How the national training survey improved cultures and training experiences at Milton Keynes University Hospital
The results from the 2018 and 2019 national training surveys highlighted issues with training and supervision in the obstetrics and gynaecology department at Milton Keynes University Hospital.
Between 2018-2019 the department received 13 below average scores across multiple areas. These included supportive environments, handover, access to adequate experience, and overall satisfaction.
Trainees also reported they were missing training opportunities due to heavy workloads. And in the free text comments, they highlighted concerns about patient safety due to staff shortages and lack of out of hours consultant supervision. A Royal College of Obstetrics and Gynaecology survey of trainees at the department and exception reporting data also supported the national training survey findings.
As a result, Health Education England (HEE) Thames Valley met with trainees to further understand the situation and the impact on training. Several risks were identified including:
- trainees were frequently undertaking clinics without direct supervision
- routine clinical guidance was vague and outdated
- poor organisation and variable staff attendance meant trainees were unable to hand patients over to colleagues effectively
- instances of bullying and undermining.
What action was taken?
In response, HEE Thames Valley set several mandatory requirements, along with recommendations to improve training.
They then conducted two virtual department visits and interviewed the local Director of Medical Education and the local College Tutor to check on progress. From this, it was evident that the department had taken significant action to address issues, including:
- hiring two additional registrars to support trainee workloads, increase access to learning opportunities and improve supervision
- creating a forum where trainees can raise concerns
- introducing more structured handovers
- increasing the visibility of consultants on the labour ward.
What was the outcome?
There have been notable improvements relating to the culture in the department. Trainees are encouraged to speak up and report instances of unacceptable and unprofessional behaviour.
Trainees also reported the new staff forum was working well and their feedback is now listened to and acted on. Handovers are well attended by all necessary staff, and trainees are encouraged to report instances of unacceptable and unprofessional behaviour. Additionally, ‘meet and greets’ for new starters with the wider team has helped to create a more supportive environment.
Follow up discussions with trainees in 2021 confirmed that improvements had been sustained and further progress had been made. This was evidenced in the 2021 and 2022 national training survey results, where there was a reduction in the number of below average scores. The results also showed that trainees rated curriculum coverage, feedback, educational governance, and regional teaching as above average.
The department will continue to be monitored locally by HEE Thames Valley, due to two below average outliers relating to rota design and local teaching in the 2022 national training survey. The department received a national training survey free text comment reporting patient safety concerns. Despite this, we’re reassured that these concerns are being addressed by the management team.
