LESS THAN FULL TIME TRAINEES (LTFTTs)

 

 

 

Why they couldn't call them part-time I will never know!

 

1. Full RCGP guidance on LTFTTs can be found here:
2. http://www.rcgp-curriculum.org.uk/nmrcgp/less_than_full_time_trainees.aspx
3. Government guidance on flexible training can be found here
4. LTFT Training Flowchart

 

 

There are some administrative things that need to be sorted ASAP

First you all need to apply formally for LTFT training according to the process detailed at : http://www.yorksandhumberdeanery.nhs.uk/policies/ltft.aspx

 

It is important that Joan Martin at the Yorkshire Deanery has all you paperwork and that it is formally approved.

It is important that you also contact the consultants to work out how exactly you plan to do less than full time training, and then to draft a Form B which needs to be submitted for approval (ask Nick Price about this).

 

 

Assessments

 

LTFTTs are a lot more hard work than full time trainees. They roughly have to do the same number of assessments but in less time. College policy requiring LTFTTs to undertake the same number of WPBA tools in a six month period as full-time is based on the need to have a minimum amount of evidence which is sufficient to make decisions about satisfactory progression. 

 

 

How Can You Make LTFT Training Work?

 

Because of less regular contact, training might appear to have less 'flow'. It's even more difficult if the trainer is part time too! So here's a suggestion how I am planning to make this work with my trainee. She's part time and I am too!

 

Firstly, I personally feel that Programme Directors should try to avoid placing part time trainees with part time trainers; with a full time trainer, it's likely the part time trainee's working timetable will coincide with that of the trainer's.

 

Okay, now on to 'how to try and make it work':

 

To try and figure out how to make this work (and happen), one needs to revisit the aims and objectives (i.e. what are we trying to achieve). For me, these would be:

 

 

 

Aims & Objectives

 

 

 

How Am I Planning to Do It?

 

I’ve got a LTFTT and she’s staying with me for another year.  One of her concerns was getting enough hospital experience.   Certainly being part time (currently 50%) doesn’t help because at the moment she’s in the practice 2.5 days of the week (and one of those is for admin/catchup time).  Clearly, if she engaged in an innovative post on a 50% part time basis, that might mean one day in GP and one day in a hospital specialty.   Is this exposure enough?  I personally don’t think so and neither does she. 

 

One way around this is to remain part time but not at 50%.   She’s thinking of going to around 60-70%.   This might work!  So we’re going to suck it and see.   The plan will work something like this:
Let’s say she chooses O&G as her specialty on a 60% basis (= 6 sessions a week).  She will spend 4 sessions a week at the practice and 2 sessions at the chosen specialty

To ensure its success as far as possible, we’re going to sit down before the start of the next term and figure out what educational and patient exposure opportunities are available in the specialty in our region.   She's going to do the hard work and figure out

a) what clinics are available in hospital

b) what clinics are available in the community (either at local treatment centres, held at other practices or even held at our practice)

c) what appropriate ward work is available (eg labour ward)

d) what appropriate theatre work might be available (at the moment, not much is educationally approrpriate me thinks!)

 

One of the ways she is planning to find this information is:

a) by talking to her colleague trainees who have done an O&G job - finding out what's useful and what's not

b) by talking to the educational lead in the specialty

 

She'll then present me with a table listing clinics, times, dates and what educational activity one might get from each. We’re then going to ‘cherry pick’ those that will serve the highest value.   So, theatre and doing C sections might be out but gynae clinic will be in (where she will actively runs a clinic, not just observes). 

 

Here's the list she's produced for O&G

Women's Health Post - the options available in North Bradford

 

 

 

Creating Your Own Post

 

Here's a link to another page called "creating your own post" which some of you may find helpful.

 

 

 

How Do We Sell This to the Consultants?

 

Again, I got the trainee to do this succesfully. She asked several consultants whether they'd mind having her on a regular basis for a certain period. She would not run another separate clinic, but instead would help them with theirs and actually SEE some of the patients on her own with input from them in terms of clinical supervision. And they liked the idea.

 

Wouldn't you if you knew someone was willing to help you with your clinic list providing you gave them some education input in return?

 

 

 

What to Say to the Consultant
Hi
I’m one of the GP trainees on the Bradford scheme.   I was wondering whether it would be okay for me to attend x sessions with you at your yyyyy clinic that you run on zzzz days.   Of course, it wouldn’t simply be me sitting and observing but I would be a free pair of hands that could help you with your clinic list for that session.   Hopefully you’d have more time with other patients whilst I saw some too.    Of course, I am relatively inexperienced but I do pick up things pretty quickly.

What do you think?

 

The clinic might look something like this

0900 trainee

0920 consultant

0940 consultant

1000 trainee

1020 consultant

1040 consultant

1100 trainee

1120 consultant

1140 consultant

 

As you can see, the consultant may only need 20 mins to see a patient, but the trainee who is just starting off will need more time. In this example, the trainee has up to 40 minutes to take a good history and examine; with time, they'll get better. The consultant won't feel pressured because instead of spending 2 1/2 hours in a clinic and trying to 'squeeze' in educational input, they end up working 1 1/2 hours with time freed for educational delivery. Result = stress free consultant, stress free trainee = both parties happy.

 

The programme directorsare planning to take this further and gather all these "tables of options" for the various specialties in order to formulate a menu of what is available for each innovative specialty (but this will take time).

 

 

 

So, in summary

 

1. I would say that the innovative model could work for LTFTTs providing they do more than 50%? (but I have no evidence to back this up)
2. By cherry picking what they end up engaging in, we cut out the stuff that serves very little educational or patient experience (eg theatre in this example).  In other words highly focussed training as opposed to training with some focus (which is the current situation).  There is a lot of less useful experience that currently occupies the daily plan of most full time trainees in hospitals.   The questions I cannot answer is ‘of what proportion’.
3. Of course, the ‘lazy’ trainee could abuse innovative posts and get very little out of them.  However, from experience, I feel this only happens when a trainee is “left to get on with it”.   I therefore wonder whether this ‘joint structured carefully devised’ plan (which needs to be continuously reviewed) is more likely to minimise the risk of this sort of abuse happening

 

With traditional hospital posts, there is sometimes too much observation, and often insufficient hands-on clinical work dealing with real patients. Surely trainees are now better off doing GP posts incorporating specific attachments (eg attending family planning clinic rather than gynae theatre) depending on their learning needs.

The key to success with LTFT trainees and innovative posts is flexibility, focussing on those aspects of these posts that fulfil an individual’s learning needs, and simply dumping the rest.

We shall see.
What are others planning to do? Let me know and I'll paste them here if they sound good and creative.

 

 

Ram

rameshmehay@googlemail.com