Dr Ben Warne, CT2; Dr Sanjay Ojha, RCP College Tutor

East Of England CMT Training Day June 2015

The CMT Can See You Now… Enabling Outpatient Experiences for Core Medical Trainees at

Addenbrooke’s Hospital

• Training requirement

• Major training concern

• Previous unsuccessful efforts at Addenbrooke’s

• Large clinic number in own time

Background

1. To determine important issues that prevent outpatient attendance

2. To develop a reliable method of monitoring attendance

3. To enable CMTS to meet their training requirements. Target: by May 2015, 90% of CMTs will be attending 0.5 clinics per week during their timetabled ward rotations.

Project Aims

Plan-Do-Study-Act Cycle

Enact

interventions

Analysis of

clinic surveys,

presentation of

data

Plan interventions,

targeting key issues

or problem firms

Clinic

Surveys

sent to all

CMTs

Measures

Run Chart

0

0.1

0.2

0.3

0.4

0.5

0.6

Jan-Aug Aug-Sep Sep-Nov Nov-Dec Dec-Jan Jan-Mar Mar-May

Mea

n N

o. C

linic

s A

tten

ded

per

wee

k p

er C

MT

in w

ork

ing

ho

urs

Run Chart Summarising CMT Clinic Attendance and Interventions to Improve it, Addenbrooke's Hospital 2014-15

Target Attendance

//

1 3 4 5 6 2

Surveys Every 6 Weeks

Target 0.5 clinics per CMT per week

Run Chart

0

0.1

0.2

0.3

0.4

0.5

0.6

Jan-Aug Aug-Sep Sep-Nov Nov-Dec Dec-Jan Jan-Mar Mar-May

Mea

n N

o. C

linic

s A

tten

ded

per

wee

k p

er C

MT

in w

ork

ing

ho

urs

Run Chart Summarising CMT Clinic Attendance and Interventions to Improve it, Addenbrooke's Hospital 2014-15

Clinics Attended Target Attendance

//

Run Chart

0

0.1

0.2

0.3

0.4

0.5

0.6

Jan-Aug Aug-Sep Sep-Nov Nov-Dec Dec-Jan Jan-Mar Mar-May

Mea

n N

o. C

linic

s A

tten

ded

per

wee

k p

er C

MT

in w

ork

ing

ho

urs

Run Chart Summarising CMT Clinic Attendance and Interventions to Improve it, Addenbrooke's Hospital 2014-15

Clinics Attended Target Attendance

Pre-QIP attempts,

including rota’d weeks & CMT-led

efforts

Survey refinements,

targeted elderly care and neuro

Survey cycles 1-3 presented to dept

and CMTs

School of Medicine visit, managerial

engagement

Letter sent to all supervisors and

CMTs

//

Run Chart

0

0.1

0.2

0.3

0.4

0.5

0.6

Jan-Aug Aug-Sep Sep-Nov Nov-Dec Dec-Jan Jan-Mar Mar-May

Mea

n N

o. C

linic

s A

tten

ded

per

wee

k p

er C

MT

in w

ork

ing

ho

urs

Run Chart Summarising CMT Clinic Attendance and Interventions to Improve it, Addenbrooke's Hospital 2014-15

Clinics Attended Target Attendance

Pre-QIP attempts,

including rota’d weeks & CMT-led

efforts

Survey refinements,

targeted elderly care and neuro

E-Hospital introduced

Survey cycles 1-3 presented to dept

and CMTs

School of Medicine visit, managerial

engagement

Letter sent to all supervisors and

CMTs

Severe bed crisis

//

Results

High workload on

the ward

Being the only junior

doctor on a firm

Lack of consultant

support in getting to

clinics

DME

Diabetes

Gastroenterology

Haematology

Hepatology

Infectious Diseases

Intensive Care

Neurology

Oncology

Renal

Respiratory

Stroke

Transplant

Results

0

0.2

0.4

0.6

0.8

1

1.2

Mea

n N

o. C

linic

s A

tten

ded

per

wee

k p

er C

MT

in w

ork

ing

ho

urs

Medical Specialty

CMT Clinic Attendance by Specialty Sept-Dec 2014 (pre-intervention) v Mar-May 2015 (post-intervention)

Sept-Dec 2014 Mar-May 2015

TARGET

• Mean clinic attendance rose

– 0.10 clinics/week/CMT at the start

– 0.53 clinics/week/CMT by May 2015

• Variation between firms

• The majority of firms show a considerable improvement in clinic attendance over the year

Results Summary

• Keys to success

– Engagement

– Objective data

• Barriers to success

– Increasing clinic requirements

– Persistent challenges

• Lessons learned - improving clinic attendance is:

– Possible…

– But not easy!

– Valued by trainees

Keys To Success, Barriers and Lessons Learned

Dr Sanjay Ojha

All of the CMTs who have completed the surveys

All of the clinical firms who have engaged with this project

Acknowledgements

Hig

h w

ork

load

on

th

e

war

d

Bei

ng

the

on

ly ju

nio

r

do

cto

r o

n a

fir

m

Lack

of

cove

r p

rovi

ded

by

the

rest

of

the

firm

Inex

per

ien

ced

fo

un

dat

ion

year

do

cto

rs

Lack

of

app

rop

riat

e cl

inic

s

in y

ou

r sp

ecia

lity

Lack

of

info

rmat

ion

rega

rdin

g cl

inic

s

Lack

of

con

sult

ant

sup

po

rt g

etti

ng

to c

linic

s

Lack

of

regi

stra

r su

pp

ort

in g

etti

ng

to c

linic

s

Lack

of

clin

ic r

oo

m s

pac

e

or

equ

ipm

ent

Lack

of

sen

ior

sup

po

rt

wh

en in

clin

ic

e-H

osp

ital

tra

inin

g

e-H

osp

ital

aft

er ‘g

o-l

ive’

DME

Diabetes and Endocrinology

Gastroenterology

Haematology

Hepatology

Infectious Diseases

Intensive Care

Neurology

Oncology

Renal

Respiratory

Stroke

Transplant

Results