ABSTRACT BOOK
Doctors In Difficulty? Strengthening
Foundations in the Early Years
Institute of Physics, 76 Portland Place, London
26th May 2011
Abstracts Accepted As Presentations
Developing mentoring skills amongst medical students to strengthen their ability to
cope with medical school and the NHS
R Patel, GWG French, S Petersen
R Patel, Department of Nephrology, Leicester General Hospital, Gwendolen Road,
Leicester, LE5 4PW
Background
Mentorship is an important part of professional and personal development in medicine. It
can be used to provide support for those in difficulty, as well as a driver for helping others
reach their full potential. As little training is made available to students before they
graduate as doctors however, a mentoring course was developed as part of the medical
education student selected module at Leicester Medical School.
Methods
36 students entering their final year have attended a four-day course based on the Egan
Skilled Helper model1 over the past two academic years. They have received feedback on
their Myers-Briggs Type Index personality classification, and training on using that
information to modify their behaviour during patient consultations, or mentoring sessions.
Results
Having started the course with an unconscious tendency for diagnostic listening and a
need to give solutions to issues brought to them, students began to demonstrate a new
awareness for active listening and helping mentees find their own solutions to problems or
opportunities. Students liked alternating between small and large group settings for
practicing skills, and preferred to receive immediate feedback on their performance during
training. Free-text comments from post-course questionnaires indicated students wanted
to return as facilitators on future courses.
Discussion
A mentorship network can be established within the medical school, if students are trained
to support each other as undergraduates. The experience of major transition points such
as entering the clinical phase of the curriculum, or prior to becoming Foundation doctors
may be better managed if individuals have the skills to mentor themselves or others
around them.
Conclusion
Mentoring which increases self-awareness, self-development and self-management may
help individuals cope with the experience of facing major assessments, as well as entering
and working in the NHS.
Supporting medical students with Specific Learning Difficulties: An international
comparison of institutional provisions and perceptions
D Shrewsbury
D Shrewsbury, C/O Medical Education Unit, Medical School, College of Medical and
Dental sciences, University of Birmingham, Edgbaston, Birmingham, B17 0NU
Background
Specific Learning Difficulties (SpLD) are hidden disabilities characterised by lifelong
deficits in: attention; reasoning; understanding; memory or coordination (Wardin & Daniels,
1997). Laws in the UK and New Zealand (NZ) charge institutions with making ‘Reasonable
Adjustments’ to ensure their opportunities are provided on an equal and inclusive basis.
Tensions exist surrounding the provision of adjustments, and variability in how
‘reasonable’ an adjustment is considered exists (Riddell et al., 2007). Medical education is
fundamentally concerned about patient safety. Institutions are responsible for ensuring
their graduates will be capable of practicing safely and in accordance with regulations set
by the professions’ governing bodies.
Aims & Objectives
This study aimed to build on previous work (Shrewsbury 2011) to quantify and compare
the support provided to medical students across the UK and NZ. Additionally, the
investigations set out to explore perceptions of academic staff surrounding the provision of
reasonable adjustments within medical education.
Methods
One NZ and two UK medical schools were visited. Following a protocol, basic information
pertaining to support services was sought from the institutions’ Internet pages and from
key staff. Semi-structured interviews were conducted with academic staff within the
medical schools. These interviews were recorded and transcribed for framework analysis
to code the data and draw out themes. All investigations were granted appropriate
institutional ethical approval prior to commencement.
Results
Central university services provide a basic level of support. In both countries, medical
schools also offered, on an ad-hoc basis, a more specifically tailored level of support to
individual students. Support staff expressed a wide range of views around access and
inclusion but were mainly positive.
Discussion & Conclusion
Student support in NZ is influenced greatly by cultural factors surrounding the Treaty of
Waitangi (1840). Faculty from both countries expressed concerns about the impact that
reasonable adjustments may have on education and clinical performance, which will be
explored in more detail.
