Trainee interview - Jenny Isherwood

23 January 2017 - Transform offices

Contact

Jenny Isherwood

jisherwood@doctors.org.uk

07815 134411

Background

Surgical trainee - Higher Specialty 3 (? check this - has done 6 years training incl. Foundation) general surgery (3 years training remaining) - Registrar
Thames Valley (Oxford)
Currently on the National Medical Directors leadership and management fellowship working in external relations at Royal College of Physicians (OOPe)
Very interested in process improvement and the way that technology can support this - self-taught basic coding to build the Oxford School of Surgery website and an app for one of the local trusts: "I am a huge ambassador for the use of technology to improve efficiency and simplify processes"

Notes from discussion

Materials used: Big Picture; Assessments App Map; video demo of Assessments/trainee portal (incl. desktop & mobile)

Work-based assessments/ePortofolio

Interested in where TIS fit in with ePortfolio - have to do all workplace-based assessments on ePortfolio.

Royal College of Surgeons ePortfoilo is Intercollegiate Surgical Curriculum Programme - ISCP (https://www.iscp.ac.uk) (NB - website includes detailed descriptions of different assessment types including sample forms etc in its public space). ISCP has been recee

Log in to ISCP at least once a week.

Different types of workplace-based assessments - all on ISCP:

CBD - Case-based discussions: trainee sees patient, discusses with consultant, links experience/discussion with curriculum topics → send to assessor who gives feedback and signs off
CEX - Clinical Examinations: Assessor will observe trainee examining a patient. Not always directly observed - if assessor is confident of trainee's ability may sign off based on word of trainee
DOPS - Direct Observations of Procedural Skills: assessor observes trainee undertaking specific procedure - tends to be more basic procedures and more junior trainees (registrars wouldn't do this as will have demonstrated competency in these procedures earlier in training)
PBA - Procedure Based Assessment: observational assessment of more detailed procedures e.g. complete operations
Annual 360 degree /TAB feedback: Trainee completes self-assessment; same form completed by 12 others (range of colleagues both clinical and non-clinical); all managed through ePortfolio - 'raters' chosen from list or trainee can invite others to register (needs to be a certain quota of different roles included). Completed forms accessed by Educational Supervisor who shares summary with trainee. Can investigate any issues flagged by raters.

All of these managed on ISCP including workflows etc for sign off.

Trainee view

Dashboard with alerts etc. Detail pages where trainee logs information. Structured areas for each type off assessment - forms with workflows etc. Example screens:

For ARCP

Educational Supervisors get a summary view of assessments completed. This is what is reviewed by panel in ARCP. (Can't see this view with Jenny's log in)

Trainee perspective of what's needed from Trainee Portal

Priorities - I want to know:

Where I am going - Placements - normally gets sent out in an email with a spreadsheet attached, couple of weeks before you're due to start work. Last year we had a regional conference and it was stuck as a poster on a wall and we all had to go and look to see were next placement was. It IS useful to see where other people in your cohort will bet to see who you will be working with etc,. Want to see other trainees' placements as well as your own. WE're quite a tight group - you know most people and will be working with many of them, write papers together etc. Core surgery - 40-50 trainees, then 5 or 6 join higher speciality each year.
Study leave/budget applications - Currently in Oxford the money goes from HEE to the Trusts who then manage it (administered by PgD Education Centre/Director of Medical Education in Trust). HEE not able to monitor where it's going and how much is left. Process of applying is different in each hospital - have to work out the process and track down the forms. If I want to go to a conference, I have to fill in three forms:

- Form to apply for day off - find form (paper), fill it in, get my consultant to sign sign it and then hand it to the person who manages the rotas
- Fill in a form to claim the budget for the conference/course (Financial claim)
- Fill in another form to claim expenses

Understand HEE is trying to centralise this process as there are issues. E.g. trainees allowed 30 training days per year - 20 of these are at the discretion of the TPD (so will be locally organised training days) and 10 at the discretion of trainee (e.g. conferences you're interested in). If the TPD doesn't allocate all of the 20 days, these can be used at discretion of trainee. Some trainees don't use all their days. But as training sits in individual trusts, no way of knowing how much of the allocation has been used if trainee moves trusts.

TPD training days hugely variable between specialties: Core Surgical have 1/2 day per month; Higher Specialty General Surgery 1 day/month; HS Orthopaedic Surgery 1 day/week; GP 1/2 day/week; Plastics 2 days/year (which are also their ARCP days, so get very little). But TPD may say there is local training available - but the trainees might not know what's available.

(Study leave/budget functionality would be part of a 'Silver' service in terms of your MVP- Gold description)

Training days - sharing and publicising training opportunities
- What training is available? e.g. Regional teaching programme regular sessions - might be 4th Friday of every month
- Currently just relies on sending out emails
- All word of mouth or relaying on people being on the right email list
- May be local training aimed at one group that others might be interested in
- Would be good to have a noticeboard of potential training opportunities - good if you could filter e.g. by Region or topic - you might want to go to something outside your region so would want to see all, and also have a specific topic of interest not directly related to your curriculum e.g. ethics or research

Has set up a surgical research collaborate. Also have a training group in Oxford and the vision was to set up an events noticeboard using Google Calendar, but they realised that it is beyond the scope for one person to manage and would quickly get out of hand, then several versions might emerge etc.

