Junior doctors
Encouraging new doctors to do medical education research Daniel Darbyshire, Department of Urology, Salford Royal Hospital, Manchester, UK Paul Baker, Department of Elderly Medicine, Royal Bolton Hospital, Bolton, UK
The role of the academic supervisor in medical education research is key
SUMMARY Background: An academic foundation programme in medical education may allow junior medical trainees to gain experience in teaching and medical education research. After 2 years, three trainees will have completed the programme, and three more will be halfway through it. The authors explore problems encountered and how trainees maximised their experience, helping to inform future planning.
Summary of work: Semi-structured group discussions covering trainees’ experiences were conducted in the summer of 2011. All six trainees in the programme participated. Summary of results: Both site-specific and general issues were raised, most of which were dealt with in a pragmatic fashion. The trainees’ goals and subsequent achievements varied. Important factors for trainees and those supervising them, and the organisa-
358 2013 John Wiley & Sons Ltd. THE CLINICAL TEACHER 2013; 10: 358–361
tion of the programme, are discussed. Conclusions: Our experience is that an academic foundation programme in medical education can be successful. This requires collaboration between trainees and supervisors. Take-home message: The role of the academic supervisor in medical education research is key, but those involved in the practicalities of helping trainees maintain their protected research time is just as important.
INTRODUCTION
F
oundation training (FT) is completed in the first 2 years of clinical practice after qualification in the UK. The Academic Foundation Programme (AFP) runs in parallel, and aims to allow interested individuals to gain experience of academia while completing FT. AFPs are available in many disciplines.1 They have a positive impact on academic aspirations,2 and on gaining academic and transferable skills.3 The format is related to the FT in which it is embedded. In many examples, a 4-month block in the second year is dedicated to the academic element; other programmes run longitudinally. Information on how the Foundation programme and its academic iteration fits in with wider postgraduate training in the UK can be found on the Foundation programme website.4 The programme in question is based in the discipline of medical education, running longitudinally across 2 years. It started in August 2009 with three trainees (Figure 1). The programme has evolved over the last 2 years, and this article provides a summary of the feedback received from the trainee doctors who have participated in the programme thus far. It provides a picture of the difficulties faced while participating in the AFP, how these were overcome and what the trainees have gained from the experience.
METHODS This study was conducted within a busy district general hospital and
FY1
Job 1 Job 3 Job 2
Job 2 Job 1 Job 3
Figure 1. Clinical rotations
By involving only the trainees, frank and open discussion was possible
foundation trust in the northwest of England.
Job 3 Job 2 Job 1
Participants The trainees involved were all entering the FT for the first time. Although two of the participants had intercalated degrees, none of the trainees entered medicine as graduates. Procedure The trainees all participated in semi-structured discussions, aiming to cover the following areas: • expectations; • experience; • problems; • solutions; • what helped; • what hindered; • what have you achieved; • issues in any particular jobs? The trainees led the sessions, so there was freedom to express their views. By involving only the trainees, frank and open discussion was possible; however, the possibility of bias is introduced. Discussions lasted between 30 minutes and 1 hour. The discussions were recorded in short-hand form and typed immediately following the discussion. A thematic analysis was performed by the lead author, using NVIVO software. All the trainees reviewed the results of this and a consensus was agreed upon.
RESULTS Expectations Trainees’ preconceptions about the format of the programme varied greatly. One trainee initially applied for a laboratory-
FY2
Job 4 Job 6 Job 5
Job 5 Job 4 Job 6
Job 6 Job 3 Job 4
based programme, and was unsuccessful, but based on their interview was offered the medical education programme. The different format of the two programmes led to a misunderstanding about the organisation of the academic component. One trainee deduced that the academic portion of the track was in clinical research, based on the job description. Only two of the six trainees felt they were confident that they knew how the programme was intended to run upon starting on it. Trainees’ expectations from the programme included: • academic achievements, signified by posters, presentations and publications; • developing teaching skills; • taking a project from inception to completion; • developing research skills; • improving transferable skills, such as time-management. Academic time The theme of protected time for research and teaching within clinical jobs came up in every discussion. It is clear that it is much easier for the trainee to take academic time in some posts, and it would also appear that being the first to do a job, or the ‘guinea pig’, was also more difficult. This is reflected in the available time reported. The discrepancy between the least and greatest time taken is shown in Figure 2. After 2 years, four of the six jobs offer the trainee the opportunity to take the academic time allocated to them (annual and study leave accounting for the discrepancy).