References
Riddell S, Wheedon E, Fuller M, Heasley M, Hurst A, Jelly K and Piggot L. 2007. Managerialism and equalities: tensions within widening
access policy and practices for disabled students in UK universities. Higher Education, 54; 615-628.
Shrewsbury D. 2011. State of play: support available to medical students with specific learning difficulties. Medical Teacher, 33: 254257.
Wardin M, Daniels C. 1997. Definition of Specific Learning Disability. Conference Proceedings from the Technology and Persons with
Disabilities
Conference.
California
State
University
Northridge.
Accessed
on
23/3/2011
via:
http://www.csun.edu/cod/conf/1997/proceedings/120.htm
Human factors associated with doctors in difficulty: A self-awareness intervention
to support doctors in early training
A Koczwara, S Thomas, F Patterson, V Archer, H Stoker
A Koczwara
Context/Setting
Unsurprisingly, there is increasing interest in how best to support junior doctors in
performing to the best of their abilities, particularly during Foundation training and early
years of specialty training when they face key transitions in their role.
Why the innovation was introduced
An extensive literature review and series of stakeholder interviews (N= 25) indicated that a
significant number of trainees struggle during early years training due to issues associated
with human factors, including lack of self-awareness, inappropriate interpersonal
behaviours and lack of self-confidence. These factors in turn can impact on their ability to
reach their potential, be fully effective in their role and therefore provide the highest levels
of patient care.
What was done?
This project designed and implemented a uniquely evidence-led training initiative, which
focused on supporting junior doctors during challenging transition periods through
developing skills in self awareness and reflection. The intervention included a series of self
awareness workshops targeting working style, career choice and leadership development
designed to support transition periods where junior doctors are particularly vulnerable to
experiencing problems.
Evaluation of results or impact
The intervention followed a set evaluation strategy to demonstrate its utility and
effectiveness, collecting evaluation data (N= 112) before and after the intervention and
follow up back in the workplace. Results indicated significant increases across affective,
behavioural and cognitive outcome domains following the workshops and evidence of
application of learning in the workplace. The initiative provides evidence of the
effectiveness of a behavioural change intervention, aimed at enhancing human factors
before difficulties arise.
Preclinical attitudinal scores are the best predictors of Frequent Relative
Underperformance in professionalism at the bedside
E Gonçalves, M Portela, MJ Costa
MJ Costa, School of Health Sciences, University of Minho, Gualtar Campus, 4710-057
Braga, Portugal
Background
Since clinical teachers might “fail to fail” students even though they have judged their
professional behaviors to be unsatisfactory1 (Dudek, Marks, & Regehr, 2005), medical
schools should predict Frequent Relative Underperformance at the bedside (FRUB). This
study looked for preclinical indicators of FRUB in professionalism, in socio-demographic,
application records and preclinical academic performance in the last preclinical course of
the curriculum (including written end of block and end of year tests and attitudinal scores).
Methods
Sample: 180 students representing 4 cohorts in one Portuguese medical school. Data
origin: the longitudinal database of the school. Method: Logistic regression in which the
independent variables were socio-demographic, application and academic performance
and the dependent variable was an indicator of FRUB. Computation of FRUB implied
calculation of the frequency with which the performance in professionalism of a certain
student remains in the lower 20% in all clinical rotations. These were collected from 25 or
more clinical teachers for each student. Students who fall into such group 6 or more times
are our relative underperformers.
Results
Of all academic performance indicators, a students’ preclinical Attitudinal Score was the
strongest academic predictor of FRUB (ME=-0.023, ZWald=-2.65; p<0.01). Sociodemographic variables with predictive power were: male (ME=0.23 ZWald=4.70; p<0.001),
being older (ME=0.16, ZWald=3.36; p<0.01), health problems (ME=0.15, ZWald=2.23;
p<0.10), daily task management (ME=0.19, ZWald=2.52 p<0.05) mother education
(ME=0.29, ZWald=3.34 p<0.01) and mother job category (ME=0.17, ZWald=3.88 p<0.001).
