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Date of visit 20th March 2019 Level(s) FY/ST

Type of visit Enhanced Monitoring Hospital Ninewells Hospital

Specialty(s) General Surgery Board NHS Tayside

Visit panel

Professor Clare McKenzie Postgraduate Dean

Mr Robin Benstead GMC Representative

Ms Angela Carragher GMC Representative

Ms Clare McNaught Royal College Representative

Mr Alasdair Robertson Training Programme Director

Dr Peter Armstrong Foundation Programme Director

Dr Allan Green Trainee Associate

Mrs Penny McGregor Lay Representative

Ms Vicky Hayter Quality Improvement Manager

Mrs Gaynor Macfarlane Quality Improvement Administrator

Specialty Group Information

Specialty Group

Surgery

Lead Dean/Director

Professor Adam Hill

Quality Lead(s)

Dr Kerry Haddow, Mr Phil Walmsley and Dr Reem Al Soufi

Quality Improvement Manager

Ms Vicky Hayter

Unit/Site Information

Non-medical staff in attendance

13

Trainers in attendance 10

Trainees in attendance Foundation trainees 17 Specialty trainees 9

FY1 x 10, FY2 x 5

Feedback session: Managers in attendance

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Date report approved by Lead Visitor

15 April 2019

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1. Principal issues arising from pre-visit review

An enhanced monitoring visit was undertaken on 16 March 2018 and the following

extract is from the visit report.

The visit panel acknowledged that both the Clinical Leads and DME staff showed

awareness of the current training issues with plans in place for improvement and that

the senior staff were engaged in addressing training. The panel recognised the work

that has already been done to implement some of the recommendations from the visit

report in January 2017. This has been achieved at a time of significant service

change.

Requirements made in the report were as follows:

• Minimise the level of service provision tasks for Foundation year 2s to reduce

level of workload and improve training opportunities

• Ensure Foundation Year 2s receive a ward-based induction

• Ensure all Foundation trainees receive feedback

• Handovers timings must be reviewed and developed to be more effective

• Trainers must ensure the availability of Specialty Trainees and Consultants for

Foundation trainees and provide a clear documented escalation process

• Specialty trainees require increased access to non-operative training

opportunities

• Ensure specialty trainees are allocated to colonoscopy training lists

• Rotas should be adjusted to ensure Foundation trainees are not working

beyond their rostered hours

Background information

This visit is part of the Deanery’s Enhanced Monitoring process which requires an

annual visit to monitor progress and is a follow up to the most recent Enhanced

Monitoring visit on 16 March 2018. The visit team include College and GMC

representation in line with the nature of the visit. The visit team investigated the issues

previously highlighted. The visit team also took the opportunity to gain a broader

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picture of how training is carried out within the department and to identify any points of

good practice for sharing more widely.

Survey data from Trainees include:

Foundation Trainees

NTS Red flags – Adequate Experience, Clinical Supervision, Induction, Overall

Satisfaction and Reporting Systems (FY2)

NTS Pink Flag – Curriculum Coverage

Core Trainees

NTS Green Flags – Overall Satisfaction and Feedback

Light Green – Reporting Systems, Team Work and Rota Design

Specialty Trainees

NTS Red Flag – Reporting Systems

NTS Pink Flags - Adequate Experience, Clinical Supervision and Clinical Supervision

OOH

2. Introduction

A summary of the discussions has been compiled under the headings in section 3

below. This report is compiled with direct reference to the GMC’s Promoting

Excellence - Standards for Medical Education and Training. Each section heading

below includes numeric reference to specific requirements listed within the standards.

Before the visit commenced the panel met with the Director of Medical Education,

Leads for Elective and Emergency Surgery, Clinical Care Group Nurse Manager and

Manager, Training Programme Director and Foundation Year 1 trainee who gave

presentations highlighting that there had been significant service changes as well as

improvements within the General Surgery departmental training since the last visit.

