Gastroscopy Consent Training for Foundation Doctors: A Novel Teaching Strategy. Chilkunda D, Beal H, ... Hull and East Yorkshire Hospitals NHS Trust. Stage 1.
Hull and East Yorkshire Hospitals NHS Trust Gastroscopy Consent Training for Foundation Doctors: A Novel Teaching Strategy Chilkunda D, Beal H, Khiyar Y Department of Endoscopy, Hull Royal Infirmary, Hull, UK Introduc*on Postgraduate Medical Educa1on and Training Board (PMETB), now part of General Medical Council, reports on Founda1on Schools have highlighted lack of consent training among Founda1on Year 1 doctors (FY1s) (1). This can impact on pa1ent safety and misguide expecta1ons, thus adversely affec1ng pa1ent experience. It could also affect FY1s’ confidence as they oLen feel they obtain consent for procedures without adequate training. Robust consen1ng skills are integral to good medical prac1ce and require urgent aPen1on. In order to achieve these goals, we developed a new teaching programme on consen1ng for diagnos1c gastroscopy (DG), which is the commonest inpa1ent procedure undertaken in the endoscopy unit, and as this procedure is less complex with rela1vely rare serious complica1ons. This has brought about a paradigm shiL in training and assessment of FY1s within Hull Royal Infirmary (HRI) and has been used as an example for seSng up competency assessments in other areas.
Methodology We ini1ated an appren1ceship model of training for consen1ng competency for newly qualified FY1s as part of mandatory induc1on. To facilitate this, we designed a formal assessment tool called Direct Observa1on of Gastroscopy Consent Taking Skills (DOGCTS). We have developed a three-‐stage process for FY1s.
Results This pioneering programme was introduced to all FY1s working in Medicine and Surgery in HRI star1ng in August 2012. Since its incep1on, 139 FYs have been trained with 100% aPendance rate. In order to avoid disrup1on to lists, only one FY1 was trained per list. Programme allowed FY1s to plan training around their clinical commitments. Successful comple1on of DOGCTS has been integrated into FY por]olio requirements. Feedback from FYs has been posi1ve and they have reported improved confidence. Pa1ents have informally expressed that they had a bePer pa1ent experience.
• Small group teaching on consent and procedure Stage 1 • Indica1ons, benefits, risks, seda1on prac1ces • FY1s choose from list of available of training slots • Liaison with HRI Endoscopy unit & East Riding Medical Educa1on Stage 2 Centre (ERMEC) • FY1s observed 1 x consen1ng process and DG by an experienced endoscopist Stage 3 • Formal assessment of competence using DOGCTS
Conclusions
Development of such a novel appren1ceship model allows for trainees and trainers to interact in an open, inclusive and non-‐threatening manner. It provides FY1s flexibility to manage their own learning needs and trainers a chance to give construc1ve, 1mely and forma1ve feedback in real-‐ 1me. Such a dynamic and proac1ve approach can not only improve confidence of FY1s but also ins1l public confidence in healthcare training. It has provided an excellent training opportunity in addi1on to being useful evidence for training por]olios. It also caters to quality assurance and medico-‐legal aspects (pertaining to consen1ng) for NHS Trusts. We aim to undertake a formal survey of pa1ent sa1sfac1on annually and roll out this programme for flexible sigmoidoscopy consent as well.
Reference
1. PMETB Report on Quality Assurance of FY1 programme visit to London deanery 2009.
