‘Transition to Leadership’

a course preparing doctors for life as a registrar

Dr Lara Menzies

28th April 2015

Aims • Leadership and management increasingly recognised as

fundamental to high-quality clinical practice and of limited availability at SHO level

• 2014 evaluation data analysis from a transition leadership course:

Is there a need for such training?

Does it have significant, sustainable educational impact?

• Night shifts• Feeling isolated and without support• Communicating with the consultant• Delegation and prioritisation on busy shifts• Decision-making and getting others to follow plans• Safeguarding, child death, withdrawal of care• Outpatient clinics • Mistakes and increased responsibility• Not being perceived as competent by juniors/parents• Leading the team, especially for resus and emergencies

Biggest fears about becoming a Registrar?

• Discussion of role with SpRs/ST3s• Mentoring/buddying with ST4 • Meet consultants in advance• Good support from consultants at start • More guidance for educational

supervisors in extending leadership skills as an SHO

• Simulation training• Procedure experience• Available acute care

guidelines • Updates on difficult areas e.g.

child protection, death, consent

• Regular ST3 sessions on management of cases

• When/How to call consultant• Management skills training• Low-fidelity sim training e.g. telephone• Managing urgent scenarios at night• Strategies for situations when ‘out of

depth’• Delegation and prioritisation• Conflict and negotiation

• Opportunity to act up under supervision

• Shadow SpR on call shift• Supervised leading e.g.

ward rounds, and resus• FEEEDBACK

Empower trainees to equip themselves with the skills they need…..

What do trainees want to help prepare?

Why do paediatric trainees feel unprepared?

• Little exposure to management role: ‘unchartered territory’• Paediatrics very senior-led, few opportunities to learn SpR role• Lack of feedback on performance and lack of confidence• Never had juniors to manage!• Big jump in job description with minimal specific training in

management skills• Limited access to clinics/CP cases as SHO• Simulation days useful but not enough alone

Course Layout• Day 1 and 2: consecutive training days 3-6 months prior to

starting Registrar post• Day 3: 1-2 months after starting Registrar post• Trainees to attend all 3 days if possible• Predominantly registrar-led sessions• ‘Putting Leadership into Practice’ interactive sessions• Feedback data from participants

Day 1•Life as a new SpR•Leaders and Followers•Understanding Hospital Systems•Leading at Night•Identifying Opportunities for Learning and Improvement

Day 2•Key updates

Child Protection

End of Life Care

Consent and the Law

•Managing a new role in Outpatient Clinics

Day 3•Decision-making•Successes and Pitfalls •Dealing with mistakes and accountability•Negotiation, Delegation and Conflict•Managing stress

Course Impact

Did the course change your feelings about being a Registrar?

Yes: 96% of attendees (n=26)

Why?

•Consultant communication: feel empowered, know when to do so•Practical advice on difficult clinical areas and how to lead•Tips, tools and strategies to cope with challenges/uncertainties•Feel more confident, less anxious, calmer from sharing fears•Feel excited/enthusiastic about taking on a new challenge•Reassuring: what the role involves and where to go for support•Know how to prepare before starting ST4 and areas to focus on (SMART)

Competence rankings

• Trainees rated whether they felt competent to deal with particular scenarios at 3 time points

1. Prior to starting the T2L course (Day 0)

2. After Day 2 (where the bulk of the training was provided)

3. Four months later, after returning for Day 3

• Rated from 1 (strongly disagree) to 4 (strongly agree)• Assessment of course effectiveness and sustainability

– 8 areas of leadership and management– 2 ‘control aspects’ not focused upon during the course

*All values shown as Mean (Standard Deviation)Sample sizes: Pre Course n=30, Post Day 2 n=26, Post Day 3 n=13, Paired T test n=24

Rated AspectPre Course

(Day 0)*Post Day

2*Post Day

3*

Difference in competence

rating

Paired T Test

P valueLeadership, Management and Communication Aspects

Knowing when to call my consultant 2.9 (0.6) 3.5 (0.5) 3.5 (0.7) +1.6 <0.001

Leading during a resuscitation 2.2 (0.6) 2.5 (0.6) 3.0 (0.6) +0.8 0.03

Managing conflict 2.5 (0.5) 2.9 (0.5) 3.2 (0.4) +0.7 0.02

Managing cases with safeguarding concerns

2.3 (0.6) 3.2 (0.6) 3.2 (0.4) +0.9 <0.001

Difficult cases regarding consent 2.2 (0.6) 3.0 (0.7) 3.1 (0.6) +0.9 <0.001

Child dying on the ward overnight 1.7 (0.5) 2.9 (0.7) 3.1 (0.86) +1.4 <0.001

Leading and managing a team on a day to day basis

2.7 (0.6) 2.9 (0.5) 3.4 (0.5) +0.7 0.06

Making mistakes and coping with increased accountability

2.2 (0.7) 2.7 (0.6) 3.3 (0.6) +1.1 0.01

Control AspectsTreating common neonatal problems 2.9 (0.6) 2.9 (0.4) 3.0 (0.4) +0.1 0.6Treating common paediatric problems 3.0 (0.4) 2.9 (0.4) 3.0 (0.4) +0.0 0.6

Impact Summary

• High demand from trainees for T2L training• Trainees valued peer support , mentorship and leadership skills

education• All 8 rated aspects of leadership, management and communication

skills showed an increase in trainee competence after Day 2• Improvements sustained over a four month period during transition • Statistically significant increased competence in 7/8 leadership and

management categories (and trend significance for 1/8)

Future Directions

• Running 3 courses in London in 2015• Aim to reach 80-90% of London-based ST3s• Course Sustainability

– Format moderation?– Work with RCPCH/other regions?– Online resource package?

• What can trainers/trainees change about their daily practice?• When should preparation start?

Thank you!

•Acknowledgements– Dr John Moreiras– Dr Caroline Fertleman– Dr Sara-Jane Smith– The many excellent faculty members– Our participants for providing evaluation data– London Specialty School of Paediatrics for course venue and

refreshments

•Contact: lacmenzies@gmail.com

Three Day Leadership and Management Course for Paediatric ST3 Trainees