Specific examples given were: education and training issues now regularly highlighted

at health board level through Staff Governance Committee; appointment with a

Clinical Lead and supporting clinicians (with dedicated time) to oversee H@N

changes; appointment of 2 new physician associates; new on call system of two

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consultants and two registrars to support single emergency surgical site and ongoing

development of web-based teaching.

The panel met with the following trainee groups as well as a group of senior

nurses/pharmacists/dietician:

Foundation Trainees

Specialty Trainees

3.1 Induction (R1.13)

Trainers: Trainers advised that departmental induction has been re-designed and is

now multidisciplinary involving a wide range of staff. Included is a clear escalation

process and arrangements for clinical/educational supervision. Trainees also receive

an individual ward-based induction. Any trainees who cannot attend are given the

same induction at a later date.

Foundation Trainees: All trainees received both hospital and departmental induction

and were enrolled and refreshed on relevant systems. General Surgery roles, nights

and cross cover were discussed, and trainees also received a ward-based induction.

Foundation year 2 had no specific induction to ward 7. Foundation year 1 had no

induction to HDU. All were emailed several induction documents.

Specialty Trainees: All trainees received both hospital and departmental induction

and felt this worked well.

Non-Medical Team: The nursing staff felt the trainee’s induction programme was

robust. Senior charge nurses, ANPs (Advanced Nurse Practitioners) and Pharmacists

attend induction to meet trainees and discuss roles. The Pharmacists provide an

induction booklet. The Administration Manager attends induction to make trainees

aware of the point of contact for rota issues and sickness absence.

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3.2 Formal Teaching (R1.12, 1.16, 1.20)

Trainers: There is a multidisciplinary local clinical effectiveness half day teaching

session once a month which is run by Consultants and Specialty trainees. Regional

teaching for specialty trainees occurs on the other half day of the clinical effectiveness

day so that all can attend. Foundation trainees are advised of the clinical effectiveness

teaching and have weekly bleep free Deanery teaching. Foundation trainees are also

encouraged to attend the student teaching. There is a colorectal MDT on a Friday.

There is online surgical teaching available which consists of a google classroom,

journal club, podcasts, what app, twitter and a Facebook page which has been

recognised with the Faculty of Medical Educators (FAME) award for excellence for

teaching.

Foundation Trainees: Trainees stated they attend weekly Deanery teaching and are

invited to the Clinical Effectiveness teaching but cannot attend due to clinical duties.

Foundation Year 2s find it difficult to attend weekly teaching due to workload.

Specialty Trainees: Trainees reported a significant improvement in teaching and

receive at least one hour per week. There is weekly ward-based teaching and well

organised monthly regional teaching which also includes Clinical Effectiveness training

which all trainees can attend. Trainees reported excellent online teaching which is

available through google classroom, what’s app and podcasts.

Non-Medical Team: Nursing staff fully support teaching and are advised of the

timetable. ANPs and nursing staff provide support to trainees to enable them to attend

bleep free teaching.

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3.3 Study Leave (R3.12)

Trainers: There are no issues with study leave.

Foundation Trainees/Specialty Trainees: Trainees have no issues with study leave.

3.4 Formal Supervision (R1.21, 2.15, 2.20, 4.1, 4.2, 4.3, 4.4, 4.6)

Trainers: Educational Supervisors are allocated to Foundation trainees before

commencing in post. Specialty Trainees select their own Educational and Clinical

Supervisors. If there were any concerns regarding a trainee, the Training Programme

Director would notify the Educational or Clinical Supervisor in confidence. All trainers

have completed training and have time in their job plans to undertake educational

roles, this is currently being reviewed within the department. Educational roles are

included in the SOAR appraisal process.

Foundation Trainees: All trainees were informed of their educational supervisor

before commencing in post. All have had meetings and agreed a personal learning

plan. The majority of trainees found the meeting useful, but this was Consultant

dependent.

