Case study two

Emergency Medicine at Ysbyty Glan Clwyd

This is what you told us:

The 2019 General Medical Council (GMC) National Trainee Survey highlighted significant concerns in the feedback from trainees in Emergency Medicine posts at Ysbyty Glan Clwyd. There was a below outlier for Clinical Supervision and eight lower quartiles (Overall Satisfaction, Clinical Supervision Out of Hours, Reporting Systems, Handover, Adequate Experience, Curriculum Coverage, Educational Supervision, Rota Design). End of placement feedback in the autumn of 2019 also corroborated these findings showing some concern with educational supervision, clinical supervision, clinical training, rotas and rota gaps, lack of support, lack of teaching and workload.

This is how your feedback was used:

After reviewing trainee feedback in 2019 we asked the Faculty Team to investigate further and provide us with a response. The local team met with trainees and facilitated a needs assessment and full review of educational provision within the department. Following this, a local action plan was developed in order to address the concerns. The local team introduced a range of improvements as below:

• A new departmental Educational Lead was appointed.
• The department instituted a regular, structured teaching programme with a clear expectation of release from clinical duties to enable attendance.
• Simulation training was supported and liaison with other teams for support of learning took place.
• An improved rota was implemented.
• A virtual training platform was instigated to facilitate educational programmes and teaching in light of the COVID pandemic.

Whilst the Health Board was implementing and monitoring the action plan, the Quality Unit continued to seek updates from the local team on progress. In addition, we continued to monitor trainee feedback through end of placement reports, where available, so that we could gather trainee views about progress. These updates told us that the new departmental educational programme was running well with trainees being released to attend teaching and having taster placements in other departments. Our monitoring with the Faculty Team highlighted that there was an improvement.

The Quality Unit continued to monitor progress in collaboration with the Faculty Team over the next year particularly in the light of the service pressures and changes introduced due to due to the COVID pandemic.

In March 2021 the Faculty Team collated some formal feedback from all Emergency Medicine trainees which was universally positive despite the pandemic.  Following this a big improvement was seen in trainee feedback via the 2021 survey where no below outliers were recorded and in fact there were three ABOVE outliers for Clinical Supervision Out of Hours, Handover and Adequate Experience as well as two upper quartile scores (Supportive Environment and Facilities).

What changed?

You can see from the table below that the results of the 2021 National Trainee Survey shows a great improvement with no below outliers for the first time in four years, three ABOVE outliers and two upper quartile scores. The Quality Unit acknowledges this rapid improvement and has reduced the risk rating for this department but will continue to monitor for sustainability for a further year.  We will continue to seek updates via the faculty team as part of our risk process and via your end of placement feedback to confirm sustainability of improvements.   

How can you Raise Concerns?

While we review your feedback via the annual National Training Survey and End of Placement Feedback you can also raise concerns via other avenues. If you want to raise a concern with someone outside of the training programme structure, you should contact your Faculty Lead (HEIW representatives based at NHS sites across Wales). Faculty Leads are well placed to respond to concerns at a local level and work in partnership with the Quality Unit at HEIW. You can also raise concerns with the medical education team within your Health Board who will pass your concern onto the relevant party.

You can also contact HEIW directly. HEIW’s Medical Deanery has a dedicated email account (HEIW.Open@wales.nhs.uk) where you can raise concerns about your training. However, please note that this is in addition to the existing mechanisms above and any urgent patient safety concerns must be raised through local reporting mechanisms to ensure immediate action can be taken if necessary. Find more information about raising concerns.