The Learning Environment

1
The Learning Environment

• This DMEs View
• Andrew A Jeffrey
• DME Northampton General Hospital
• Chairman NACT UK

2
Primo non nocere

• Our post-graduate trainees want to learn
• They have proved themselves capable of learning
• They are motivated to do their best for patients
• They will (in very large measure) do well if
  allowed to.
• We must nurture these things

3
The 3 elements

• Becoming a really useful member of the clinical
  team what do they need?
• They need to feel Secure
• They need to feel Useful
• They need the right Experiences

4
The 3 elements 1
Feeling looked after
Knowing what to do
Security
Workplace
Personal
Knowing where you are and where you are going
Having back-up
5
The 3 elements 2
Earning a living
Making people better
Utility
Workplace
Personal
Contributing to the team
Making a difference
6
The 3 elements 3
Feedback and guidance
Appropriate patients
Experience
Workplace
Personal
Access to the Master
Time to reflect and learn
7
Creating the Learning Environment
Security
Utility
Experience

• A good learning environment requires
• Whole organisation behaviours and plans
• Cannot be created just for Foundation
• Changes to one group impact on others
• Will vary from organisation to organisation
• Cannot be micro-managed from outside
• Needs local knowledge
• Foundation Schools need to work with DMEs to be
  effective

8
The DME
Security
Utility
Experience

• Is responsible for delivering the training
  contract for
• All specialties
• All grades
• Knows the key local players
• Has street cred
• Has the ear of (and usually is part of) the
  hospital management

9
Creating the Learning Environment
Security
Utility
Experience

• Knowing what to do
• Ensuring good induction
• Appropriate, accessible clinical and procedural
  guidelines
• Having back-up
• Team structures, patterns of work and study to
  ensure availability
• Feeling looked after
• mentoring, time to get to know them
• Knowing where you are and where you are going
• Effective educational supervision

10
Creating the Learning Environment
Security
Utility
Experience

• Making people better
• Making clinical decisions, seeing their effects
• Contributing to the team
• Clarity on clinical role (e.g. when to seek
  permission to act)
• Availability (service teaching)
• Earning a living
• Being a wage earner and an agent for social good
• Making a difference
• Having a voice that is listened to

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Creating the Learning Environment
Security
Utility
Experience

• Appropriate patients
• Rotations, timetables
• Access to the Master
• Team structures, rotas
• Feedback and guidance
• Skilled clinical supervision, clinical
  supervisors
• Time and opportunity to reflect and learn
• Rotas, team structures, access to computers,
  physical space

12
Maintaining the Learning Environment
Security
Utility
Experience

• Teamwork

Deanery PG Schools LEP Management
Local MET Trainees
13
Maintaining the Learning Environment
Security
Utility
Experience

• Learning occurs principally in the LEP
• The Learning Environment of the LEP is crucial
  but very hard to maintain
• Foundation Schools need to work with and through
  the DMEs (and their linked FPDs) to be effective

Deanery PG Schools LEP Management
Local MET Trainees
14
Conclusions

• To train really useful doctors we need to
  provide
• Security
• Utility
• Experiences
• This needs a good dose of reality, teamwork,
  understanding, co-ordination and effective
  communication

15
Conclusions

• The operational framework needs
• To be revised to emphasise this joined-up
  approach
• More emphasis on creating Utility

16
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