Hands-on teaching, shadowing, and supported learning through acute clinics to help improve the confidence of and meet training needs for junior doctors working in ear, nose, and throat surgery

BACKGROUND: Ear, nose, and throat (ENT) surgery is a niche and unique specialty that has been recognized as being poorly taught throughout medical school and postgraduate training. Junior doctors who rotate into this specialty often find it hard and struggle to manage patients. Aims: The aim of this study was to devise a junior doctor-focused induction program with specific emphasis on shadowing and partnered working to improve confidence and competence. METHODS: Feedback from previous trainees was used to identify valuable training opportunities within the 4-month rotation. Trainers identified clinical areas where supported learning could be delivered. Trainees were allocated to rotate between theater, ward, on-call shifts, and acute clinics. The degree of time spent in each area was analyzed in order to balance service provision vs learning needs. Furthermore, novel strategies were introduced in each session to maximize learning experiences. Junior doctors were aware of the opportunities that would be available to them at the start of the rotation. In order to assess whether the aims were met, a questionnaire survey was used to assess exposure to core ENT practical skills and junior doctors’ confidence levels in carrying them out unsupervised. RESULTS: Junior doctors spent 40% of their time assessing new acute admissions. Twenty percent of time was spent in ENT clinic, but novel practical methods of induction were introduced such as 1 week of directly supervised shadowing, followed by a transition period with regular debrief. A three-stage model was used to offer training in practical procedures in the clinical setting. Over half of the trainees felt confident in undertaking 50% of the core ENT procedures unsupervised. CONCLUSION: Our study reveals that giving junior doctors a relevant, focused and appropriate induction helps orientate them, give them the opportunity to ask questions, and also find their grounding in order to begin working. Having dedicated time to shadow and be with a colleague to assess and treat patients initially, with ongoing telephone and in person support, ensured that their confidence and competence improved very quickly. It also improved workplace satisfaction and motivated doctors to undertake self-directed learning and improve and enhance their skills beyond the minimum.