‘Transition to Leadership’
a course preparing doctors for life as a
registrar
Dr Lara Menzies
28th April 2015
Aims
• Leadership and management increasingly recognised as
fundamental to high-quality clinical practice and of limited
availability at SHO level
• 2014 evaluation data analysis from a transition leadership
course:
Is there a need for such training?
Does it have significant, sustainable educational impact?
Biggest fears about becoming a Registrar?
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Night shifts
Feeling isolated and without support
Communicating with the consultant
Delegation and prioritisation on busy shifts
Decision-making and getting others to follow plans
Safeguarding, child death, withdrawal of care
Outpatient clinics
Mistakes and increased responsibility
Not being perceived as competent by juniors/parents
Leading the team, especially for resus and emergencies
What do trainees want to help prepare?
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Simulation training
Procedure experience
Available acute care guidelines
Updates on difficult areas e.g.
child protection, death,
consent
• Regular ST3 sessions on
management of cases
Clinical
learning and
practical
experience
Management •
leadership & •
communication
skills
When/How to call consultant
Management skills training
Low-fidelity sim training e.g. telephone
Managing urgent scenarios at night
Strategies for situations when ‘out of
depth’
Delegation and prioritisation
Conflict and negotiation
Empower trainees to equip themselves
with the skills they need…..
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Opportunity to act up
under supervision
Shadow SpR on call shift
Supervised leading e.g.
ward rounds, and resus
FEEEDBACK
Putting
leadership
into practice
Peer support
and
mentoring
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Discussion of role with SpRs/ST3s
Mentoring/buddying with ST4
Meet consultants in advance
Good support from consultants at start
More guidance for educational
supervisors in extending leadership
skills as an SHO
Why do paediatric trainees feel unprepared?
• Little exposure to management role: ‘unchartered territory’
• Paediatrics very senior-led, few opportunities to learn SpR role
• Lack of feedback on performance and lack of confidence
• Never had juniors to manage!
• Big jump in job description with minimal specific training in
management skills
• Limited access to clinics/CP cases as SHO
• Simulation days useful but not enough alone
Course Layout
• Day 1 and 2: consecutive training days 3-6 months prior to
starting Registrar post
• Day 3: 1-2 months after starting Registrar post
• Trainees to attend all 3 days if possible
• Predominantly registrar-led sessions
• ‘Putting Leadership into Practice’ interactive sessions
• Feedback data from participants
Day 1
• Life as a new SpR
• Leaders and
Followers
• Understanding
Hospital Systems
• Leading at Night
• Identifying
Opportunities for
Learning and
Improvement
Day 2
• Key updates
 Child
Protection
 End of Life
Care
 Consent and
the Law
• Managing a
new role in
Outpatient
Clinics
T
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Day 3
• Decision-making
• Successes and
Pitfalls
• Dealing with
mistakes and
accountability
• Negotiation,
Delegation and
Conflict
• Managing stress
Course Impact
Did the course change your feelings about being a Registrar?
Yes: 96% of attendees (n=26)
Why?
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Consultant communication: feel empowered, know when to do so
Practical advice on difficult clinical areas and how to lead
Tips, tools and strategies to cope with challenges/uncertainties
Feel more confident, less anxious, calmer from sharing fears
Feel excited/enthusiastic about taking on a new challenge
Reassuring: what the role involves and where to go for support
Know how to prepare before starting ST4 and areas to focus on (SMART)
Competence rankings
• Trainees rated whether they felt competent to deal with
particular scenarios at 3 time points
1. Prior to starting the T2L course (Day 0)
2. After Day 2 (where the bulk of the training was provided)
3. Four months later, after returning for Day 3
• Rated from 1 (strongly disagree) to 4 (strongly agree)
• Assessment of course effectiveness and sustainability
– 8 areas of leadership and management
– 2 ‘control aspects’ not focused upon during the course
Difference in Paired T
Pre Course Post Day Post Day
Test
Rated Aspect
competence
(Day 0)*
2*
3*
rating
P value
Leadership, Management and Communication Aspects
Knowing when to call my consultant
2.9 (0.6)
3.5 (0.5)
3.5 (0.7)
+1.6
<0.001
Leading during a resuscitation
2.2 (0.6)
2.5 (0.6)
3.0 (0.6)
+0.8
0.03
Managing conflict
2.5 (0.5)
2.9 (0.5)
3.2 (0.4)
+0.7
0.02
Managing cases with safeguarding
concerns
2.3 (0.6)
3.2 (0.6)
3.2 (0.4)
+0.9
<0.001
Difficult cases regarding consent
2.2 (0.6)
3.0 (0.7)
3.1 (0.6)
+0.9
<0.001
Child dying on the ward overnight
1.7 (0.5)
2.9 (0.7)
3.1 (0.86)
+1.4
<0.001
2.7 (0.6)
2.9 (0.5)
3.4 (0.5)
+0.7
0.06
2.2 (0.7)
2.7 (0.6)
3.3 (0.6)
+1.1
0.01
3.0 (0.4)
3.0 (0.4)
+0.1
+0.0
0.6
0.6
Leading and managing a team on a day
to day basis
Making mistakes and coping with
increased accountability
Control Aspects
Treating common neonatal problems
Treating common paediatric problems
2.9 (0.6)
3.0 (0.4)
2.9 (0.4)
2.9 (0.4)
*All values shown as Mean (Standard Deviation)
Sample sizes: Pre Course n=30, Post Day 2 n=26, Post Day 3 n=13, Paired T test n=24
Impact Summary
• High demand from trainees for T2L training
• Trainees valued peer support , mentorship and leadership skills
education
• All 8 rated aspects of leadership, management and communication
skills showed an increase in trainee competence after Day 2
• Improvements sustained over a four month period during transition
• Statistically significant increased competence in 7/8 leadership and
management categories (and trend significance for 1/8)
Future Directions
• Running 3 courses in London in 2015
• Aim to reach 80-90% of London-based ST3s
• Course Sustainability
– Format moderation?
– Work with RCPCH/other regions?
– Online resource package?
• What can trainers/trainees change about their daily practice?
• When should preparation start?
Thank you!
• Acknowledgements
– Dr John Moreiras
– Dr Caroline Fertleman
– Dr Sara-Jane Smith
– The many excellent faculty members
– Our participants for providing evaluation data
– London Specialty School of Paediatrics for course venue and
refreshments
• Contact: lacmenzies@gmail.com
Three Day Leadership and Management Course for Paediatric ST3 Trainees