Trainee representatives, training programme directors and the specialist training committee set out to establish a world-class diabetes and endocrinology (D&E) training programme in the Health Education West Midlands (HEWM) region. The methods are replicable nationally and internationally to facilitate high quality, cost-effective speciality training. Mechanisms used include: curriculum mapping of training days to ensure full content coverage; defining and standardising training representatives’ roles and responsibilities; digitising processes around training day and administration; innovative education approaches, including simulation; additional educational opportunities to promote holistic training and a COVID-19 responsive approach to training and learning, tracking trainee opportunity.
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D&E training within the HEWM region incorporates training in 12 hospital sites across a wide geographic area. There are currently 32 trainees. Typically, between four and seven trainees start the programme annually. The historical structure of training comprised six training days each year, with trainees expected to attend four. Training days were organised by two regional training representatives. Consultants were invited to chair sessions and asked to nominate a D&E theme of interest. It was felt that there was significant potential to innovate and improve education delivery, building on these foundations. Different approaches were taken, including: curriculum mapping of training days to ensure full content coverage; training representatives with clearly-defined roles in organising the training days; digitising the processes around training days and administration; implementation of innovative education approaches, including simulation, plus incorporating additional educational opportunities to promote holistic training. The central methodological approach was to ensure truly trainee-led innovationat regional level. This approach is only successful if direct support is provided by trainers and the wider deanery apparatus, as was utilised here. This model is unusual as trainee-led innovation is often restricted to local innovation. The innovations and changes were proposed by trainees and their representatives, worked into proposals, evaluated and piloted. All elements have collated feedback from participating trainees, with transparency to ensure feedback is utilised to shape future innovation (creating a closed loop). Feedback was collected digitally soon after each innovation, ensuring ‘real-time’, meaningful feedback. Where possible, feedback was made compulsory for the issuance of attendance certificates or similar, to ensure high response rates.
The model has been highly effective, with all elements fully embedded into routine HEWM D&E education/training. Trainees are familiar with, and supportive of, the initiatives. The effectiveness of the intervention is demonstrated by the responsiveness of the model to the unexpected COVID-19 pandemic. Trainees’ digital support continued during the pandemic, including delivery of a TPD briefing, virtual pituitary training, further planned virtual sessions, a virtual Annual Review of Competency Progression and examination preparation group. The communication approach was used to deliver a redeployment and specialty exposure assessment across 10 regional NHS Trusts. This is believed to be the only assessment of its kind and noted substantial variation in the experiences and exposures of trainees, supporting educational restoration. Importantly, in terms of effectiveness and trainee perceptions, the overwhelming request from trainees was to restore the full training model as soon as possible.
Sustainability and Spread
This model has sustainability at its core and can be readily disseminated across regions and internationally. The opportunities of digitisation have resulted in a calculated reduction of 100 human hours, worth £3,000 in human resources cost. Another benefit has been a reduction of 60,000 litres of water pollution over a single year through a decrease in, or near elimination of, the use of paper. Prior to going paperless, approximately 1,200 pages were printed annually for training days. Although this amounts to only £20 for paper and £30 for toner, between four and 19 litres of water is needed to produce one sheet of A4 paper, depending on quality. This fact was used to estimate that the initiative avoided 60,000 litres of water pollution. This is before taking account of the reduction in recycling, landfilling, deforestation and air pollution which will ultimately contribute to climate change. Furthermore, sustainability has been ensured by creating a protocol for the training rep roles, enabling these positions to be handed over smoothly and meaning innovations are not dependent on any one individual or group of individuals. A shadowing period at the point of handover is also included to ensure continuity. Information about the training model has appeared in a peer-reviewed journal and it is hoped that the QiC Awards will further promote and support dissemination of this essential work.
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