities for patient care must be appropriate for their stage of education and training. Supervisors must determine a learner’s level of competence, confidence and experience and provide an appropriately graded level of clinical supervision.

R1.10 Organisations must have a reliable way of identifying learners at different stages of education and training, and make sure all staff members take account of this, so that learners are not expected to work beyond their competence.

R1.11 Doctors in training must take consent only for procedures appropriate for their level of competence. Learners must act in accordance with General Medical Council (GMC) guidance on consent. Supervisors must assure themselves that a learner understands any proposed intervention for which they will take consent, its risks and alternative treatment options.

R1.12 Organisations must design rotas to:

  1. a make sure doctors in training have appropriate clinical supervision
  2. b support doctors in training to develop the professional values, knowledge, skills and behaviours required of all doctors working in the UK
  3. c provide learning opportunities that allow doctors in training to meet the requirements of their curriculum and training programme
  4. d give doctors in training access to educational supervisors
  5. e minimise the adverse effects of fatigue and workload.

R1.13 Organisations must make sure learners have an induction in preparation for each placement that clearly sets out:

  1. a their duties and supervision arrangements
  2. b their role in the team
  3. c how to gain support from senior colleagues
  4. d the clinical or medical guidelines and workplace policies they must follow
  5. e how to access clinical and learning resources.

As part of the process, learners must meet their team and other health and social care professionals they will be working with. Medical students on observational visits at early stages of their medical degree should have clear guidance about the placement and their role.

R1.14 Handover4 of care must be organised and scheduled to provide continuity of care for patients and maximise the learning opportunities for doctors in training in clinical practice.

R1.15 Organisations must make sure that work undertaken by doctors in training provides learning opportunities and feedback on performance, and gives an appropriate breadth of clinical experience.

R1.16 Doctors in training must have protected time for learning while they are doing clinical or medical work, or during academic training, and for attending organised educational sessions, training days, courses and other learning opportunities to meet the requirements of their curriculum. In timetabled educational sessions, doctors in training must not be interrupted for service unless there is an exceptional and unanticipated clinical need to maintain patient safety.

R1.17 Organisations must support every learner to be an effective member of the multiprofessional team by promoting a culture of learning and collaboration between specialties and professions.

R1.18 Organisations must make sure that assessment is valued and that learners and educators are given adequate time and resources to complete the assessments required by the curriculum.

R1.19 Organisations must have the capacity, resources and facilities5 to deliver safe and relevant learning opportunities, clinical supervision and practical experiences for learners required by their curriculum or training programme and to provide the required educational supervision and support.

R1.20 Learners must have access to technology enhanced and simulation-based learning opportunities within their training programme as required by their curriculum.

R1.21 Organisations must make sure learners are able to meet with their educational supervisor or, in the case of medical students, their personal adviser as frequently as required by their curriculum or training programme.

R1.22 Organisations must support learners and educators to undertake activity that drives improvement in education and training to the benefit of the wider health service.

 

1 For undergraduate education, the learning outcomes for graduates are set out in Outcomes for graduates. For postgraduate training, the curriculum is approved by the General Medical Council.

2 Organisations that are responsible for the learning environment and culture.

3 This will normally be a doctor, but on some placements it may be appropriate for a senior healthcare professional to take on this role.

4 Handover at the start and end of periods of day or night duties, every day of the week.

5 Resources and facilities may include: IT systems so learners can access online curricula, workplace-based assessments, supervised learning events and learning portfolios; libraries and knowledge services; information resources; physical space; support staff; and patient safety orientated tools.