Discussion
In this study, the strongest predictive power over poorest professionalism at the bedside
was found in preclinical attitudinal score. This reinforces the importance of monitoring
student behaviors in preclinical courses. Socio-demographic factors were proved good
predictors of worst professionalism at the bedside.
Conclusion
Student attitudinal behaviors and socio-demographic variables are helpful for the
prospective identification of students who are consistently marked by clinicians in the lower
end of their classes.
References
Dudek, N. L., Marks, M. B., & Regehr, G. (2005). Failure to Fail: The Perspectives of Clinical Supervisors. Academic Medecine , 80,
S84-S87.
Abstracts Accepted As Posters
Pass the sick bag! Medical students and alcohol: a survey of usage and attitudes
T Abbott, K Saunders
T Abbott, University of Oxford Medical School, John Radcliffe Hospital & K Saunders,
University Department of Psychiatry, Warneford Hospital
Introduction
Misuse of alcohol has become an increasing public health concern. Drinking behaviour
among medical students has implications for individuals, medical schools and patients.
Excessive alcohol use is associated with highter rates of depression and anxiety,
increased criminal behaviour, poor motivation and concentration, all of which could directly
and indirectly impact on patients. In addition student attitudes towards drinking may
influence the perception of alcohol use in others, their ability to identify those who are
drinking excessively and subsequent advice they might offer.1
Method
We conducted a web based survey of drinking behaviour and attitudes using the AUDIT
with additional questions regarding professional behaviour.
Results
296 responses were received. Mean audit score was 7.94. 12 students described
themselves as abstinent. Men had a significantly higher score than females (p=0.007) and
were more likely to be audit positive (χ2=0.005). However, females predominated in those
with scores of >20. 73% thought it unprofessional to attend with a hangover or still drunk
although 33% had attended with a hangover and 8% whilst still drunk. 50% felt that they
should not be bound by the same professional codes as doctors.
Discussion
Alcohol misuse among Oxford medical students is similar to that reported in other medical
schools. The higher number of audit positive males has been previously described but the
predominance of females with very high scores is of concern as it has been suggested
that women are less likely to recognise or acknowledge their alcohol problems despite
being more vulnerable to the consequences of this behaviour. Student attitudes were
divided regarding professional behaviour were not consistent with their reported behaviour.
Conclusion
Alcohol misuse is prevalent among medical students although there was no suggestion
that rates of alcohol misue in oxford differed significantly from elsewhere. The uncertainty
expressed by students regarding professional behaviour may reflect the lack of clarity in
the guidance given by the GMC2 although it is unclear to what extent students were aware
of this publication. Early identification and education is necessary particularly among
preclinical students where there there is little patient contact and students may percieve
being hungover or drunk as more acceptable. Attitudes towards alcohol are likely to
influence subsequent medical practice and should be a high priorty target for medical
schools. The introduction of a new curriculum for educating students 3 is welcomed and
evaluation of its’ impact upon rates alcohol misuse will need further evaluation
References
1.General Medical Council. Student health and conduct. London: GMC, 1997.
2.General Medical Council (2009). Medical students: professional values and fitness to practice. London
3.Audhali N, Checinski K. Substance misuse on the curriculum. Student BMJ 2010;18:2746
Trainees in difficulty – Surgical trainers’ perspective
R McNamara, G Quinn
R McNamara, Emergency Department, Midwestern Regional Hospital, Limerick, Ireland
The challenges of aiding and facilitating trainees in difficulty are varied, and have been
poorly studied. This study was done to gain a better understanding of the scope of the
problem from a trainer’s perspective. A web-based survey was distributed to 360 trainers
in the Republic of Ireland.
58 trainers completed the survey, of whom 41 reported encountering a trainee in difficulty
in the last 12 months. Difficulties reported included clinical underperformance (70%), poor
professional manner (37.5%), health and personal problems (each 27.5%). Only 7.7% of
the respondents had/were aware of a written policy for managing trainees in difficulty in
their departments. Only 32.7% had formal systems of remediation in their institution for
trainees.
