National training survey 2014

Transcription

1 Natioal traiig survey 2014 Key fidigs NATIONAL TRAINING SURVEY Joi us o #GMCsurvey

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3 Itroductio Every year, we ask aroud 54,000 doctors i postgraduate traiig what they thik about the quality of their traiig. This year we had a record respose rate of 98.2%. The survey is a importat part of how we make sure medical educatio ad traiig is meetig the stadards we set to support high quality medical care ad patiet safety across the UK. This report gives a overview of the mai fidigs of the 2014 survey. * UK-wide scores have rise slightly i each area we measure, ad overall satisfactio remais high, particularly i geeral practice ad aaesthetics traiig. At a local level, although the stadard of may areas of traiig has improved or remais high, some areas still remai a cocer. We have reviewed the areas with three years of poor results i our tred reports, ad we are workig with the relevat deaeries, local educatio ad traiig boards (LETBs) ad local educatio providers (LEPs) to address problems ad make sure actio is take. The report also icludes several case studies to show how results from the survey have bee used to make positive chages to educatio ad traiig. How ca the fidigs be used? Deaeries, LETBs, LEPs ad employers look at local data to fid out which aspects of their traiig work well or ca be improved. Medical royal colleges ad faculties ca also use the results of the specialtyspecific questios to iform how they develop ad deliver their curricula. We also work closely with other regulators to esure the survey fidigs are used effectively i their work to assure the quality ad safety of healthcare. This year, for the first time, we have three years of results available, allowig data to be aalysed for treds (see page 11). The data geerated from this survey are just oe source of iformatio about the quality of medical educatio ad traiig ad should be cosidered alogside other data. I some cases, local orgaisatios will eed to follow up survey results with a detailed ivestigatio. You ca see the detailed results i our iteractive tool at * The survey was ope from 26 March to 8 May Doctors i traiig were asked about the post they were i o 26 March UK-wide scores are the overall score for each idicator, across all specialties ad stages of traiig. We itroduced our olie reportig tool i 2012, ad so we ow have three years of results to display side-by-side. Geeral Medical Coucil 01

4 Who aswered the survey? This year, 53,077 doctors i traiig completed the survey out of 54,068 who were eligible, givig a respose rate of 98.2%. * This compares with 97.7% i The respose rate by deaery or LETB raged from 92.1% to 100%, with ie achievig over 99%. Figure 1 shows the respose from doctors at differet stages of traiig. Figure 1: Respose from doctors at differet stages of traiig (=53,077) 55.6% of respodets were female ad 44.4% were male (=53,077). 11.3% said they were i less tha full-time traiig (6,010 of =53,077). Of these, 80.4% were female ad 19.6% were male. Health ad disability Doctors i traiig were asked if their day-to-day activities were limited because of a health problem or disability that has lasted, or is expected to last, at least 12 moths. 2.3% said their day-to-day activities Foudatio were limited a little or a lot (1,174 of =51,959), traiig compared with 2.4% i Of those reportig a health problem or disability that limited their Core traiig activities, 38.8% said that they ad up to ST3 eed adjustmets to be able to carry out their work, ad 6.8% of those 81.6 who eed adjustmets, said that the adjustmets they eed have ot bee made. I traiig locatios where adjustmets ST4 owards have ot bee made, we will discuss the issues 83.7 with the relevat deaeries ad LETBs. 28% Foudatio traiig 45% Core traiig ad up to ST3 ST3 = third year of specialty traiig ST4 = fourth year of specialty traiig 27% ST4 owards * Not all doctors i traiig aswered all questios, so we have give the total umber of respodets with valid aswers i brackets for each key fidig. We excluded aswers that were ot applicable from the aalysis. All percetages ad scores have bee rouded to oe decimal place. 02 Geeral Medical Coucil

