2017 Training Data Analysis. Topic: LTFT training

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1 2017 Training Data Analysis Topic: LTFT training Background Obstetrics and Gynaecology is a speciality with a relatively high proportion of less than full time (LTFT) trainees and therefore it was decided to analyse the TEF results to identify whether there were any clear differences positive or negative for LTFT trainees compared with full time (FT) trainees. Training Issues / Questions Do LTFT trainees report the same scores for the TEF questions as FT trainees? Are there specific areas of training where LTFT trainees report fewer or greater opportunities / inadequate access to training opportunities? Are the results similar to those from the GMC survey? Analysis In January 2017, 270 of the 1457 (18.5%) Obstetrics and Gynaecology trainees who completed the TEF declared themselves to be LTFT.

2 TEF Respondents by LETB LETB Total TEF Respondents FT LTFT (All) LTFT (40%) Number of: LTFT LTFT (50%) (60%) LTFT (70%) LTFT (80%) LTFT (90%) East Midlands East of England Kent Surrey and Sussex London Mersey North Western Northern Deanery Northern Ireland Oxford Peninsula Scotland Severn Wales Wessex West Midlands Yorkshire & the Humber Due to small numbers of LTFT trainees in many LETBs it was not possible to undertake a meaningful comparison of LETBs. Unfortunately the GMC survey results for 2017 have not divided LTFT from FT trainees so could not be used for this analysis. The 2015 GMC National Trainees survey was analysed for differences between FT and LTFT and only 5% of the respondents in Obstetrics and Gynaecology were LTFT suggesting either that LTFT trainees are under-represented in that survey or that LTFT trainees were not correctly identified as such.

3 2017 TEF Indicators FT trainees vs LTFT trainees Indicators with a difference between FT and LTFT trainees, arbitrarily defined as a score difference greater than 1, were explored in greater detail.

4 Gynaecological Training General (FT scored 2.0 points higher than LTFT) Question Response Full time LTFT N % n % Appropriate opportunity to fulfil training requirements for the year in gynaecology Trainers supportive in completing the required gynaecology workplace-based assessments Clinical supervisors have provided feedback that is constructive and helpful Opportunities to attend gynaecology clinic frequently enough to fulfil my learning needs Appropriate supervision for my level of training in gynaecology clinic Opportunities to attend specialist clinics (e.g. urogynaecology, fertility and paediatric and adolescent clinics) All things considered I would recommend the unit to other trainees for the development of gynaecological skills dis dis dis dis dis dis dis

5 Gynaecological training Procedural (FT scored 3.5 points higher than LTFT) Question Response Full time LTFT n % n % Appropriate opportunity to fulfil training requirements in Minor procedures dis Appropriate opportunity to fulfil training requirements in Intermediate procedures Appropriate opportunity to fulfil training requirements in Major procedures Appropriate opportunity to fulfil training requirements in Emergency procedures Appropriate opportunity to fulfil training requirements in Outpatient / office procedures Appropriate supervision for level of training in elective theatre cases Appropriate supervision for level of training in emergency theatre cases Appropriate supervision for level of training in managing emergency gynaecological admissions dis dis dis dis dis dis dis

6 Professional Development (FT scored 1.6 points higher than LTFT) Question Response Full time LTFT n % n % I was given sufficient independence / clinical responsibility appropriate to my level of training (i.e. allowed to practice independently) dis I had sufficient opportunity to develop management and leadership skills I have had the opportunity to develop my teaching and training skills I received encouragement and support undertaking clinical audit projects Audit/clinical governance meetings were constructive I received encouragement and support in undertaking Clinical research I participated in clinical research dis dis dis dis dis dis

7 Working environment (FT scored 1.4 points higher than LTFT) Question Response Full time LTFT n % n % Handover arrangements were effective and appropriate for patient safety dis I felt included as part of the multidisciplinary team whilst working in this unit I was allowed study leave for appropriate courses (i.e. not regional teaching) I was often obliged to work beyond contracted hours On call accommodation was available if required The rota allowed team working and continuity of care The work intensity was too high for my learning needs The work intensity was too low for my learning needs There was a suitable area for resting when on duty dis # dis dis dis dis dis dis dis

8 Education support and supervision (FT scored 1.3 points higher than LTFT) Question Response Full time LTFT n % n % I felt able to voice concerns about my training if required dis I was able to have regular meetings with my educational supervisor to review my progress and ongoing learning needs My educational supervisor was supportive and approachable when required My induction meeting included an effective assessment of previous training and competence and my learning needs dis dis dis Conclusions Overall, reassuringly, the differences between LTFT and FT trainees were small for all indicators. LTFT trainees did however have lower scores for 11 of the 14 indicators and in 5 indicators there with a score difference greater than 1. These 5 indicators were explored in more detail. For 2 indicators, Obstetric procedural training and Gynaecology basic ultrasound, LTFT trainees scored higher. In 1 indicator, Behaviours Experienced behaviours by others eroding professional confidence or self-esteem, there was almost no difference and this is a positive finding as it suggests that LTFT trainees feel just as valued as FT. LTFT trainees appear to find their Gynaecology training to be less satisfactory than FT trainees with the differences much less marked for Obstetric training. Analysis of individual questions shows that for general gynaecological training the lower score appears to be entirely due to less satisfaction with appropriate opportunity to fulfil the training requirements for the year in gynaecology. This

9 difference was greater for those working lower percentages. There was no significant difference between grades. For procedural gynaecological training the dissatisfaction was more widespread with lower levels of satisfaction for almost all the questions both in terms of opportunity and supervision with the only exceptions being in opportunities to perform minor gynaecological procedures and supervision for managing emergency gynaecology admissions. In this indicator however it was those who were working 70-90% that were less satisfied than those working 40-60% which possibly represents a greater acceptance amongst those working the lower percentage that their opportunities will be limited in a calendar year. Analysis of the individual components of professional development showed that the lower score for LTFT trainees was due to fewer opportunities and less encouragement to undertake research. Once again it was those working 70-90% rather than 40-60% who were least satisfied for most of the questions in this indicator with those working 40-60% often scoring almost the same as full time trainees. The difference in the working environment scores was due to less satisfaction with handover arrangements as well as team working and continuity of care. The dissatisfaction with handover was only amongst those working 40-60% with those working 70-90% scoring exactly the same as full time trainees. This suggests that the difference is related to the fact that LTFT trainees may have significant numbers of days when they are not in work meaning that they actually need a more detailed handover than a trainee who is there most days. All the 1.3 point difference in education support and supervision was due to LTFT trainees being less able to have regular meetings with the educational supervisor. It could be postulated that this is likely to relate to there being fewer opportunities each week due to non-working days but this seems unlikely as those working 40-60% had identical scores to full time trainees with those working 70-90% being dissatisfied. It is difficult to understand why those training 70-90% appear to be less satisfied with their training over a wide variety of indicators than those training 40-60%. It is not related to the stage in training as the numbers of trainees in each grade band (ST1-2, ST3-5, ST6-7) were the same in each LTFT group. As the differences are small they may well have occurred by chance but they suggest a trend towards LTFT trainees being less satisfied with their training compared with FT trainees especially with regard to gynaecology procedures. Recommendations To investigate ways to improve access to procedural gynaecological training.

10 Suggestion for GMC survey program specific questions (PSQs) To have specific questions about LTFT training and the impact it may have on training opportunities Suggestions for changes to TEF questions None Authors Dr Sarah Coleridge, Obstetrics and Gynaecology LTFT Trainee, Trainees Committee representative South West Severn. Dr Jennifer Davies, RCOG LTFT Training Adviser