Specialty Trainees: Trainees assign their own Education Supervisor and can choose

multiple Clinical Supervisors which enables a broad range of feedback from

assessors. Trainees have no issues arranging meetings as all trainers are easily

accessible and work closely with trainees.

Non-Medical Team: All trainees know who to contact both during the day and OOH.

There is a clear escalation policy for all trainees and nursing staff have an open-door

policy and can be contacted at any time.

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3.5 Adequate Experience (opportunities) (R1.15, 1.19, 5.9)

Trainers: Foundation trainees have a clear curriculum; specialty trainees are mapped

to curriculum through ISCP. The rota is published every week, trainees are allocated

to clinics and theatre and have the opportunity to attend special interest areas. For

curriculum competencies which are difficult to achieve such as HPB experience, TPD

arranges external placements. Endoscopic training is provided by Gastroenterologists

for trainees with NTNs.

Foundation & Trainees: Foundation trainees reported a good training experience,

and all are achieving the required competencies. Foundation year 2s can find it

difficult to attend theatre due to workload. It was reported that when in a surgical

Foundation post, trainees are not required to consent for ERCP, however when in a

medical Foundation post, they are.

Specialty Trainees: The majority of trainees reported they are ahead of target

numbers to achieve the required competencies for CCT. Work placed based

assessments are easy to achieve and trainees regularly attend both theatre and

clinics. Trainees reported lower numbers for HPB work and Upper GI (which is

recognised as a UK wide issue). Trainees report being able to achieve endoscopy

training.

Non-Medical Team: Staff informally contribute to training by teaching on the wards

and help trainees as and when required. Pharmacists provide a training session to

junior trainees and offer a range of quality improvement projects.

3.6. Adequate Experience (assessment) (R1.18, 5.9, 5.10, 5.11)

Trainers: Trainers stated they discuss the required assessments with trainees at the

initial educational supervisor meeting and again throughout the year. Trainees have

checklists to make sure they are on track to complete the required competencies.

Trainers have completed train the trainer courses but do not currently benchmark

against each other.

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Foundation Trainees: Trainees stated they have no issues obtaining the required

assessments.

Specialty Trainees: Trainees have no issues completing the required assessments

and all are fair and consistent.

Non-Medical Team: Staff regularly provide feedback to all trainees including TABs for

Foundation trainees.

3.7. Adequate Experience (multi-professional learning) (R1.17)

Trainers: A wide range of staff are invited to multi-disciplinary learning such as Nurse

specialists, Undergraduate staff, Postgraduate staff, Anaesthetics, O&G, Urology,

Radiology and clinical care departments. There is a weekly Colorectal meeting and

local monthly MDTs.

Foundation Trainees: Trainees are aware of Clinical Effectiveness teaching but

reported due to workload they cannot attend.

Specialty Trainees: There are many opportunities for multiprofessional learning such

as Clinical Effectiveness training, M&M meetings and teaching with various

departments such as Anaesthetics, Radiology and Paediatric Surgery. There is also a

weekly colorectal MDT and Endoscopy teaching with Gastroenterologists.

Non-Medical Team: Trainees can attend ANP teaching, MDT meetings and regularly

receive multi professional learning with Consultants or Specialty Trainees on daily

ward rounds.

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3.8. Adequate Experience (quality improvement) (R1.22)

Trainers: All trainees are encouraged at induction and regular educational supervisor

meetings to undertake quality improvement projects. There is an informal weekly ward

meeting to discuss audits.

Foundation Trainees: Trainees stated there are opportunities to complete a quality

improvement project.

Specialty Trainees: Nursing staff stated trainees have many opportunities to engage

in quality improvement projects. The senior trainee representative attends the QI

meeting and supervises junior trainee projects. Trainees have recently submitted an

abstract for the upcoming national conference.

