User perceptions of multi-source feedback tools for junior doctors

Context:  The effectiveness of multi-source feedback (MSF) tools, which are increasingly important in medical careers, will be influenced by their users’ attitudes. This study compared perceptions of two tools for giving MSF to UK junior doctors, of which one provides mainly textual feedback and one provides mainly numerical feedback. We then compared the perceptions of three groups, including: trainees; raters giving feedback, and supervisors delivering feedback. Methods:  Postal questionnaires about the usability, usefulness and validity of a feedback system were distributed to trainees, raters and supervisors across the north of England. Results:  Questionnaire responses were analysed to compare opinions of the two tools and among the different user groups. Overall there were few differences. Attitudes towards MSF in principle were positive and the tools were felt to be usable, but there was little agreement that they could effectively identify doctors in difficulty or provide developmental feedback. The text-oriented tool was rated as more useful for giving feedback on communication and attitude, and as more useful for identifying a doctor in difficulty. Raters were more positive than other users about the usefulness of numerical feedback, but, overall, text was felt to be more useful. Some trainees expressed concern that feedback was based on insufficient knowledge of their work. This was not supported by raters’ responses, although many did use indirect information. Trainees selected raters mainly for the perceived value of their feedback, but also based on personal relationships and the simple pragmatics of getting a tool completed. Discussion:  Despite positive attitudes to MSF, the perceived effectiveness of the tools was low. There are small but significant preferences for textual feedback, although raters may prefer numerical scales. Concerns about validity imply that greater awareness of contextual and psychological influences on feedback generation is necessary to allow the formative benefits of MSF to be optimised and to negate the risk of misuse in high-stakes contexts

Working in isolation

The key finding from our research was that professional isolation remains a major issue for today’s sessional GPs. We found that sessional GPs had limited access to information about education, clinical systems and professional support structures. This included missing out on information cascades from deaneries and PCTs relating to education,up-to-date guidelines and services, vacancies and career opportunities. There were limited opportunities for professionalpeer interaction, for example to receive feedback; discuss significant events, challenging cases and new clinical updates, and to benchmark against peers. This lack of professional interaction was often the result of not being invited to practice meetings, or them being held during days on which they were not working. These findings have significant implications regarding revalidation in terms of the way these doctors work, integrate and are supported

Addressing performance concerns

Aim: To assess the impact of the National Clinical Assessment Service (NCAS) on governance activity for medical and dental practitioners in Northern Ireland. Method: Telephone interviews were conducted with a purposive sample of referrers to NCAS in Northern Ireland. Results: Twenty-two referrers agreed to take part and nineteen were interviewed. Respondents held a range of positions, including senior human resources personnel, but the majority were Medical Directors or Clinical Directors. The majority of referrals were for issues related to clinical competence, although this frequently overlapped with behavioural, health and probity issues. As well as automatically-triggered referral as part of disciplinary cases, reasons for seeking input from NCAS included seeking reassurance, expertise and objective advice. In some cases, employers reached their limits with a case, and NCAS filled the 'governance gap' between local and regulatory responsibility. All respondents expressed satisfaction with the service and found NCAS to be approachable, accessible and neutral. Some challenges remained in handling performance concerns. These included: achieving a balance between patient safety, service delivery and responsibility to the practitioner in question; initial contact with the practitioner; and challenges in identifying and managing performance concerns in doctors who were not located with a long-term employer (i.e. trainees and locums). Conclusion: NCAS has value as an independent non-regulatory body in addressing performance concerns, and could have a positive future role in supporting the regulatory process of revalidation

Are specialist registrars fully prepared for the role of consultant?

The step-up from specialist registrar (SpR) to consultant has been acknowledged by doctors as being large. It can involve relatively sudden change, and can be both stressful and demanding.1,2 There is increasing pressure on available time for training, with shortened training programmes and fewer hours spent at work as a result of the European Working Time Directive.2,3 Medical education research has not fully addressed this transition or explored ways of improving it for the benefit of patients and doctors. Newly appointed consultants are more prepared for some aspects of their work than others. The quality of training in clinical skills is rated most positively, although even this has room for improvement.2,4 New consultants feel less well prepared for their management responsibilities than they do for clinical work,2,4,5 including self-management.6 Training and experience in handling complaints, dealing with difficult professional relationships, recruitment and disciplinary proceedings have also been identified as weaker areas of specialty training.5,6 Feeling inadequately trained in communication and management skills can impact on stress, burnout and the mental health of consultants.4,7 It is notable that two-thirds of cases referred to the National Clinical Assessment Service (NCAS) involved behavioural issues (including difficulties with colleagues), either on their own or in conjunction with other concerns.8 In the light of these issues, a research project was developed to determine the extent to which specialty training provides doctors with the skills they require when they become consultants

Collecting patient feedback in different clinical settings: problems and solutions

Patient feedback has increasing importance in medical careers This paper describes practical issues in the collection of patient feedback Access to the clinical setting varied between hospital and GP environments Personal anxiety about hearing patients’ views was offset by its perceived value It is vital that the introduction of patient feedback is sensitive to the clinical setting and target population of doctors