G204 RANDOM SAFETY AUDITS: A LESSON FROM INDUSTRY APPLIED SUCCESSFULLY TO THE NEONATAL INTENSIVE CARE UNIT

L. Lee, S. Girish, E. van den Berg, A. Leas.Neonatal Intensive Care Unit, Southmead Hospital, Bristol, UK

Aim: Random safety audits are process audits used in high risk industry to improve practice in previously identified error prone areas.¹ They audit real-time practice and provide immediate feedback for instantaneous change to best practice. This is in direct contrast to traditional audits which suffer from long time scales and feedback often occurring after many of the relevant staff have changed job, making the outcome less pertinent. Their use in clinical medical practice is new.² Our aim was to introduce random safety audits to our NICU and evaluate their success as a means of improving practice.

Method: We designed straightforward data collection tables to audit 11 infection control and four general neonatal standards. Two audits were performed during each weekly grand round. Strategies for feedback of results were immediate verbal feedback during the ward round, use of the staff communication book and a designated audit board. Based on results, guidelines were reviewed, clarified, and amended as necessary. Educational issues were highlighted for improvement in practice. Each audits was then repeated to close and continue the loop.

Results: Between May and November 2005, we completed three audit cycles for each of the 15 topics. Our percentage compliance with the 11 infection control standards for each consecutive cycle, given as median (range), were 63 (20–100), 95 (75–100), and 95 (66–100) respectively. For the general neonatal standards the results were 60 (25–85), 50 (45–82), and 58 (50–100)

Conclusion: We have shown that random safety audits can fulfil the function of improving practice and therefore patient safety. Their ability to improve real-time practice and sustain this change by immediate feedback is an important tool for optimising patient care.

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G205 WARD BASED RESUSCITATION SCENARIO TRAINING

C. Macano, J. Hacking, P. McMaster, S. Parke, M. Samuels.University Hospital of North Staffordshire, Stoke on Trent, Staffs, UK

Aims: To determine whether paediatric staff achieve acceptable standards in ward based scenarios for the emergency management of the critically ill child in accordance with APLS guidelines; to assess whether staff were content with this teaching method.

Methods: During the period June 2003 to June 2005, we undertook ward based emergency scenarios to promote staff confidence, assess their management, the ward equipment, and processes. The lead nurse and doctor running each scenario were graded by APLS instructors as excellent, satisfactory, unsatisfactory, or remedial. Participating and observing staff, as well as instructors, have completed feedback forms after every scenario assessing presentation, content and relevance of the scenario, and freehand comments. Instructors recorded learning points for clinical management and the ward processes. A video assessment of adherence to APLS guidelines was carried out for all scenarios held during 11 May 2005 to 24 June 2005.

Results: Between June 2003 and May 2005, 583 staff participated in the scenarios, including 298 nursing staff (D–G grade), 157 medical staff (SHO-Consultants), and 128 others, including students, clinical support workers, and pre-registration house officers. Fifty nine out of 63 assessments of nurses performing basic life support were satisfactory or excellent; 40 out of 50 assessments of medical staff performing advanced life support were satisfactory or excellent. Analysis of video recordings over a two month period showed that there was adherence to APLS guidelines in between 57% and 100% of scenarios (mean 76%). Staff feedback (193 forms) showed average scores (5 maximum, 1 minimum) for presentation, content, and relevance of the scenario were 4.4, 4.5, and 4.7.

Conclusion: Staff rated this method of teaching highly and it appeared to demonstrate emergency skills at a satisfactory level. Recommendations included performing scenarios in varying locations and covering topics appropriate for specific wards. These data provide an excellent tool for clinical governance, aiming to maintain and improve the quality of services. Even with basic equipment, this method of training can be transferred to any healthcare environment in the world.