5 Overall satisfactio with traiig Overall satisfactio by stage of traiig To measure satisfactio, we asked doctors i traiig about various aspects of their post, such as how they rate the quality of teachig, experiece ad supervisio, how useful the post will be for their future career, ad whether they would recommed the post to a fried. Figure 2: Overall satisfactio of doctors at differet stages of traiig (=52,588) The overall satisfactio score is 81.2 out of 100, which is slightly up from the score of 80.8 i This follows the patter of risig satisfactio levels from 2006 to Figure 2 shows the overall satisfactio score for doctors at differet stages of traiig (=52,588). Followig the treds from previous years, we ca see that satisfactio rises as doctors progress through their traiig, with foudatio doctors givig lower scores tha those i core traiig ad up to the third year of specialty traiig (ST3) ad those i the fourth year of specialty traiig (ST4) owards. Core traiig ad up to ST Foudatio traiig 78.4 This is ot a uexpected fidig. Doctors who are i later stages of traiig will most likely have chose to pursue a career i that specialty, ad have acquired experiece ad competece, so it follows that overall satisfactio will be higher. ST4 owards 83.7 Geeral Medical Coucil 03

6 Overall satisfactio by post specialty Figure 3 shows the overall satisfactio score split by post specialty. * Post speciality is determied by where the doctor i traiig was workig at the time of the survey. For example, the score for the geeral practice posts icludes foudatio doctors i geeral practice posts. This year, the survey shows doctors traiig i geeral practice posts are the most satisfied. However, doctors traiig to be geeral practitioers (GPs) give lower scores whe traiig i other specialty posts. We discuss this further i our focus o key idicators o page 8. Like most specialties, satisfactio of doctors traiig i surgery has bee risig sice 2006 (72.9 i 2006, risig to 77.1 i 2014). Noetheless, it cosistetly has the lowest average score compared with other specialties whe all doctors traiig i surgery posts are icluded. However, whe surgery satisfactio scores are separated ito the three mai stages of traiig, we see big differeces: 72.1 for foudatio traiig, 77.2 for core traiig ad up to ST3, ad 85.5 for ST4 owards i This represets the biggest differece i satisfactio scores betwee foudatio traiig ad ST4 owards i ay of the specialties. Foudatio doctors givig lower satisfactio scores for their surgery posts is a recogised tred ad, i Eglad i particular, work is beig doe to broade the Foudatio Programme ad give extra support to foudatio doctors i surgery posts. The biggest rises i overall satisfactio this year came i occupatioal medicie posts (up 1.2 sice 2013) ad obstetrics ad gyaecology posts (up 1.0), whereas satisfactio i ophthalmology posts has falle slightly (from 84.2 to 84.1). Perhaps because of the well documeted pressures i emergecy services, recruitmet ito the specialty remais a challege. Despite this, satisfactio of doctors traiig i emergecy medicie posts remais above the UK-wide average (81.6, compared with 81.2). * We use the terms post specialty ad programme specialty to differetiate betwee the specialty a doctor is curretly workig i (post specialty) ad the programme of traiig the doctor is udertakig (programme specialty). For example, a doctor i traiig ca have a programme specialty of foudatio, core medical traiig or geeral practice, but be workig i a cardiology post. Therefore, post specialty scores for surgery are for all doctors curretly workig i surgery posts, icludig foudatio, core ad geeral practice, as well as those i higher surgical specialties. For more iformatio, see the report Broadeig the Foudatio Programme: recommedatios ad implemetatio guidace at hee.hs.uk/wp-cotet/uploads/sites/321/2014/02/broadeig_the_ Foudatio_V16-Fial.pdf. 04 Geeral Medical Coucil

7 Figure 3: Overall satisfactio score by post specialty ad chage i the score sice 2013 * 2014 Average score 100 Overall satisfactio Aaesthetics Foudatio traii Emergecy medicie Core traiig ad u Geeral practice Medicie Obstetrics ad gyaecology Occupatioal medicie Ophthalmology Paediatrics ad child health No chage ST4 owards Cliical supervisio Foudatio traii Core traiig ad u ST4 owards Pathology Educatioal super Psychiatry Foudatio traii Public health 82 No chage Core traiig ad u Radiology ST4 owards Surgery 77.1 No chage Hadover Foudatio traii Core traiig ad u ST4 owards Iductio Foudatio traii Core traiig ad u ST4 owards * We have icluded the pharmaceutical medicie score i the score for medicie. This is differet from previous years whe it was recorded separately because doctors traiig i pharmaceutical medicie were surveyed i a separate IT system. Adequate experie Foudatio traii Core traiig ad u ST4 owards Geeral Medical Coucil 05