2013 John Wiley & Sons Ltd. THE CLINICAL TEACHER 2013; 10: 358–361 359
The ’learning process of project development’ was seen as the key component
is an interesting question, to which there is no clear answer. Further research, perhaps looking at this across AFPs in multiple disciplines, may prove valuable.
Figure 2. Potential academic time and the time taken by the trainees with the most and least time, by job
That is not to say that taking the academic time is always easy, or that it is always at the time originally planned. The trainees’ perceptions of what was responsible for this change are multiple. For the initial trainees a lack of clarity about the exact make-up of the programme was evident. Uncertainty about the academic component of the programme made it difficult to organise, and fight for, time for teaching and research. Along with developing a shared understanding of the programme, many of the trainees stated that persistence, and ensuring that the consultants they worked for, and other juniors that they worked with, understood what the time was for, was needed. This was greatly facilitated by the Foundation programme directors. Despite the improvements, some jobs have proved more resistant to change than others. Experience Perhaps reflecting difficulties acquiring time for academic projects, the initial cohort described problems with being the ‘guinea pigs’. The experience was described as ‘trying at times’, with ‘projects falling through’ and ‘not getting off the ground’. This was expected, and reflected the ‘realities of academic practice, particularly in a district general’. Despite some problems and difficulties, the programme was described as ‘successful’ and ‘enjoyable’. Academic time was not thought to be a barrier to gaining
the clinical competencies required of the AFP, perhaps because of the ‘excellent clinical jobs’. Research The ‘learning process of project development’ was seen as the key component. Inevitably, the programme was ‘slow to get going’, and was hindered by difficulties with navigating research ethics approval. The academic supervisor’s advice and support in ‘hitting the ground running’ soon became wisdom, given the realities of trying to have work finished in time for job applications. The level of support to help with these problems was substantial. The academic supervisor was readily available for advice, and many of the trainees described the regular meetings as a source of motivation: their experience and contacts also helped trainees to progress their projects. The deanery Senior Research Fellow in medical education was cited by the majority of trainees as being an invaluable source of help in progressing their projects, and especially in navigating the research ethics process. Peer support from the other AFP trainees was mentioned as being valuable, along with the excellent local library service. Five of the trainees thought the longitudinal nature of the programme useful in terms of seeing a project through to completion. One trainee said they would have preferred a block placement, as they would have been able to focus all their efforts on the project for that time. This
360 2013 John Wiley & Sons Ltd. THE CLINICAL TEACHER 2013; 10: 358–361
Teaching Delivering teaching was ‘hugely enjoyable’, and one trainee discussed how it helped ‘refresh my knowledge’; however ‘organising teaching was very time consuming’, and contact with the university could be improved. The local clinical skills educator and the medical education office administrators were especially helpful in organising teaching sessions. The willingness of the other foundation trainees to help deliver teaching was vital to the success of individual sessions. Examples of the teaching delivered includes: • revision sessions for third- and final-year objective structured clinical examinations (OSCEs); • recognition and management of acute illness; • handover; • ophthalmology for final-year students; • a series on history taking and examination for third-year students. Achievements Along with delivering teaching, the trainees have so far produced a considerable body of work: • eight journal publications; • seven oral presentations at conferences, from local to international level; • seven poster presentations at a similar variety of places; • the initial three trainees have completed postgraduate exams. All trainees also completed audits, as expected of foundation trainees, and most were involved in management or quality improvement projects.
DISCUSSION The academic component of each job has changed, as the balance between clinical and academic commitments has been attempted. The original and current format is outlined in Figure 3. All trainees participate in teaching and medical education research: the exact focus is trainee dependent, and is negotiated with the academic supervisor. The potential academic time available is 61 days, just over 12 weeks. This is reduced by oncalls and leave, but is comparable to a 4-month block with on-calls. The thematic analysis suggested several major themes: • organising research time requires effort, persistence and support; • this is even greater for the first cohort; • research is difficult; • with the available support, success is achievable; • teaching is the real highlight of the programme for most trainees; • the clinical component of this programme is highly regarded by trainees. Now the programme is becoming better weaved into the fabric of the departments in which the trainees work, it is hoped that greater opportunities to participate in a wider range of teaching and research will develop. Limitations The results above represent the views of the trainees and not their supervisors. Recognition of this obvious bias when analysing the text should allow readers to draw
The clinical component of this programme is highly regarded by trainees
Figure 3. Planned academic time by job
Box 1. Recommendations for setting up an academic foundation programme (AFP) in medical education • Very clear job adverts • Clear and defined point of contact for both programme-based problems and academic support • Early discussion between trainee and academic supervisor • Clearly defined protected academic time, listed on the rota if possible • Willingness to change how the programme works, especially at the onset
Box 2. Recommendations when undertaking an academic foundation programme (AFP) in medical education • Start early – arrange to speak or meet your academic supervisor long before the programme officially starts • Record feedback from your teaching session • Ask for money if presenting at conferences • Persevere, with both projects and getting academic time • Talk to your clinical supervisors
reasonable conclusions. The methodology is informal and pragmatic.