G206 HIGH FIDELITY CLINICAL SIMULATORS CAN BE USED TO EDUCATE PAEDIATRIC INTENSIVE CARE STAFF TO USE CONTINUOUS VENO-VENOUS HAEMOFILTRATION

A. Mayer, B. Harvey, S. Hancock, S. Fidment, J. Delany.Sheffield Children’s Hospital, Sheffield, UK

Aims: To develop and evaluate a multiprofessional training scenario in paediatric veno-venous haemofiltration using high fidelity clinical simulation.

Methods: The simulator (METI paediaSIM) was assessed by a multiprofessional clinical faculty. Key points and educational outcomes were agreed. The latter included: set up and initiation of BM25 haemofiltration machine, recognition and treatment of hypotension, recognition of: changes in arterial filter pressure, consequences of fluid removal, and subsequent treatment of this, finally team communication throughout scenario. The scenario was tested by the faculty leading to minor changes due to practical difficulties in the simulator. The faculty and trainees were a multiprofessional mix of doctors, nurses, and ICU technicians. The scenario was run during a paediatric intensive care training day (with three other PICU scenarios). It lasted approximately 20 minutes followed by video enhanced debrief. Assessment was made using standard formatted questionnaire from trainees and team discussion as to whether educational outcomes were met during the scenario.

Results: The simulation and all components of the system worked as intended. Of the seven educational outcomes three were met, one was partially met, and three were not met. There was therefore discussion in the video enhanced debrief which was fruitful and beneficial. This included alternative patient management strategies and interprofessional communications techniques. Evaluation on the day from all trainees was very positive. A further evaluation was carried out by re-running the scenario three months latter with the same trainees. Six of the educational objectives were met and one was not. Negotiation and discussion skills also appeared to have changed to allow different care delivery to take place leading to a positive view about simulator training. The scenario continues to be adapted in the light of the evaluation.

Conclusion: High fidelity clinical simulation is an effective way of training staff in complex sometimes infrequent scenarios requiring psychomotor, time critical, and judgemental skills within a safe environment. Multiprofessional joint training reflects the reality of care delivery. Debrief should be positive and non-judgmental. Further work should include a comparison between simulation and other forms of training and evaluation of the effectiveness of multiprofessional approach.

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G207 USE OF THE DUNDEE READY EDUCATION ENVIRONMENT MEASURE TO ASSESS SHORTENED UNDERGRADUATE PAEDIATRIC TEACHING

S. Fountain-Polley, S. Underwood, V. Walker, V. Diwakar.Birmingham Children’s Hospital, Birmingham, UK

Background: Curriculum reform at University of Birmingham Medical School has led to a single six week paediatric attachment from the previous eight weeks. Students had rotated, spending four weeks each in the tertiary paediatric hospital and one of 10 district general hospitals (DGH). Now, the whole six weeks is spent in either one DGH, or the tertiary centre (TC)

Aims: To evaluate any perceived change in the learning environment as a result of shortening the paediatric module and restricting training to one centre.

Methods: The validated Dundee Ready Education Environment Measure (DREEM) assessment tool¹ was distributed to cohorts of students before and after introduction of the shorter single centre module, halfway through their attachment. Scores were recorded and analysed with SPSS v12.0.1.

Results: 30/50 longer two centre and 29/50 shorter single centre questionnaires were returned with full answers. Tests of normality and homogeneity indicated a non-parametric distribution, thus data was analysed by the Mann-Whitney U test. The median total DREEM score fell from 134 to 114 (U = 230, p<0.05, r = −0.038, a moderate effect). Significant differences were found in the academic, atmosphere and social subscales. For academic self-perception, students felt less prepared from previous work and for their future careers, and previous learning strategies were less likely to be of benefit. There was concern that memorization of knowledge would be inadequate. Learning objectives were not clear, nor were examples of problems. For perception of atmosphere it became apparent that the students felt the shortened course was not well timetabled, and left them feeling stressed, uncomfortable, and disappointed. In social self perception they felt that their social life suffered, they were more tired and lonely, and inadequate support was available if they were stressed. No significant changes were demonstrated in student perceptions of teaching, or of course organisers. No differences were shown between those based at a DGH or the TC, or between genders.

