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Prof Kevin Carson, President of the College of Anaesthesiologists of Ireland, has the following message for Trainees, Members and Fellows following the publication of the Medical Council survey ‘Your Training Counts’

This week, the Medical Council published the findings of its “Your Training Counts” survey of Trainee doctor’s experiences of Clinical Learning Environments in Ireland 2014-2016.  https://issuu.com/daniellesmith03/docs/your_training_counts_2016_report

Your Training Counts is the Medical Council’s annual National Trainee Experience survey. Commenced in 2014, the findings from the survey over the past three years have highlighted a number of areas of concern, and identified opportunities for significant improvement in the quality of training experiences and outcomes for trainees. Continuous improvement and support for postgraduate medical education and training in Anaesthetics, Intensive care and Pain Medicine will have a positive impact on the quality of medical education and training in Ireland, and will also fundamentally contribute to improved patient outcomes and the wider health service.

The College of Anaesthesiologists of Ireland actively encouraged doctors enrolled on our national training programme to participate in this survey which was based on similar work carried out in other jurisdictions.

The Dutch Residency Educational Climate Test (D-RECT) was used to collect trainee experiences of clinical learning environments. D-RECT contains 50 questions which, when added together, provide a rating for clinical learning environments on a scale of 50-250 (with higher scores indicating higher quality learning environments). Over the three years of the survey Anaesthetic Training has recorded an improved score of 179.1 in 2016, up from 178.3 in 2014.

It should be noted that there are significant differences in D-RECT scores from trainees located in different types of learning environments. Anaesthesia, Surgical & Medicine Trainees in smaller and larger hospitals reported significantly lower D-RECT scores than trainees in GP practices and mental health services. Accordingly, the Medical Council will focus their accreditation of training sites in the first instance to those smaller and larger hospital sites.

Importantly this cumulative survey indicates that the overall quality of clinical learning environments scores reported show statistically significant gains, indicating that trainees have perceived and scored their learning environments more highly over the past three years.

Another statistically significant improvement over the past three years is the rise in numbers 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. This is a positive and important finding. The College of Anaesthesiologists of Ireland are committed to continually improving the supports available to trainees and will work with the clinical learning environments to ensure that trainees are aware of such supports and that they know how to access them.

Your Training Counts demonstrates that the contribution of our tutors and trainers remain positively recognised. Trainees are benefitting from steady improvements in formal education, supervision, coaching and assessment. Teamwork and peer collaboration have consistently scored highly and trainee have reported that work is being adapted to their competence. Importantly 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.

In terms of retention of our doctors, there has been a significant decrease in the number of trainees who do not see themselves staying in Ireland for their long term future. This will undoubtedly be influenced by the quality of posts available to new Consultants and it is hoped that the continuing improvements in trainee experiences of medical education and training in anaesthetics, Intensive Care and Pain Medicine will make a positive impact on the retention of doctors in the system.

The survey also highlights the areas where postgraduate training bodies need to focus their attention.

Trainees have reported a variation in learning experiences at clinical sites, and this is something that we will continue to monitor as part of our hospital inspection process.

While most trainees reported a positive overall experience of induction and orientation to the clinical environment, many trainees identified deficiencies in core areas. Whilst this is particularly prevalent in the intern year, we know that induction and orientation have a significant impact on the trainees’ overall perception of the quality of a learning environment and is an area where we can continuously improve.

It is clear from this survey that we all need to do more to improve how we deliver training in the clinical setting and how we communicate and work with each other. Weaknesses were identified around providing feedback to trainee doctors. The College of Anaesthesiologists of Ireland are responding positively to this challenge through the implementation of work based assessments based on entrustable professional activities.

Of concern is the fact that more than one third of doctors in training across all specialties reported feeling bullied or undermined while carrying out their duties, with the incidence being highest in our acute hospitals.

I would urge anyone who feels they are being subjected to bullying or undermining behaviour, or who feels unsafe at work, to seek help. At hospital level all our clinical sites approved for training are required to have local policies and procedures in relation to supporting employees who feel they are subject to bullying or intimidation. We are constantly collaborating with sites to help improve the clinical learning environment for trainees. The College of Anaesthesiologists of Ireland have an extensive network of tutors and trainers around the country and we continue to improve the supports available to trainees. We will continue to work with our CAT committee to identify additional practical solutions to support trainees.

We are committed in the College of Anaesthesiologists of Ireland to do everything we can to enhance the training and wellbeing of trainees.

Mr Bill Prafiska, CEO of Medical Council of Ireland and Mr Martin Mc Cormack, CEO of College of Anaesthesiologists of Ireland at the launch of “Your Training Counts- Trainee  experiences of Clinical Learning Environments in Ireland 2014-2016”