8 Focus o key idicators We asked doctors i traiig a umber of questios about the quality of differet aspects of their medical educatio ad traiig. This year we have focused o five key idicators: cliical supervisio educatioal supervisio iductio hadover adequate experiece. The average idicator score (o a scale of 0 100) is show i figure 4. The figure separates resposes from doctors i foudatio traiig, i core traiig ad up to ST3, ad i ST4 owards. * Figure 4 shows that the further doctors progress through traiig, the more satisfied they are with most aspects of that traiig, with the exceptio of educatioal supervisio ad hadover. This could reflect a geeral sese of assurace amog doctors that icreases with experiece ad greater competece. We have looked i more detail at each of these key idicators ad icluded some case studies illustratig how the survey has bee used to make chages i local systems ad traiig eviromets. * Foudatio icludes years oe ad two of the Foudatio Programme (F1 ad F2). Core traiig icludes years oe, two ad three of the core traiig programme (CT1, CT2 ad CT3). 06 Geeral Medical Coucil

9 Figure 4: Average idicator score for five key idicators by stage of traiig Overall satisfactio Foudatio traiig Core traiig ad up to ST3 ST4 owards Average score Cliical supervisio Foudatio traiig Core traiig ad up to ST3 ST4 owards Educatioal supervisio Foudatio traiig Core traiig ad up to ST3 ST4 owards Hadover Foudatio traiig Core traiig ad up to ST3 ST4 owards Iductio Foudatio traiig Core traiig ad up to ST3 ST4 owards Adequate experiece Foudatio traiig Core traiig ad up to ST3 ST4 owards Geeral Medical Coucil 07

10 Cliical supervisio The day-to-day cliical supervisio of doctors i traiig is fudametal i makig sure patiets receive safe, high quality care. The quality of cliical supervisio is measured by askig doctors i traiig a umber of questios icludig the followig. Did you always kow who was providig your cliical supervisio? Did you feel forced to cope with cliical problems beyod your competece? If yes to either of the questios above, how frequetly? I ST4 owards, cliical supervisio is the highest raked of all the key idicator scores, with scores of 92.5 out of a possible 100. Lookig at respodets programme specialty, * doctors who are traiig to be GPs have oe of the lowest scores for cliical supervisio (89.0, compared with aaesthetics at 92.7). However, whe lookig at respodets post specialty istead, geeral practice posts attai oe of the highest scores (92.1). Doctors traiig to be GPs rotate through a umber of other specialties durig their traiig (icludig emergecy medicie ad obstetrics ad gyaecology, amog others). The differece betwee the programme specialty ad post specialty scores could be explaied by doctors i GP traiig beig more satisfied with the supervisio they receive i GP practices tha with their supervisio i other settigs. * For this aalysis, programme specialties have bee grouped together by the royal college, faculty or joit board that maages the curriculum for those programmes. For example, all eight surgical specialty programmes are grouped together uder surgery. Case study: doctors i traiig work with cliical supervisors to resolve problems with out-of-hours work After services had bee recofigured across two local hospitals i the same trust/board, the results of the atioal traiig survey showed that doctors i traiig were feelig usupported ad uder pressure whe workig out of hours. Recogisig this was ot oly a risk to the quality of educatio ad traiig, but a risk to the quality ad safety of care provided out of hours, the deaery/letb immediately called a meetig with traiers ad local doctors i traiig to deal with the problem. As a result, the trust/board provided fudig for a extra doctor over the weeked. This doctor ow works across both sites, depedig o where they are most eeded. Workload is ow much more maageable ad feedback has bee extremely positive, both from doctors i traiig ad cosultats. Educatioal supervisio Educatioal supervisio provides a importat source of support for a doctor i traiig, both for their professioal developmet ad pastoral care. We assessed the quality of educatioal supervisio by askig doctors i traiig about the support they received from their educatioal supervisor. Educatioal supervisio has high idicator scores across all stages of traiig: 89.9 for foudatio traiig ad 90.7 for core traiig ad up to ST3, but fallig slightly to 88.9 for ST4 owards. This patter is cosistet with last year s results, but the 2014 scores are slightly higher i each group. 08 Geeral Medical Coucil