RECOMMENDATIONS From the analysis above we have formulated a set of recommendations for anyone thinking of developing a similar programme, as well as a set for anyone undertaking such a programme (Boxes 1 and 2). REFERENCES 1. Carney S. Rough guide to the academic foundation programme and compendium of academic competencies; 2009. Available at http://
www.foundationprogramme.nhs.uk/ pages/academic-programmes. Accessed in February 2011. 2. Lyons OT, Smith C, Winston JS, Geranmayeh F, Behjati S, Kingston O, Pollara G. Impact of UK academic foundation programmes on aspirations to pursue a career in academia. Med Educ 2010;44:996–1005. 3. Yunus A. Foundation programmes in academic medicine; 2007. BMJ Careers. Available at http://careers.bmj.com/ careers/advice/view-article.html? id=2241. Accessed in February 2011. 4. UK Foundation Programme Office. The Foundation Programme. Available at http://www.foundationprogramme.nhs.uk/pages/home. Accessed in August 2011.
Corresponding author’s contact details: Dr Daniel Darbyshire, Department of Urology, Salford Royal Hospital, Manchester, UK. E-mail: [email protected]
Funding: None. Conflict of interest: None. Ethical approval: Not required. doi: 10.1111/tct.12038
2013 John Wiley & Sons Ltd. THE CLINICAL TEACHER 2013; 10: 358–361 361
Encouraging new doctors to do medical education research Daniel Darbyshire, Department of Urology, Salford Royal Hospital, Manchester, UK Paul Baker, Department of Elderly Medicine, Royal Bolton Hospital, Bolton, UK
The role of the academic supervisor in medical education research is key
SUMMARY Background: An academic foundation programme in medical education may allow junior medical trainees to gain experience in teaching and medical education research. After 2 years, three trainees will have completed the programme, and three more will be halfway through it. The authors explore problems encountered and how trainees maximised their experience, helping to inform future planning.
Summary of work: Semi-structured group discussions covering trainees’ experiences were conducted in the summer of 2011. All six trainees in the programme participated. Summary of results: Both site-specific and general issues were raised, most of which were dealt with in a pragmatic fashion. The trainees’ goals and subsequent achievements varied. Important factors for trainees and those supervising them, and the organisa-
358 2013 John Wiley & Sons Ltd. THE CLINICAL TEACHER 2013; 10: 358–361
tion of the programme, are discussed. Conclusions: Our experience is that an academic foundation programme in medical education can be successful. This requires collaboration between trainees and supervisors. Take-home message: The role of the academic supervisor in medical education research is key, but those involved in the practicalities of helping trainees maintain their protected research time is just as important.
INTRODUCTION
F
oundation training (FT) is completed in the first 2 years of clinical practice after qualification in the UK. The Academic Foundation Programme (AFP) runs in parallel, and aims to allow interested individuals to gain experience of academia while completing FT. AFPs are available in many disciplines.1 They have a positive impact on academic aspirations,2 and on gaining academic and transferable skills.3 The format is related to the FT in which it is embedded. In many examples, a 4-month block in the second year is dedicated to the academic element; other programmes run longitudinally. Information on how the Foundation programme and its academic iteration fits in with wider postgraduate training in the UK can be found on the Foundation programme website.4 The programme in question is based in the discipline of medical education, running longitudinally across 2 years. It started in August 2009 with three trainees (Figure 1). The programme has evolved over the last 2 years, and this article provides a summary of the feedback received from the trainee doctors who have participated in the programme thus far. It provides a picture of the difficulties faced while participating in the AFP, how these were overcome and what the trainees have gained from the experience.