Conclusions: Overall the students’ perception of their learning environment worsened with a shorter single centre paediatric course.

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G208 EVALUATION OF A NEW UNDERGRADUATE INTERPROFESSIONAL LEARNING PAEDIATRIC PRESCRIBING WORKSHOP

S. Yuen¹, D. Taylor², D. Heller¹, L. Hunt¹, A. Emond¹.¹University of Bristol, Bristol, UK; ²University of Bath, Bath, UK

Background: Prescribing for children has not previously been taught at undergraduate level in Bristol. Furthermore, few studies have prospectively investigated the benefits of interprofessional learning (IPL) with respect to academic outcome.

Aims: The aims of this study were firstly, to design and implement a new paediatric prescribing workshop and secondly, to evaluate whether teaching this in an interprofessional environment increases knowledge and skills and leads to a change in attitudes as compared with uni-professional education.

Methods: We designed an innovative workshop to teach paediatric prescribing. Two thirds of the students were taught in groups with pharmacy students, one third alone. A questionnaire administered before and after the workshop was designed to reflect attitudinal changes in participants’ working and learning with other professionals. We used prescribing questions in the end of course written and OSCE examinations to test knowledge and skills.

Results: Ninety six medical students and 66 pharmacy students learned together in nine groups over the year. 68 medical students learned alone in 10 groups. 97% completed questionnaires. The medical students in the IPL groups showed a significant positive improvement in their attitude towards learning and working with students from other professions (p<0.05 in 6 of 9 questions). The pharmacists had a trend towards improved attitude. In the uni-professional group there was only one significant change: after the workshop they felt more strongly that their skills in communicating with other health professionals would not benefit from IPL. Both groups of medical students had an equal improvement in their confidence in prescribing and in their knowledge and skill.

Conclusions: We were able to show objectively, that interprofessional learning had a significant positive impact on attitudes to working and learning with other professionals. The improvement in knowledge and skill of prescribing for children was the same as in the uni-professional group. The workshop remains a core part of the curriculum and is popular with the students.

G209 SUBSEQUENT PUBLICATION OF ABSTRACTS SUBMITTED TO THE ROYAL COLLEGE OF PAEDIATRICS AND CHILD HEALTH 2002 SPRING MEETING

L. Bartholome, R. Ranmal, M. McColgan, L. Tyler, M. Levene, N. Modi.Royal College of Paediatrics and Child Health, London, UK

Aims: To compare the rates at which abstracts accepted and rejected for presentation at the Royal College of Paediatrics and Child Health (RCPCH) 2002 Spring Meeting were subsequently published in peer reviewed journals. An additional objective was to evaluate if abstracts accepted for plenary sessions were more likely to be published in higher impact factor journals compared to papers accepted for group presentations.

Methods: A list of all accepted and rejected abstracts submitted to York in 2002 was obtained from the RCPCH conference organiser. A total of 661 abstracts were submitted; 24 were accepted for plenary presentation, 236 were accepted for group presentation, and 401 were rejected. A brief questionnaire was designed to collect information regarding subsequent publication of submitted abstracts. Questionnaires were sent to the first and last author for accepted abstracts and the first author for rejected abstracts because additional author details were not recorded. The questionnaire was resent four weeks later to non-responding authors. All journal publication information was verified through Medline searches, and impact factors for journals were recorded.

Results: Information was collected for 65% of abstracts (432/661). Response rates for accepted and rejected abstracts were 79% (204/260) and 57% (228/401), respectively. The total publication rate for submitted abstracts was 43%. There was no significant difference in the publication rates for accepted (49%) and rejected abstracts (39%). Forty per cent of submitted abstracts were never submitted for publication. There was no significant difference in the proportion of accepted (35%) and rejected (44%) abstracts never submitted for publication. The median journal impact factor for all submitted abstracts subsequently published was 1.72. There was no significant difference in the median impact factors for plenary and group presentations (2.44 v 1.72). Further, the median journal impact factors for accepted (1.83) and rejected (1.72) abstracts subsequently published were not significantly different.

