Teaching professionalism to junior doctors: experience of a multidisciplinary approach in the Foundation Programme

The Foundation Programme and medical professionalism

The Foundation Programme introduced a two-year programme for newly qualified doctors with the intention ‘to develop and enhance core or generic clinical skills essential for all doctors eg team-working, communication, ability to produce high standards of clinical governance and patient safety, expertise in accessing, appraising and using evidence’.¹ Although such skills are fundamental to medical practice,² and are described in the Foundation Programme curriculum,³ how these skills can be taught to postgraduate doctors is unclear.

In Dorset, pilot sites for FY2 schemes were established prior to the compulsory implementation of the Foundation Programme, and it soon became clear that due to the numbers of different posts involved and the complexities of modern junior doctor working patterns, innovative ways of teaching these doctors were required, rather than the traditional lunchtime meeting. Teaching days on what at that time we called ‘generic skills’, sharing the teaching load between clinical educators from the local acute trusts, were therefore devised and FY2 trainees from these trusts were invited.

The Royal College of Physicians (RCP) has considered the topic of how medical professionalism has changed in the current iteration of the NHS, defining professionalism as ‘a set of values, behaviours, and relationships that underpins the trust the public has in doctors’.⁴ At a series of subsequent roadshows, the majority of doctors were ‘unsure of the best way to incorporate medical professionalism into the teaching of young doctors’.⁵ This definition of professionalism encompassed the aim of the ‘generic skills’ teaching programme (Fig 1).

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Fig 1.

The six components of professionalism.

The FY2 professional skills in medicine teaching programme

Doctors work with many other healthcare professionals and non-medically trained people during their careers, so interprofessional working forms part of the Foundation Programme curriculum.³ A group of educators from three local acute trusts and the School of Health and Social Care was therefore established, meeting regularly to discuss how the professional values of being a doctor are viewed by those inside and outside the medical profession, and to consider ways of trying to teach these. The university faculty staff come from a wide range of professional backgrounds, including nursing and social work.

The course has evolved since the inception of the Foundation Programme, but the Dorset programme remained consistent in having six separate teaching days, as part of the study leave allowance, with the following themes:

• professionalism and judgement: dealing with uncertainty and ethical issues

• relationship with society: NHS structures and how professional bodies work

• accountability: clinical governance, appraisal and revalidation

• teamworking and leadership

• relationship with patients: communication skills and appropriate behaviours, ‘bad news’ breaking and confidentiality

• excellence and continuous improvement: learning and teaching.

The themed days have been taught in different orders and in different ways, and throughout feedback from both the trainee participants and from those developing and delivering the programme has been used to continuously modify and improve the scheme as required.

Teaching professional skills to FY2 doctors

There are now a total of around 80 FY2 trainees in the three local acute trusts. They are divided into three groups, with approximately equal numbers in each from each trust. The members of each group are allocated within each trust to minimise disruption to a particular unit. The programme is organised by a senior lecturer at the university, supported by a programme administrator, liaising closely with the postgraduate medical education centres at the acute trusts. Each themed teaching day is run three times, facilitated by at least one clinical educator and one university faculty member. As far as possible, we try to keep the groups together to ensure cohesiveness and facilitate discussion, but if a trainee cannot attend due to extenuating circumstances, they are permitted to attend a different date. The days are held at Bournemouth University to ensure a ‘neutral ground’ where trainees feel free to express their opinions and share their experiences. They are also assured of confidentiality within the groups, so that any comments are taken as expressions of learning.

The session teachers meet or correspond to prepare beforehand. The emphasis is on group discussion between the participants, and feedback to the whole group, rather than traditional didactic lecture-based teaching. Table 1 shows examples of the questions trainees are asked to consider during the course of the programme. The aim of this is to encourage the Foundation Programme doctors to become more reflective in their practice, and to discover their own answers to their queries, so developing skills in making judgements, which is fundamental to professional medical practice. The trainees are given references to discuss which are relevant to the particular topic, but the majority of the teaching is scenario based, as evidence so far confirms that that professionals learn best by considering examples of their own practice, and how they deal with it.⁶ Traditionally, junior doctors have tended to reflect on their experiences in the pub after work. Through this programme, a forum has been provided to give that reflection more structure and to ensure that the maximum amount of learning is gained from their experiences.

At the end of each day, the trainees are asked to feedback their opinions to the faculty via an anonymous questionnaire. The data from these forms are used to make appropriate changes, with a resulting evolution of the course based on trainee feedback. In addition, funding for a formal evaluation using qualitative research methods has now been obtained.

Postgraduate Certificate in Professional Medical Practice

In 2009 a further development in the FY2 professional skills course was implemented by introducing an optional Postgraduate Certificate in Professional Medical Practice, which has been validated by the university authorities. The certificate has three modules: evidence of learning, assuring and improving the quality of patient care, and proficiency in clinical practice. These are related to the professional skills course, with the trainees having to write reflective essays and presentations on aspects of their practice. As a result of Modernising Medical Careers, trainees have to focus on their career plans at a much earlier stage. Experience has shown that Foundation Programme trainees have realised that extra qualifications, such as this postgraduate certificate, could help to obtain specialist training posts.