3.9. Clinical supervision (day to day) (R1.7, 1.8, 1.9, 1.10, 1.11, 1.12, 2.14, 4.1,

4.6)

Trainers: Supervisors are aware of individual trainees’ abilities and training

requirements and work closely together as a team. Coloured lanyards are worn

throughout the department making it clear of the different stages of training. Trainees

are aware of who to contact for advice or support both during the day and out of

hours. There is a clear escalation process which is discussed with trainees at

induction and a minimum of 2 Registrars and 2 Consultant surgeons are on call every

day. There is a simplified system of on call bleeps making it easier to contact

individuals. Named consultants cover the wards. Generally, it is the responsibility of

Consultant to consent patients. No Foundation trainees consent patients.

Foundation Trainees: All trainees stated they know who to contact both during the

day and out of hours. Foundation year 1s are expected to cover HDU when FY2s are

in theatre or on sick leave. Trainees did not feel safe covering this as they do not

receive an induction for HDU. Foundation year 2s reporting working beyond their

rostered hours when working in ward 8 due to the timing of handover (commencing at

5pm which is the end of the trainee shift).

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Specialty Trainees: Trainees can access senior support both during the day and out

of hours. Trainees do not feel they have to deal with problems beyond their

competence and find the Consultants both approachable and accessible.

Non-Medical Team: The rota enables staff to differentiate between grades and levels

of competence of staff. Staff do not feel trainees cope with problems beyond their

competence but if they did they would speak to any of the senior team to review and

discuss concerns.

3.10. Feedback to trainees (R1.15, 3.13)

Trainers: Trainers reported immediate feedback is given to trainees informally and

formal feedback is documented on ISCP. Supervisors have regular informal chats with

trainees and provide both positive and negative feedback. Trainers recognised that

not all these interactions were perceived as feedback by trainees. One trainer

highlighted that laparoscopic procedures are videoed and discussed with trainees.

Foundation Trainees: Trainees reported a lack of feedback unless it is specifically

sought out by individuals.

Specialty Trainees: Trainees receive a mixture of informal and formal feedback

regularly and find it constructive and meaningful.

3.11. Feedback from trainees (R1.5, 2.3)

Trainers: Trainers are currently looking at a tool for trainees to provide 6 monthly or

annually feedback on the trainers. Some trainers have sent Multi Source Feedbacks to

trainees (for their revalidation).

Foundation Trainees: Some Educational Supervisors ask trainees for feedback, but

this is Consultant dependent. The Foundation year 1 representative can feedback any

issues on behalf of trainees. Foundation year 2 do not have currently have a

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representative and there is no feedback mechanism in place for trainees to feedback

on trainers.

Specialty Trainees: Trainees complete multi-source feedback requests to provide

feedback to trainers. There is a junior and senior representative on the Specialty

Training Committee where feedback of any concerns can be communicated.

3.12. Workload/ Rota (1.7, 1.12, 2.19)

Trainers: Trainers reported no current rota gaps. Two specialty trainees and two

Consultants are always on call at the same time to allow greater flexibility. The

Emergency rota has been embedded in the last 18 months and the FY rota has been

re-designed.

Foundation Trainees: Foundation trainees reported a varied and unpredictable rota.

There is an uneven distribution of Foundation trainees on the wards and trainees

would like a better balance. Foundation year 2 trainees reported a heavy workload at

the weekends which can impact on patient safety. The rota is not always up to date

and is managed by an administrator. The foundation trainee representative has

escalated the issue. The rota is currently only accessible from within the hospital,

trainees would like the ability to access this out with.

Specialty Trainees: Trainees reported no gaps in the rota due to the appointment of

board funded posts which have made a significant positive impact. There are no rota

implications for patient safety and the rota does not impact on training. Trainees

praised the Training Programme Director for all his work achieving this.

Non-Medical Team: Staff do not have any issues regarding the rota impacting on

trainees.

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3.13. Handover (R1.14)

Trainers: Trainers reported a robust electronic handover.

Foundation Trainees: Trainees reported a good handover for specific jobs, but the

weekend handover could be improved by trainees providing more patient detail as the

context is not always clear.

