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Improving Confidence and Knowledge in Raising Concerns: A Development Half-Day for Representatives of Postgraduate Doctors in Training
- Katie Thomas, Sian Davies, Vicki Ibbett, Shay-Anne Pantall, Ruth Scally
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- Journal:
- BJPsych Open / Volume 9 / Issue S1 / July 2023
- Published online by Cambridge University Press:
- 07 July 2023, p. S18
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Aims
Raising a concern is an integral duty for a doctor. The General Medical Council guidelines on Good Medical Practice state that a culture should be promoted that allows “all staff to raise concerns openly and safely”. Appointment of Postgraduate Doctors in Training to Representative (Rep) positions can be an effective way to allow trainee voices to be heard. Here we present the results of a Development Half-Day created to empower Reps with the knowledge and confidence to represent peers effectively within a large mental health Trust. The training session was identified as a ”change idea” in a wider Quality Improvement Project (QIP) seeking to improve trainee confidence in raising concerns.
Methods16 Postgraduate Doctors in Training Reps were invited to attend a Development Half-Day in November 2022. The day included talks on their roles and responsibilities, respectful challenge and maintaining well-being.
Quantitative and qualitative data were gathered using anonymous questionnaires completed before and after the session. The questionnaire contained 4 questions asking them to rate their knowledge of their role as a rep and confidence in raising trainee concerns. This was quantified using a 1-10 scale for each question with 1 being lowest confidence/knowledge and 10 being highest. Mean scores and standard deviations were calculated. A paired one-tailed t-test was used to assess the statistical significance of the difference in pre- and post-session scores.
Results9 Reps attended the Development Half-Day and completed the pre- and post-session questionnaires.
There was a statistically significant improvement between pre- and post-session scores for all questions (all p values <0.05). Importantly there was a significant increase in the confidence felt by reps in knowing where and who to raise trainee concerns to (p < 0.05).
Qualitative feedback indicated that attendees found the session useful and they appreciated that it was in-person. The only suggestion for improvement was for the session to have been held earlier, closer to when reps were initially appointed; this will be a change that will be implemented in the next “Plan, Do, Study, Act” cycle of the QIP.
ConclusionImplementation of a Development Half-Day for Trainee Reps was shown to have a significantly positive impact on their confidence in their roles and their ability to respectively challenge seniors. The Reps additionally reported being better equipped at knowing where and who to raise concerns to. This will hopefully aid in their ability to signpost and empower other trainees to do the same.
Understanding Trainees’ Current Likelihood of Raising Concerns
- Vicki Ibbett, Manjinder Padda, Katie Thomas, Rajendra Harsh, Sian Davies, Tabassum Mirza, Katherine Hubbard, Ainy Gul, Khadija Kulman, Marium Fatima, Amy Shaw, Ella Kulman, Razan Saeed, Shay-Anne Pantall, Ruth Scally
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- Journal:
- BJPsych Open / Volume 9 / Issue S1 / July 2023
- Published online by Cambridge University Press:
- 07 July 2023, p. S96
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Aims
Raising concerns is a duty for all doctors. However, a scoping exercise within a large mental health Trust demonstrated that trainees experience difficulties in raising both patient safety and training concerns. As part of a trainee-led quality improvement (QI) project within this Trust, our aim was to develop a pulse survey to capture the current likelihood of trainees raising concerns and factors influencing this.
MethodsAn online survey was developed using ‘plan do study act’ (PDSA) methodology. The initial draft was informed by data from the Autumn 2021 scoping exercise. The survey was refined using a collaborative trainee-led approach. It was tested by trainees involved in the QI project followed by two other trainees and was revised accordingly.
Trainees across all training grades were invited to complete the survey through various communication channels. The pulse survey will be repeated monthly with a two-week response window.
ResultsTen trainees out of 103 responded to the first pulse survey open from 18th to 31st January 2023 (response rate 9.7%). Seven respondents were core trainees and three were higher trainees.
Respondents were more likely to raise patient safety concerns than training concerns (average score of 3.8 out of 5, where 5 equals ‘very likely’, versus 3.4 out of 5 respectively). Of the three respondents who had experienced a patient safety concern in the past 2 weeks, only two had used any existing process to raise it. These data were replicated for training concerns.
No respondents were confident that effective action would be taken if they raised a training concern, while less than half of respondents were confident that effective action would be taken if it were a patient safety concern.
The reasons for the low response rate are likely varied. However, there may be some similar underlying reasons for low engagement in surveys and low engagement in raising concerns. Given this, a more negative picture of trainees’ likelihood of raising concerns may have been portrayed if more trainees engaged in the survey.
ConclusionEngaging trainees to provide insight into their likelihood of raising concerns is challenging. Despite the low response rate, this initial pulse survey demonstrated that trainees continue to experience barriers to raising concerns. PDSA methodology will continue to be used to optimise the monthly pulse survey response rate. The key QI outcome measures will also be integrated into pre and post intervention surveys as a pragmatic approach to evaluate specific change ideas.
The Fool's Heart and Hobbes' Head
- Thomas Scally
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- Journal:
- Dialogue: Canadian Philosophical Review / Revue canadienne de philosophie / Volume 20 / Issue 4 / December 1981
- Published online by Cambridge University Press:
- 05 May 2010, pp. 674-689
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Chapter fifteen of Leviathan is concerned with what Hobbes calls “the laws of nature”; however, it is evident from the start that justice is the central problem of the chapter. Hobbes demonstrates a rather subtle sensitivity to a possible misunderstanding of his views on the state of nature and the function of natural reason by inventing the character of the fool who purports to use Hobbes' own principle of self-interest to deny the existence of justice. The fool may finally be a “straw man” who proposes precisely that argument which Hobbes can quickly refute, but even if this is so, the straw man has Hobbes' face, or one like it, because the line between the views of the fool and those of Hobbes himself is very fine indeed. This section of Leviathan is more significant than it would seem at first glance because it provides an avenue by means of which one can distinguish the political philosophy of Hobbes from that of classical “individualists” such as Callicles and Thrasymachus. It is all too easy to read Hobbes as an elaborate restatement of the sophistic position of Socrates' famous opponents; the example of the fool belies this facile identity and to a certain extent constitutes a refutation of the classical power theorists.