Register/request annual leave and record absences

This is all done within the local Trust. Use Cascade HR system. Alerts trust and approvals managed through workflows. (Form R - have to record different absences - those that are not study leave and annual leave.) WOUld be good to be able to track the process online - would give audit trail for trainee. Currently hand over paper form and then if it goes missing, you have no proof that it was submitted. I have had problems so have taken to photographing the form (signed by the relevant administrator) to prove it was.

Making ARCP easier

(NB - Thames Valley uses Intrepid Form R)

ARCP in TIS will benefit administrators, not the trainees, as it's a process we only go through once a year. Have to provide information:

Wider scope of practice
Form R
Educational Supervisor's form

Form R on Intrepid. It's not that difficult - everything else the trainee does is on ePortfolio.

Form R - placements, training numbers etc done by the administrators → we just need to fill in a few boxes - only takes me about 25 mins.

One thing - once it's submitted you can't make any changes. I can see why. But if you make a mistake and then submit, you have to contact admin to unlock it for you.

ARCP notification - Admin send out a massive email - about 10 attachments - with times and dates and this is what you need to do and fill in. Links to Intrepid Form R etc.

Attachments:

Invitation letter
3 x timetables (2 days of panel review, 1 days of trainee feedback)
Wider scope of practice form (I think this is on Intrepid so they are doubling up - I don't know why)
Ed Supervisor's form
Plus link to Intrepid with instructions

You also need to provide proof that you have completed GMC Survey. Every trainee has to do this annually - it's on GMC website. But you have to take a screen shot and then submit this for your ARCP. Would be great of there was a link so that GMC could confirm that you'd done it.

Also have to do a declaration of ongoing investigation etc - I think that's on Form R.

Reviewed trainee portal prototype video:

Liked the idea of mobile first - would definitely be more likely to be able to use it at work than current system (couldn't complete Form R on Intrepid on a mobile device as too wordy and complex - currently does it on laptop at home. 'No time to complete it at work' but more likely to grab a few minutes to do it on mobile)
Liked design with 'dissected' form to make completion easy - drop downs, tick boxes etc. Finds difficult to type long sentences etc on phone, likely to increase errors etc, so mobile design good
ISCP has a mobile app (iOS only - has bought an Apple especially) - it's very handy
Showed in the demo where self declaration would be made (assumed this is the highest volume of text that would need to be input) - very happy to do this as not very much information to be put in there - it's normally just a brief note and a cross-reference to ePortfolio. Also very few trainees would actually have to declare incidents - maybe one in 20

Oxford School of Surgery Website

Got funding from TPD to set this up & run for 3 years - funding will run out this summer

Was a need for this because Thames Valley deanery website is out of date (training information is on a website linked from the HEE Thames Valley section on the main HEE website:

"Postgraduate education information for doctors in the Thames Valley is available on a separate website - www.oxforddeanery.nhs.uk"). Still called 'deanery' and the information on Surgery only lists 3 of the specialties available. (NB - these pages currently state they are under review). Anyone applying for Surgical training at Oxford would look at the website - fact it doesn't list all specialties says a lot. Not having good information means that you won't get the best trainees.

Set up own website to provide more useful information for surgical trainees. (Will add link/screenshots here when I have them)

Other ideas for TIS

Exams

If trainees fail more than 2 or 3 times deanery have a duty to put them in touch with education support officer. It would be good if the system could automatically trigger support if they are in this position.

Training placements

Doing training placements is a real headache for TPDs. There will be people on OOPs, maternity leave etc. They have to self-create a spreadsheet of all the potential jobs (won't change year by year), then work out which trainees are in programme, then for surgery there are certain requirements and levels each trainee has to fulfil. Would be great of they could drag and drop the names of trainees in programme and available jobs. It would mean they could spend more time thinking about actual training needs and not the complicated logistical part.

Applying for OOP

I had to spend about 6 hours driving time to get 15 minutes face time when applying for my OOPE (Out of Programme Experience):

To High Wycombe where TPD based to get form signed (5 mins face time)
To Oxford to see Head of School based (5 mins)
Oxford to see Programme Manager to hand over paperwork (5 mins)

Would love to have been able to apply online - would save all this time (and Oxford is the smallest area, so goodness knows what it's like if you are in Peninsular - hopefully they have better processes!)

Passport checks

Think this is already being worked on in HEE. Trying to create a "passport" so that you don't have to undergo employment checks every time you go to a new employer (every 6 months or 1 year).

Currently have to present your documents - passport, DBS (formerly CRB) checks, occupational health records. New passport would carry over when you changed employer. (Don't think this would include mandatory HR training e.g. H&S etc, which is specific to workplace.)

Relationship with HEE/Trust/Colleges

HEE has 'removed' contact with trainees. Main contact is with TPD when you start, at ARCPs and when you get your golden handshake. That's about all trainees want - if you see them more often not a good sign

Most other contact is emails telling you dates or chasing forms

Trust - is your employer, so your home for the time you're there - but that changes every year (when qualified this would be where most people would call 'home'). Trust is who administers your HR, pays you etc.

Colleges - most trainees have no idea what what colleges do apart from take a large chunk of money from you every year and charge an extortionate amount for exams! Working at Royal College of Physicians I now have an appreciation of everything they do - mostly about advocacy to govt etc, promoting health policy and developing the profession.

Think RCP would be open to a discussion about closer links with ePortfolio (don't know who yo; d contact though). Royal College of Surgeons updated theirs last summer, so would be hot on requirements etc - theirs is more advanced than a lot, as they have to capture so much more information - every operation you need details of the patient, who was involved etc.

Royal College of Paediatricians has had huge problems with their ePortfolio- so much so that they have had to abandon workplace-based assessments