Specialty Trainees: There is a protected handover twice a day. Trainees reported a

disconnect at the handover as all Foundation doctors attend the hospital at night

handover and therefore are not involved with the ST handover.

Non-Medical Team: There is a robust daily handover between junior and senior

trainees. Foundation trainee’s handover with hospital at night to review and update the

lists. Hospital at night attend the conference call and any concerns are raised and

managed.

3.14. Educational Resources (R1.19)

Trainers: Trainees have access to a wide range of online learning resources and

teaching opportunities which are advertised on what’s app. There is a registrar room

with computers. Trainees have access to simulation through the Dundee Institute for

Healthcare Simulation (DIHS) formerly the Cuschieri skills centre.

Foundation Trainees: Trainees have access sufficient computers but reported these

were extremely slow.

Specialty Trainees: Trainees have access to a dedicated reg room and doctors mess

and the University of Dundee library. There are computers available, but these are

very slow.

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3.15 Support (R2.16, 2.17, 3.2, 3.4, 3.5, 3.10, 3.11, 3.13, 3.16, 5.12)

Trainers: If Trainees are struggling with the health issues or the job they can contact

their Educational or Clinical Supervisor or escalate to the Training Programme

Director or Associate Postgraduate Dean or Clinical Lead. Trainees can also inform

their trainee representative or attend the drop-in sessions with the clinical lead. TPD

can attend the monthly deanery performance support meetings regarding trainees

who need support. Trainers give trainees career advice or refer to the Deanery APGD.

FY taster weeks are available.

Foundation Trainees: Trainees stated they would speak to their Educational

Supervisor if they were struggling with job/health issues. Trainees report that if they

report in sick, this information is not always cascaded to the staff in the department.

Specialty Trainees: Trainees felt they would be well supported if they are struggling

with the job or had any health issues. A trainee who returned from maternity leave was

well supported on the return to the department.

Non-Medical Team: If staff had any concerns regarding the performance of a trainee,

these would be escalated to the trainees Educational Supervisor. Previous examples

were given, and staff felt these were addressed promptly and both the trainee and

member of staff who raised the issue felt well supported.

3.16 Educational governance (R1.6, 1.19, 2.1, 2.2, 2.4, 2.6, 2.10, 2.11, 2.12, 3.1)

Trainers: Trainers stated the quality of education and training is manged by the

Training Programme Director, Associate Postgraduate Dean and the Director of

Medical Education.

Foundation Trainees: Trainees stated they have Deanery teaching on a Wednesday

and fill out feedback forms. Trainees would contact the Clinical Lead regarding their

education and training.

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Specialty Trainees: Trainees would contact the Training Programme Director

regarding their education and training.

3.17 Raising concerns (R1.1, 2.7)

Trainers: Trainers stated they have an open-door policy and a team approach to

discuss any concerns. Trainees can raise a Datix, which is undergoing a Health Board

review to update and improve feedback systems. There is a red flag meeting and a

quarterly M&M meeting to discuss any concerns raised.

Foundation Trainees: Trainees would contact a Specialty Trainee, Senior Charge

nurse or raise a Datix if they had any patient safety concerns. Trainees reported rarely

using Datix. Foundation Year 1s would also contact their Foundation representative.

All would contact their Educational Supervisor if they had any issues in relation to

education or training.

Specialty Trainees: Trainees would contact a Consultant, trainee representative or

raise a Datix if they had any patient safety concerns. Any education or training

concerns would be raised with an Educational/Clinical supervisor or Training

Programme Director.

Non-Medical Team: Staff have a clear escalation policy and can report any concerns

through a variety of networks including Datix. There are regular Clinical Governance

and Clinical Effectiveness meetings and weekly meetings with the Lead nurse, Case

Manager and the Clinical Director to discuss any concerns.

