Demystifying professional support for trainees: what does it mean?

'Professional support' is a commonly used term in medical training but it is not always clear what is meant by it and what the implications are for an individual trainee and his/her trainer. This article explores the concept of professional support in medical training.

Infantile haemangioma: their presentation and management.

Haemangiomas are the commonest type of vascular tumour in infancy. This article summarizes the pathophysiology and classification of the subtypes as early identification of high-risk lesions is essential for consideration of treatment to prevent short- and long-term complications from the condition.

Use of smartphone apps by paediatric trainees.

Over 70% of the population owns a smartphone and there are now millions of apps available. This study looks at smartphone and app use among paediatric trainees, in particular whether they are accessing medical apps to help with clinical practice.

A multisource feedback tool to assess ward round leadership skills of senior paediatric trainees: (2) Testing reliability and practicability.

BACKGROUND: A five-domain multisource feedback (MSF) tool was previously developed in 2009-2010 by the authors to assess senior paediatric trainees' ward round leadership skills. OBJECTIVES: To determine whether this MSF tool is practicable and reliable, whether individuals' feedback varies over time and trainees' views of the tool. METHODS: The MSF tool was piloted (April-July 2011) and field tested (September 2011-February 2013) with senior paediatric trainees. A focus group held at the end of field testing obtained trainees' views of the tool. RESULTS: In field testing, 96/115 (84%) trainees returned 633 individual assessments from three different ward rounds over 18 months. The MSF tool had high reliability (Cronbach's α 0.84, G coefficient 0.8 for three raters). In all five domains, data were shifted to the right with scores of 3 (good) and 4 (excellent). Consultants gave significantly lower scores (p<0.001), as did trainees for self-assessment (p<0.001). There was no significant change in MSF scores over 18 months but comments showed that trainees' performance improved. Trainees valued these comments and the MSF tool but had concerns about time taken for feedback and confusion about tool use and the paediatric assessment strategy. CONCLUSIONS: A five-domain MSF tool was found to be reliable on pilot and field testing, practicable to use and liked by trainees. Comments on performance were more helpful than scores in giving trainees feedback.

A multisource feedback tool to assess ward round leadership skills of senior paediatric trainees: (1) Development of tool.

BACKGROUND: Leading a ward round is an essential skill for hospital consultants and senior trainees but is rarely assessed during training. OBJECTIVES: To investigate the key attributes for ward round leadership and to use these results to develop a multisource feedback (MSF) tool to assess the ward round leadership skills of senior specialist trainees. METHODS: A panel of experts comprising four senior paediatric consultants and two nurse managers were interviewed from May to August 2009. From analysis of the interview transcripts, 10 key themes emerged. A structured questionnaire based on the key themes was designed and sent electronically to paediatric consultants, nurses and trainees at a large university hospital (June-October 2010). RESULTS: 81 consultants, nurses and trainees responded to the survey. The internal consistency of this tool was high (Cronbach's α 0.95). Factor analysis showed that five factors accounted for 72% of variance. The five key areas for ward round leadership were communication skills, preparation and organisation, teaching and enthusiasm, team working and punctuality; communication was the most important key theme. A MSF tool for ward round leadership skills was developed with these areas as five domains. CONCLUSIONS: We believe that this tool will add to the current assessment tools available by providing feedback about ward round leadership skills.

Annual planning meetings: views and perceptions.

BACKGROUND: In 2009, annual face to face planning meetings (APMs) were introduced as an optional meeting for all paediatric trainees. APMs are a formative assessment process whereby the trainee meets with a panel of consultants and sets the agenda for discussion. METHOD: A questionnaire about APMs was given to all participating trainees and trainers in 2011. RESULTS: The response rate was 93 per cent (139/150) and 67 per cent (12/18) for trainees and trainers, respectively. All trainers had received panel member training. Ninety-one per cent of trainees (126/139) felt adequately prepared for the meeting. Issues discussed included career plans (93%), future training placements (73%), ePortfolio (61%) and previous training posts (61%). Trainees felt that the APM was a helpful formative assessment process (with a mean score of five on a six-point Likert scale: 1, strongly disagree; 6, strongly agree), and that panels were fair, supportive, communicated clearly, listened to concerns and focused on individual learning needs. Sixty-seven per cent (8/12) of trainers would have liked more information about the process beforehand. DISCUSSION: The main benefits of APMs were trainees feeling supported in their training and better informed regarding career options. APMs would be of value to all specialties to enable annual formative assessment to be undertaken at a different time to the summative assessment process. APMs facilitate reflection on learning needs, and the formulation of personal development plans and career goals for trainees. Trainees felt that the APM was a helpful formative assessment process.

Choosing a career in paediatrics: do trainees' views change over the first year of specialty training?

