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This page is part of the learning materials to support our Raising and acting on concerns decision tool

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Raising concerns about the ratio of trainees

Background

Dr Miller is a urology specialty trainee in her first year working in a tertiary hospital. She is concerned that the hospital pressures are impacting the supervision of trainees. 

In particular she is worried that trainees working on the inpatient wards and outpatient clinics are not receiving adequate clinical supervision, Ultimately she is troubled that this is having a detrimental effect on trainees education and patient clinical care. 

Scenario

Most recently on Dr Miller's ward, a 67 year old patient, Mr Singh, had been admitted with acute urinary retention secondary to a malignant enlarged prostate and required a urinary catheter. Mr Singh also takes Warfarin for atrial fibrillation. 

The foundation doctor, Dr Rao, who was managing Mr Singh  was anxious as he had never inserted a catheter where the patient had the above pathology. 
He also remembered that there is a risk of bleeding when inserting a catheter in those with an enlarged malignant prostate, and identified that Mr Singh is also on warfarin.  Dr Rao therefore informed the patient he could not do the procedure without appropriate senior supervision. 

The experienced registrar was unavailable for over 2 hours as he was attending to urgent surgery. The delay caused Mr Singh and his family a lot of distress as he was in considerable pain.

Mr Singh decided to make a formal complaint.

What the doctor did

Dr Miller discusses with her colleagues that trainees are filling gaps in the rota in place of more senior doctors. Some trainees complain that they feel uncomfortable treating patients with many co-morbidities, without input from clinical supervisors. They worry about the risk to patient safety and the quality of care. They also feel that the time they spend filling gaps in the rota means they have less time available for formal training and there has been no response so far from the hospital management about the incident reports. 

Despite the trainees raising their concerns with their educational supervisors, action on staff shortages is not given priority. It seems that the restructure of the acute admissions unit is taking priority, staffing and other resources. 

The trainees decide to approach the Medical Director, Dr Clark, about their concerns with the rotas. Although he is sympathetic, he implies that his hands are currently tied given the demands of the restructure. The trainees feel that their concerns are not being taken seriously enough and tell Dr Clark they plan to contact the Deanery for advice.

The trainees write a letter to their postgraduate Dean about their concerns. A follow-up Deanery visit confirms the service and training issues. The postgraduate Dean talks about the issues with Dr Clark who agrees to reassign the rotas and make arrangements for closer clinical supervision a priority.

The postgraduate Dean kept the GMC informed of the situation and they check the progress made until satisfied that patient safety is no longer at risk.