Protected training raised during Council inspections

The Medical Council has today published reports into two sets of inspections carried out at nine hospitals across the Dublin Midlands Hospital and Children’s Hospital Groups. The purpose of each inspection visit was to assess if and how each clinical training site is complying with Medical Council standards.

The ten clinical sites were inspected in 2018 to assess compliance with standards for medical education and training at intern and specialist level. No sites were found to be non-compliant but the Council has voiced concern about access to protected training time and excessive working hours.

All three clinical training sites in the Children’s Health Ireland group were visited:

National Children’s Hospital, Tallaght
Temple Street Children’s University Hospital
Our Lady’s Children’s Hospital, Crumlin

All seven sites in the Dublin Midlands Hospital Group were visited:

St Luke’s Hospital, Rathgar
Coombe Women and Infants University Hospital
St James’s Hospital
Naas General Hospital
Tallaght University Hospital
Midland Regional Hospital, Tullamore
Midland Regional Hospital, Portlaoise

As part of the inspection process, the Medical Council Assessor Teams met with hospital group management, clinical training site management, trainers, specialist trainees and interns, and inspected the educational facilities on site.

In terms of specialist training, clinical training sites in the Dublin Midlands Hospital Group were found to be 49 per cent fully compliant and 51 per cent partially compliant with Medical Council standards. There was no evidence of non-compliance with specialist training standards at any of the seven sites.

Five of the seven sites within this group facilitate intern training, and were found to be 60 per cent fully compliant and 40 per cent partially compliant with Medical Council standards. There was no evidence of non-compliance with intern training in any of the sites.

Within the three clinical training sites that make up the Children’s Hospital Group, compliance with specialist training standards was at 52 per cent full compliance and at 48 per cent partial compliance.

Two of the three hospitals facilitate intern training. Compliance with intern training standards was at 86 per cent full compliance and 14 per cent partial compliance with Medical Council standards.

There was no evidence of non-compliance with intern and specialist training standards.

The findings reflect a high standard of medical education within the two hospital groups which stands to benefit the future of Irish healthcare.

However, assessors as well as interns, trainees and trainers working at the sites voiced concerns about staffing levels which created barriers to accessing protected training time.

Concerns also arose in some areas over the number of hours worked above the European Working Time Directive and again staffing shortages were cited as the reason behind this.

Both protected training time for all grades and working excessive hours are areas of key concern for the Medical Council.

Some of the other findings of the inspections included:

Medical and professional development being curtailed as interns are heavily involved in basic medical procedures
Poor Wi-Fi or computer access for interns was identified at a number of sites.
Assessors were impressed by the active commitment to providing a comprehensive range of pastoral and health supports at a number of sites
Assessors were impressed by the culture of collegial multi-disciplinary teamwork
Interns had high praise for the supports provided by the intern support staff
Assessors were impressed with the commitment of trainers to providing education and training
Assessors were impressed with the active commitment to providing a comprehensive range of pastoral and health supports

Speaking on the publication of the reports, Mr Bill Prasifka, CEO of the Medical Council, said: “I welcome the news that all hospitals surveyed were either fully compliant or partially complaint with standards set and that no site was found to be non-compliant in any area. The results of the report reflect the high standard of medical education that is offered in Ireland despite ongoing challenges in recruitment and retention within the healthcare system”

“However, concerns continue to exist regarding access to protected training time due to staffing shortages. Such training is vital in the early career stages of these individuals as well as to the standard of Irish healthcare”.

“We must ensure that access to education for NCHDs is not hindered by staff shortages resulting from the ongoing retention crisis. It is of paramount importance that we offer our early career stage medics the best training and educational experience to safeguard the future of our health service”.

“Staff shortages mean that doctors at all levels feel unable to leave their patients even for training purposes even though such training is of benefit to the patient in the long run. These shortages have also resulted in doctors working hours above what is permitted in the European Working Time Directive.”

“Such conditions create a vicious cycle whereby our young doctors are emigrating in search of better conditions resulting in staff shortages which in turn places greater stress on the healthcare system. As well as posing a threat to doctor wellbeing, such long hours in turn threaten patient safety as mentally and physically exhausted doctors try to work at full capacity,” concluded Mr Prasifka.

The Hospital Groups will be requested to develop an Action and Implementation Plan to address these recommendations and report back to the Medical Council with the proposed Plan within three months of the issue date of the final Inspection Report