11 This year, most doctors said they had a desigated educatioal supervisor (the perso resposible for appraisig their educatioal progress; =52,446): 99.6% of foudatio doctors, compared with 99.3% i % of doctors i core traiig ad up to ST3, which is the same as i 2013 Case study: doctors i traiig use the survey results to improve their departmet s iductio The survey highlighted that doctors traiig i the aaesthetic departmet were uhappy with the iductio they received whe startig their posts. 99.4% of doctors i ST4 owards, which is the same as i Of all respodets, 88.1% said they were told who to talk to i cofidece if they had persoal or educatioal cocers (=49,390), compared with 85.4% i Iductio A structured iductio to the workplace is key to esurig of doctors i traiig practise safely whe startig i a ew role, providig them with the ecessary local kowledge of policies ad procedures. Agai, the overall score for this idicator has improved. The scores are higher i later stages of traiig tha i earlier stages, ad have icreased sice 2013: 83.0 for foudatio traiig, compared with 82.2 i for core traiig ad up to ST3, compared with 84.1 i for ST4 owards, compared with 85.3 i By post specialty, surgical specialties have the worst score for iductio (score of 80.9, agaist a atioal mea of 84.8). As a result, doctors i traiig took the iitiative to gather further feedback o iductio from all doctors traiig i the departmet. This feedback highlighted several problems with iductio. For example, doctors i traiig atteded a log lecture i a small, o-air coditioed room i the middle of a very hot summer, makig it difficult to cocetrate ad retai key messages. Also, the iductio cotaied a lot of iformatio but did ot cover key practical tasks, such as receivig passes to access key areas of the hospital. Doctors i traiig took their feedback to departmetal cosultats as evidece that iductio eeded to be improved. They worked together to come up with improvemets to iductio i the departmet. Oe improvemet was to make sure that practical matters, such as security badges, lockers i theatre ad theatre shoes, were sorted out at the start of the iductio process. Learig was the split ito a series of shorter talks, rather tha oe big lecture. Seior doctors i traiig have captured feedback o the ew process, which shows that results have moved from beig very poor to good. More chages are beig implemeted to icrease feedback to excellet ad improvemets will be moitored usig the survey results. Geeral Medical Coucil 09

12 Hadover A well maaged, thorough ad orgaised hadover is crucial for esurig the quality ad safety of patiet care. It is particularly importat for high risk specialties, such as obstetrics ad gyaecology. Poor hadover ca cotribute to a fragmeted experiece for doctors i traiig. The atioal score for hadover has rise slightly i 2014 (from 66.0 to 67.8) with big rises i emergecy medicie (from 52.2 to 58.0) ad ophthalmology (from 39.0 to 43.3) posts. For specialties that use hadover, scores for hadover have ot dropped i ay post specialty. Scores for hadover have icreased across all stages of traiig. Accordig to respodets i obstetrics ad gyaecology posts, hadover is far better tha i other specialties (86.5, compared with a atioal mea of 67.8). We pla to examie why obstetrics ad gyaecology scores so highly to uderstad how other specialties could improve their results. Case study: usig survey results to idetify hadover issues ad improve processes by sharig good practice Results from the 2013 atioal traiig survey showed that, i oe hospital, hadover was cosidered to be excellet i the gyaecology departmet but poor i the medicie departmet. The gyaecology departmet s lead was ivited to speak to the medicie departmet ad share their experiece. They suggested several measures the departmet could take to improve hadover. Adequate experiece It is essetial that doctors i traiig are give opportuities to acquire the the experiece they eed. We ask doctors i traiig to rate their practical experiece ad ask how cofidet they are that their post will help them acquire the competeces they eed at this stage of their traiig. As with other key idicators, scores for adequate experiece are higher for doctors later i traiig: 79.7 for foudatio traiig, compared with 79.2 i for core traiig ad up to ST3, compared with 80.5 i for ST4 owards, compared with 83.4 i By post specialty, doctors i medical posts gave the lowest scores (78.3, compared with 88.0 for geeral practice posts). But this is still a rise from 2013, whe medical posts scored 77.9 ad geeral practice posts scored Low scores i adequate experiece could poit to traiig posts where traiig is eglected i favour of service delivery. Several of these measures are ow beig used ad have led to a much improved hadover process. For example, the day ad ight teams ow meet i perso twice a day. There is ow also a Friday afteroo meetig where the full medicie team provides hadover to the weeked team, iformig team members of patiets to be reviewed ad those who could potetially be discharged. 10 Geeral Medical Coucil

