The Welsh Clinical Leadership Fellowships are a fantastic opportunity, not only for the individuals undertaking the posts, but for the projects that they work with.
The year offers the trainee the opportunity to develop their leadership and management skills whilst developing an understanding of the bigger picture of NHS Wales and how it functions. The fellows have contributed enormously to the projects they have been seconded to, whilst having a unique opportunity to meet the individuals who lead NHS Wales and develop connections with multiple collaborators and stakeholders not only for the current project but for their future careers.
'LINCymru – a central platform for trainee led QI' by Dr Miriam John
LINCymru was created to develop a network of trainee doctors and dentists in Wales with an interest in quality improvement. Initially development was led by successive cohorts of leadership fellows and it was given continuous project lead support from autumn 2017.
The purpose of LINCymru is to collaborate with the Wales Deanery QIST programme to support trainees and their trainers with quality improvement activities. Whilst the QIST Silver IQT training equips trainees and their trainers with the knowledge and skills to conduct quality improvement projects, the LINCymru platform offers additional resources and support during their first and any subsequent projects. Those with ongoing projects registered on the system will automatically receive monthly emails containing guidance on what QI tools would be appropriate to use based on a six month project timeframe.
By using a central online platform to register quality improvement projects, it is possible for all registered users to see what other projects are happening across the NHS in Wales. Projects can be searched by speciality, health board or hospital and the system has been designed to enable users to communicate with project leads to open possibilities for running simultaneous projects across multiple sites and encourage multidisciplinary working.
In a previous survey, trainees have shown that they are motivated to engage with QI activities to improve patient care and because they are frustrated with current systems where they work, however they have also voiced that they are frustrated that changes they do implement are rarely sustained. LINCymru aims to address this by linking projects to higher level strategic organisational objectives such as 1000 Lives Improvement programmes. The website advertises the contact details for the programme leads and allows projects to be mapped against these programmes. It is hoped that by encouraging trainees to focus on these strategic objectives, their implementation efforts will be better sustained when they rotate to new posts.
As a cohort of staff, trainees have additional motivators for involving themselves in QI activities. Firstly, it is on their training programme curriculums, although there is a broad spectrum of requirements between the royal medical colleges. Secondly, training recruitment processes are set up so that applicants compete for jobs based on a points based system. Since all applicants will have similar levels of academic achievement and clinical experience, the discriminating factors then become involvement with medical education, quality improvement, publication of articles in professional literature and presentations at scientific meetings. LINCymru aims to support trainees with the latter two of these by encouraging project leads to log their completed projects on the system with an abstract based on the SQUIRE guidelines for writing QI reports. These will then be ready to submit to calls for abstracts for scientific meetings. In addition, QIST and LINCymru will run a biannual competition where the top three abstracts submitted to the LINCymru platform will be offered the financial and academic support to write a QI report for submission to BMJ Quality Reports.
Although LINCymru is initially aimed at trainee doctors and dentists and their trainers, the platform is designed to allow any NHS Wales employee, Welsh Government employee or those affiliated with academic institutions in Wales full access to the secure members' area. It is hoped that this will encourage trainees to work with other disciplines and across the health and social care sector in Wales.
The platform is active and currently in its initial stages of implementation. It will be targeted at those schools who have already started QIST Silver IQT training cohorts but membership is open to anyone working in NHS Wales and we would welcome feedback on the platform to continue to develop it to meet trainee needs.
Emergency Medicine QIST Days
Dr Nirmal James
The All Wales School of Emergency Medicine, in conjunction with 1000 lives and the School of Anaesthesia, held two days of Silver Quality Improvement Training. Day 1 was held in September 2017 and Day 2 in November 2017. Both days were attended by Emergency Medicine trainees and trainers from across Wales.
This was my second time attending the course as I had attended it last year. The Royal College of Emergency Medicine has, as part of its exit exams, included Quality Improvement Projects (QIP) for trainees to submit. The concept of QIP from an exam perspective is quite new to most of the trainers and the two days helped not just the trainees, but also the trainers to get to know the concept of a QIP.
Prior to the two days, all trainers and trainees completed their bronze QI training. Day 1 introduced the concept of QIP and its basics including model for improvement methodology. The delegates were then given two months to identify and start a QIP topic in their place of work. Day 2 focused on supporting them on this and also included the presentation of QIP’s that had been carried out and how things could have been done differently.
My involvement for the two days was as a faculty and I spoke from an Emergency Medicine perspective and what was expected from an exam point of view. I found all the sessions useful and it was encouraging to see all the delegates actively getting involved in the various workshops. It was great to see a lot of interactive Q&As after each session and the explanation of the run charts and SPCC was very useful. It was obvious from the training days that the delegates attending had learnt what a QIP actually meant and how it was different form an audit. This was important in getting the methodology of carrying out a QIP right from the very beginning. Feedback received has been positive.
The All Wales School of Emergency Medicine plans to hold 2 day QIST events every year with a view of supporting new trainees.