IMPROVED CLINICAL SUPERVISION AND USE OF WORKPLACE-BASED ASSESSMENTS TO OPTIMISE THE LEARNING EXPERIENCE OF GENERAL PRACTITIONER TRAINEES DURING NEONATAL INTENSIVE CARE UNIT ROTATIONS

The Royal College of General Practitioner (RCGP) has required General Practitioner (GP) trainees in the United Kingdom (UK) to complete a three-year mandatory training programme since 2008. Following the government's promotion of 'Better Care, Better Lives' strategy for children with complex needs in 2008, the RCGP further published the 'RCGP Child Health Strategy 2010-2015', recommending all GPs to gather adequate clinical experience to ensure their competencies in assessing a sick child. In order to achieve these competences, GP trainees are trained in Paediatric speciality in a hospital setting as part of their integrated curriculum. This includes working in a neonatal intensive care unit (NICU). During their NICU placement, trainees are expected to acquire the full responsibility of a paediatric trainee, including writing neonatal ward round summaries, attending resuscitation of newborn deliveries, identifying sick neonates, performing neonatal cannulation and managing ventilated preterm neonates. This has presented various training challenges. For example, GP trainees may be rushed through their learning objectives as a result of their short duration of placement on NICU. The frequent changeover of inexperienced trainees can also be more disruptive to the continuity of patient care and raises the question of patient safety being compromised. Other issues such as training opportunities may be commonly reserved for paediatric trainees when GP trainees are on-call at the same time. The shift system of working due to the European Working Time Directive has further limited their training opportunities. As Acute Paediatrics and Neonatology is a highly specialised field, the pressure and workload of the intensive care environment may be particularly challenging for GP trainees. Indeed, apart from becoming accustomed to a new working environment with established organisational culture and policies, trainees are also expected to learn new practical knowledge and skills. Stress and anxiety can affect attention, effectiveness and decision-making skills (Smith, 1990; Askenasy et al., 1996; Lehner et al., 1997). Is it possible to provide effective GP training in a NICU setting whilst delivering safe and high quality patient care? The ultimate goal of medical staff training and education is to ensure and safeguard patient safety in long term. However, its potential contribution to risks or health-associated injury should not be taken lightly (Battles, 2006). These risks can be decreased to minimum through close clinical supervision and utilisation of an assessment feedback tool. This leads to our next question of how a robust system can be built in order to achieve high standard of workplace based learning experience whilst delivering excellent patient care through clinical supervision and effective use of workplace-based assessment (WBA). As current workplace-based training has shaped towards 'situated learning', most social-cultural theorists have proposed various contextual factors (e.g. social and organisational culture and policies) and learner's capability and adaptability as causes influencing learners' performance at work. General attributes that may ensure successful learning include motivation, calm response in acute situations, efficient prioritisation and management skills, and ability to work in a team. WBAs can be powerful tools both to monitor and encourage development of these skills. However, given the multipurpose use of WBAs and lack of effective feedback and clinical supervision, WBAs largely fail at present to effectively aid learning. Fundamental changes have to be made to achieve effective utilisation of WBAs through close clinical supervision and guidance. This includes encouraging supervised learning by completing WBA tools, which should be designed to assess specific skills at workplace including team working, handover accuracy, leadership skills and clinical management. Further studies are required to optimise the utilisation of WBAs for paediatric training in the UK.