How the national training survey improved support and training at Aberdeen Maternity Hospital
Aberdeen Maternity Hospital serves the area of Grampian and the Scottish islands of Shetland and Orkney. The site provides training for Paediatrics trainees, at various levels. NHS Education for Scotland (NES) routinely monitor the quality of training at the site, through the national training survey and Scottish Training Survey (STS).
In 2016 there was a marked deterioration in Aberdeen Maternity Hospital’s national training survey results. Trainees and trainers rated the department poorly in a number of areas, including reporting systems, supportive environments, adequate experience, educational governance, supervision, regional teaching, and study leave.
The national training survey results initiated a visit to the department from the NES team. During the visit discussions with trainees highlighted an unsupportive culture in the department that was affecting training. This was attributed to several issues including:
- feedback was felt to be overly critical and often delivered in a public forum
- staff were providing different clinical guidelines, which trainees found confusing
- trainees were discouraged from asking questions and discussing cases with senior staff
The department voiced issues with adequate staffing, detailing an imbalance between the number of trainees, higher specialty trainees and consultants. This had resulted in a disparity between service provision and training. While trainees were able to advance their skills through their daily clinical work, trainees found it difficult to access formal teaching and training.
What actions were taken?
Following the visit to the department NES escalated the case to our enhanced monitoring processes. As a result, the department made several innovative changes. These included:
- a set of clinical guidelines were developed with trainees, providing consistency between different staff members
- clinical staff took part in leadership training, improving the culture within in the department and the delivery of feedback
- an electronic feedback system was developed, which allowed senior staff to notify trainees of their good work
- the creation of a staff forum gave trainees more opportunities to raise issues and provide feedback
- provision of pre-induction information, informing new trainees of the fast-paced nature of the department and detailing the types of support available
The department also recruited a physician associate and additional locum doctors to alleviate the workload pressures and rota gaps within the department. This has created more time for trainees to gain the curriculum requirements they need. There is also now protected time within their rotas for training.
What was the outcome?
We visited the department with NES regularly between 2017-2020 and found that the actions taken had led to significant improvements being sustained. The national training survey, STS pre-visit questionnaires helped to monitor progress and track the increasing satisfaction levels, which had substantially increased.
The department’s proactive attitude has also meant that the national training survey results have continually improved since 2016. In 2021, the department received seven above average scores and no below average scores. This data, alongside feedback from trainees, meant that we were able to remove the department from enhanced monitoring.
Steps to improve the quality of training and culture in the department have enabled a better balance between service provision and training, resulting in an improved learning environment. Work is ongoing to maintain these improvements and the national training survey will continue to play an integral part in ensuring that these are sustained.
