Medical Council
Education and Training
Symposium 2015
“Supporting the Transition from Student to Doctor”
Chester Beatty Library, Dublin Castle, 22nd of
September 10am-1pm
Introduction
In response to findings from Your Training Counts 2015, the Medical Council’s Annual Education and
Training Symposium 2015 focussed on the theme of “Supporting the Transition from Student to
Doctor”.
The Symposium was planned to listen to international experience on the topic, discuss findings from
a recent study of stakeholder views commissioned by the Medical Council, and explore options to
better support learners at this key stage in their professional development. The specific objectives
were:
• Identify and apply theory and evidence about supporting transitions to development of the
intern year.
• Communicate with key stakeholders on Medical Council plans/ideas for development of the
intern year.
• “Test” key ideas for development of the intern year with key stakeholders, specifically
definition of intended learning outcomes using an Entrustable Professional Activity-based
model (EPA).
• Identify facilitators/barriers to development of intern year.
The programme for the Symposium is at Appendix 1 and a full list of participants can be found at
Appendix 2. Speaker presentations are available here.
This report supports a Consultation Paper on a Review of Intern Training in Ireland conducted by the
Medical Council’s Strategy and Policy Subcommittee 2015. The Symposium was designed to support
and inform that review. Participants were asked to discuss five themes regarding the current
position and future direction of Intern Training in Ireland:
1.
2.
3.
4.
5.
Supporting Trainees in the Intern Year
Supporting Clinical and Educational Supervisors in the Intern Year
Learning outcomes and entrustment
Assessment of learning
Continuum and trajectory of learning
This report summarises the table-top discussions of participants and supports a Consultation Paper
on a Review of Intern Training in Ireland conducted by the Medical Council’s Strategy and Policy
Subcommittee 2015.
Acknowledgements
We are grateful to Symposium participants for engaging constructively in discussion of the various
themes presented to them.
Thanks to the following Medical Council staff members who acted as rapporteurs: Niamh Manning,
Aoise O’Reilly, Alicia McGrath, Simon King, Carol Fitzgerald.
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Theme 1: Supporting Trainees in the Intern year
What are the main challenges for trainees in the intern year and how can each be addressed?
Participants identified preparedness for on-call duty as the main challenge facing interns. This was
described as a sudden step change into a new situation. The assessment and management of the
acutely unwell patient was a particular issue.
The consequence of the intern matching process which means that some interns are beginning
internship in clinical settings where they have never had any practical experience was noted as a
challenge; this was compared with the previous matching process where most trainees had some
previous experience of the place they would work and learn as interns from their time as a medical
student.
Some Intern Networks have implemented a “Nigh Nanny” system where new intern benefit from
support and supervision in commencing on-call duty.
While on-call duty was identified as a challenge, participants also recognised that this was a rich and
important training opportunity and was a very important element of the intern year.
Participants recognised that the transition to intern year presented some trainees with health and
wellbeing challenges. Typically, intern induction included talks on health and safety, fire training etc.
However there is very little mentioned if anything at all, about self-care and the intern’s mental
health. It can be a very stressful time for interns and they need to know where they can turn to if
they run into trouble. Mental health seems to be an ‘elephant in the room’ for a lot of interns.
What would “learner centred” mean in the context of developing the intern year?
Participants’ view of “learner centred” was that it included personal, self-management aspects and
the broader needs of the individual intern not just the clinical knowledge and skills.
It was recognised that many interns will – at various stages during intern training - feel out of their
depth; however it is important that help and support is available to them to work through these and
to develop as doctors as opposed to changing the depth of the challenges interns face. Interns need
to be facilitated to balance a focus between career development and self-development as well as
maintain a work-life balance.
Self-confidence and self-esteem were recognised as important for interns and maintaining and
developing these is imperative to their success. Self-esteem and self-confidence develops with
experience, some of which will be very difficult and challenges, but it is important that trainees are
support to meet these aspects of the intern year.
In summary, interns needs to recognise that facing significant challenges will be part of their role,
but that there is support available and they should ask for this.
