Support Services for Clinical Fellows

Support Services for Clinical Fellows

Background

It has been widely observed that new International Medical Graduates (IMGs) / Clinical Fellows (CFs), find it difficult to make a smooth transition from their home country to the UK in terms of training, working practices and adapting to life in general. This often affects their confidence, precludes achievement of full potential and hinders career progression.

The Royal Wolverhampton Trust (RWT) supports all new CFs. This largely focuses on the induction sessions which they are required to attend induction prior to starting clinical work. Induction occurs at various levels.

Trust Induction

This takes place over one day during the first week of every month. CFs are welcomed to the Royal Wolverhampton NHS Trust by the Trust’s Chief Executive and other stakeholders and they are familiarised to the Trust, its policies and services. Some of the mandatory training sessions are also included in the induction.

Directorate Induction

This takes place for all CFs in their respective directorates. The CFs are introduced to their colleagues and provided guidance about their clinical role, local workflow and directorate policies.

Enhanced Support Services

With a view to supplementing the standard induction process described above, we have developed a framework of enhanced support services for CFs, to facilitate their adaptation to medical practice in the UK and maximising the chances of benefiting from the Clinical Fellowship Programme (CFP).
This unique initiative enhances the existing support in two ways:
• In a majority of instances these services would be run by experienced, welcoming and enthusiastic CFs already excelling in the Trust. This allows a new CF to be more interactive and obtain greater benefit.
• The support provided would an on-going process and would not rely on a single timepoint of contact. The follow-on sessions would be held during the initial period after the arrival of a new CF when the help is most required.

Support Services Offered

  • Buddy Group
  • IT Training
  • ePortfolio Support
  • Annual Appraisal and Revalidation
  • Communication Skills
  • University of Wolverhampton Support
  • Clinical Fellow Forum
  • Certificate of Eligibility for Specialist Registration (CESR) support
  • Enhanced On-call Training

Buddy Group

It is recognised that most Clinical Fellows (CFs) are new not only to the UK medical practice, but also to UK life in general. The vast difference in lifestyle and everyday miscellanea can often cause significant confusion amongst the new CFs. This can have a negative effect on their quality of life and their work experience.

The Buddy Group for Clinical Fellows has been created with the concept that new CFs, coming to the UK from abroad should have contact with another doctor in the Trust, in most instances another CF, to provide guidance on a variety of matters. The Trust has a network of doctors, dubbed “buddies”, who have shown commitment and willingness to help settle the new CFs in the Trust and the UK.

The Buddies formally start supporting new CFs from a very early phase; in most instances, before the CFs have even arrived at the Trust. They provide assistance and advice to all new Clinical Fellows in clinical and in non-clinical issues including accommodation, transport, shopping, banking, childcare and leisure.

IT Training

All CF’s at the Royal Wolverhampton NHS Trust are required to make use of IT systems during the course of their duties. The Trust has a number of IT systems that are designed for various purposes such as accessing and managing patients’ healthcare records, managing Pathology and Radiology requests and reports, electronic prescribing of medication, completing patient discharge documentations and observing patients vital signs and assessments.

Most of the CFs would not have used these systems before, and some may not be skilled in IT in general. This can lead to significant difficulties in transitioning into UK medical practice. CFs traditionally receive a brief overview of these systems during Trust Induction. This is not sufficient for most of the CFs, who tend to struggle with these systems during their working time on the wards further delaying their full contribution to patient care.

Enhanced IT Training Support Service provides a more sustained hands-on experience to CFs and these sessions would be held 2 weeks after the trust induction. Experienced CFs would provide training on how to use the IT systems listed above, thereby giving the new CFs ample opportunity to be comfortable with patient care. Interactive training sessions are held every month with a small group of Clinical Fellows.

Some service areas have additional systems related to specialist services and orientation of such systems should be covered by Local Induction and enhanced by the Buddy System.

ePortfolio

ePortfolio is a web-based tool that enables trainees to log evidence of their experience, competencies, training courses, teaching, reflections, clinical meetings, educational meetings and professional development. All doctors in training in the UK are expected to use the ePortfolio designated for their speciality and grade. Clinical Fellows are encouraged to use an appropriate ePortfolio to collect evidence of their training and development. The competencies gained and documented can contribute significantly towards drawing up PDP, annual appraisal and entry into future training programmes in the UK and/or CESR applications.

Most of the Clinical Fellows, being new to working in the UK, may not be familiar with the use of ePortfolio. This can lead to gaps in documenting valuable evidence of progression in training.

Enhanced ePortfolio Support Service familiarises new CFs to making the best use of ePortfolio by highlighting the following:

  • Collecting appropriate workplace-based assessments
  • Collecting multi-source feedback
  • Collecting teaching observation forms
  • Requesting consultant reports
  • Collecting audit assessments
  • Logging educational and clinical meetings
  • Logging reflections on learning and clinical events
  • Collecting curriculum-specific evidence

Workshops on ePortfolio are held every 3 months.

Annual Appraisal and Revalidation

All doctors licensed with the General Medical Council (GMC) need to have annual appraisal, which leads to revalidation every 5 years. This serves as a quality check on behalf of the GMC that ensures that clinicians are working at a required standard. Trainees do not need appraisal within the Trust and their assessment is undertaken by the local deanery. However, as CFs are locally appointed at Trust level, they require annual appraisal as set out by the GMC.

The process of appraisal can sometimes be difficult for CFs as this process involves collecting various kinds of evidence, setting up a meeting with any of the designated appraisers within the Trust and completing extensive documentation.

