Exploring communities of practice in the NHS: A core medical trainee experience

Factors that influence the quality of the clinical supervision experience in a first contact physiotherapy (FCP) role - The perspectives of supervisors and supervisees - A qualitative analysis

PURPOSE

First contact practitioner (FCP) roles have been developed to supplement the primary care workforce in managing the burden of musculoskeletal conditions. In order to quality assure and standardise capability of these clinicians an educational framework was developed by NHS England. The Roadmap to Practice (2020) was the curriculum designed to support and develop capability for FCP roles. This secondary analysis of a broader research project aimed to understand the factors affecting the supervisory experience from both a supervisor and supervisee perspective.

METHODS

A qualitative design using group interviews and an online survey was utilised to examine the experiences of these clinicians on their journey navigating and supporting the Roadmap to Practice portfolio process.

FINDINGS

Three principal themes were identified that affected the supervisory process; preparation of both supervisors and supervisee; the person (supervisor) and the practicalities associated with supervision.

CONCLUSION

There were numerous factors influencing the quality of clinical supervision. Adequate preparation of the supervisor and supervisee is critical to success. The attributes of the supervisor were important in the enhancing the quality of supervisory process. Time afforded to undertake supervision and access to appropriate supervisors need to be adequate and accounted for in workforce planning. A paradigm shift in workplace culture is required so clinical supervision is seen as an integral component in maintaining quality and assuring patient safety.

State of the art: A roadmap for the national echocardiography team 2023

Over the past 30 years, echocardiography has carved a vital professional role within the care of millions of patients per year. Here, I examine the provision of this vital service through the lens of the people who provide it, focussing on the challenges and opportunities facing this unique workforce over the next 10 years.

The use of locum doctors in the NHS - results of a national survey of NHS Trusts in England

BACKGROUND

Locum working in healthcare organisations has benefits for individual doctors and organisations but there are concerns about the impact of locum working on continuity of care, patient safety, team function and cost. We conducted a national survey of NHS Trusts in England to explore locum work, and better understand why and where locum doctors were needed; how locum doctors were engaged, supported, perceived and managed; and any changes being made in the way locums are used.

METHODS

An online survey was sent to 191 NHS Trusts and 98 were returned (51%) including 66 (67%) acute hospitals, 26 (27%) mental health and six (6%) community health providers. Data was analysed using frequency tables, t-tests and correlations. Free-text responses were analysed using thematic analysis.

RESULTS

Most NHS Trusts use locums frequently and for varying lengths of time. Trusts prefer to use locums from internal locum banks but frequently rely on locum agencies. The benefits of using locums included maintaining workforce capacity and flexibility. Importantly, care provided by locums was generally viewed as the same or somewhat worse when compared to care provided by permanent doctors. The main disadvantages of using locum agencies included cost, lack of familiarity and impact on organisational development. Some respondents felt that locums could be unreliable and less likely to be invested in quality improvement. NHS Trusts were broadly unfamiliar with the national guidance from NHS England for supporting locums and there was a focus on processes like compliance checks and induction, with less focus on providing feedback and support for appraisal.

CONCLUSIONS

Locum doctors provide a necessary service within NHS Trusts to maintain workforce capacity and provide patient care. There are potential issues related to the way that locums are perceived, utilised, and supported which might impact the quality of the care that they provide. Future research should consider the arrangements for locum working and the performance of locums and permanent doctors, investigating the organisation of locums in order to achieve safe and high-quality care for patients.

Experiences of a community of research practice: a service evaluation

BACKGROUND

A community of research practice (CRP) was established to increase research capacity and provide learning opportunities and networking for healthcare practitioners, working within a Children's Care Group. The CRP aimed to engage research-interested practitioners in research to develop their skills and confidence, encourage networking, and build research capacity.

AIM

To report the results of a service evaluation that was undertaken to review the CRP's value in practice.

DISCUSSION

Thematic analysis revealed four themes - 'positive environment', 'confidence', 'professional development' and 'networking' - highlighting benefits from the CRP, alongside the challenges encountered.

CONCLUSION

This article highlights the significant contribution of CRP for practitioners in the context of an innovative organisation with a supportive culture.

IMPLICATIONS FOR PRACTICE

A CRP empowers healthcare practitioners to engage with research while in clinical practice, enabling increased research confidence, and the development of research skill and knowledge and enhanced networking. CRP can potentially influence recruitment and retention.

Novel Integration of Administrative Pharmacy Residents in a Management Course

Background:

Management skills are an essential component of a pharmacy graduate’s abilities for successful practice. Although pharmacy education standards require that students have a working knowledge of management principles, students often do not see the value in management and business courses. One innovative approach is restructuring course content using case examples and real-world experiences to improve student understanding of finance and management principles.

Innovation:

Two specific changes were implemented in a second year (P2) management and finance course to improve the relevance of business principles. Course content was organized around current pharmacy service cases from a variety of practice settings and supported by the value of problem-based learning. Post-graduate year 1 (PGY-1) administrative pharmacy residents were engaged as course teaching assistants (TAs) who brought real-world experiences into the class. An analysis of pre- and post-course voluntary surveys, course evaluations, and TA evaluations assessed the impact of the course redesign.

Findings:

The course redesign achieved its intended goal of improving student-perceived course relevance. This was shown through statistically significant improvements in course evaluations that were intended to measure student perception of pharmacy management and its relevance in their future career. Student completed TA evaluations showed that those who reported their TA shared real-world applications had higher confidence in applying course concepts and greater understanding of course materials.

Conclusions:

Administrative pharmacy residents were successfully integrated into a pharmacy management course redesign, resulting in improved student perceptions of course relevance.

Development of a north-west London paracentesis simulation course for core medical trainees

We designed, implemented and evaluated a near-peer simulation training programme teaching diagnostic and therapeutic abdominal paracentesis to core medical trainees (CMTs). We taught diagnostic and therapeutic abdominal paracentesis to 77 north-west London CMTs over 8 training days over 4 years, 2015 to 2019. The programme was optimised by use of plan, do, study, act (PDSA) cycles and the content was evaluated by anonymous pre- and post-course questionnaires. There was a need for this training; 89% of participants reported inadequate training opportunities pre-course and only 28% felt 'confident' or 'very confident' to insert an ascitic drain. Simulation training appears effective when teaching these skills. Having been low in confidence before the course, all participants reported increased confidence after completing the course. Simulation training has been highlighted as a key aspect of the new internal medicine training programme, which replaces CMT. We would recommend using PDSA cycles to implement effective simulation programmes.