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G538 A quality improvement project to meet training needs: a trainee-led development of a national multi-centre network
  1. H Murch,
  2. C Course,
  3. I Morris
  1. Paediatrics, Wales Deanery, Cardiff, UK


Context This is a trainee-led, multi-centre project incorporating all Paediatric and Neonatal units across Wales, aiming to improve trainee research and education experience; promote a collaborative to audit, research and quality improvement; and ultimately benefit paediatric and neonatal care across Wales.

Problem Paediatric trainees in Wales have raised concerns regarding limited opportunities to become involved in research, audit and service evaluation or quality improvement projects during their training. Smaller ‘in-house’ projects are often described as time-consuming and unfulfilling, and do not endow trainees with essential project leadership and management skills. Such projects often involve a lot of work but involve small numbers of patients, limiting trainee’s potential to produce high-quality work that can build their portfolios and improve patient care. Similar projects are replicated across multiple units compounding the problem.

Assessment of problem and analysis of its causes A small focus group of trainees, paediatric and neonatal consultants, and research teams discussed strategies to overcome these problems. Our solution was to construct a trainee-led, multi-centre network to undertake research, audit and service evaluation projects within Welsh paediatric and neonatal units, facilitating higher-quality projects that improve patient care, build trainees skills and portfolios, and provide education in research methodology.

Intervention, design and strategy for change The Welsh Research and Education Network (WREN) has been developed, a network of consultants and trainees with representation from paediatric and neonatal unit across Wales. WREN is administered by an executive committee comprising trainee and consultant members. A consultant representative was recruited in each unit, with local trainees volunteering to co-ordinate project fulfilment. This provides infrastructure and support for multi-centre, national projects to occur, hoping to produce work that could be recognised at regional and national levels, improve patient care and enhance trainee experience/skills.

Project proposals are submitted by trainees and selected by committee, on the basis of clinical validity and potential to improve patient care. Project leads are identified and proposals are cascaded within the network. Results are communicated with WREN via regular meetings, and distributed on a regional and national basis. WREN meetings incorporate educational events on topics including critical appraisal, research methodology and statistics.

Results/effects of changes WREN was founded one year ago and, although still in its infancy, has been highly effective and remains a trainee-led initiative. Two educational events were hosted and well received. Five projects have been undertaken across 10 out of 13 units in Wales, with two having been completed (The use of Chest Radiographs in Acute Paediatric Respiratory Illness, and Audit of Management of Respiratory Distress Syndrome). Both have been presented at regional and national conferences and submitted for publication. Those involved have gained essential skills on leadership of multi-centre projects, alongside fulfilling RCPCH training requirements for audit, and have produced high-quality work which is influencing patient care in Wales. Educational sessions have included sessions on critical appraisal skills, the use of statistics in medicine, and research funding.

This has been an ambitious and difficult project. Geographical, logistical, and resource problems have all been encountered in this unfunded collaborative effort. Organising events and completing projects has relied upon great effort and enthusiasm amongst an initial small but steadily growing number of collaborators. Moving forward, WREN events are hoping to be incorporated in to the Deanery teaching programme, and future, more ambitious projects will hopefully grow to include all Welsh units as the network expands.

Conclusion Using a co-operative, co-ordinated approach, it is possible to maximise trainee experience of audit and research and offer vital leadership and management experience, that can simultaneously lead to the production of high-quality, clinically relevant work that can directly improve patient care.

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