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Improving psychiatric training through revised early supervision and support

In partnership with Health Education England, Tees, Esk and Wear Valleys NHS Foundation Trust’s project was aimed at improving basic psychiatric training through revised early supervision and support arrangements.


Related themes

  • Rotas and scheduling
  • Multi-professional team
  • Change and empowering employees
  • Improving training programmes and pathways
  • Mental health

Background

Supervision of trainee psychiatrists was not a formal process until the introduction of workplace based assessment (WBAs) which saw regular observation of clinical practice become standardised.
Since the introduction of WBAs, there have been concerns raised about how they are carried out, linked both to the national exam standards and how they are delivered. It has been noted that where trainers were observing their trainees in the initial weeks, this was more about checking competency than using direct supervision and feedback as a training tool.

How they did it

This pilot project enabled trainees who were new to adult and old age psychiatry services to perform core tasks more quickly and earlier into post.
After reconfiguring posts, each doctor had a ‘home team’ where they carried out the greater part of their clinical work and then they rotated to other teams to ensure they gained access to the right mix of clinical experience. Trainees went through a familiarising ‘green phase’ followed quickly by a ‘blue phase’ where they completed a core list of psychiatric tasks in key areas (e.g. information gathering and processing, communications and prescribing). Trainees were able to participate in shorter inductions from some areas of work such as electronic records training in order to carry out ‘on the job’ training more efficiently.
New processes for clinical supervisors meant they then carried out WBAs with doctors in training for every patient encounter.

What they achieved

  • A 55% increase in the amount of directly supervised clinical work, especially in doctors who were new to their post
  • An increase in trainee confidence was observed
  • Trainees in the pilot group ranked the quality of training higher than those not in the pilot. Trainees’ experience of induction, supervision, training and clinical experience was scored as a mean of 4.4, with a high of 5.0 for ‘excellent’, against a control group that achieved a mean score of 3.6
  • A consensus was found among 26 clinical supervisors who stated that the project had resulted in a more standardised approach to supervision
  • Clinical supervisors agreed that patient care had benefited as a result of the project
  • Improved multi-professional team working and a more tolerant multi-professional culture
  • Trainers and non-medical staff believed that doctors new to psychiatry are now more prepared for practice and that their contribution to service delivery has improved
  • There was a 50% reduction in time spent in induction on e- training on their systems

What they’ve said

The BTBC pilot to support doctors new to psychiatry has been very useful in shaping our strategic plans to assess and accommodate their training needs in the vital first few weeks. It has given the impetus and focus to develop more structure and clarity about the content of the programme with their individual trainers and we have already made some important changes to our trust-wide and locality induction programmes.” Trust Director of Medical Education

“BTBC is a project with high face validity which is difficult to contradict. The amount and quality of direct supervision for beginners in speciality postings has to deliver better training and care.” Trust Senior Postgraduate Tutor

“I do feel that the BTBC initiative has been a worthwhile improvement and needs to be rolled out to the entire organisation and beyond.” Trust Foundation and GP Tutor

“Induction was very well organised and useful… feedback was constructive and encouraging…thorough and useful start to the programme…highly supported in psychiatry as a non-psychiatry trainee” Trainee

Toolkit

Please look at the toolkit materials in the documents section below. The top tips and business cases have been developed by the BTBC team to support organisations to implement these changes and the case studies and project resources have been developed and approved by the project teams.

The top tips include lessons learnt that have been identified throughout the project. The business case will guide you through the management principles and communications and engagement activities. The case studies provide a detailed overview of the project. Feel free to adapt these resources to suit your projects. Your organisation may have its own materials and templates that you can use or you may find the NHS Improving Quality (NHS IQ) learning handbook useful too.

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