13 Tred aalysis I the autum of 2013, we added several ew features to the reportig tool, icludig tred aalysis. Jue 2014 will be the first time that three years of results have bee displayed side-by-side. Tred aalysis is a powerful way of displayig improvemets or deterioratio i results over three years. It allows traiig providers to istatly see where, accordig to the perceptios of doctors i traiig, thigs have improved or eed attetio. I figure 5 below, you ca see the patters for paediatrics i a particular trust. Figure 5: Example from the reportig tool, showig tred aalysis for post specialty by trust or board Outcome Mea Post Specialty Trust / Board Idicator Overall satisfactio Cliical supervisio Hadover Paediatrics Name of trust or board Iductio Adequate experiece Workload Educatioal supervisio Access to educatioal resources Feedback Local teachig Regioal teachig Study leave KEY: Below outlier Withi the middle quartile (Q2/IQR) Withi the lower quartile (Q1), but ot a below outlier Withi the upper quartile (Q3), but ot a above outlier is the umber of doctors i traiig whose resposes cotribute to the outcome. Q1, Q2, Q3 (quartiles) are how the bechmark group is divided. For a explaatio of how outcomes are calculated (what makes a result gree or red), please visit Above outlier <3, result ot published Geeral Medical Coucil 11

14 Figure 5 shows that the trust had problems i paediatrics i seve out of 12 idicators i There were improvemets i 2013, but overall satisfactio remaied poor. If there were three years of red here, we would expect to see a respose i the dea s report. There have clearly bee vast improvemets across the board i 2014, with grees appearig i hadover, adequate experiece ad feedback. Lookig at the scores, we ca also see that overall satisfactio has shot up from i 2013 to i Iductio remais a problem area ad will eed to be examied further, but overall the sigs for this departmet are ecouragig. What our stakeholders say about tred aalysis Dr Eleaor Wood, Director of Medical Educatio, Cosultat Physicia & Gastroeterologist, ad Dr Emma Breese, Head of Medical Educatio at Homerto Uiversity Hospital, say: Tredig is a powerful way of viewig the survey results. Educatioal supervisio i edocriology ad diabetes suddely chaged from white (2012) to red (2013) which was uexpected. We were the able to ivestigate further ad idetified accessibility as a issue. We provided support ad allocated a ew supervisor. Chages across time idetified by tredig is a very useful way to assess the impact of previous/ ogoig itervetios. Withi the gastroeterology departmet several ew cosultats uderwet faculty developmet traiig which cotributed to improved feedback to traiees (2011 white, 2012 ad 2013 gree). Formalised iductio was also implemeted with a chage from white (2011, 2012) to gree (2013). Tredig supports our itegratio of traiig with service. A major review of the elderly care/geriatric service resulted i the opeig of a 56-bed elderly care uit. This has cotributed to the chage i adequate experiece from pik (2012) to white (2013) i geriatrics. The followig case study shows a real example of how tred reportig ca be used to make crucial itervetios ad quick improvemets to esure good quality traiig. 12 Geeral Medical Coucil

15 Case study: usig tred reports to idetify serious issues at a local educatio provider By lookig at treds i survey results over two years, a deaery/letb oticed cocers i a departmet of a LEP. I 2012 this departmet had o particularly egative results, but i 2013 they had several. The results therefore poited to a ew ad potetially serious problem with traiig. It is possible that the problem related to a icreased umber of doctors i traiig leavig their posts to complete academic traiig, which i tur icreased the pressure o those left behid. As a result, we joied the deaery/letb o a follow-up visit i May 2014 that focused oly o this issue. The visit showed this was ot a immediate cocer ad foudatio doctors were ot beig left usupervised. The trust ad deaery/letb will work together to stregthe the formal supervisio arragemets. The cocer about doctors i specialty traiig o out-of-programme experiece is still beig addressed ad the LETB/deaery is moitorig this. The deaery/letb reported this case to us ad we worked with them to moitor progress ad to set the LEP requiremets that they must fulfil. The deaery/letb has carried out visits to the LEP, which has cofirmed that half of the requiremets have ow bee met. Problems were also reported with supervisio icludig, for example, foudatio doctors beig left usupervised o the o-call rota. Geeral Medical Coucil 13

