UK Wide Solutions:
Developing a Hospital at Night e-learning resource

Cardiff and Vale NHS Trust Ymddiriedolaeth GIG Caerdydd a’r Fro

Background

The introduction of the Working Time Directive in 2004 resulted in junior doctors’ hours being reduced to 56 hours per week, with a phased reduction to 48 hours per week by 2009. Despite this reduction, the requirement to maintain the same level of clinical service throughout the 24 hour period has not changed and it has therefore been necessary to introduce new working arrangements in order to comply with the legislation. Traditional on call arrangements have been replaced by shift systems in many NHS settings. As a result, junior doctors availability is reduced during daytime hours where daytime teaching takes place. Cardiff and Vale NHS Trust introduced H@N arrangements in January 2005 and has recently undertaken a project to pilot H@N specific online educational resources for nurse practitioners and for junior medical staff.

The online H@N educational resource

Whilst it is critical to achieve the correct balance for staff between service provision and protecting training time, it is also crucial that neither element is compromised as a result of the reduction in hours.

We have developed an e-learning resource through support from the Welsh Assembly Government and in conjunction with OnExamination.com, this resource provides online training for staff who work on H@N teams.

This is in keeping with the original H@N concept to deliver a safe and acceptable service to patients, supporting individuals in their professional development and thereby enhancing the knowledge base of the H@N teams.

Whilst similar in set up, two e-learning resources were developed, one for nurse practitioners and one for junior doctors. Both contain reading material, assessment function (initial and final test), clinical outcomes, ECGs, algorithms and guidelines in medicine and surgery along with a reflection area for users. There is also a supervisor area, enabling educators to reflect on the scores of their allotted trainees. A brief fire safety module was also included to consider the applicability of online mandatory training. Over 200 users registered for the pilot project across Welsh NHS trusts.

Evaluation

Limited and full access accounts were introduced. Both limited and full account holders undertook an initial test to assess their baseline knowledge. Following this test, the limited account holders accessed reading material alone, whilst the full account holders accessed this reading material plus assessment questions. At the end of the 2 month pilot period, both groups then received the same test questions as a final test to assess progress in knowledge. Subjective satisfaction of users with the resource was also assessed through a questionnaire. Users with full access reported very positively on the benefits of all elements whilst those with limited access wanted more questions and response on their performance. Many commented on their preference to using this resource compared to traditional text book study and that it allowed them to study and undertake assessment in a nonthreatening environment.

Educational supervisors valued the timely access (ie at a time convenient to them) to review trainees’ progress and the resources ability to support the appraisal process. Supervisors also felt that recognition of effort and progress.

Conclusion

The provision of this H@N e-learning resource has been successful in that a flexible learning resource has been tailor made for those working on the H@N teams focused on emergency medicine and surgery. With an increasing number of people using online material as a primary source of study and web pages becoming a preferred medium for seeking healthcare information, organisations will be required to provide education in innovative and flexible ways. A resource such as this one developed at Cardiff and Vale provides just that, whilst also supporting the appraisal process by providing evidence of learning and increased knowledge base. It has the scope to provide more extensive modules and other application in the recruitment process, targeted learning for examinations and study in specific specialties. With study leave allocation at a premium and escalating associated costs, cost savings can be achieved through reduced training costs and time away from service. It also allows staff to study in a self directed yet supported manner.

For further details contact:
Delyth Martin, Cardiff and Vale NHS Trust delyth.martin@
cardiffandvale.wales.nhs.uk
Steve Davies, OnExamination.com
steve.davies@onexamination.com