3.18 Patient safety (R1.2)

Trainers: Trainers have no patient safety concerns. Patient safety was central in the

recent service re-design. There are two specialty trainees and two consultants on

during the day to minimise risk. Although boarding is rare, all surgical patients are

seen every day.

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Foundation Trainees: Trainees reported during busy periods at handover or

weekends urgent jobs have to be put aside due to workload. Foundation year 1s

reported covering HDU when FY2s are in theatre of if there is staff sickness and feel

this is a potential patient safety issue as they have not received in induction or worked

in HDU before. Trainees believe covering surgical receiving and 5 other wards when

its busy is also a patient safety concern. Foundation year 2s reported making

antibiotics which can be difficult when there are several unwell patients.

Specialty Trainees: Trainees would have no concerns if a friend or relative was

admitted to the department. Patients are rarely boarded out and if they are they are

location in another surgical ward such as ENT or Plastic Surgery. The clerkess has a

dedicated list and patients are seen every day. There is a whiteboard with all boarded

patients listed on the acute admissions ward.

Non-Medical Team: Staff have no concerns regarding patient safety and any patients

at risk are discussed at safety huddles. Patients are rarely boarded out but if they are

there is a clear mechanism in place to monitor patients.

3.19 Adverse incidents (R1.3)

Foundation Trainees: Trainees are aware of the procedure should an adverse

incident occur. Several have raised a Datix in the past but have never had feedback.

Specialty Trainees: If an adverse incident occurs the trainees record this on the Datix

system and receive feedback. Incidents would be discussed at the M&M meeting and

clinical effectiveness meeting. There is weekly multi-disciplinary red flag meeting to

discuss any adverse incidents.

Non-Medical Team: Adverse incidents are recorded on the Datix system and a review

will take place depending on the severity of the issue. Any red incident is escalated

immediately to the executive team and discussed as a learning opportunity. Pharmacy

reported medication which had changed brand which was at risk of error therefore

educational material was produced to mimimise the risk.

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3.20 Duty of candour (R1.4)

Trainers: Trainers comply with a robust complaints system and all complaints are

addressed at level 1. There is a no blame culture and all responsibility lies with the

Consultants. Trainees are led by example.

Specialty Trainees: Trainees reported supportive Consultants who would openly

discuss any concerns.

3.21 Culture & undermining (R3.3)

Trainers: Trainers reported a close working department which is like family. There

have been difficulties in the past, but these have been overcome and the department

has a good culture of training. All surgical units work closely together and although

bullying and undermining officers have been put in place officers have never been

contacted. There is a clear bullying and undermining policy and zero tolerance.

Foundation Trainees: Trainees reported excellent ward-based nursing staff. Support

is available for trainees, but this is consultant dependent. Alleged undermining

behaviour was reported by another specialty and has been raised through Datix.

Specialty Trainees: Trainee’s reported a supportive department. Trainees are

listened to and have a good working relationship with nursing staff, PAs and

Pharmacists. Trainees have not witnessed any bullying or undermining behavior but if

it happened any issues would be raised with senior Consultants, Educational or

Clinical Supervisors or a well-being Ambassador.

Non-Medical Team: Staff reported a well-established and supportive team with good

working relationships and are not aware of any undermining or bullying behaviour.

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Other:

Specialty Trainees: Trainees reported a very good training experience in comparison

to other units they have trained in. Trainees feel that all have benefitted from a period

of time at another location in Scotland.

Trainees reported a high pass rate in the department for FRCS and have received 2

gold medals in the last 5 years.

There are currently no Core trainees based within General Surgery at Ninewells

Hospital and trainees feel it would be an excellent training experience for core

trainees.

There is now access to Endoscopy which has improved over the last 6 months.

Interventional Radiology offer a day for Vascular trainees to take part in cases which is

unique across Scotland. Trainees have access to simulation through the Dundee

Institute for Healthcare Simulation (DIHS) formerly the Cuschieri skills centre. This is

an excellent training resource as trainees have the opportunity to teach on courses,

appreciate lectures and participate in teaching.