METHODS This study was conducted within a busy district general hospital and
FY1
Job 1 Job 3 Job 2
Job 2 Job 1 Job 3
Figure 1. Clinical rotations
By involving only the trainees, frank and open discussion was possible
foundation trust in the northwest of England.
Job 3 Job 2 Job 1
Participants The trainees involved were all entering the FT for the first time. Although two of the participants had intercalated degrees, none of the trainees entered medicine as graduates. Procedure The trainees all participated in semi-structured discussions, aiming to cover the following areas: • expectations; • experience; • problems; • solutions; • what helped; • what hindered; • what have you achieved; • issues in any particular jobs? The trainees led the sessions, so there was freedom to express their views. By involving only the trainees, frank and open discussion was possible; however, the possibility of bias is introduced. Discussions lasted between 30 minutes and 1 hour. The discussions were recorded in short-hand form and typed immediately following the discussion. A thematic analysis was performed by the lead author, using NVIVO software. All the trainees reviewed the results of this and a consensus was agreed upon.
RESULTS Expectations Trainees’ preconceptions about the format of the programme varied greatly. One trainee initially applied for a laboratory-
FY2
Job 4 Job 6 Job 5
Job 5 Job 4 Job 6
Job 6 Job 3 Job 4
based programme, and was unsuccessful, but based on their interview was offered the medical education programme. The different format of the two programmes led to a misunderstanding about the organisation of the academic component. One trainee deduced that the academic portion of the track was in clinical research, based on the job description. Only two of the six trainees felt they were confident that they knew how the programme was intended to run upon starting on it. Trainees’ expectations from the programme included: • academic achievements, signified by posters, presentations and publications; • developing teaching skills; • taking a project from inception to completion; • developing research skills; • improving transferable skills, such as time-management. Academic time The theme of protected time for research and teaching within clinical jobs came up in every discussion. It is clear that it is much easier for the trainee to take academic time in some posts, and it would also appear that being the first to do a job, or the ‘guinea pig’, was also more difficult. This is reflected in the available time reported. The discrepancy between the least and greatest time taken is shown in Figure 2. After 2 years, four of the six jobs offer the trainee the opportunity to take the academic time allocated to them (annual and study leave accounting for the discrepancy).
2013 John Wiley & Sons Ltd. THE CLINICAL TEACHER 2013; 10: 358–361 359
The ’learning process of project development’ was seen as the key component
is an interesting question, to which there is no clear answer. Further research, perhaps looking at this across AFPs in multiple disciplines, may prove valuable.
Figure 2. Potential academic time and the time taken by the trainees with the most and least time, by job
That is not to say that taking the academic time is always easy, or that it is always at the time originally planned. The trainees’ perceptions of what was responsible for this change are multiple. For the initial trainees a lack of clarity about the exact make-up of the programme was evident. Uncertainty about the academic component of the programme made it difficult to organise, and fight for, time for teaching and research. Along with developing a shared understanding of the programme, many of the trainees stated that persistence, and ensuring that the consultants they worked for, and other juniors that they worked with, understood what the time was for, was needed. This was greatly facilitated by the Foundation programme directors. Despite the improvements, some jobs have proved more resistant to change than others. Experience Perhaps reflecting difficulties acquiring time for academic projects, the initial cohort described problems with being the ‘guinea pigs’. The experience was described as ‘trying at times’, with ‘projects falling through’ and ‘not getting off the ground’. This was expected, and reflected the ‘realities of academic practice, particularly in a district general’. Despite some problems and difficulties, the programme was described as ‘successful’ and ‘enjoyable’. Academic time was not thought to be a barrier to gaining
the clinical competencies required of the AFP, perhaps because of the ‘excellent clinical jobs’. Research The ‘learning process of project development’ was seen as the key component. Inevitably, the programme was ‘slow to get going’, and was hindered by difficulties with navigating research ethics approval. The academic supervisor’s advice and support in ‘hitting the ground running’ soon became wisdom, given the realities of trying to have work finished in time for job applications. The level of support to help with these problems was substantial. The academic supervisor was readily available for advice, and many of the trainees described the regular meetings as a source of motivation: their experience and contacts also helped trainees to progress their projects. The deanery Senior Research Fellow in medical education was cited by the majority of trainees as being an invaluable source of help in progressing their projects, and especially in navigating the research ethics process. Peer support from the other AFP trainees was mentioned as being valuable, along with the excellent local library service. Five of the trainees thought the longitudinal nature of the programme useful in terms of seeing a project through to completion. One trainee said they would have preferred a block placement, as they would have been able to focus all their efforts on the project for that time. This
