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Medical Council Publishes the first Reports into Inspections of Clinical training sites in the South/South West and Saolta Hospital Groups

Nine Hospitals inspected as part of Medical Council’s quality assurance role in medical education and training

Wednesday, 15th August, 2018: The Medical Council has today published the first reports into two sets of inspections carried out in nine Hospitals across the Saolta University Health Care Group and the South/South West Hospital Group as part of the Medical Council’s quality assurance role in medical education and training. The purpose of each inspection visit was to assess if and how each clinical training site is complying with Medical Council standards for clinical training sites.

The nine hospitals were inspected in 2017 to assess compliance with two sets of standards, one for interns and the other for specialist trainees. 

Four of the six clinical training sites in the Saolta University Health Care Group were visited, namely:

  • Galway University Hospital
  • Letterkenny University Hospital
  • Portiuncula University Hospital
  • Sligo University Hospital

Five of the nine clinical training sites in the South/South West Hospital Group were visited, namely:

  • University Hospital Kerry
  • South Tipperary General Hospital
  • Mercy University Hospital
  • University Hospital Waterford
  • Cork University Hospital

As part of the inspection process, the Medical Council Assessor Teams met with Hospital Group management, clinical training site management, trainers, specialist trainees and interns and inspected the educational facilities on site.

In terms of Intern Training Standards, it was found that the Saolta University Health Care Group was 36% Partially Compliant and 64% Fully Compliant with the Standards; and the South/South West Hospital Group was 3% Non-Compliant, 63% Partially Compliant and 34% Fully Compliant. 

However in relation to the Specialist Training Standards, it was found that the Saolta University Health Care Group was 7% Non-Compliant, 62.5% Partially Compliant and 30.5% Fully Compliant; and South/South West Hospital Group was 8% Non-Compliant, 69% Partially Compliant and 23% Fully Compliant.

Similar issues on non-compliance have emerged in both reports across all nine hospitals, especially around the area of protected training time, which is an area of concern for the Medical Council.

Although it is acknowledged that efforts are underway at a national level to ensure access to protected training for NCHDs and a ‘Supporting NCHD access to Protected Training Time’ agreement has been put in place, there are evident difficulties in ensuring the delivery of training to NCHDs through protected time for trainers, as identified during the clinical site inspection visits. Repeatedly, prioritising service delivery over education due to a lack of resources has been presented as a barrier to compliance, which apparently cannot be controlled by individual clinical sites, or Hospital Group management.

The Council has raised concerns regarding access to protected training time for trainers with the HSE’s National Doctor Training and Planning Directorate, the Forum of Irish Postgraduate Medical Training Bodies and the Department of Health.

Some of the other findings of the inspections included:

  • Interns being asked to perform duties above their grade
  • Trainees left unsupervised when a consultant was absent for a week
  • Medical Registrar refusing to write notes in patients’ charts and leaving this to interns to complete regardless if they have seen the patient or not
  • Trainees taking consent when unqualified/untrained
  • Unprofessional treatment of interns by members of a Radiology department
  • Signs on another Radiology department door saying ‘No NCHDs’
  • Allegations of bullying by a consultant in relation to the organisation of the on-call rota
  • Allegations of bullying being observed by interns which went unchallenged by other members of a multidisciplinary team
  • In one site, male interns reported receiving preferential treatment from nurses, compared to that of their female colleagues
  • Medical and professional development being curtailed as interns are heavily involved in basic administrative and medical procedures, such as ECG and Phlebotomy
  • Poor Wi-Fi or no Wi-Fi access for interns was identified in a number of sites
  • A number of sites need to upgrade the on-call accommodation facilities

Speaking about the publication of these reports, Ms Úna O'Rourke, Director of Education, Training and Professionalism with the Medical Council said, “Although the nine hospitals visited were, for the most part, found to be at least partially complying with Medical Council standards, numerous similar issues arose across many of the clinical training sites. These issues, such as allegations of bullying, a lack of respect shown to trainees and lack of protected training time, are widely known and are repeatedly highlighted in other ways, including in the Medical Council’s Your Training Counts survey.”

“In saying that, many positives were identified during the inspections, especially the strong commitment and dedication of the Chief and Associate Academic Officers, the commitment of Intern Coordinators and some trainers, who provide regular feedback and assessment and further personal development supports to trainees.” concluded Ms. O’Rourke.

Medical Council President, Dr Rita Doyle said “We must ensure that our interns and NCHDs are treated with equality and respect in a bullying-free work environment. Bullying in the work place will not be tolerated. Interns and NCHDs must have the resources required to allow them to treat their patients and to develop their skills while furthering their education. When doctors are overworked without appropriate rest periods and breaks this can lead to an impact on their physical and mental wellbeing and, in turn, could become a patient safety issue.”

“Doctors must be supported in their roles in caring for their patients, especially our interns and our specialist trainees who are the future of Irish healthcare.” concluded Dr Doyle.

Hospital Groups must submit an action plan following an inspection. Implementation of the action plans will be monitored on an annual basis until the next Medical Council visit.

The Medical Council is the independent regulatory body for doctors and has a statutory role in protecting the public by promoting the highest professional standards amongst doctors practising in Ireland. The Medical Council maintains the Register of Medical Practitioners who are legally permitted to carry out medical work in Ireland. The Council also sets the standards and monitors compliance for medical education and training in Ireland. It oversees lifelong learning and skills development throughout doctors’ careers through its professional competence requirements and is charged with promoting good medical practice. The Medical Council is also where a person may make a complaint against a doctor.

DOWNLOAD THE REPORTS:

For further information please contact: Alan Gallagher, Head of Communications, Medical Council 01 498 3185 / 087 3615253 agallagher@mcirl.ie  / communications@mcirl.ie