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Your Training Counts - Trainee experiences of Clinical Learning Environments in Ireland 2014-2016

Your Training Counts, the annual national trainee experience survey, is designed and delivered by the Medical Council in order to inform and support the continuous improvement of the quality of postgraduate medical training in Ireland.

With three years of cumulative data since the survey first ran in 2014, it is a timely opportunity to assess the impact on trainee experiences of the remedial actions which have been taken to address earlier findings. In doing so, we have identified areas where the survey is having a positive impact and highlighted areas where efforts need to be concentrated over the coming years

This Your Training Counts report focuses on trainee experiences of clinical learning environments in Ireland 2014- 2016. Follow the survey on Twitter.

speaker icon Listen to Dr Audrey Dillon's presentation at the Your Training Counts Report 2016 Launch, held on August 31st 2017.

Teamwork

Peer collaboration and Consultants' role are rated the most positive aspects of clinical learning

Training

Those in General Practice Training had an average D-RECT score of 180.9 in 2016

54%

of YTC respondents were female and 46% were male in 2016

1/3

of trainees reported being bullied or undermined in post and over half of trainees had witnessed someone else being bullied

1/4

of trainees scoring their overall experiences very poorly; and around the same proportion scoring them reasonably highly

5%

increase among those who reported needing support and accessing it in 2016

More Information

Why “Your Training Counts”

 

National Trainee Experience Survey - aims to support the continuing improvement of the quality of postgraduate medical training in Ireland. Specifically, the objectives of Your Training Counts are to:

  • Monitor trainee views on the quality of clinical learning environments in Ireland;
  • Monitor trainee views on other aspects of postgraduate medical education and training,
  • including preparedness for transitions, retention and career plans, health and wellbeing, and trainee perceptions of safety at clinical sites;
  • Inform the role of the Medical Council in safeguarding the quality of medical education and training through identifying opportunities for strengthening standards and guidance, and through focussing on our quality assessment role; and
  • Inform dialogue and collaboration between all individuals and bodies involved in medical education and training in Ireland so as to continually improve the experience and outcomes of trainees in Ireland.
Response Rate for Your Training Counts 2016
  • 828 doctors participated in the Your Training Counts 2016 survey, although not all questions were answered by all participants. This represents a response rate of 24% (resulting in a margin of error of ±3% for national level statistics).
  • Trainee population demographics were reasonably well-represented in the sample meaning we can generalise the results at a national level.
  • The average age of YTC respondents in 2016 was 31.4 years.
  • 45% of YTC respondents were male.
  • 54% of YTC respondents were female.
  • 81.6% of YTC respondents were graduates of Irish medical schools.
  • 18.4% of YTC respondents were graduates of other medical schools.
  • 16.5% of YTC respondents were interns.
  • 83.5% of YTC respondents were trainee specialists.
Towards Improvement – Changes in YTC Results 2014 – 2016
  • While 828 participants took part in the 2016 survey, 701 participants completed enough of the survey to generate full D-RECT scores, representing a 15.3% level of attrition.
  • Eight of the eleven D-RECT subscales have seen statistically significant gains, including feedback, coaching and assessment, role of patient handover, work being adapted to trainees’ competence, formal education, supervision, teamwork and peer collaboration.
  • The three scales where improvements were not statistically significant relate to those in positions of authority within the clinical learning environment. These include professional relations between consultants, the role of the educational supervisor and the consultant’s role in the training environment.
  • Another statistically significant improvement over the past three years is the rise in the number of trainees reporting “good” or better quality of life. In 2016, there was a reported 5% increase among those who needed support and subsequently accessed it.
  • Over the past three years there has been a statistically significant decrease in the percentage of trainees reporting that they do not see themselves staying in Ireland for their long-term future, indicating that trainees are more likely to remain in Ireland following completion of training.
Towards Improvement – Changes in D-Rect Scores 2014 – 2016
  • Over the past three years, the D-RECT score for male trainees has improved significantly, reflecting a perceived improvement in the learning environment for this group.
  • Statistically significant improvements were also noted for those in Higher Specialist Training, who also recorded the highest level of D-RECT scores in 2016; and for those in General Practice Training, who recorded a mean score of 180.9 in 2016, representing an increase of over 10 points on their 2014 score.
  • Graduates of Irish and International medical schools, in both direct entry or graduate entry medical programmes all had year-on-year improvements in overall D-RECT scores. These were found to be statistically significant for trainees who were Irish graduates and those who completed direct entry basic medical qualifications.
  • In line with the statistically significant improvement noted for those undertaking General Practice Training, recording an improved score of 180.9 in 2016 (see earlier scores by Stage of Training), when scores were analysed by postgraduate training body, trainees of the Irish College of General Practitioners gave statistically significant improving scores over the last three years.
  • There were significant differences in D-RECT scores from trainees located in different types of learning environments. Trainees in smaller (M=165) and larger hospitals (M=174) reported significantly lower D-RECT scores than trainees in GP practices (M=199) and mental health services (M=205).
Focus on Patient Handover
  • Patient Handover (sometimes referred to as “clinical handover”) refers to the transfer of professional responsibility and accountability for some or all aspects of care for a patient, or group of patients, to another person or professional group on a temporary or permanent basis. Patient handover has a substantial established relationship with clinical error and outcome, delayed treatment and patient safety.
  • The survey data shows a statistically significant improvement in D-RECT scores in the role of patient handover, in line with the improvements in overall D-RECT scores in the quality of clinical learning environments.
  • It can be seen from the data that there has been particular growth in the use of patient handover as a teaching opportunity.
What Have We Learned?
  • The contribution of clinical teachers remains positively recognised. Trainees are benefiting from steady perceived improvements in formal education, supervision, coaching and assessment.
  • Teamwork and peer collaboration in clinical learning environments have consistently scored highly and continue to steadily improve.
  • The majority of trainees feel physically safe at their clinical site and rated the quality of care being provided to patients at the site highly. Over two thirds of respondents would recommend their site as a place for patients to receive care.
  • There has been an emphatic improvement in overall scores from general practice and higher specialist trainees, with the Irish College of General Practitioners also showing a substantial upward trend. However, trainees appear to have better experiences in some postgraduate training programmes than in others.
  • There has been a significant decrease since the inaugural survey in the number of trainees who do not see themselves staying in Ireland for their long-term future. Continuous improvements in trainee experiences of medical education and training in Ireland will, however, undoubtedly make a positive impact on the retention of doctors within the system.
  • The variation in learning experiences at clinical sites and on training programmes has shown worrying trends over the term of the survey, with around a quarter of trainees scoring their overall experiences very poorly; and around the same proportion scoring them reasonably highly.
  • Safer transitions to the next stage in a doctors’ professional development are clearly required. Only half of trainees felt their previous medical education and training prepared them well for the intern year, whereas a large majority of HST (Higher Specialist Training) trainees felt prepared for their next role.
  • Scores consistently indicate that a substantial number of trainees do not receive any, or any proper, induction and/or orientation. It appears induction is not always offered, or trainees are unable to attend due to work demands. When provided, induction does not always guarantee that trainees receive all the information they need about their workplace, such as explaining their role and responsibilities.
  • Feedback is an essential part of effective learning as it provides trainees with clear guidance on how to improve, yet it has been the lowest ranking attribute of clinical learning environments consistently, year on year.
  • One third of trainees report being bullied or undermined in post and over half of trainees had witnessed someone else being bullied or undermined and harassed in post. With trends indicating that trainees are most likely to be bullied by a trainee at the next level/grade up from their own, this indicates that bullying is endemic throughout the system.
  • During each annual survey, one fifth of trainees reported that they had a potentially “clinically relevant” wellbeing issue during training and almost one third of trainees report that they felt the need for support with a wellbeing issue during training. However, only a fraction of those who felt the need for support with a wellbeing issue actually accessed support, although this figure rose from 14% to 19% over the life of the survey.
Towards Improvement – Responding to YTC Findings
  • In response to participant feedback, continual improvements are being made to the survey through technological enhancements, to enrich participants’ experience.
  • Engagement with our Student and Trainee Consultative Panel continues, as we seek to better understand the issues they face.
  • This valuable data has provided an opportunity to learn from what clinical sites and training programmes are doing well.
  • In order to better understand how trainers can be supported in this critical role, we meet trainers as a matter of course during all accreditation visits and offer them the opportunity to provide a frank and open account of the supports they receive and challenges they face.
  • We are also developing an annual Trainer Survey, to run concurrently with future surveys of trainees, which will provide an even fuller picture of the state of intern and postgraduate medical training in Ireland.
  • The Medical Council works with the HSE NDTP to ensure that the training sites they propose to the Medical Council have robust and effective systems and processes in place to quality control the clinical learning environment. A programme of Medical Council regional visits to clinical training sites has been agreed and commenced in 2017.
  • As part of our Education, Training and Professional Development Strategy 2015-2020, we are committed to developing a more coherent approach to outcomes across the professional lives of doctors.
  • A key step in developing a more consistent, better-quality experience for interns is the formation of the Medical Intern Board, bringing together the key players responsible for delivering, funding and quality assuring the intern year.
  • A ‘Safestart’ project has also been initiated, to address the needs of interns and all other new entrants to the Irish healthcare system.
  • We have shared bullying and undermining data with each postgraduate training body and through national and international conferences, to raise awareness of the issue.
  • The Council sees this annual survey as a means of ensuring its work in medical education and training is collaborative, appropriate, evidence-based and in line with emerging needs. There is clear evidence that the survey has already made its mark in a relatively short period of time and will continue to provide trainees with a voice, supporting 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.
View Previous Your Training Counts Reports