Specialty trainees stated there had been a significant improvement in the department

over the last few years and praised both the Training Programme Director and Clinical

Director.

The Clinical Fellow has gained all training requirements and would highly recommend

this post to colleagues.

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4. Summary

The visit panel acknowledge that there has been significant improvement across the

department and a high level of engagement in addressing any ongoing training issues.

Significant work has been done to improve the recommendations from the previous

visit held in March 2018.

The panel recommend de-escalation from the enhanced monitoring process which will

be reviewed by the GMC after final submission of this report.

What is working well:

• Approachable and supportive Consultants, engaged in undertaking

assessments.

• Contribution by non-medical staff in supporting trainees – nurses, pharmacists

and physician assistants.

• The department has established a culture of education.

• Evidence of engagement by senior clinical and managerial staff, visible to

trainees.

• New structure where Health Board are made aware of training concerns.

• Trainees have a clear known escalation process.

• Introduction of two on call registrars and two on call consultants is a positive

development.

• Excellent google classroom, and online learning such as WhatsApp, podcasts

etc.

• Highly regarded regional teaching and Clinical Effectiveness teaching.

• Recognised improved access to Endoscopy teaching for Specialty Trainees.

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• Recognition of the impact of improvements to the quality of training by Mr

Moses and Mr Kulli.

• Introduction of the trainee representative role is welcomed which should be

further developed to allow trainees formal routes to influence service changes.

What is working less well:

• Workload for FY1/2 remains a concern e.g. inconsistencies in the number of

FY1 trainees allocated to wards on a daily basis, requirement for FY2s to make

up iv antibiotics, timing of ward round in Ward 8 means FY2s are required to

work beyond rostered hours.

• No current induction for FY1s in HDU – this is necessary as they can be

expected to cover this area when F2s are required in theatre or are on sick

leave.

• Lack of involvement of Foundation trainees in attending Clinical Effectiveness

Teaching.

• Disconnect at handover with Specialty Trainees as FY trainees currently attend

H@N handover.

• Lack of trainee engagement with Datix as a lessons learned opportunity.

Overall satisfaction scores:

Foundation Year 1 – 7/10

Foundation Year 2 – 6/10

Specialty Trainees – 8/10

Is a revisit required?

Yes No

Highly Likely Highly unlikely

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5. Areas of Good Practice

Ref Item Action

5.1 Google classroom, WhatsApp groups, podcasts N/A

5.2 Impressive success rate in college exams N/A

5.3 Facebook page recognised by Faculty of Medical

Educators award for excellence for teaching

N/A

6. Areas for Improvement

Ref Item Action

6.1 The department should work with

other surgical departments to

develop a clear process for

supporting trainees who have

been allegedly undermined from

staff out with the general surgery

department. Trainees should be

provided with feedback on actions

taken to address issues raised.

N/A

6.3 Accessible Rota out with hospital N/A

6.4 Consideration of a trainee

representative, with clear role

descriptor and link to service

leads, for all training grades

N/A

6.5 Barriers preventing Foundation

trainees attending Clinical

Effectiveness teaching should be

addressed

N/A

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7. Requirements - Issues to be Addressed

Ref Issue By when Trainee

cohorts in

scope

7.1 Minimise the level of service provision tasks

for Foundation year 2s to reduce level of

workload and improve training opportunities

(e.g. making iv antibiotics)

December

2019

FY2

7.2 Ensure Foundation Year 1s receive induction

to HDU

December

2019

FY1

7.3 The rota must ensure even and consistent

distribution of Foundation trainees to wards

December

2019

FY1 & FY2

7.4 Handovers timings must be reviewed and

developed to be more effective to enable

Foundation year 2s to leave work on time

(e.g. Ward 8)

December

2019

FY2

7.5 Improve trainee involvement in Datix

particularly lessons learned.

December

2019

ALL