360 2013 John Wiley & Sons Ltd. THE CLINICAL TEACHER 2013; 10: 358–361
Teaching Delivering teaching was ‘hugely enjoyable’, and one trainee discussed how it helped ‘refresh my knowledge’; however ‘organising teaching was very time consuming’, and contact with the university could be improved. The local clinical skills educator and the medical education office administrators were especially helpful in organising teaching sessions. The willingness of the other foundation trainees to help deliver teaching was vital to the success of individual sessions. Examples of the teaching delivered includes: • revision sessions for third- and final-year objective structured clinical examinations (OSCEs); • recognition and management of acute illness; • handover; • ophthalmology for final-year students; • a series on history taking and examination for third-year students. Achievements Along with delivering teaching, the trainees have so far produced a considerable body of work: • eight journal publications; • seven oral presentations at conferences, from local to international level; • seven poster presentations at a similar variety of places; • the initial three trainees have completed postgraduate exams. All trainees also completed audits, as expected of foundation trainees, and most were involved in management or quality improvement projects.
DISCUSSION The academic component of each job has changed, as the balance between clinical and academic commitments has been attempted. The original and current format is outlined in Figure 3. All trainees participate in teaching and medical education research: the exact focus is trainee dependent, and is negotiated with the academic supervisor. The potential academic time available is 61 days, just over 12 weeks. This is reduced by oncalls and leave, but is comparable to a 4-month block with on-calls. The thematic analysis suggested several major themes: • organising research time requires effort, persistence and support; • this is even greater for the first cohort; • research is difficult; • with the available support, success is achievable; • teaching is the real highlight of the programme for most trainees; • the clinical component of this programme is highly regarded by trainees. Now the programme is becoming better weaved into the fabric of the departments in which the trainees work, it is hoped that greater opportunities to participate in a wider range of teaching and research will develop. Limitations The results above represent the views of the trainees and not their supervisors. Recognition of this obvious bias when analysing the text should allow readers to draw
The clinical component of this programme is highly regarded by trainees
Figure 3. Planned academic time by job
Box 1. Recommendations for setting up an academic foundation programme (AFP) in medical education • Very clear job adverts • Clear and defined point of contact for both programme-based problems and academic support • Early discussion between trainee and academic supervisor • Clearly defined protected academic time, listed on the rota if possible • Willingness to change how the programme works, especially at the onset
Box 2. Recommendations when undertaking an academic foundation programme (AFP) in medical education • Start early – arrange to speak or meet your academic supervisor long before the programme officially starts • Record feedback from your teaching session • Ask for money if presenting at conferences • Persevere, with both projects and getting academic time • Talk to your clinical supervisors
reasonable conclusions. The methodology is informal and pragmatic.
RECOMMENDATIONS From the analysis above we have formulated a set of recommendations for anyone thinking of developing a similar programme, as well as a set for anyone undertaking such a programme (Boxes 1 and 2). REFERENCES 1. Carney S. Rough guide to the academic foundation programme and compendium of academic competencies; 2009. Available at http://
www.foundationprogramme.nhs.uk/ pages/academic-programmes. Accessed in February 2011. 2. Lyons OT, Smith C, Winston JS, Geranmayeh F, Behjati S, Kingston O, Pollara G. Impact of UK academic foundation programmes on aspirations to pursue a career in academia. Med Educ 2010;44:996–1005. 3. Yunus A. Foundation programmes in academic medicine; 2007. BMJ Careers. Available at http://careers.bmj.com/ careers/advice/view-article.html? id=2241. Accessed in February 2011. 4. UK Foundation Programme Office. The Foundation Programme. Available at http://www.foundationprogramme.nhs.uk/pages/home. Accessed in August 2011.
Corresponding author’s contact details: Dr Daniel Darbyshire, Department of Urology, Salford Royal Hospital, Manchester, UK. E-mail: [email protected]
Funding: None. Conflict of interest: None. Ethical approval: Not required. doi: 10.1111/tct.12038
2013 John Wiley & Sons Ltd. THE CLINICAL TEACHER 2013; 10: 358–361 361