It was agreed that “learner-centeredness” has improved in the last four to five years, with the role of
Intern Network Coordinators and Intern Tutors, who are available specifically for interns. The role of
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the Intern Tutor was highlighted as especially important since they can provide an on-the-ground
and peer-level point of support which is not possible for the Intern Network Coordinator.
Supporting interns to manage through conflict was recognised as a particularly important aspect of
promoting learner-centeredness.
How can we respond to the trainee in difficulty?
Participants agreed that this is a very important issue; however, it was noted that it arises very
rarely. The Medical Council guidance was noted. However, one of the challenges in dealing with
this was getting to the root cause of the issue and having robust information about the problem. It
was agreed that the development of the competency framework presented at the Symposium would
be helpful.
The structure of experience rotations was discussed as a challenge in responding to the trainee in
difficulty. Where trainees have short rotations, the context means that there is insufficient
opportunity to work with the intern to identify and respond to any difficulties. Leave arrangements
following night duty also militate against opportunity to identify and respond to any interns with
difficulties.
How do we develop interns who assume responsibility for learning and practice?
The relative attractiveness, or otherwise, of pursuing specialty training in various areas of practice
was discussed and participants recognised that it was important that career options were actively
promoted. The relationship between experience of the intern year and commitment to continuing
practice of medicine in Ireland was discussed.
The role of e-portfolios enabling interns to take responsibility for their learning was discussed and
participants thought that incorporating the new outcome framework into an e-portfolio would be
useful.
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Theme 2: Supporting Clinical Educational Supervisors
in the Intern Year
What should clinical supervision and educational supervision mean in the intern year?
Participants discussed the supervision of interns. It was recommended that clinical duties and
supervision duties should be separated – potentially including separation through contracts –
although there was a view that clinical supervision and education supervision could be combined or
separated. However, the need to support the development of clinicians involved in clinical teaching
was emphasised and it was agreed that not all doctors who are strong as clinicians may also be
strong as teachers.
What are the main challenges for clinical educational supervisors in the intern year and how can
each be addressed?
Participants recognised that resources for clinical teaching – especially time and money – were the
main challenge. Resolving this would involve investment in additional staff. ICT support for clinical
teachers was also important. The tension between focus on service provision versus focus on
training and supervision facing many consultants was discussed.
Albeit resources were an important challenge, participants recognised that the competency
framework presented at the Symposium should be relatively easy to complete since it reflected what
was being done by the intern on a day to day basis and so assessment based on observation should
be straightforward.
How should clinical and education supervisors be valued and supported?
The participants identified mentorship of clinical teachers and supervisors as important to their
success. Careful recruitment into the role was also important.
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Table 3: Learning Outcomes and Entrustment
What are the strengths and weaknesses with clarifying expectations of what trainees are to
achieve at the end of intern training?
The participants agreed that clarifying what was to be achieved by interns through a formal
framework of entrustable tasks/competencies was important. There was strong support for this
approach.
However, some issues were identified. Clarifying expectations could lead to some trainees taking a
minimal approach of doing “just enough to get by”. Further, some areas or items which are not may
explicit may get overlooked so it is important that any framework is comprehensive.
What do you think entrustment means in the context of the intern year?
The participants proposed that “entrustment” should mean trusting the trainee to perform key
competencies relevant to the safe practice of medicine. While the activities expressed in any EPA
was important, how the activity is performed should be embedded in the EPA.
Feedback was discussed by participants. Some felt that the process of accepting and receiving
feedback needs to formally begin in medical school so that students are used to this by the time they
become interns.
The participants recognised a potential challenge in relation to time and workload in incorporating
EPAs into the intern year. It would be important that the individual reporting on EPA performance
should have actually observed the intern performing the task first hand. Resources would be a
challenge for implementation.
What aspects of practice are relevant when it comes to entrustment and how should learning
opportunities be planned to address these?
The participants felt that it was important to ensure was that trainees had sufficient and equal
access to trainers. Separating the low stakes feedback from the higher stakes summative feedback
was also viewed as important.
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Table 4: Assessment of Learning
Who should undertake assessment and what methods should they use?
