1. Quality development – the InSight experience Jan Sumner and Pam Dyson Oxford Centre for Diabetes, Endocrinology & Metabolism Churchill Hospital Oxford OX3 7LJ

2. The InSight programme First course 2002 Four weekly sessions, 15 hours in total Facilitates skills for matching insulin to carbohydrate intake based upon reflection from self-monitoring diaries Supports self-management of hypoglycaemia, hyperglycaemia, illness and exercise

3. Applying structured education to routine clinical care Clear, written and agreed philosophy Structured curriculum underpinned by learning theories Trained educators Audit and evaluation Quality development

4. Objectives of QD To demonstrate that the InSight course meets the documented philosophy and curriculum To show that the programme delivers the education it is designed to provide To ensure that the facilitation is of an appropriate standard

5. How long has the QD been in place? InSight has developed and utilised a QD system since 2006 InSight runs in 4 centres (Oxford, Banbury, High Wycombe and Stoke Mandeville) with a total of 10 educators Each educator should undergo QD annually – this was achieved in 2008

6. What does the QD for Insight consist of? An educator from a different centre observes week 3 of the InSight course The outside educator complete a QD form including a dot test during the hypo session At the end of the session, the 2 educators complete self and peer reflection forms The outside educator then facilitates a reflection based upon the forms The completed forms are filed

7. An example of the QD form Comments Introduction Scheduled start time …………… Actual start time ………………… If there were any differences between the above, how were they negotiated? Reflection of food diaries Subject 1 Was the subject encouraged to present their own information? Were they encouraged to explore issues and provide their own solutions? Was the whole group involved? Did the educator facilitate agreement on appropriate solutions?

8. Dot test The hypo session lasts 45 minutes The aim of the session is to explore the symptoms, physiology and treatment of hypoglycaemia Each 10 seconds the observer notes whether a participant or educator is talking The aim is that the educators talk no more than 50% of the time

9. Strengths Ensure that the programme does what it says on the tin Identify the strengths of the programme Identify the bits that aren’t going so well Identify the strengths and challenges of each facilitator

10. Challenges Uncomfortable for facilitators to be assessed in this fashion – often feel they are being judged When a significant issue is identified with a facilitator, a training plan is agreed further assessment takes place within 6 months Resources