62.7% of trainers provided their trainees with a structured assessment of needs. Trainers
relied most frequently on informal staff reports to alert them that a trainee was in difficulty.
The most common interventions were mentoring or one-to-one teaching with over 90%
indicating that they used these methods.
If a trainee was not remediable, the majority of trainers indicated that they would report the
trainee to the regional training coordinator or local training supervisor. 56.8% indicated that
they would never report unremediable trainees to the Irish Medical Council (IMC) and
61.9% would never suspend the trainee. 28.9% reported that they would never exclude an
unremediable trainee from clinical work. Only 6 trainers had reported trainees to the IMC,
of these 5 were unhappy with the outcome but declined to explain why. Only 50% of
trainers felt it was possible to dismiss a poorly performing trainee.
The majority of trainers indicated that the current IMC registration process does not ensure
a satisfactory standard of trainee (57.1%). 47% of trainers felt that the current system for
managing trainees in difficulty was failing patients, while 37.3% felt it was failing trainees.
Numbers of foundation doctors in difficulty appear to be increasing
N Kumar, S Pandey, D Fee, H Davis, G Crackett
N Kumar, Head of Foundation School, Northern Deanery, Waterfront 4, Goldcrest Way,
Newburn Riverside, Newcastle-upon-Tyne, NE15 8NY
Introduction
The foundation programme began its existence by way of pilot schemes in Northern
Deanery from 2004 onwards. Throughout this time data regards doctors in the foundation
years, who require additional or different support has been recorded. This has been done
by way of a ‘Doctors with differing Needs’ proforma. Since then terminology has changed
around whether these doctors are in difficulty or have differing needs and this debate will
almost certainly continue. Anecdotally it has been thought that the needs of foundation
doctors have increased and it was felt timely to review our databases.
Method
Data was transferred from hard copy into excel spread sheets. These were then analysed
looking at broad trends and areas of need. Table 1 shows the results.
Results
Data collection improved with time as reflected by the improving completion of gender.
Numbers of posts have always been around the 800 mark. The results show that there
appears to be an increasing trend for foundation doctors needing additional support.
Although requests for maternity leave and subsequent flexible training appears to be
increasing this in itself would not explain the gender differences seen. The HR section
pertains to all those who had visa or employment difficulties and for those who needed
additional support in areas other than those listed.
Table 1: numbers of doctors with differing needs with broad areas of need
pre 2006 2006-7
2007-8
2008-9
2009-10
n
69
26
86
105
131
% female
52
35
50
43
60
% male
26
50
28
52
34
unknown
22
15
22
6
6
underperformance 16
1
15
23
22
conduct
3
9
12
6
6
health
19
6
7
10
19
HR*
31
7
42
52
66
maternity
2
3
7
10
10
OTHER
2
0
3
4
8
*HR Human Resources
Discussion and Conclusions
Many colleagues believe that as a profession we are better at reporting and dealing with
junior doctors in difficulty and this explains the increasing numbers seen. However our
methods of reporting have not changed and we believe our results show a true increase in
difficulties. We accept data recording may not have been complete and may have had
inadequate detail initially. NDFS intends to drill down this data and look for themes within
this category. Not only will this help planning to evolve our approach to such doctors but
also to allocate resource appropriately.
Patterns and demographics of 12 years of GMC Fitness to Practise referrals
A Sturrock, H Spencer, Y Khatib, L Conlon, J Dacre
A Sturrock, Academic Centre for Medical Education (ACME), UCL Division of Medical
Education (DoME), Holborn Union Building, 4th Floor, Room 418
Whittington Campus, Highgate Hill, London, N19 5LW
Background
The General Medical Council (GMC) was established in 1858 to protect, promote and
maintain the health and safety of the public. The Medical Act (1983) defined one of its
functions as ‘to deal firmly and fairly with doctors whose Fitness to Practise (FtP) is called
into question’.
Aims & Objectives
We investigate the pattern of doctors referred to the GMC for a performance assessment.
We examine the demographics of the doctors that have been referred for a performance
assessment in terms of age, gender and specialty in which they practise.