The participants felt that there needed to be a designated supervisor/tutor role defined and this
needs to be standardised nationwide. A need for training specific for those teaching and supervising
interns was also recognised; participants felt it was important that it be accepted that teaching and
training is not a role for every clinician.
What are the risks with assessment, how can these be avoided and how can feedback me
maximised?
Consistent assessment of learning was agreed to be important. In practice, it can be difficult to allow
for adequate time and resource to conduct assessment. Greater standardisation of training was
recognised as important and the standard of teaching and supervision by supervisors needs to be
consistent. Assessment and supervision of supervisors was something to be considered.
How should the outputs from assessment be organised, and how should this link with progress
decisions and regulator assurance.
The participants discussed remediation of interns with difficulties. It can be a burden on other
interns if one is falling behind. It would be useful to be able to have a remediation session with an
intern who’s falling behind or having trouble. There is a requirement for feedback after a shift, and
possibly an informal de-briefing session with a supervisor especially regarding critical incidents. It
may be useful to consider a system of bullet-pointed written handover between shifts in order to
ensure effective and efficient communication.
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Table 5: Continuum and trajectory of learning
How can the intern year be developed to better support a trajectory of learning along a
continuum?
Participants proposed a number of tactics to provide for better support of trajectory of learning
along a continuum:
•
•
•
•
•
•
•
•
Outcomes based-planned progress;
Interviews - Points entry, no assessment / no selection criteria;
EPA competencies linked to meaningful activities;
Gaps in options - doctor seen as only route, other options for medical degree should be
highlighted;
A more transitional approach to learning competencies;
More supportive environment;
Supervision;
A robust set of standards and consistency in standards nationwide.
What are the implications for undergraduate medical education?
Participants recognised a need to see that learning at each stage of professional development was
not separate, it is a continuum. A number of tactics were proposed to promote integration between
undergraduate medical education and intern training. Curricula could be aligned and designed as a
continuum. Undergraduates could be provided with more responsibility for structured work with
supervision. Sub-internship models were recognised as useful.
What are the implications for postgraduate medical education?
Participants discussed the important of developing lifelong learning skills. Introduction of EPAs into
the postgraduate sector which were aligned with the EPAs proposed for the intern year would also
be useful.
What tactics do you think can support coherence along a professional development continuum?
In summary, participants agreed that an EPA-model had potential to promote coherence, as was the
case in the USA.
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Appendix 1: Agenda for the 2015 Medical Council Education and Training Symposium 2015,
“Supporting the Transition from Student to Doctor”
Time
Topic
Speaker
10:00-10.15
Welcome
Prof Freddie Wood
10:15-11.00
11:00-11:20
11:20-11:40
11:40-12:00
Supporting transitions in the professional development of
doctors – linking theory and research with practice
Supporting interns transition from students to doctors –
reflections on challenges and opportunities
Views on the current state of intern training and
transition from student to doctor – what we heard
Defining expectations for the end of intern transition –
international practice and local implications
Prof Jan Illing
Dr John Jenkins
Dr Paul Kavanagh
Dr Dara Devitt
12:00-12:50
Table top discussion and plenary feedback
All
12:50-13:00
Close
Prof Freddie Wood
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Appendix 2: Medical Council Education and Training Symposium 2015, “Supporting the Transition
from Student to Doctor” – List of Participants
John Barragry
Tomas Barry
Deirdre Bennett
Josephine Boland
Anthony Breslin
Dara Byrne
Anne Carrigy
John Crowe
Suzanne Donnelly
Lorna Farren
Fintan Foy
ADK Hill
John Jenkins
Alan Johnson
Paul Kavanagh
Marie Kehoe O'Sullivan
Siobhan Kelly
Hadas Levy
Pauline McAvoy
Martin McCormack
Eilis McGovern
Deirdre McGrath
Eleanor Molloy
Daragh Moneley
John Nisbet
Finbarr O'Connell
Siun O'Flynn
Paula O'Leary
Denise O'Mara
Ann O'Shaughnessy
Ellen O'Sullivan
Leah O'Toole
Aileen Patterson
Dermot Power
Michael Ryan
Rupak Sarkar
Keshav Sharma
Miriam Silke
Cornelia Stuart
Sean Tierney
Emma Troy
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