Conclusion: There was no difference between accepted and rejected abstracts with regard to publication rates and journal impact factors. A large proportion of both accepted and rejected abstracts were never submitted for publication. These findings indicate many factors impact whether an abstract submitted for presentation is subsequently published and suggest that further research is needed to clarify these variables.

G210 IS COMMUNITY TRAINING SUCCEEDING?

D. Nathan, V. Campbell, R. Dennick.Queens Medical Centre, Nottingham, UK

Introduction: Changing morbidity patterns demand greater community health competencies in the 21st century paediatrician. Community paediatrics is hence a core competency and defined by the Royal College of Paediatrics and Child Health for all postgraduate trainees. Competency however is not assessed beyond the Membership exam and concerns about reduced training opportunity for postgraduates prompted this study. No previous studies have considered this area.

Method: Knowledge levels as a subset of competency were explored. A purpose designed questionnaire was validated then administered to medical students and specialist registrars (SpRs) in paediatrics. This True/False paper was based on core knowledge expected at SHO level. It examined preferred sources of knowledge acquisition and assessed knowledge in community against hospital paediatrics. Statistical reliability was not assessed but the study had 99% power to identify an 8% difference between groups.

Results: Sixty nine medical students from three hospitals and across five teaching firms were surveyed. Their results were compared to 43 SpRs in two Health Regions. There was no significant difference in community based knowledge between undergraduates and postgraduates (p<0.001). Comparable results were obtained when comparing medical students to postgraduates within two years of passing the membership exam—one way ANOVA F = 1.127 with no significance in post hoc Bonferroni (p = 0.75). There was a significant difference in the hospital knowledge between the two groups (p<0.001). Postgraduates had a significant difference (p<0.001) between their community and hospital scores.

Conclusion: There is no significant difference in community knowledge as measured by this study between undergraduates and postgraduates. Postgraduates do however have substantially greater hospital based knowledge compared to undergraduates. This exposes deficits in postgraduate training around both community knowledge acquisition and the RITA process that may allow progression regardless of competency.

G211 COMPETENCY BASED ASSESSMENT IN COMMUNITY CHILD HEALTH: USE OF MODIFIED FOUNDATION YEAR ASSESSMENT TOOLS

M. Anderson, C. Campbell.University Hospital of North Staffordshire, Stoke-on-Trent, UK

Introduction: Four assessment tools for Foundation Year clinical competencies are currently being piloted by nearly 2000 doctors in the UK. Similar assessment tools are likely to be extended to cover all doctors in training as the Modernising Medical Careers reforms are implemented. Assessment of competencies in community child health has been perceived by trainers and trainees to be difficult because trainees tend to work in relative isolation. The differences in the workplace in community placements compared to hospitals can lead to a lack of focus by the trainees on their aims and objectives.

Aim: To demonstrate that the existing foundation year assessment tools can be developed to assess competencies of doctors undergoing training in community child health, improve their definition of goals, and realise their achievement of aims during the placement.

Methods: The RCPCH document A framework of competencies for core Higher Specialist Training in Paediatrics and the BACCH syllabus were examined to identify defined competencies that were most appropriately gained and assessed during a period of training in community child health. These competencies were grouped under eight commonly encountered community paediatric presentations and then subdivided into those that could be assessed by mini-Clinical Evaluation Exercise (mini-CEX) or the Case-Based Discussion (CBD) assessment tools. These tools were then used to assess the competences of paediatric doctors rotating through the community child health department at the University Hospital of North Staffordshire.

