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Why Your Training Counts - Dr Audrey Dillon

In 2014, the Medical Council began asking detailed questions of all trainee doctors in Ireland, writes Dr Audrey Dillon, member of the Medical Council. Now currently running for the fourth year, the annual Your Training Counts survey provides all trainees with an opportunity to share their views on the places where they learn as doctors; and puts their voice at the heart of discussions on the future of postgraduate medical education and training.

This year’s report has taken a slightly different approach to the ones we have previously published. There have been some very interesting findings from the last three years’ surveys, which we felt it was timely to share with you. The report displays the cumulative data which can be accessed here however it is also of great importance to take this opportunity to share some of the outcomes which are a direct result of Your Training Counts.

From the outset, the data has helped the Medical Council and key stakeholders in medical education and training to identify areas for improvement. Inconsistencies in learning experiences have been shown to exist across training sites and programmes. Trainees, especially interns, do not feel prepared for the next stage in their professional development. They often don’t receive adequate (if any) induction when they enter a new training role and the likelihood of them receiving constructive feedback in post appears to be at the whim of their supervisor. Bullying and undermining behaviour has been found to be endemic throughout the Irish health system and is likely to negatively impact on a doctors’ health and wellbeing. Supports are not always available or adequate for trainees with health or wellbeing issues.

The survey findings have helped determine corrective actions required to address these issues, such as improving educational governance; better preparing undergraduate students for intern training; developing a competency-based intern curriculum; introducing mandatory, certified induction and orientation at training sites; clarifying trainee roles and responsibilities and training objectives; providing feedback on trainee performance; and addressing the endemic health service culture of bullying and undermining behaviours. In doing so, we must also focus our attention on hospitals, where trainee experiences are typically rated lower than in GP practices and mental health services. Remedial actions are being taken, but they can be slow to filter through the medical education and training system, so it is most gratifying to see that the data is already showing statistically significant improvements in the overall quality of clinical learning environments. In particular, areas such as formal education, feedback, coaching and assessment, work being adapted to trainees’ competence, supervision, patient handover, teamwork and peer collaboration, have all shown statistically significant improvements over three years.

It has been widely reported in the media and elsewhere that the Irish health system has been haemorrhaging doctors for several years and is becoming increasingly reliant on international medical graduates to fill posts. Although there are many factors at play here, improving trainee experiences appears to be having an encouraging influence on the number of doctors intending to remain in Ireland following completion of training. In our 2014 survey, 21% of participants did not see themselves staying in Ireland for their long-term future. By 2016, this number had reduced to 14%. We expect continuous improvements in trainee experiences to positively affect retention of doctors within the Irish health system. The Medical Council does not wish to simply “pick holes” in the medical education and training system. The ultimate aim here is to provide leadership and direction and continuously drive improvements; always moving in a positive direction, for the benefit of trainee doctors, the Irish health service and ultimately patient experiences. The survey has also identified strengths in the system and these successes can be examined with a view to replicating them in current areas of poor performance.

So, you may very well ask, what difference, if any, is all of this information making; and what is the Medical Council actually doing about it? We use D-RECT scores from Your Training Counts to prioritise which clinical training sites to visit as part of our four-year schedule of regional inspection visits. Currently, this is the most reliable data available to us and, with each survey, becomes an increasingly valuable data source. A worrying finding is that the intern year appears to be the “weakest link” in the medical education and training system. Survey results prompted further research into intern training in Ireland. A set of defined competencies for intern training have been developed and are ready to be piloted. The overall governance of the intern year will be managed by a new Medical Intern Board which brings all the key stakeholders together with the mutual aim of significantly improving intern training.

The Council’s “Safestart” project, in collaboration with postgraduate training bodies, is actively developing support systems for doctors entering into the Irish healthcare system. Further research will be undertaken to identify the nature of the behaviours which trainees associate with bullying and undermining so that these behaviours can be addressed appropriately within the system. Consultants, GPs and other clinical trainers face multiple competing demands to deliver increasingly busy clinical services. Although we meet trainers during our accreditation visits and they are encouraged to openly tell us about the support they receive, we will also provide them with an opportunity to keep us informed in between visits via a Trainer Survey, to run concurrently with future surveys of trainees. We will also continue to strongly advocate for protected time for training. Of course, it would be naïve of us to think that we could do all of this good work ourselves. We have consulted and collaborated with several partner organisations to make a concerted effort to respond positively to our trainees.

Your Training Counts data has inspired and informed initiatives undertaken by other organisations, such as the RCSI’s “Doctor Emigration Project”; RCPI’s study into the frequency and nature of adverse events; responses from the Forum of Postgraduate Training Bodies, HSE NDTP and IMO to address bullying and undermining of trainees; a HSE initiative to assess and support the health and wellbeing of doctors; and a UCC study into the “Challenges and Priorities in Irish Clinical Learning Environments”. The Medical Council strives to ensure that doctors get the best possible education and training in medical schools and clinical training sites and that their educators, trainers and tutors are supported in their roles. Well-educated and well-trained doctors, whose training is appropriate to the needs of Irish patients and who experience and learn professionalism from those who train them, ultimately improves the quality of patient care and safety in Ireland.

Your Training Counts is a means of ensuring our work in medical education and training is collaborative, appropriate, evidence-based and in line with emerging needs. The survey has quickly made its mark in a relatively short period of time and will continue to provide trainees with a voice and support the Medical Council and our key stakeholders in driving quality improvements in medical education and training for the benefit of trainees, trainers and patients into the future.

Click here to find out more information about participating in this year’s survey.

Audrey Dillon at YTC Launch

Dr Audrey Dillon was appointed to the Medical Council through the election in the Non-Consultant Hospital Doctor category and is Chair of the Ethics and Professionalism Committee.