the situation the requirements the benefits what’s needed to make it work how to move forward

• • • • The situation

The requirements

The benefits• • • •

• • • •

What’s needed to make it work• • • •

How to move forward• • • •

• • • • The situation

The requirements

The benefits• • • •

• • • •

What’s needed to make it work• • • •

How to move forward• • • •

Problems junior doctors face in doing clinical audits

The situation

Limited time

Lack of effective training and information

Inappropriate expectations

Lack of support

Problems NHS trusts face relating to junior doctors’ audits

Clinical audits done by junior doctors are not registered

Last minute requests for help

Inappropriate subjects for clinical audit

No reports provided

Audits are not ‘completed’

• • • • The situation

The requirements

The benefits• • • •

• • • •

What’s needed to make it work• • • •

How to move forward• • • •

The benefits to NHS trusts of junior doctors’ clinical audits

Commissioners’ clinical audit requests

National clinical audits

Clinical audit evidence for Care Quality Commissionregulations and outcomes

Supplement to the workforce to carry out clinical audits

Clinical audit evidence for NHS Litigation Authority RiskManagement Standards

Audits in clinical audit programmes for clinical services orthe Trust

• • • • The situation

The requirements

The benefits• • • •

• • • •

What’s needed to make it work• • • •

How to move forward• • • •

The bases for requirements for junior doctors

Good Doctors, Safer Patients, Department of Health

Good Medical Practice, General Medical Council

The UK Foundation Programme Curriculum, Academy ofMedical Royal Colleges

General Standards for Training, Postgraduate MedicalEducation and Training Board

A Reference Guide for Postgraduate Specialty Trainingin the UK, The Gold Guide, UK Health Departments

Foundation doctors’ requirements

Outcome Demonstrates the knowledge, skills, attitudes and behaviours to use audit results to improve patient care

Knowledge • The audit cycle and relevance• Data sources for audit• Data confidentiality• The audit cycle’s relationship to the

improvement of clinical care

Competences • Describes the audit cycle and recognises how it relates to the improvement of clinical care

• Has participated in an audit project• Makes links explicitly to learning/professional

development portfolios

“Foundation doctors are encouraged to consider their possible career pathways and subsequent specialty training

programmes when choosing … audit projects …”

The UK Foundation Programme Curriculum

“Trainees must regularly be involved in the clinical audit process, including

personally participating in planning, data collection and analysis”

Audit reports are one evidence that Registrars are expected to have in their learning portfolios to demonstrate their

experiences and attainment of skills

General Standards for Training and A Reference Guide for Postgraduate Specialty Training in the UK,The Gold Guide

Registrars’ requirements

Junior doctors’ motivations to carry out clinical audits

Meet training requirements for the current level oftraining

Show interest in and commitment to the workinvolved in the next job in the doctor’s careerprogression

Want to make things better for their patients

• • • • The situation

The requirements

The benefits• • • •

• • • •

What’s needed to make it work• • • •

How to move forward• • • •

What’s needed to make junior doctors’ clinical audits work properly

Getting commitment

Providing training

Arranging support

Communicating arrangements

Selecting subjects

Recognising achievement

Strategy document on clinical audit refers to therole of junior doctors in clinical audit

NHS trust policy on involving junior doctors inclinical audit

Getting commitment

The NHS trust’s policy on involving junior doctors inclinical audit

The training on clinical audit available and how toarrange participation

How to access clinical audit documentation such as aproposal form or a report template

Sources of information about clinical audit

Providing training

Who to contact for information or help

At induction — Distribute a clinical audit information sheet

Content in clinical audit training for Foundation doctors

The clinical audit process

How to —

develop standards to measure the quality or safety ofpatient care

collect and collate data, including data protectionrequirements

analyse problems and find their causes

take action and repeat data collection

design a clinical audit

Content in clinical audit training for Registrars

distinguish among descriptive studies, serviceevaluations, research studies and clinical audits

select an important subject for clinical audit

test the validity of standards used in a clinical audit

develop a data collection protocol

report compliance with measures correctly

carry out peer review of clinical audit findings and adjustcompliance percentages as needed

develop detailed action plans to achieve improvement andmonitor implementation

analyse variation in practice

test the statistical significance of a change in practice

How to —

Other points about training on clinical audit

Emphasise that audit doesn’t stop at data collection— goes all the way to getting evidence of improvement

Have practical training sessions with time for practicalwork in the sessions

Subject training to formal evaluation and take action toimprove its appropriateness and effectiveness as needed

Issue certificates recognising participation in training onclinical audit

Clinical audit manager and staff

Clarify roles of —

Clinical audit leads

Clinical audit committee

Clinical directorate or trust clinical governancecommittees

Clinical and educational supervisors

Clinical directors

Arranging support

Registering clinical audits

Access to patient records or electronic data forclinical audit purposes

Sharing and handing over clinical audits amongFoundation doctors

Sharing clinical audit subjects among Registrars

Communicating arrangements

The Trust’s or a clinical service’s clinical auditprogramme

Any subject based on the Foundation Curriculum’scompetences

Selecting subjects

Rapid-cycle approach

One objective

One standard or a few standards

Short time period for data collection

Analysis of problems

Action taken

Repeat data collection

Presentation or celebration event

Certificates of recognition

Participation in training

Participation in a clinical audit

Completion of a clinical audit

Recognising achievement

Summary of what’s needed for junior doctors

Commitment

Information and training

Support

Clear understanding of arrangements

Appropriate subjects

Recognition of achievements

• • • • The situation

The requirements

The benefits• • • •

• • • •

What’s needed to make it work• • • •

How to move forward• • • •

How to move forward

Assess current arrangements in the NHS trust forinvolving junior doctors in clinical audit

Work with key stakeholders to improvearrangements as needed

Assessing current NHS trust arrangements to support junior doctors’ involvement in clinical audit

Find your strengths to build on

Identify your opportunities for improvement

Possible actions

Could you —

Arrange for a policy to be agreed?

Provide an information sheet for junior doctors onclinical audit?

Communicate arrangements such as registration andaccess to records?

Recommend or assign subjects, in consultation withclinical audit leads?

Provide certificates?

Provide training sessions?

See Guide to Involving Junior Doctors in Clinical Audit at www.hqip.org.uk