Results: Assessment by mini-CEX and CBD were performed over an initial four month period with paediatric trainees on community placement. Outcomes were assessed as number of prescribed competencies achieved compared to the previous group and feasibility of using the tools in a busy environment. Feedback will be presented from trainees and trainers.

Conclusions: The foundation year assessment tools seem easily adaptable for assessment of competencies in community child health from this pilot study. There is evidence that assessment in this way provides a focus for trainees and trainers which is beneficial, drives their learning, and records their achievements. The extra time expended will likely reduce with practice and be acceptable.

G212 AN ASSESSMENT OF FLEXIBLE TRAINING IN PAEDIATRICS OVER THE LAST 10 YEARS: HAVE JOB SHARES BEEN SUCCESSFUL?

M. Parr, W. Kelsall.Cambridge University Hospitals NHS Trust, Cambridge, UK

Background: In order to develop a quality service in the NHS it is essential to train and retain a diverse workforce. Increasing numbers of doctors are working flexibly with female trainees forming the majority of this group. Following the recent decrease in central funding and increased demand many Deaneries are experiencing difficulties with the provision of flexible training posts

Aims: To assess the experience of 10 years of flexible training in Paediatrics in a Deanery with reference to job share experience, career progression, and ultimate career aims.

Methods: A questionnaire was distributed to 30 paediatricians identified as currently working or having worked as flexible trainees in the Deanery over the last 10 years.

Results: 18/30 questionnaires were returned with 77% of trainees placed in job share posts and the remainder in supernumerary positions. 61% of respondents agreed that training flexibly had been an advantage for their career with only 16% claiming that it had prevented them from training in the subspeciality of their choice. 61% of trainees felt valued with 81% expressing the view that they functioned as effective members of the clinical team. 27% of trainees had experienced discrimination from senior colleagues and a third of trainees had experienced difficulties in applying for a flexible post. 61% of the trainees who replied felt that their salary adequately reflected their contribution though all current trainees would consider an alternative pay banding if it guaranteed flexible training. 88% of the specialist registrars would consider an alternative career if unable to train flexibly.

Conclusion: If job share slots can be attained then they appear to work successfully with the vast majority of flexible trainees reporting positive experiences in terms of integration into clinical teams, career progression, and career opportunities. However it was overwhelmingly clear that if denied the opportunity for flexible training most paediatric registrars would seek an alternative career.

G213 MULTISTATION INTERVIEWS: THE CANDIDATES’ OPINION

S. Humphrey¹, D. Wall², H. M. Goodyear².¹Birmingham Children’s Hospital, Birmingham, UK; ²Birmingham Heartlands Hospital, Birmingham, UK

Aims: To assess trainees’ opinions of the change in interview format from a traditional panel style to a newly developed multistation interview, in particular how well the candidates felt prepared for this type of format and whether they felt it was a fair interviewing method.

Methods: A questionnaire was given to all candidates, immediately following interview, for the centrally recruited SHO rotations which will start in February 2006. The questionnaire had eight questions about the interview scored on a Likert scale (1–6) and also asked demographic data including age and years of experience in Paediatrics. The data were analysed using the SPSS statistical package.

Results: 75% (72/96) of candidates completed the questionnaire. Reliability of the questionnaire was good with a Cronbach’s alpha of 0.876. 30 (42%) of candidates were female and 42 (58%) male. 64% of candidates were aged 26–30 years. 75% of candidates were F2 trainees. The majority of candidates (83%) had not been to this type of interview before. There was however no statistical difference in how the candidates answered questions in relation to their sex, age, or previous experience of multistation interviews (p>0.05). The candidates were mostly overseas graduates (79%) who preferred the format compared to UK graduates (p = 0.01). Despite all candidates receiving written information about the interview format, 67% of candidates wanted more information beforehand about the interview process. Candidates who gave lower scores to questions about fairness and helpfulness of the interview wanted more information than those who were happy with the process. All agreed that the process was well organised with a mean score of 5 for this question.

