Filling the gaps in learningBMJ 2012; 344 doi: http://dx.doi.org/10.1136/bmj.e3113 (Published 04 May 2012) Cite this as: BMJ 2012;344:e3113
The projects in the excellence in healthcare education category share a common theme: all are imaginative solutions to gaps in training and education. These diverse finalists show a strong commitment to the importance of career long learning.
Concerns over delays in diagnosis of childhood brain tumours led to Headsmart, a campaign to raise awareness of the condition among both parents and health professionals. The aim of the campaign, a collaboration between the Children’s Brain Tumour Research Centre at Nottingham University, the Samantha Dickson Brain Tumour Trust, and the Royal College of Paediatrics and Child Health, is to speed up the time taken to diagnose childhood brain tumours.
Childhood brain tumours can be difficult to diagnose, says Sophie Wilne, a consultant paediatric oncologist at Nottingham Children’s Hospital.
“The initial symptoms are often non-specific and can occur with other more common and less serious childhood illnesses, and there is also lack of awareness among healthcare professionals that brain tumours do occur in children,” she says.
The campaign, at www.headsmart.org.uk, raises awareness of symptoms among the public and health professionals. It also helps health professionals in both primary and secondary care to distinguish children who may have a brain tumour from those who don’t, as well as advising on appropriate management.
Early evaluation of the campaign is positive. A study of 149 children at 19 children’s cancer centres before the launch of the campaign in June 2011 showed that the average interval between onset of symptoms and diagnosis was 2.1 months. After the launch of the campaign another study of 146 children showed that had gone down to 1.7 months. The ultimate target is six weeks, the best reported worldwide interval.
“Most childhood brain tumours are curable, and we know that if we reduce the time taken to diagnose we will reduce the likelihood of a child suffering from long term, life altering disability,” says Wilne.
The Script e-learning programme addresses a paradox: junior doctors do the majority of prescribing in hospitals but, when they begin their careers, have little practical training in it.
NHS West Midlands commissioned Birmingham, Aston, and Warwick Universities to analyse the foundation curriculum and the General Medical Council guidance on prescribing. The universities then came up with 40 e-learning modules for foundation trainees, which were fully launched in August 2011.
Sarah Thomas, research pharmacist at Birmingham University and the content and editorial manager of Script, says that the course fills a gap in trainees’ education.
“At undergraduate level there’s little focus on prescribing, and for junior doctors it’s perhaps one of the hardest things they have to do. It’s the one thing they cannot practise as undergraduates,” she says.
The evaluation has shown that trainees who have undertaken the programme think that their prescribing skills have improved, a view supported by their clinical tutors.
The reorganisation of strategic health authorities means that from this August foundation trainees in the East Midlands and East of England will be doing the course, and there are plans to adapt it for general practitioners and registrars.
The team’s ambitions are big. “There’s no reason why this couldn’t go national,” says Thomas.
It was the growing realisation that junior doctors and managers barely even say “hello” to each other, let alone work together, that was the catalyst for the Paired Learning project. The brainchild of Bob Klaber, a consultant paediatrician at Imperial College Healthcare NHS Trust, along with colleagues from management and education, the project brings together junior doctors and managers to learn from one another.
“Throughout my postgraduate training I didn’t speak to any managers and that’s the norm. We have very little exposure to them, and managers keep themselves away from the front line. If they need clinical contact they go to the consultant,” says Klaber.
The project, which is low cost and has already spread to North Middlesex Hospital and King’s in London, has four elements: conversations between pairs; work shadowing; workshops on building self awareness, leadership, and improvement skills; and service and quality improvement workshops.
A detailed evaluation highlighted examples of how bringing juniors and managers together has led to improvements in patient care. But it’s the long term gains that have the most potential, says Klaber.
“It’s about having a transformational experience. These are young people likely to have careers in the NHS for the next 35 to 40 years, and if they can change their attitudes to each other that’s the most exciting gain,” he says.
Lessons Learnt: Building a Safer Foundation
Maria Ahmed was a second year foundation trainee at Manchester Royal Infirmary when she realised that there was a gap in the training of junior doctors—she and her peers had received no training on patient safety. To them it was an “alien concept,” she says.
She pitched for funding from NHS North West and enlisted the support of the North Western Deanery and safety experts at Imperial College London to develop, deliver, and evaluate a workplace based training course to plug that gap. Lessons Learnt: Building a Safer Foundation involves trainees discussing patient safety incidents encountered in practice with the support of senior doctor facilitators.
To date over 1500 foundation trainees in all 19 hospitals in north west England have taken part, with over 120 consultants and senior registrars trained as facilitators.
“Most junior doctors end up complaining about things in the mess in an unstructured way,” says Ahmed, now a clinical research fellow at Imperial College. “Here, they can have these discussions in a structured and safe environment and brainstorm solutions. It helps them navigate the system. Lessons Learnt is a springboard for them to effect change in the workplace,” she adds.
Hospitals that have taken part in the course have seen their incident reporting levels double. “Incident reporting among doctors is really poor,” says Ahmed. “The higher reporting in part reflects the improved safety culture brought about by Lessons Learnt,” she says.
Cite this as: BMJ 2012;344:e3113
For more information about the BMJ Group Improving Health Awards 2012 go to http://groupawards.bmj.com.