Abstract:

The Royal College of General Practitioner (RCGP) has required General Practitioner (GP) trainees in the United Kingdom (UK) to complete a three-year mandatory training programme since 2008. RCGP further published the ‘Child Health Strategy 2010-2015’, recommending all GPs to gather adequate clinical experience to ensure their competencies in assessing a sick child. To achieve these competences, GP trainees are trained in hospital Paediatric speciality as part of their integrated curriculum. This includes working in a neonatal intensive care unit (NICU).

During NICU placement, trainees are expected to acquire the full responsibility of a paediatric trainee, including attending resuscitation of newborn, identifying sick neonates, performing neonatal cannulation and managing ventilated preterm. This has presented various challenges. For example, trainees may be rushed through their learning objectives due to their short duration of NICU placement. The frequent changeover of inexperienced trainees can also be more disruptive to the continuity of patient care and raises the question of patient safety being compromised. Training opportunities may be commonly reserved for paediatric trainees when GP trainees are on-call simultaneously. The shift system of working due to the European Working Time Directive has further limited their training opportunities. Indeed, apart from becoming accustomed to a new working environment with established organisational culture and policies, trainees are also expected to learn new practical knowledge and skills. Stress and anxiety can affect attention, effectiveness and decision-making skills (Smith, 1990; Askenasy et al., 1996; Lehner et al., 1997).

Is it possible to provide effective GP training in a NICU setting whilst delivering safe patient care? The ultimate goal of medical staff training and education is to ensure and safeguard patient safety in long term. However, its potential contribution to risks or health-associated injury should not be taken lightly (Battles, 2006). These risks can be decreased to minimum through improved clinical supervision and utilisation of assessment feedback tool.

This leads to the next question of how to achieve high standard of workplace based learning experience through clinical supervision and effective use of workplace-based assessment (WBA). As current workplace-based training has shaped towards ‘situated learning’, most social-cultural theorists have proposed various contextual factors (e.g. social and organisational culture and policies) and learner’s adaptability as causes influencing learners’ working performance. General attributes that may ensure successful learning include motivation, calm response in acute situations, prioritisation and management skills, and team working. WBAs can be powerful both to monitor and encourage development of these skills. However, given the multipurpose use of WBAs and lack of effective feedback and clinical supervision, WBAs largely fail at present to effectively aid learning.

Fundamental changes have to be made to achieve effective utilisation of WBAs through close clinical supervision and guidance. This includes encouraging supervised learning by completing WBA tools, which should be designed to assess specific skills at workplace including team working, handover accuracy, leadership skills and clinical management. Further studies are required to optimise the utilisation of WBAs for paediatric training in the UK.

Keywords:

Workplace, assessments, training, learning, patient safety, clinical supervision, social-cultural theories.