Enhanced Appraisal Support Service for Clinical Fellows aims to simplify annual appraisals for CFs by providing guidance on

  • What is an appraisal and its importance in clinical practice
  • Choosing an appraiser
  • Collection and presentation of required evidence
  • Completion of the complex appraisal documentation

Training sessions on appraisal are delivered twice a year, ensuring timely and successful appraisals for Clinical Fellows.

Communication skills

(a) General communication

Clinical Fellows who are new to the Trust often find it difficult to communicate effectively at workplace with patients and healthcare professionals. Effective communication can be linked to linguistic and cultural factors and often is the main difference between the medical practice in the UK and in the country of their origin.

The Trust organises frequent sessions led by Daphne Laing on Clinical Communication in general as well as in specific or difficult circumstances. CFs who wish to improve their communication can liaise with WMI to book the next available session. These interactive sessions are helpful as the trainer goes through various difficult communication scenarios. In addition, there is an opportunity for CFs to discuss the difficulties they may have encountered in their practice thus far and they learn how best to deal with them next time.

(b) PACES communication

CFs in medical specialities need to undertake PACES exam as part of their MRCP(UK) qualification. MRCP (UK) is essential for career progression and higher speciality training in the UK. The exam consists of clinical and communication stations. The communication stations are based on ethical, legal and practical issues encountered during medical practice.

The Trust already has a PACES programme which focuses on the clinical aspects of the PACES exam. It was observed that IMGs often needed more refinement in their communication skills in order to pass the PACES exam. PACES-oriented communication teaching sessions have therefore been developed to enable the CFs to specifically develop their communication skills while preparing for their PACES exam.

University of Wolverhampton Support

As a part of the Clinical Fellowship programme, Clinical Fellows are entitled to a fully funded master’s Qualification (MSc Clinical Medicine) from the University of Wolverhampton. The benefits of enrolling to this programme are manifold. It enhances innovation, leadership, teaching, learning and research skills, thereby facilitating personal and professional development and strengthening the ability to bring about positive changes, solve problems effectively, and ensure patient safety. The Masters programme has four themes of progression, ensuring that there is something attractive on offer for clinicians of any grade and speciality. These themes are:

  • Leadership and Management
  • Teaching and Learning
  • Evidence based practice
  • Speciality Medicine

Enhanced University Support Service for Clinical Fellows would aim to maximise participation and successful attainment by CFs of a postgraduate qualification from the University of Wolverhampton.

  • Numerous benefits of the University of Wolverhampton’s programmes would be outlined clearly based on the CFs grade, speciality and individual circumstances.
  • Suitable progression themes would be advised individually to CFs.
  • Enrolment would be simplified.
  • For CFs with time constraints, the flexibility offered by the University in terms of extensions and sequencing of modules would be outlined and simplified.
  • CFs who have some difficulty in completing their assignments would be offered informal mentorship.

Clinical Fellows’ Forum

Clinical Fellows’ Forum, also known as “Meet and Greet”, is a trust wide meeting between CFs of all grades and specialities. These meetings are held every 4 months. Sessions are usually held face-to-face, although circumstances may occasionally require these sessions to be held virtually.

  • During these informal meetings, new CFs would get to know each other and other colleagues.
  • They can discuss any current or ongoing issues and concerns.
  • Possible solutions to highlighted concerns are discussed and actioned.
  • Any concerns that need escalation are dealt with appropriately.
  • Any queries, feedbacks or comments for improving the CFP and the working environment in the Trust are also highlighted and addressed.

In addition to the Forum, monthly social events such as movie nights and quiz are also organised for CFs and their families from time to time.

CESR Support

Certificate of Eligibility for Specialist Registration (CESR) is one of the alternative routes for registering as a Specialist, thereby gaining eligibility for securing a Consultant appointment in the NHS. This route is designed for those doctors who have not completed a GMC approved programme of training but are able to demonstrate that they have the knowledge, skills and experience equivalent to the approved curriculum for their speciality.

Applying for a CESR is a long and exhaustive process. A large amount of evidence needs to be collected, compiled and appropriately verified. A number of referees need to support the candidate with a structured report. The application fee is high, and candidates are only allowed to apply twice. For this reason, a well-developed support process for CESR in the organisation is of great benefit to the candidates to guide suitable candidates to proceed with this pathway.

There is a well-established CESR peer group, which provides guidance to CFs who wish to pursue CESR. There is usually a brief presentation by either a CESR successful candidate or a CESR guide and this is followed by interaction amongst the CESR applicants which creates an informal environment conducive to professional and social interaction between the CESR doctors and allows them to learn from shared experiences.

We aim to support and enhance the peer-support for CESR in the following ways

  • Formalise a timetable for these meetings to be held every 6-8 weeks
  • Inviting an additional surgical lead
  • Encourage greater participation
  • Establish support specifically targeting those CFs who are uncertain of the path they wish to pursue to obtain specialist qualifications

Enhanced On-call Training

Most Clinical Fellows (CFs) have experience of performing on-call and out-of-hours duties in their medical roles, however, in an unfamiliar working environment, performing on-calls can get quite challenging. This can have patient safety implications. Difficult experience in this regard could adversely affect the confidence of the doctor setting up a vicious cycle leading to underperformance.

For CFs expected to join the medical on call rota, we have developed an enhanced On-call Training to improve the readiness, competency and safety of CFs in undertaking their on-call duties. The training is now a mandatory requirement for all CFs joining the Trust, and is even being offered to international medical graduates undertaking GPVTS and FY training schemes.