‘QM for a School of Anaesthesia –
Quality or Management?
Dr Andrew Skinnner
The meeting was opened by the President, Dr Christine Bell, who welcomed the MSA to the joint meeting. Dr Bell announced the sad news of the deaths of Dr David Bowsher, a former consultant at the Walton Pain Centre, and honorary member of the LSA and Dr Paul Davies, Associate Specialist in Anaesthesia in Chester and Glan Clwyd Hospitals.
Dr Bell then introduced the speaker, Dr Andrew Skinner, a former Mersey trainee and consultant anaesthetist at Whiston hospital, who is now based at the James Cooke Hospital in Middlesbrough.
Dr Skinner opened his talk with a brief personal history of his training in Mersey, his subsequent consultant post at Whiston Hospital and the reasons behind his move to Middlesbrough in 2003. He then began to talk about his interest in the quality management of the Northern region’s training programme. One of the most important aspects of this role is being able to find out what is actually happening in the training programme. The process must be confidential, relevant but not anonymous however the trust of trainees is essential for them to give accurate information. This requires people with integrity and energy to run it. He described a number of ways of finding out what is happening, such as surveys of trainees within the hospitals, hospital visits and feedback from trainees about trainers. The survey tool uses was the Anaesthetic Theatre Educational Environment Measure (ATEEM) which was initially developed in New Zealand. The response rates from trainees to the survey have been high. The results are then fed back to Training Departments.
Dr Skinner then demonstrated some results of the surveys in graphical form demonstrating one or two outliers as well as some comments from trainees. He then spoke about the annual visits to training departments, which he had found to be very useful and significantly better, in his opinion, than the three yearly College visits that had formerly been in place. Dr Skinner thought that it is most important that the Regional Advisor does not attend these visits so as to keep the functions of the School and the College separate. The advantage to this system is when problems have been demonstrated in a Department. The regional adviser can then be brought in for an independent opinion relatively quickly compared to requesting an official from another region. Dr Skinner expanded his views about the benefits of school visits in comparison to the original College visits: firstly, they happen more frequently, secondly the assessors already know some of the issues which cannot be swept under the carpet so easily, and thirdly, when issues arise, visits can be repeated within months, until issues have been resolved. Consequently there is no hiding place for poorly performing units.
Dr Skinner then spoke about obtaining feedback from trainees about trainers. Increasingly, this had been an annual process by every trainee about every trainer with whom they have had significant contact. It is detailed, comprehensive and confidential. He thought that the benefits of this for trainers are that it could demonstrate the quality of training delivered by individuals mapped to GMC standards. It would also be useful to inform appraisal and revalidation. On a personal level, it should enable trainers to address some of their shortcomings and help to further improve the training environment. The principle questions look at clinical knowledge, clinical training abilities, supervision and teaching of practical skills, as well as input when on call and other professional standards such as approachability and the trainer’s ability to give feedback. The system had been piloted at James Cooke hospital and then been rolled out across the Deanery, but with each Department being able to opt out without sanction if required. Having initially been on paper, it is now electronic via Survey Monkey. Dr Skinner then gave several examples of these pages. From a small start, there were now 600 complete returns on 120 consultants from about 90 trainees around the Region. Dr Skinner then showed his own feedback form with both positive and some negative remarks!
This system had given the School a well evidenced list of trainers, and had highlighted a number of problems with trainers, which had then been tackled. One of the most important aspects was gaining trust from trainees who, if truthful about problems, could then see them confronted and subsequently resolved. Dr Skinner commented that on the whole, the process worked well because the results of the surveys, visits and trainee feedback seemed to deliver similar results, and confirm many historical truths about training units, which have then been managed.
Dr Skinner then briefly spoke about his view of the Northern Deanery. He compared the workings of the Deanery to episodes of “Yes Minister”. He thought that its main function was to try and keep the GMC at arms’ length, which he certainly thought was a very good idea. However to do this, the Deanery needs many reports and evidence. Evidence, he stressed, was not the same thing as proof. His main concern about the Northern Deanery was its wish to take over the trainee feedback function, which he felt would consequently lead to distrust and devaluation of the process by trainees.
In conclusion, he thought that the best way of making improvements was to ask direct questions of the training units if consistent criticism through evidence produced from surveys, visits and feedback could be demonstrated. If problems persisted, frequent visits from senior members of the school often focussed minds. Departments are always concerned with the possibility of sanctions even though in reality they may never happen. He thought the future lay in fewer training units and getting hospitals to deal with matters of service interfering with training. He also thought that specialist areas of training should happen after CCT and certainly were not for everyone and should not turn into dead-end jobs. He commented that although there was uncoupling between CT and ST training, there was still a coupled mentality and proper uncoupling would allow greater flexibility and stop core trainees feeling they have to rush into specialist training as soon as possible.
His final comment was about MMC, which he felt had succeeded in its main aim of getting rid of the so-called “lost tribe”. The consequence of this was to loose flexibility both for filling service posts and accommodating trainees. The result of this has been to replace one problem with another.
Dr Skinner then took some questions from the floor and Dr David Gray gave the vote of thanks.
14th October 2011