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Dr Paul Kavanagh said the Council would “very much expect” that the matter is being “reflected upon” by the HSE, Chief Academic Officers of the new Hospital Groups, hospital managers and Chief Executives. He was speaking to MI in advance of his presentation on the Council’s ‘Your Training Counts’ trainee survey at the Irish Network of Medical Educators (INMED) annual scientific conference this week. He will be presenting on the findings tomorrow with Mr Simon O’Hare, Research, Monitoring and Evaluation Manager with the Council.
“I think we would all be interested in working in a focused way, collectively, in trying to make sure that trainees have as good an experience as possible,” said Dr Kavanagh.
Dr Paul Kavanagh
The findings from ‘Your Training Counts’, which will be an annual exercise, suggested there were “lessons that could be learned” from mental health services and GP practices that could be applied to hospitals, he added. According to the survey, trainees in GP practices (4.5 per cent) and mental health services (7.2 per cent) were less likely to have been frequently bullied and undermined than trainees in larger hospitals (16.1 per cent) and smaller hospitals (18.6 per cent).
Dr Kavanagh noted that the Council will begin a programme of clinical training site inspections from this year and will meet with trainees, trainers and management.
“We will be able to have the sort of dialogue with individual clinical sites to ask, what do you think is going on for you; what do you think your challenges are; how are you seeking to address those challenges; and how can you provide us with assurance that you are seeking to manage the clinical learning environment in a way that meets the criteria that the Medical Council has set out?
“If we find that recommendations are not being taken seriously, and aren’t being taken forward, we have a responsibility, we have a duty, and we have statutory powers to then affect the status of that clinical site as being a place where trainees can train.”
‘Your Training Counts’, initiated in 2014 following a consultation exercise, is one of the most significant pieces of research undertaken by the Medical Council in recent years.
Just over 50 per cent of trainees (or 1,636 trainees) responded to the survey in 2014. Some 85 per cent reported that they rated the quality of care provided at the clinical site as ‘good’ or ‘very good’.
Areas of the clinical learning environment rated highly were ‘Consultants’/GPs’ role’, ‘Teamwork’ and ‘Peer collaboration’.
However, the research also found that, based on trainee-reported experience, bullying and undermining behaviours were “endemic in the clinical learning environment”.
Some 33.7 per cent of trainees reported personal experience of bullying and harassment in their post, compared with 13.4 per cent of trainees in the UK. Some 51.5 per cent reported witnessing someone else being the victim of bullying and harassment, compared with 19.6 per cent in the UK.
The scale of the issue and the systematic variation in this specific aspect of trainee experience of this culture is concerning
Furthermore, 43.8 per cent of trainees in Ireland had experienced, in their current post, behaviour from a consultant/GP that undermined their professional confidence and/or self-esteem, compared with 26.5 per cent in the UK.
In contrast to older trainees, trainee-reported personal experience of bullying and undermining behaviours was more prevalent among younger trainees.
While bullying and undermining behaviour has been described as a feature of medical education and training in various international studies, ‘Your Training Counts’ noted that the “scale of the issue and the systematic variation in this specific aspect of trainee experience of this culture is concerning”.
Trainee-reported experience of bullying and undermining behaviours was associated with a poorer trainee view of the clinical learning environment, it was also noted.
Dr Kavanagh said the Medical Council’s view was that actions were required on this issue.
“We would expect where a trainee is working, that the organisation would have in place policies and procedures and mechanisms to proactively prevent and then responsively to deal with any issues that there may be around bullying and harassment in the workplace.”
The Council was concerned about how such experiences shaped a doctor’s development, he said.
“Trainees being in an environment where they themselves experience people misusing power through bullying and harassment behaviour, or where they see that happening to other people, we don’t think that is positive in terms of doctors learning of medical professionalism and how they are forming their identity as doctors.”