Examples of how your answers improve training

On this page, you can read case studies on how we’ve used the national training survey to improve training in recent years.

Monitoring change in Yorkshire and the Humber

Foundation trainees in trauma and orthopaedic surgery and general surgery posts at Leeds General Infirmary (LGI) and in general surgery at St James’s University Hospital (SJUH) faced many problems around clinical supervision and poor access to education. We intervened with enhanced monitoring to help Health Education Yorkshire and Humber work with the hospitals to make improvements. The results of the national training survey were used throughout to monitor the impact of the changes that had been made. In 2019, national training survey results supported the positive findings on visits, and we were able to bring enhanced monitoring to a close.

In December 2012, Health Education Yorkshire and Humber found several challenges around clinical supervision and poor access to education.

Visits to the trust in 2014 showed they had made significant progress in addressing the issues. However, visits in 2015 and 2016 found that there remained ongoing concerns around support for foundation year one trainees. In the 2018 national training surveys results, there was good feedback from foundation trainees in general surgery at SJUH. But some concerns remained based on the feedback from foundation trainees in trauma and orthopaedic surgery at LGI. Again, lack of support and supervision alongside isolation were recurring themes.

A Monitoring Learning Environment (MLE) meeting was held in January 2019. This meeting highlighted significant progress – rotas had been revised, four locums had been appointed to fill rota gaps, and handover was now registrar led.

At an MLE visit in July, we met with the senior management team as well as with trainees. They told us about a series of changes, which had been put in place to address the concerns. These included initiatives like ‘registrar of the week’, the appointment of intermediate grade doctors to enable trainees to attend teaching, and the recruitment of physician associates to share the workload. We also learnt about the support orthogeriatricians gave to trainees, an initiative that was highly praised by all. The department had made successful progress and all trainees reported an improved experience.

Our 2019 national training survey results showed considerable improvement for the trauma and orthopaedic department. This included significant improvements in workload, rota design and study leave. We closed the enhanced monitoring case in July and will continue to follow this case routinely.

Providing evidence to support new initiatives

Association of Anaesthetists fatigue working group - more detail available in the Training environments 2018 report

Following the tragic death of an anaesthetic trainee driving home after working night shifts, the Association of Anaesthetists established a working group to help improve the culture around fatigue. In 2016 they surveyed anaesthetics trainees to investigate how fatigue and shift work was impacting them. The findings highlighted a serious problem among UK trainees.

To address the issues raised, they established a fatigue working group with the Association of Anaesthetists, Royal College of Anaesthetists, Faculty of Intensive Care Medicine and experts in the field. The group developed standards for rest facilities and culture. They produced educational resources on fatigue, sleep, and managing shift work, and ran a #fightfatigue campaign. Anecdotal feedback suggested some organisations were adopting their recommendations but for others, change was slower.

In 2018, all anaesthetics trainees were asked four new questions about fatigue and shift work as part of the specialty specific questions in the national training survey. The results highlighted areas for concern including that one in three trainees regularly felt too tired to get home safely. The results also suggested that teaching on fatigue and sleep was helpful, but unfortunately this was not available for most trainees.

The fatigue working group see the inclusion of questions about fatigue in the national training survey as crucial; ongoing data collection and feedback is needed to support change by individuals and departments. It also signifies how serious national organisations consider the issue and its potential to impact on training. The fatigue working group hope to influence behaviour by changing conversations at local, regional and national levels, and see the inclusion of questions in the national training survey as an important step in allowing these conversations to begin

Using trainer results to understand issues and good practice

Deanery quality management and improvement in Scotland - from 2017 key findings report.

In Scotland, deanery quality management and improvement is managed by eight specialty Quality Management Groups (sQMGs).

Each sQMG is accountable for the quality management of training in all posts and programmes within its scope across Scotland.

At the start of each quality annual cycle, typically in August or September, each sQMG convenes Quality Review Panels (QRPs) with college, trainee and lay members to review all of the new data, information and intelligence available for all posts and programmes. Each QRP reviews data from a number of sources, including: national training surveys results from trainees and trainers; patient safety and bullying and undermining comments; Deans’ reports; enhanced monitoring details; Scottish Training Survey data; and requirements from recent deanery visits.

Reviewing all of this information allows the QRPs to identify how training environments are performing. Supported by a ‘decision aid’ the panels decide which posts or programmes need 'triggered visits' to gather more information.

The trainer survey data is integral to the data, information and intelligence that is reviewed and discussed for each post at the QRPs. When the trainers' survey shows several red or pink flags - despite indications otherwise that the training environment is satisfactory - a Director of Medical Education enquiry is triggered (and the response would be considered by the sQMG). NHS Education for Scotland have also investigated sites that have green flags in the trainers' survey to understand what good practice may be taking place.

Valuing education through an education contract

Health Education and Improvement Wales Education Contract - from the 2017 key findings report.

Health Education and Improvement Wales (HEIW) has recently introduced an Education Contract, between the doctor in training, local education provider (LEP) and itself. It documents specialty specific expectations in terms of sessions trainees must attend, and key education and training opportunities.

HEIW mapped these criteria and metrics against our approved curricula and royal college training standards. Our Promoting excellence standards form the basis against which we and HEIW will monitor the delivery of training across Wales. And a number of those standards and requirements are detailed within the education contract.

Accountability for meeting the responsibilities set out in the contracts lies with the trainee, LEP, and HEIW. To make sure issues are identified quickly, HEIW reviews progress against the contract at agreed intervals through existing processes, such as the trainees' Annual Review of Competence Progression; trainee end of placement evaluation feedback processes; real-time monitoring systems and self-reporting for LEPs.

The national training survey results are used in three ways to aid the accountability. Firstly, results from the existing processes highlighted above are triangulated with the national training survey results to determine trends and whether there is alignment over particular concerns. Secondly, the survey results are used to inform HEIW of whether any sites need to be added to the risk register. Thirdly, the results are used as a means of measuring the effectiveness of interventions put in place to address issues.

By signing this contract, all parties are demonstrating their commitment and support to developing a culture across NHS Wales which supports learning, education and training.

Working together to improve training and patient safety

North Middlesex University Hospital NHS Trust

In March 2016, we carried out an inspection of the emergency medicine department of North Middlesex University Hospital with Health Education England (HEE). Previous national training surveys showed very poor results for doctors in the second year of the Foundation Programme, general practice and specialty doctors in training at this department.

We worked closely with the trust, HEE, NHS England, NHS Improvement and the Care Quality Commission to closely monitor these concerns and to put measures in place to help improve the standard of training and patient safety in the department. Follow up visits in June and September 2016 revealed some improvements in the level of support and supervision that doctors in training were receiving and we saw echoes of this in the national training surveys results for the department in 2017.

However when some of the measures were withdrawn in 2017, North Middlesex began to deteriorate again. We set additional conditions, which were more prescriptive, with specific requirements around how supervision of doctors in training should be structured. We did this in order to make sure the trust was clear about our expectations, and to help them plan and implement a structure that met our standards.

A series of visits throughout late 2017 and early 2018 confirmed that the conditions had been enacted, resulting in a safer and more supportive environment. We continue to work closely with all the organisations involved to keep the situation under close review to make sure that trainees are being properly supported.