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Maximising training in the outpatient setting
  1. R Shute1,
  2. V Ponnusamy2,
  3. W Kelsall1
  1. 1Neonatal Intensive Care Unit, Addenbrookes Hospital, Cambridge University Hospitals NHS Trust, Cambridge, UK
  2. 2Department of Paediatrics, Lister Hospital, East and North Herts NHS Trust, Stevenage, UK

Abstract

Aim Outpatient experience (OPE) is recognised as an integral component of paediatric training.1 Feedback from trainees suggested that inpatient work often takes priority over OPE. Trainees were pulled from clinics to cover acute work during the day and out-of-hours. The authors reviewed the OPE of our trainees.

Methods The authors conducted a telephone survey of trainee representatives from ST1–3 (SHO) and ST4–8 (SpR) paediatric and neonatal rotas in hospitals across our region during November 2009.

Results Information relating to the quality and quantity of OPE was obtained from all 18 hospitals in the deanery. 21 SHO and 21 SpR rotas were reviewed. Theoretically, 75% of SHO rotas allowed OPE but because of annual leave and floating/flexible cover for other paediatric areas only 30% guaranteed OPE. Most SHOs had the opportunity to attend specialty clinics on an ad-hoc basis. In 35% of rotas SHOs were able to see patients independently. All SpR rotas included some OPE, but the mean number of clinics per week was low (1.2/week (range 0.1–3)). In 57% of rotas SpRs managed their own clinics but only 23% of rotas were designed to allow them to follow up their own patients. Dedicated administrative time was built into 38% of rotas. In places without SpR-led clinics, trainees were often expected to cover other areas in preference to clinics. Trainees felt they received adequate feedback and support from consultants in 90% of rotas. All participating trainees felt that OPE was a good learning opportunity.

Conclusion Out-patient training is incorporated into working rotas in many ways, but is generally inadequate to provide the required OPE for trainees at all levels. Due to a stretched workforce trainees are often pulled out of clinic to cover other duties. Combined with the newly designed European Working Time Directive compliant rotas, this has led to the importance of OPE being overlooked. The authors propose to use this information at a regional level to develop departmental rotas that maximise OPE for our trainees.

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