16 What happes ext? Doctors i traiig play a key role i esurig patiet safety by raisig cocers if they feel that patiets are at risk. The survey icludes a opportuity for doctors i traiig to raise cocers about patiet safety, as well as ay cocers they have about bullyig ad udermiig. We will ivestigate all these cocers ad publish our fidigs i the autum. From 23 Jue, deaeries, LETBs, LEPs, ad royal colleges ad faculties will examie their results ad ivestigate ay areas of cocer. Deaeries ad LETBs will report to us o these results i their October deas reports ad will explai actios they are takig to resolve the problems idetified. Should the problem require more regular updates, they will report to us through our ehaced moitorig process. Royal colleges ad faculties will report o ay problems idetified i their results i the aual specialty returs ext year. We publish all these reports o our website. 14 Geeral Medical Coucil

17 Aex A: key fidigs i the four coutries of the UK Table 1: Mea score ad umber of respodets for all 12 idicators across all stages of traiig Eglad Norther Irelad Scotlad Wales UK total Overall satisfactio Cliical supervisio Educatioal supervisio Iductio Hadover Adequate experiece Feedback Regioal teachig Workload Local teachig Study leave Access to educatioal resources Mea ,661 1,626 4,971 2,330 52,588 Mea ,416 1,624 4,962 2,324 52,326 Mea ,627 1,626 4,968 2,327 52,548 Mea ,520 1,617 4,927 2,313 52,377 Mea ,873 1,180 3,371 1,601 35,025 Mea ,661 1,626 4,971 2,330 52,588 Mea ,004 1,397 4,344 1,958 45,703 Mea , ,359 1,262 28,260 Mea ,534 1,626 4,971 2,330 52,461 Mea ,303 1,120 3,396 1,659 37,478 Mea ,741 1,224 3,669 1,837 40,471 Mea ,431 1,576 4,728 2,289 51,024 Geeral Medical Coucil 15

18 Table 2: Mea score ad umber of respodets for the six idicators reviewed i this report across the three stages of traiig Overall satisfactio Cliical supervisio Educatioal supervisio Iductio Hadover Adequate experiece Foudatio traiig Eglad Norther Irelad Scotlad Core traiig ad up to ST3 ST4 owards Foudatio traiig Core traiig ad up to ST3 ST4 owards Foudatio traiig Core traiig ad up to ST3 ST4 owards Mea ,231 19,616 11, ,575 2,235 1,161 Mea ,215 19,490 11, ,575 2,231 1,156 Mea ,225 19,600 11, ,575 2,232 1,161 Mea ,227 19,566 11, ,574 2,225 1,128 Mea ,517 13,928 10, ,680 1,010 Mea ,231 19,616 11, ,575 2,235 1,161 Overall satisfactio Cliical supervisio Educatioal supervisio Iductio Hadover Adequate experiece Foudatio traiig Wales Core traiig ad up to ST3 ST4 owards Foudatio traiig Total Core traiig ad up to ST3 ST4 owards Total Mea , ,983 23,663 13,942 52,588 Mea , ,964 23,530 13,832 52,326 Mea , ,977 23,643 13,928 52,548 Mea , ,978 23,591 13,808 52,377 Mea ,679 17,028 12,318 35,025 Mea , ,983 23,663 13,942 52, Geeral Medical Coucil

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20 Website: Telephoe: Geeral Medical Coucil, 3 Hardma Street, Machester M3 3AW Textphoe: please dial the prefix the to use the Text Relay service Joi our facebook.com/gmcuk likd.i/gmcuk youtube.com/gmcuktv This iformatio ca be made available i alterative formats or laguages. To request a alterative format, please call us o or us at publicatios@gmc-uk.org. Published Jue Geeral Medical Coucil The text of this documet may be reproduced free of charge i ay format or medium providig it is reproduced accurately ad ot i a misleadig cotext. The material must be ackowledged as GMC copyright ad the documet title specified. The GMC is a charity registered i Eglad ad Wales ( ) ad Scotlad (SC037750) Code: GMC/NTS2014KF/0614