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New Ways of Working need New Ways of Training
EWTD and Supervision
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Ramneesh Puri, ST3 Psychiatry Hutton Centre Regional Medium Secure Unit, Middlesbrough
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ramneeshpuri{at}yahoo.com Ramneesh Puri
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McLernon et al have highlighted a very relevant and in some ways contentious issue through this article. Being a "transition SHO" i have personal experience of the concerns related to the impact of EWTD working on the training of junior doctors. Since the advent of the EWTD an average junior doctor spends only just over half of his/her 6 month post in the ward under the supervision of his/her consultant. Annual leave,study leave (MRCpsych course and other courses),2-3 weeks of nights (depending on the rota)and the consultant's leaves being the factors responsible. Add to this the fact that lots of oncalls are now non resident "second on- calls" where juniors are rarely called to assess patients, it almost seems like a training crisis. However it is important that hasty conclusions are not drawn and the impact on training is not exaggarated. The old system of "long weekends" assessing "revolving door patients" coming in drunk in the A&Es had its own pitfalls and wasn't entirely suited to delivering rounded training. It is also important to realise that seeing scores of acute emergencies doesn't necessarily prepare juniors better for the MRCPsych exam. What is needed is a better understanding of the theoretical basis of illnesses along with an ability to propose management plans for complex presentations taking into account all the relevant bio-psycho-social factors. This needs observational and experiental learning in multidisciplinary enviornments both on the wards and in the community. The New Ways of Working (NWW) policy document of the Department of Health places clear emphasis on the changing role of psychiatrists. We will be increasingly dealing with fewer patients and expected to case- manage only complex cases. It is the other members of the multidisciplinary team who would take up the care coordinator roles for a majority of our current patients. The new Mental Health bill is already a step towards this. Its therefore important that we move on in our attitudes towards our own training. The training needs of the doctors of tomorrow should not be defined by the duties of the doctors of yesterday. Our new ways of working should be the breeding ground for our new ways of training. Only then will we be able to play a continuing constructive role towards our patients' management. |
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Vishal Agrawal, SpR in Psychiatry South Essex Partnership NHS Foundation Trust
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vishalagraw{at}gmail.com Vishal Agrawal
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There has been lot of scepticism about the introduction of European working time directives (EWTD) for junior doctors. The fears have mainly been around the quality of training they would receive. McLernon et al also explore this in their article and feel clinical experience is being lost in some key areas. We took a look at the effect of EWTD on trainee supervision in South Essex Partnership NHS Foundation Trust. A survey was conducted in July 2003, when we had just introduced the partial shift system, and repeated in February 2007. All SHOs were asked about their supervision experience. Regular weekly supervision rate had dropped from 75% in 2003 to 68% in 2007. The main reasons for this was lack of time due to on call commitments, planned leaves and day off after night shifts. However, there were some improvements following the survey in 2003. These centred mainly on the quality of supervision offered. There was an increase in percentage of trainees receiving individual supervision and a drop in those receiving group supervision. Also, there was an increase in number of trainees having supervision for the stipulated one hour. Trainees were taking an active role in deciding what topics they wanted to discuss in the supervision. This is especially relevant in post MMC world where trainees will have to take the initiative for work placed based assessments and supervision will provide a suitable platform for developing strategies to help complete these assessments |
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