OBJECTIVES: To look at why a regional cohort of UK doctors chose a paediatric career and to ascertain views on their career near the end of training year one. DESIGN: A 20-item questionnaire was sent to all new regional paediatric specialty trainees. Three focus groups were held with trainees near the end of year one to elicit key themes. SETTING: West Midlands Deanery, UK. PARTICIPANTS: Twenty-nine new regional paediatric specialty trainees in year one completed the questionnaire. A total of 15 trainees participated in the focus groups near the end of year one training. MAIN OUTCOME MEASURES: Reasons for choosing a paediatric career and factors which further influence career choice for trainees during their first specialty training year. RESULTS: Key influencing factors for choosing paediatrics were enjoying working with children and positive undergraduate experience of the specialty. All trainees had paediatrics as their first choice specialty and undertook a paediatric Foundation post. Near the end of year one, doubts were cast on career aspirations due to seeing middle grade colleagues struggling with work-life balance and a growing feeling that family came first. CONCLUSIONS: Senior trainees need to be aware that they act as powerful role models for their more junior colleagues and therefore have an influential role on how juniors perceive a paediatric career. Family friendly flexible working patterns in paediatrics are vital to retain junior trainees. All paediatric staff are role models and need to be enthusiastic, keen to teach and to promote a positive working environment.

First year doctors experience of work related wellbeing and implications for educational provision.

OBJECTIVE: To explore factors which affect newly qualified doctors' wellbeing and look at the implications for educational provision. METHODS: Data were collected by free association narrative interviews of nine Foundation doctors and analysed using a grounded theory approach. Two Foundation programme directors were interviewed to verify data validity. RESULTS: Two main themes emerged: newly qualified doctors' wellbeing is affected by 1) personal experience and 2) work related factors. They start work feeling unprepared by medical school, work experience ("shadowing") or induction programmes at the beginning of the post. Senior colleague support and feedback are much valued but often lacking with little discussion of critical incidents and difficult issues. Challenges include sick patients, prescribing, patient/relative communication and no consistent team structure. Working shift patterns affects personal and social life. Enjoyment and reward come from helping patients, feelings of making a difference or teaching medical students. CONCLUSIONS: Whilst becoming familiar with their roles, newly qualified doctors search for identity and build up resilience. The support given during this process affects their wellbeing including coping with day to day challenges, whether posts are experienced as rewarding and how work influences their personal and social lives.

A new tool to evaluate postgraduate training posts: the Job Evaluation Survey Tool (JEST).

BACKGROUND: Three reports in 2013 about healthcare and patient safety in the UK, namely Berwick, Francis and Keogh have highlighted the need for junior doctors' views about their training experience to be heard. In the UK, the General Medical Council (GMC) quality assures medical training programmes and requires postgraduate deaneries to undertake quality management and monitoring of all training posts in their area. The aim of this study was to develop a simple trainee questionnaire for evaluation of postgraduate training posts based on the GMC, UK standards and to look at the reliability and validity including comparison with a well-established and internationally validated tool, the Postgraduate Hospital Educational Environment Measure (PHEEM). METHODS: The Job Evaluation Survey Tool (JEST), a fifteen item job evaluation questionnaire was drawn up in 2006, piloted with Foundation doctors (2007), field tested with specialist paediatric registrars (2008) and used over a three year period (2008-11) by Foundation Doctors. Statistical analyses including descriptives, reliability, correlation and factor analysis were undertaken and JEST compared with PHEEM. RESULTS: The JEST had a reliability of 0.91 in the pilot study of 76 Foundation doctors, 0.88 in field testing of 173 Paediatric specialist registrars and 0.91 in three years of general use in foundation training with 3367 doctors completing JEST. Correlation of JEST with PHEEM was 0.80 (p < 0.001). Factor analysis showed two factors, a teaching factor and a social and lifestyle one. CONCLUSION: The JEST has proved to be a simple, valid and reliable evaluation tool in the monitoring and evaluation of postgraduate hospital training posts.

Annual review of competence: trainees' perspective.

BACKGROUND: An annual review of competence progression (ARCP) is compulsory for all UK specialty trainees. AIM: We explore specialty trainees' views on ARCPs, including the usefulness of annual review, and how well prepared they felt for it. METHODS: A 15-item questionnaire was completed anonymously by 63 paediatric specialty trainees following their ARCPs in the West Midlands Deanery. After further trainee and trainer education on ARCPs, 21 trainees participated in telephone semi-structured interviews. RESULTS: Seventy-six per cent of paediatric specialty trainees found having an ARCP helpful, although 70 per cent did not feel well informed about the process: this did not vary by training year or gender. Apart from trainees valuing a regional review of progress, the other key themes from the semi-structured interviews were negative around ePortfolio, IT, lack of consultant training and willingness to undertake assessments, being unaware of the evidence needed for ARCP and electronic ARCP feedback. CONCLUSION: Although three-quarters of paediatric trainees found having an ARCP helpful, they did not feel prepared for the ARCP. Educating both trainees and trainers about ARCPs and the required portfolio evidence is continuing; however, we believe trainees will only truly feel prepared for their ARCPs after successfully addressing the more challenging issues of good IT infrastructure in each trust, with consultants readily undertaking workplace-based assessments (WBAs) and with educational supervision being of a consistently high standard.