Methods
Doctors under investigation undertake performance procedures by the GMC. If the
investigation needs to assess the doctors clinical performance, for the last 12 years there
has been a specific assessment comprising of a peer led work based assessment and a
test of competence.
Results
Since the introduction of the FtP procedures, more than 800 doctors have been referred
for an assessment. The number of doctors being referred to the GMC has increased from
2214 in 1996 to 5185 in 2007. Of those doctors that require further investigation, only a
small percentage requires a performance assessment. Sixteen (16%) of these
assessments involve women and 54% involve doctors over 50 years old. The majority of
assessments are of general practitioners; surgeons are the second most common
specialty however the range includes physicians, anaesthetists, O&G doctors, psychiatrist,
paediatricians, radiologists and pathologists.
Discussion and Conclusion
Overall referrals to the GMC have increased significantly in terms of numbers and
proportion of practising doctors. However the number of doctors requiring an assessment
of their performance is relatively stable at 70 per year. In the cohort of doctors that have
been referred for a performance assessment the groups that appear to be overrepresented are men, the over 50s, and surgeons.
References
Department of Health (1983) The Medical Act (Amendment) and Miscellaneous Amendments Order 2006. Report on Consultation.
London: Department of Health.
Peer Led Support for Foundation Trainee Doctors
Z Morris
Z Morris, School of Medicine, Cardiff University
Mentoring is not a new concept, dating back to ancient Greece (McKimm et al 2007; A.
Morton, 2003), but its role in medical training has only been explored over the last 10
years as part of a focus to improve the working lives of doctors and their educational
outcomes (DOH , 2001). Mentoring has been strongly advocated as a vehicle for helping
doctors through the various stressful changes in their careers (Dangerfield et al 2004) and
was particularly noted by junior trainees and newly qualified doctors as one of the top five
factors that they feel would improve their working lives (Dornhorst et al, 2005). The
mentoring mantle has been taken up by several deaneries for a variety of training grade
doctors (Viney and Paice 2010; McKimm et al 2007), but is not widespread at a peer level.
Peer and near-peer support systems traditionally exist within medicine, but have been
affected by changes in working patterns. Peers are well positioned to support each other
emotionally, provide feedback and encouragements and also has an increased level of
acceptance (Moss et al, 2008). Mentoring is one form of peer support that, through
appropriate training, can unlock the potential of people to help each other (Houlston et al,
2009). Mentoring can reduce stress at work; help trainees achieve a healthy work-life
balance as well as helping personal and professional development (Frei et al, 2010).
Given these points, mentoring and foundation training appear a natural marriage.
In our mentoring scheme Foundation Year Two (F2) doctors are asked to volunteer as
mentors for Foundation Year One (F1) doctors from their induction and throughout their
first year of work. The F2 mentors who volunteer are asked to participate in a two hour
mentor training workshop before being assigned their mentees in at August induction. The
mentees also receive training as final year students so as they can get the most out of the
scheme. The mentoring scheme of which they are a part is an informal one which
provides each F1 with an F2 mentor at induction, though each mentor may have more
than one mentee. Their activity is offline, confidential and not monitored. The aim of the
scheme is to provide another layer of support for F1 trainees to help them through the
initially stressful first year of work, provide career guidance, networking and a close
professional role-model.
Initial feedback suggests that final year medical students value the idea of having a mentor
and would prefer a near-peer mentor. The F1’s all like having the option of turning to a
mentor if they require. Future work will involve looking at the educational benefits to
mentors.
References
Dangerfield, P., Nathanson, V., Seddon, C., Martyn, E., Ben-Galim, D. And Gohil, D. (2004). Exploring Mentoring. U.K: BMA Board of
Education.
Department of Health. (2001). Improving the Working Lives of Doctors. London : DOH.
Dornhorst, A., Cripps, J., Goodyear,H. and Marshal, J. (2005). Improving Hospital Doctors Working Lives : Online Questionnaire
Survey for all Grades. Postgraduate Medical Journal, 81, 49-54.
