How the national training survey improved training at Guy’s and St Thomas’ NHS Foundation Trust
In 2019, the clinical oncology department at Guy’s and St Thomas’ NHS Foundation Trust received below average scores in 14 areas of the national training survey.
The survey found our standards relating to supportive cultures, educational governance, and leadership were not being met, with trainees flagging issues relating to clinical supervision, overall satisfaction, workloads, and access to training. As a result, there were also concerns about the implications for patient safety.
Health Education England (HEE) London met trainees to explore these issues in more detail. Doctors in training reported that they found it difficult to access support and raised concerns about bullying and there was a blame culture within the department.
They also expanded on the issues identified in the national training survey, highlighting:
- inductions did not include all the important information, with this often being passed on by more senior trainees
- rota gaps meant they had to regularly work beyond their hours
- heavy workloads meant they found it difficult to prepare for exams
- feedback was unconstructive and wasn’t confidential
HEE London also met with the senior leadership team who highlighted similar concerns. In particular, they noted that the local faculty group meetings, where trainees were able to raise issues with senior colleagues, were not taking place.
As a result of these challenges, doctors training in the department had become demoralised.
What action was taken?
In response to the national training survey results and trainee feedback, we placed the department into enhanced monitoring in 2019. HEE London also stipulated issues relating to consultant clinical cover, supervision, and bullying had to be addressed within five working days.
Further visits from HEE London and our team resulted in a wide range of positive actions being taken to address the cultural issues. There has been comprehensive training within the department to address unprofessional behaviours and staff have been provided with resources to address bullying. Educational supervisors have also undertaken training to help them speak up about issues. The trust also appointed a Guardian of Safe working hours, who meets regularly with trainees to understand concerns.
The department also took steps to improve supervision:
- a named consultant now acts as a point of contact if trainees need support or want to escalate concerns
- educational supervisors have allocated time each week to meet with trainees
- trainees helped to redesign the work rota
- the department hired more doctors to support the on-call rota and help reduce trainee workloads.
What was the outcome?
The actions taken by the department led to significant improvements in the 2021 national training survey results, notably for rota design, workloads, and supervision. As the department’s results have demonstrated a sustainable improvement since 2019, we were able to remove the department from enhanced monitoring in 2021.
The 2022 national training survey results also showed that the improvements have been sustained. Trainees are positive about working in the department, saying it’s supportive with a strong focus on wellbeing, and that they receive high-quality supervision and training. Recommendations from trainees have also boosted the demand for training posts.