ESRC seminar Leeds 2011 Preparedness, induction and performance Trudie Roberts University of Leeds.
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Transcript of ESRC seminar Leeds 2011 Preparedness, induction and performance Trudie Roberts University of Leeds.
“You come out of medical school knowing bugger all—no wonder August is the killing season. We all kill a few patients while we're learning”
Cardiac Arrest TV series 1994
The killing season—fact or fiction?
Paul Aylin and Azeem Majeed BMJ 1994
Early In-Hospital Mortality following Trainee Doctors' First Day at Work
Jen, Bottle, Majeed, Bell and Aylin
www.plosone.org/article/info:doi/10.1371/journal.pone.0007103
Accessed Sept 2011 published August 2009
Published evidence
Current Expectations of transitions
Students – ‘it will be awful’
Medical schools – ‘employers will moan they always do’
Employers –’ what have the medical schools been doing for 5 years’
Regulator –’ why isn’t it working?’
Current prevailing thinking
• Doctors can be prepared for new levels of responsibility/transitions
• They need first to learn (acquire) knowledge, skills, values
• Knowledge, skills, values are transferred to new situations
• Knowledge, skills, values are then applied to those new situations, being modified through experience
The Medical Schools
The poor us approach:
Despite no recognition for teaching, no proper funding for teaching and NHS clinicians who will not teach we have managed to graduate these new doctors so that ungrateful hospitals can continue to function
The Medical Schools
Not our fault approach:
“We, the unwilling, led by the unknowing, are doing the impossible for the ungrateful. We have done so much, for so long, with so little, we are now qualified to do anything with nothing.”
Ps ‘Mistakes might be made but not by us’
The Employers
The blame others approach:
‘What have these doctors done in 5 years at medical school?’
And the ‘we’ll sort these people out approach:
‘We’ll provide an induction so they don’t kill anyone’
The Regulator
The flexing muscles approach:
‘We want the students, medical schools and employers to do as they are told, so we’ll insist on an induction’
And the fingers crossed approach:
‘We hope no patients are harmed in the training of these doctors’
Some facts
Doctors experience multiple transitions during training and subsequent careers
Generally, transitions are known to be associated with increased risk of untoward and adverse events
Doctors with lots of transitions (locums) make up a sizable proportion of FtP referrals
The Team
• Trudie Roberts,
• Sue Kilminster,
• Naomi Quinton,
• Miriam Zukas
ESRC Public Services Programme
Sub-theme on medical regulation
ESRC RES-153-25-0084
Four levels to consider when thinking about links between transitions, responsibility and performance:
Individual
Teams and sites
Employers
Regulation
Conclusion 1
Conclusion 2
For the individual local knowledge is key in many cases to (perceptions of) good performance
Conclusion 3
Local relationships are key to good and safe performance so tribalism needs to be replaced by collegiality
Conclusion 4
The effect of local culture is enormous should not be under estimated and is the key to safe transitions
Performance
Performance tends to be understood as skill (possessed or acquired) but our work argues it is better understood as practice (doing or being)