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Improving Trainee Experience of Raising Concerns: Redefining a Representative Structure for Post-Graduate Doctors in Training

Published online by Cambridge University Press:  01 August 2024

Katherine Hubbard*
Affiliation:
Birmingham and Solihull Mental Health NHS Foundation Trust, Birmingham, United Kingdom
Sian Davies
Affiliation:
Birmingham and Solihull Mental Health NHS Foundation Trust, Birmingham, United Kingdom
Vicki Ibbett
Affiliation:
Birmingham and Solihull Mental Health NHS Foundation Trust, Birmingham, United Kingdom
Shay-Anne Pantall
Affiliation:
Birmingham and Solihull Mental Health NHS Foundation Trust, Birmingham, United Kingdom
Ruth Scally
Affiliation:
Birmingham and Solihull Mental Health NHS Foundation Trust, Birmingham, United Kingdom
*
*Presenting author.
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Abstract

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Aims

As part of a wider quality improvement project (QIP) aiming to improve trainees’ experiences with ‘Raising Concerns’ in a large mental health trust, we sought to improve the trainee representative (rep) structure. This would give trainees more transparent processes and provide intermediaries by which to raise concerns. Based on change ideas generated from our driver diagram, roles were created to coordinate meetings and represent specific groups of trainees and on-call rotas.

Methods

Prior to August 2022, there were an undefined number of ‘Senior House Officer’ (SHO) reps who were recruited informally by the Post-Graduate Medical Education Team. The duties of these reps were not clearly detailed. As part of our first ‘Plan, Do, Study, Act’ (PDSA) cycle, we identified groups of trainees that needed additional representation (International Medical Graduates [IMGs], Less than Full Time trainees [LTFT]) and introduced a Wellbeing Rep to cover all training grades. Specifically for SHOs, we introduced three core roles (Rota/Placement, Inclusion, and Social) and individual roles for the six on-call rotas. Following the implementation of this rep structure, we gathered quantitative data, including whether trainees had utilised the reps and how effective they were in raising concerns, and qualitative feedback. We gathered data from both the reps and the whole cohort of trainees. We then started another PDSA cycle in August 2023.

Results

On a 1–5 scale (5 = very effective), the average response from trainees for how effective the trust reps were in supporting raising concerns was 3.8 (5 responders), with no trainees who responded feeling that any of the rep roles needed restructuring. However, the rep survey highlighted that the following roles needed restructuring: Rota/Placement rep, Social rep, and Rota reps. The Rota/Placement role was highlighted as being unnecessary due to the existence of individual rota reps, but there was a need for a ‘lead’ rep to coordinate rep meetings and induction. Unfortunately, a Social rep was not recruited, however it was identified that due to the importance of the role more than one trainee may be required to arrange social events.

Conclusion

Overall, the trainee response to the new rep structure has been neutral/effective, but we hope to obtain more responses in the next PDSA cycle. The rep feedback highlighted the need for coordinator roles to improve cohesion. The results have informed change ideas which we implemented in August 2023. The second PDSA cycle will be completed in July 2024.

Type
3 Quality Improvement
Creative Commons
Creative Common License - CCCreative Common License - BY
This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Copyright
Copyright © The Author(s), 2024. Published by Cambridge University Press on behalf of Royal College of Psychiatrists

Footnotes

Abstracts were reviewed by the RCPsych Academic Faculty rather than by the standard BJPsych Open peer review process and should not be quoted as peer-reviewed by BJPsych Open in any subsequent publication.

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