Frei, E., Stamm, M. And Buddeberg-Fischer, B. (2010). Mentoring Programmes for Medical Students – A Review of Pub Med Literature
2000-2008. BMC Medical Education, 10:32.
Houlston, C., Smith, P. and Jessel, J. (2009). Investigating the Extend of Peer Support Initiatives in English Schools. Educational
Psychology 3: 323-344.
McKimm, J., Jollie, C. and Hatter, M. (2007) Mentoring : Theory and Practice. London : London Deanery Faculty Development.
Morton, A. (2003). Continuing Professional Development Series No 2 – Mentoring. UK : Learning and Teaching Support Network.
Moss, J., Teshima, J. and Leszcz, M. (2008). Peer Group Mentoring of Junior Faculty. Academic Psychiatry 32: 230-235.
Viney, R. And Paice, E. (2010). The First 500 – Report on the London Deanery’s Coaching and Mentoring Service 2008-2010. London
: London Deanery.
Doctors in Difficulty? - Managing ill health during training
N Redfern, H Paterson, J Harrison
N Redfern, Consultant Anaesthetist, Newcastle upon Tyne Foundation Trust, Queen
Victoria Rd, Newcastle upon Tyne, NE1 4LP
Context & setting
A system for managing and supporting doctors who become ill during training.
Why this was introduced
Ill Doctors are reluctant to seek helpi. Guilt, shame, worries about confidentiality, loss of
control, losing respect of others, stigma, and the consequent threat to career, are all
described. Doctors in training have the same range of illnesses as others of similar age,
including psychiatric illness, diabetes, epilepsy, multiple sclerosis, arthritis and
inflammatory bowel disease.
What was done
We describe a system to manage and support doctors who have become ill during training
that aims to
 Assist with return to work, following sick leave
 Define the doctor’s capability in a good environment
 Enable the doctor to tackle challenging situations
 Encourage trainees to develop robust attitudes to their health and well-being
Key to the scheme’s success is its emphasis on sustained well-being as well as return to
health. Well-being incorporates both good health and physical, social/relational and
psychological aspectsii of work, and covers four main areas: good health, good work, good
relationships and good support liii.
Our care pathway incorporates
A. Good care from clinicians with expertise in managing doctor-patients, including a
specialist Occupational Physician – good health
B. Careful management of return to work including rotational placements providing
‘reasonable adjustments’ that match functional capabilities with training and practice, a
culture of acceptance that doctors get ill, educational supervisor who understands the
challenges of returning to work. – Good work
C. Rotational placement where the trainee has good working relationship and effective
support and management including careful attention to confidentiality.,– Good
relationships
D. Access to a mentor, confidential counselling and to the Deanery. – Good support
DOCTORS WITH ILL HEALTH OR DISABILITY
Occupational
Health
Trust
Trainers
Deanery
Clinician
Caring for
doctor
Ill Doctor
House
Concern
Helplines
Redfern, Paterson & Harrison
Impact
We have managed over 150 doctors with many different illnesses from numerous
specialties, over 15 years. Our network of clinicians and trainers each have a clear role
and responsibilities, behave confidentiality and respect clear boundaries. Few trainees
have been lost to medicine, most pass professional exams and many achieve CCT /
CCST.
References
i
Silvester, S., Allen, H., Withey, C., Morgan, M., & Holland, W. 1994, The provision of medical services to sick doctors. A conspiracy of
friendliness?, Nuffield Provincial Hospitals Trust, London.
ii
Employee well-being: Taking engagement and performance to the next level. Towers Watson, 2010.
http://www.towersperrin.com/tp/getwebcachedoc?webc=USA/2009/200910/Perspectives_EmplyeeWellBeing-FINAL.pdf
(Accessed
2/3/11)
iii
The
Workwell
model:
an
integrated
strategic
approach.
Business
in
the
Community.
http://www.bitc.org.uk/workplace/health_and_wellbeing/healthy_workplace_model/index.html (Accessed 2/3/11)