‘Transition to Leadership’ a course preparing doctors for life as a registrar Dr Lara Menzies 28 th 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?

Clinical learning and practical experience Management leadership & communication skills Peer support and mentoring Putting leadership into practice 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 Aspect Pre Course (Day 0)* Post Day 2* Post Day 3* Difference in competence rating Paired T Test P value Leadership, 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) Managing conflict 2.5 (0.5)2.9 (0.5)3.2 (0.4) 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) Making mistakes and coping with increased accountability 2.2 (0.7)2.7 (0.6)3.3 (0.6) Control Aspects Treating common neonatal problems 2.9 (0.6)2.9 (0.4)3.0 (0.4) Treating common paediatric problems 3.0 (0.4)2.9 (0.4)3.0 (0.4)

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:

Three Day Leadership and Management Course for Paediatric ST3 Trainees