Anatomy Of A Multi-professional Learning Organisation

Anatomy of a Multi-Professional Learning Organisation Paresh Dawda

Abstract There is a need for multi-professional training capacity in primary care providing training for a range of healthcare professionals at different stages of their career. This need is driven by national policy and supported by Darzi’s next stage review.

South Street Surgery is a large training practice with 20000 patients. The surgery has a complement of 2 trainers, 4 associate trainers, one of whom is a nurse partner and a further nurse educator.

The surgery provides training to;

•2-3 GP Registrars per annum and Innovative Post ST2 •9 F2 doctors per annum •3rd and 5th year medical students •undergraduate nurse students •1 year attachments for social work students •attachments for Emergency Care Practitioners and •ad hoc training placements e.g. homeopathy students, nurse practitioners, mentorship for PCT employed nurses for specific courses e.g. prescribing.

Providing training to a large cohort of learners brings about numerous benefits but also many challenges.

The challenges include making effective use of resources e.g. rooms and trainers. The approach has been to encourage innovation in delivering education, involve all staff in training, use opportunities for cascade teaching, peer learning and encourage multi-professional learning sets, supported by using an eLearning platform, that is being developed in-house using Moodle. Underpinning this approach is an electronic training record for all learners that supports their educational supervision. A flexible rota system, managed by a rota administrator, with staggered surgeries 2 makes effective use of facilities, together with combined teaching activities where appropriate e.g. tutorials.

South Street Surgery A large General Practice with a registered list size of 20,000 patients. It operates over split sites and is a multidisciplinary training practice.

Ten partners including one nurse partner, approximately 50 employed staff in addition to Primary Health Care Team. It provides a number of essential, additional and enhanced services under the nGMS contract framework. The practice’s mission is to be ‘Delivering Excellence in Healthcare’ and it's vision is ‘To be recognised as an excellent healthcare organisation’.

The practice has been a training practice for many years. The level of training has increased significantly in the last 5 years.

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The Trainers and The Learners Dr. Mark Jenns •Trainer

Dr. Paresh Dawda •Trainer

Dr. Alison Jordan •Associate Trainer

Dr. Milinda Tennekoon •Associate Trainer

Dr. Sarah Dixon •Associate Trainer

Nurse Beverley Vincent •Associate Trainer

Nurse Deborah Proud •Nurse Trainer

GP Training (ST3)

•2 Posts •Currently supporting additional 2 for extended training

GP Training (ST2)

•18 month GPR posts •Innovative SHO posts

F2

•3 F2 post every 4 months

Medical Students

•3rd year Clinical Students •5th year Clinical Students

Undergraduate Nurse trainees Social Work Training Misc

•12 month post

•Emergency Care Practitioners •Nurse Prescribers •Homeopathy Students

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The Challenges Training Capacity • Having sufficient number of trainers to deal with the learners Facilities Capacity • Having sufficient number of rooms Managing Learners

• Multiple learners at different stages creates a great deal of complexity with differing needs that include tutorials, teaching surgeries, extended hours, out of hours, video surgeries and educational supervision sessions into the rota. Continuity of Care for Patients

• Multiple learners, with trainers having reduced availability for clinical sessions because of training commitments, can potentially create issues around continuity of care.

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The Solutions – Innovation is critical Training Capacity The development of training capability was planned with anticipation of increasing number of learners

Facilities Capacity

Partners attended Associate Trainers courses in a strategic and planned way

We have had no resources to extend our premises to accommodate increase in learners

We use an approach of cascade and multidisciplinary teaching

We were creative with our rota and applied Lean methodology to use our existing facilities to their maximum

Managing Learners We have a rota administrator who has been trained in the needs of the different learners at different stages of their training

She will roster them into the rota and include tutorials, extended hours, out of hours, video surgeries and educational supervision sessions into the rota.

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Key factors for success Team Approach Cascade and Group Teaching

• Everyone is involved in training • We also use community pharmacist, PHCT members, non-clinical staff to deliver teaching • Nurses and doctors who are non-trainers are involved in clinical supervision • Trainers have a responsibility in planning educational prescriptions • There is a regular training meeting of all trainers

• We plan tutorials with groups together e.g. F2, GPR, medical students all at the same time • The trainer’s role is as a facilitator of the group

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Communication We use an Electronic Teaching Record (ETR) developed in house to which everyone involved in training adds Web based portal

Previous version used MS Access database

The ETR is a generic form with data fields for Date, Learner, Trainer, Title

Objectives, Summary

Needs identified, Actions Needed

Reference to website or field to attach a document

Trainers Reflection on teaching activity

The completed electronic form is stored on a database so trainers can review and update as necessary

The form is also emailed to the learner and trainer (except for the trainers reflection field) The learner is able to add this email to their own ePorfolio

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The Benefits Patients • Provide link between acute trusts and practice • Improve Access • Hawthorne effects of being a learning organisation Trainers • Variation to working week • Stimulation • Enhanced Job satisfaction Practice • Additional revenue • Source of Locums and future clinical staff • Value added services for patients e.g. Social worker 9

Learner Feedback “Practice met my expectations and I gained a lot of valuable experience by learning here” “Always had feedback that helped me to look at my areas where I can improve and help me to develop as a better GP” “Excellent staff who were always available to help and made me feel very welcome” “Always felt I was able to contribute to the practice and my attendance at meetings was always encouraged” “Very good. We were allowed to specify our weaknesses so that teaching was tailored” 10

The Future Continuity of Care

• This continues to be an issue. • There is no evidence it is related to number of learners e.g. Our patient satisfaction survey on continuity of care was no different in the year after we started to train 9 F2 per annum than it was the year before The use of technology • We are developing an in house eLearning platform using open source software known as Moodle • We are one of 15 practice selected in the East of England to be a pilot site on a 2 year project exploring technological solutions to develop multi-professional training capacity in practices • Continue to develop the ETR based on feedback from learners and trainers

Group and Cascade Teaching • Further refine group teaching to try and incorporate multi-professional groups

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