Conclusion: The majority of candidates thought that overall the interview process was fair, well organised, and that the questions were easy to understand. Most of the candidates preferred the multistation style format as opposed to a traditional panel interview. Follow up studies are needed for this interview cohort to see if they become successful paediatricians of the future.

G214 GENERAL PAEDIATRIC CLINICAL HANDOVER: PASSING THE BATON OR PASSING THE BUCK?

M. Anderson.University Hospital of North Staffordshire, Stoke-on-Trent, UK

Introduction: The introduction of the European Working Time Directive for junior doctors has resulted in a major increase in shift patterns of working. As a result, the number of occasions when clinical information is handed over between doctors has increased enormously. Enhanced training and systems for effective and safe handover are essential to maintain high standards of care.

Aim: To compare clinical handover practices in general paediatric units across three postgraduate deaneries in the UK with the guidance on best practice in handover in the documents Safe handover: safe patients published by the BMA and the NHS Modernisation Agency and Good Practice in Handover published by the RCPCH and to identify common problems in order that solutions might be shared.

Methods: A telephone/email audit of all 24 general paediatric units providing SpR training in the West Midlands, Nottingham and Trent, and Leicestershire, Northamptonshire, and Rutland Postgraduate Deaneries was carried out, asking questions about attendance, location, and timing of handovers and specific questions relating to educational provision and feedback from senior doctors regarding handover style and content.

Results: Sixteen of 24 units had consultants in attendance at morning handovers. Two had representative nursing staff. In nine handover time was not included in contracted hours of work. 13 units used continuously updated computer records, eight used handwritten records, and in three the handover was solely verbal. Seven had departmental written guidance regarding handover; seven reported regular feedback from seniors on handover content and style; only two described a regular review of handover practices; and only three reported provision of departmental teaching on handover. 14 units reported that handover time was used for additional educational activities varying from planned topics to “clinical pearls”.

Conclusion: There is a significant unmet need for training in the practice of clinical handover. The written guidance provided in some units has been collated and the author is piloting a short handover education session. In addition, handover times in which senior doctors are not present represent missed opportunities for “quality assurance” of clinical care and education of junior doctors. It is important to make the most of these opportunities given the continuing reduction in doctors’ hours.

G215 CLINIC LETTER TRAINING AND CURRENT PRACTICE: A REGIONAL STUDY IN THE LIGHT OF DEPARTMENT OF HEALTH GUIDANCE

G. Modgil, A. Baverstock.Musgrove Park Hospital, Taunton, Somserset, UK

Introduction: Recent guidance from the Department Of Health (DoH) states that it is good practice to copy clinic letters to patients and parents and is expecting all trusts to comply with this initiative.¹

Aims: This study aimed to determine current practice and training of core paediatric specialist registrars (SpRs) in clinic letter writing.

Methods: A structured questionnaire was given to all core paediatric SpRs in the southwest region at training days in Autumn 2005.

Results: There was an excellent response rate—97% (31/32) SpRs completed the questionnaire. Training: only 3% of SpRs had formal training in clinic letter writing and only 42% had received informal training. However 90% would welcome a training session. 16% had used the SAIL assessment tool.²Feedback: 55% had feedback on clinic letters from their consultant, 42% from secretaries and only 3% from GPs. Letter style: this was most influenced by the previous filed clinic letter. 71% preferred a free text letter with problem list, 52% used a more structured style with paragraph headings. Parents: 58% of SpRs were aware of the DoH guidance and of these only 17% had received had received information from their trust. There was considerable confusion regarding the principles of this guidance, when not to copy letters, copying to young children, consent, confidentiality, and third party involvement. Despite 90% believing that copying letters to parents/patients will lead to improved communication only 52% of registrars currently do so.

Conclusion: Our study has found that in general paediatric SpRs have had no formal training in clinic letter writing. Despite recent DoH guidance only half are copying letters to parents. At present there is a training gap for SpRs in how to write a clinic letter. We plan to look at ways to address this.

