Providing e-learning modules to streamline induction for doctors gives them the opportunity to train in areas that are more appropriate, and brings induction processes up to date. The benefits are being felt by both the doctors and patients, says Kamal Nathavitharana.

Over 3,500 doctors in training, taking up posts across the West Midlands in August, have now completed all 18 generic induction modules, developed and pilot tested by the West Midlands Deanery. 

This quality, innovation, productivity and prevention (QIPP) funded project was designed to deliver standardised generic induction where knowledge is assessed and the certificate of completion produced is recognised and transferable across all trusts in the region.

For the first time, trusts are not required to repeat induction on generic topics, enabling them to focus on local issues including trust and departmental induction. This efficient, cost effective development is a significant step forward to enhance patient safety.

Induction is a mandatory requirement in the NHS, where patient safety is key. It is well recognised that multinational organisations promote their brand and customer service through effective induction. Generic induction should be seen as a medium for communicating the vision, ethos and values of the NHS to its employees.  

Hitherto, doctors in training have been exposed to many different local versions of the same generic induction topics as they rotated across trusts. Although necessary, this has made induction repetitive, time-consuming and ineffective, defeating its object.  Service delivery and training are interlinked in the UK. This has been a successful model for many years. However, repetitive induction is counter-productive to service both delivery and training.

This West Midlands Deanery project was conceived to raise the standard of generic induction and avoid repetition. In a departure from outdated, traditional, classroom-room based format, e-learning techniques were specifically selected.

A core group consisting of multi-professional, multi-disciplinary colleagues was formed with representatives from trusts across the region as well as other stakeholders that included the deanery and strategic health authority. This group was charged with defining the necessary modules, identifying module leads, subject matter experts and all aspects of project delivery, including competitive commissioning of IT provider and operational matters. 

The 18 generic induction modules (see table 1, below), with integral assessments and administrative systems, were hosted on NHS Local West Midlands (figure 1). Each module took between five and 40 minutes to complete, with an overall completion time of seven hours.

The e-learning format provided users the facility to access material at a time of their choosing, enabling return to part-completed modules at their convenience. Modules catered for different learning styles. They were constructed with case vignette based formats, integral questions and links to authentic, well-recognised resources (eg NICE, GMC). 

Active engagement, collaboration and regular communication with all stakeholders and trusts throughout the region ensured wide acceptance of the project. Trusts inductions have been modified as a result.

Users were required to evaluate the programme before generating a certificate of completion, accepted by all trusts throughout the region. An administrative system for trust and deanery personnel to access the system in order to establish full compliance with the completion of all 18 modules prior to start date was incorporated. 

As the August start date approached, increasing numbers of doctors completed their induction (figure 2, attached right). This surge in activity tested the online induction and deanery information systems - despite the pilot testing involving over 100 trainees, trainers and other stakeholders.

Challenges successfully addressed by the IT support team included inaccurate usernames / passwords, problems with access, freezing screens, loss of data (in minority of cases) and managing excessive administrative access as deadlines approached.

This project meets SMART (specific, measurable, achievable, realistic, time) criteria.  It promotes good practice, encapsulates multi-professional teamwork and demonstrates how training in the NHS can be made both efficient and effective. Further advantages of this innovative project are listed (table 2, below). 

E-induction is available in many trusts across the country, both within and outside the NHS. However, provision of a standardised deanery-based generic induction, with an assessment component and transferable certificate of completion, accepted by all Trusts in the region, is a novel initiative.

The potential benefits to the NHS of delivering a verifiable, transferable online generic induction throughout the United Kingdom are immense. In the current climate of austerity, NHS managers responsible for cost-improvement programmes should welcome this resource saving initiative. The impact on patient safety, litigation and other costs, is incalculable.  

Although originally developed for doctors in training, the West Midlands Deanery generic induction could be adapted for wider use among allied NHS healthcare professionals, non-training grade doctors, locums and students. Access to study leave and training is not readily available to locums, who may never receive an induction due to the short term nature of their employment.

NHS risk management should require all locums to complete a generic induction prior to commencing employment.  NHS and other regulators need to define justifiable and realistic intervals for completion of generic induction topics in trusts.

Future editions of the West Midlands Deanery generic induction need to be more concise, up-to-date and incorporate a pool of randomly selected new questions for quality control. Robust IT, backed by funding, is imperative for the continuing success of this innovative e-induction project.

Table 1: the 18 Generic Modules

Statutory

  • Are you sitting comfortably?
  • Health & Safety
  • Manual Handling
  • Fire Safety

Patient Safety

  • Infection prevention and control
  • Blood transfusion
  • Anticoagulation & thromboprophylaxis
  • Prescribing
  • Mental capacity
  • Consent
  • Safeguarding children
  • Safeguarding adults

General

  • Audit, clinical & information governance
  • Risk management
  • Coroner / death certification
  • Equality & diversity
  • Conflict resolution
  • Complaints

Table 2: advantages of e-induction

  • Contributes to patient safety
  • Fulfils regulatory requirements
  • Consistent standards across all Trusts
  • Prevents repetition
  • Easy, secure access
  • User-friendly, flexible (i.e. non-continuous) access
  • Engaging presentation with relevant links to additional material
  • Ease of updating material
  • Integral assessment component
  • Certificate of Completion, transferable across Trusts
  • Minimises interruption to service delivery
  • Permits time for service-based training
  • Significantly reduces costs
  • Readily adaptable for allied healthcare professionals

The author wishes to acknowledge multi-professional colleagues in the NHS West Midlands Deanery, strategic health authority and NHS trusts across the West Midlands who generously contributed their time and expertise through all stages of this project.

Related files/tables