DOPS assessment: a study to evaluate the experience and opinions of trainees and assessors.

BACKGROUND: Workplace based assessments (WBAs) have been part of UK training for the last 3 years. Carrying out procedures efficiently and safely is of paramount importance in anaesthesia. AIMS: To explore opinions and experiences of Direct Observation of Procedural Skills (DOPS) assessments in a regional anaesthetic training programme. METHODS: 19 and 20-item questionnaires were distributed to trainees and consultants respectively. RESULTS: Questionnaire response rate was 76% (90/119) for trainees and 65% (129/199) for consultants. 43% of consultants and 33% of trainees were not trained in DOPS use. Assessments were usually not planned. 50% were ad hoc and the remainder mainly retrospective. Time spent on assessment was short with DOPS and feedback achieved in ≤15 minutes in the majority of cases with lack of suggestions for further improvement. Both trainees and consultants felt that DOPS was not a helpful learning tool (p = 0.001) or a reflection of trainee competency. CONCLUSIONS: DOPS assessments are currently not valued as an educational tool. Training is essential in use of this WBA tool which needs to be planned and sufficient time allocated so as to address current negative attitudes.

Trainee doctors' views on workplace-based assessments: Are they just a tick box exercise?

BACKGROUND: In August 2007, run-through specialty training and workplace-based assessments (WBAs) were introduced for UK junior doctors. AIM: This study explores whether WBAs have been successfully integrated into paediatric training programmes. METHOD: A 20-item questionnaire was distributed to regional paediatric trainees. RESULTS: Eighty seven per cent (130/150) trainees responded. Reliability of the study was good (Cronbach's alpha 0.813); 92% (119/130) trainees knew how to conduct WBAs (scoring ≥ 4 on the six-point Likert scale). However, they were ambivalent about WBAs being a true reflection of their capabilities (mean Likert score 3.46). A common problem was finding assessors with 40% of trainees stating that staff had refused to do assessments. Almost half of the assessments were done retrospectively. Trainees did receive feedback but advice on future improvement was not always given (highest mean Likert score 4.00). Free text comments analysis mostly centred on difficulties in getting WBAs done. CONCLUSIONS: A cultural change is needed for trainees to feel that WBAs are not just a tick box exercise, but a useful educational tool for learning. Ongoing work on implementation needs to include additional training, especially on the value of WBAs for formative assessment and consultants having protected time in their job plans for training.

Medical students' views on selecting paediatrics as a career choice.

Despite increasing numbers of UK medical students, the number of trainees selecting paediatrics as their specialty choice has decreased. Previous studies show that most students will choose their ultimate career during undergraduate training. We therefore explored the views of students in the final year at Birmingham University about a career in paediatrics. Students completed a 27-item questionnaire during the penultimate week of their paediatric clerkship (PC) and 97% responded (127/131). Prior to the PC, 29% (37/127) of students had considered a career in paediatrics, rising to 50% (63/127) after the PC (p < 0.001). Students felt that paediatricians were enthusiastic and keen on teaching, and the ward working atmosphere was good. However, students perceived paediatrics as a difficult specialty with high competition for training posts. Students felt their paediatric experience was too limited and advice was needed on paediatric careers early in undergraduate training. This study confirmed that focusing on improving the PC is not sufficient if we are to inspire medical students to consider a career in paediatrics. Exposure to the specialty is needed from year 1 of undergraduate training along with career advice to dispel current myths about specialty training. Students would then be able to make more informed career decisions.

Senior paediatric specialist registrars' experience in management.

BACKGROUND: There is an increasing focus on trainees acquiring management skills which form part of college curricula and the guidance provided by the General Medical Council in the UK. OBJECTIVE: To explore the managerial learning activities of senior paediatric specialist registrars (SpRs). DESIGN, SETTING, PARTICIPANTS: Questionnaire study; West Midlands region, UK; senior paediatric SpRs in the last 2 years of training. METHODS: A 17 item questionnaire was sent by post to all 45 paediatric SpRs in the last 2 years of training. A follow-up email was sent to non-responders. RESULTS: 87% (39/45) SpRs completed a questionnaire. All had participated in clinical managerial activities with 44% (17/39) doing >or=4 h per week. Popular activities were teaching and development of treatment guidelines. Non-clinical managerial experience, mainly rota management and teaching programme organisation, was limited with 64% (25/39) doing