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G216 EDUCATION: A RIGHT OR A PRIVILEGE?

T. Bindal, A. Coe.Walsgrave Hospital, Coventry, West Midlands, UK

Background: The Calman reform of higher specialist training was to ensure standards of medical training improved and were safeguarded. However, with the implementation of the European Working Time Directive (EWTD) we may be taking a step backwards, which will lead to a detrimental impact on education and training.

Aims: To explore the views of the paediatric specialist registrars, (SpRs) in the West Midlands region on their education and training opportunities during contracted (paid) and own time (unpaid) hours following the implementation of EWTD.

Method: Questionnaires were distributed at local and regional registrar training days and via post to those who did not attend over a three month period.

Results: Of the 118 registrars in the region, 85 responded (72%), with most responders being in years 1 and 2. Formal teaching within contracted hours was variable with x ray meetings (65%) and protected local teaching (60%) being the most common. Average attendance at contracted teaching was 63%. The commonest reasons for non attendance were due to shift system/EWTD (68%) and the wards being too busy (27%). Informal teaching during contracted hours was during handovers (37%) and ward rounds (31%). Outside contracted hours the most popular form of learning was reading journals (74%). However 15% of SpRs reported doing none or hardly any other form of learning during unpaid hours.

Conclusions: Structured teaching is important especially with the enforcement of ETWD. SpRs have the expectation that this will occur within contracted hours. Therefore strategies at creating more teaching opportunities to cover a broader range of SpR shift hours rather than just 9–5 pm need to be considered. Formal teaching is variable across the region and informal teaching appears to be consultant dependent. In addition, there was a universal lack of community paediatric teaching during contracted hours. SpRs however, need to take on some ownership for their own learning, even more so as the number of contracted hours per week will reduce over the next few years.

G217 PAEDIATRIC SPECIALIST REGISTRARS’ VIEWS ON EDUCATIONAL SUPERVISION AND HOW IT CAN BE IMPROVED

B. Lloyd, D. Becker.Royal Free Hospital, London, UK

Aims: To determine what paediatric SpRs think of educational supervision and to learn how SpRs think educational supervision could be improved.

Methods: Postal questionnaire (with four questions) to 129 year 3, 4, or 5 paediatric SpRs in North Thames. Question 1 asked SpRs to rate their educational supervision on a Likert scale (0 = complete waste of time; 100 = excellent). The other three questions asked: which aspects were most useful; which aspects were done poorly; what advice would you give to a consultant who wanted to be a better educational supervisor.

Results: Eighty six SpRs responded (67%). Mean score on the Likert scale was 57; 37% of respondents gave a score of less than 50. The most helpful aspects of educational supervision were: feedback on performance (cited by 56%); career advice (48%); objective setting (40%). Aspects carried out poorly included: commitment to process (cited by 49%); ensuring sessions are bleep free (48%); listening rather than talking (26%); being encouraging (20%). Advice to consultants wanting to improve their educational supervisions skills included: listen; give objective constructive criticism and feedback on performance; give guidance on objective setting; understand individual needs of trainee; be encouraging; meet regularly to discuss progress and review objectives. Free text comments included: “Talk constructively about the trainee not yourself or internal politics”; “Take it seriously”; “Some consultants are totally unaware of what is required and see process as a form filling exercise”; “Ask to see my portfolio so that I can at least think you are vaguely interested”; “When supervisors are genuinely interested in educational supervision it is often useful, when they are not, it is usually completely useless.”

Conclusions: Our results show that: educational supervision is generally not highly valued by SpRs; only committed consultants should do it; consultants should listen to the SpR, understand their ambitions, provide feedback on performance, individualise the advice they give and be encouraging; form filling is of less importance. To our knowledge this is the first study of SpRs’ views of educational supervision and how it can be improved.