Training principle of the month 1: Every patient encounter is a learning opportunity

We introduce our first principle for paediatric training as we prepare for Progress+, our updated training programme going live from 2023. Each patient has a unique story, and unique characteristics, and so there are continual learning opportunities. Dr Laura Kelly and Dr Segn Nedd kick off our first principle with some guidance in case studies and a teaching presentation.
RCPCH Progress+ Training principle of the month
Last modified
27 October 2021

We start with the voices of children and young people...

From the RCPCH Epilepsy12 Youth Advocates

We’re a group of young people set on creating awareness, and we are very adaptable for situations that may occur so that we help make the change and educate others together.

Young people have been working with doctors, nurses and teams over the last year to help them with their work, so that they can keep providing the best care possible.  We have done this for epilepsy services - but our project, what we have learnt and our resources could be used in lots of different places or for different health needs. Find out more on our Epilepsy12 Youth Advocates page.   

Here are our top tips:

  • Get involved! It’s interesting to hear our views to make a change for the future as we are the young people experiencing it 
  • Work together! Speak with the people you work with and the patients and families 
  • Share what you find! Tell other people what you have found out to help their work too 

We wanted to do something with health teams to help you to help us, so that we could give you advice and our ideas on how to meet our needs, or how to give us support for things that we might be struggling to tell you, like our mental health or our worries and anxieties. So we created a Clinic Chat Check List full of tips and ideas about how to look at your service from our point of view.   

Young people have even made lots of games and activities over the years in the Recipes for Engagement and Recipes for Rights booklets that can help you to find out what matters to children and young people. These can help you learn more about the patients you are supporting and help turn every patient encounter into a learning experience.

Engagement is the big one and if you want your team to have a second opinion, then work with us as our project is about working together to create change. Speak to the patients in your area and learn together.

Creating a culture of resilience and joyful learning  - a consultant's tips by video

Each day, each patient encounter makes us better professionals and people. This includes our failures and successes.

Dr Anju Singh introduces this principle with a short video. Anju is a consultant neonatologist at Birmingham Women's and Children's NHS Trust; Clinical Lead Organ Donation BWC; Clinical Lead West Midlands Neonatal Operational Delivery Network (South). She was previously a long standing Training Programme Director (TPD) in the West Midlands and won the 2020 West Midlands PAFTA award 'The Annie Callaghan Award for Best Educational Supervisor'.

More than pictures - case study

Training level: All levels 

Setting: Accident & Emergency 

What prompted the change? All departmental X-ray reports were reviewed. Corresponding management plans were checked to ensure appropriate treatment had been given. Individual cases were reviewed. However opportunities for further shared learning were not always identified. 

What happened? Following review of daily X-ray reports. Cases where the predominantly skeletal X-ray findings were not managed as per the indicated report were collated. This included cases where pathology had been missed and cases which had been managed as abnormal (but had no pathology identified following Radiology review). The collated cases were used for regular teaching which reviewed the learning points from each case. Where recurring issues were found extra teaching was given. Further departmental teaching on elbow injuries and X-ray findings was given as a number were missed during a review period . 

How did this support training and trainees? This enabled individual trainees to increase their exposure and subsequent confidence in recognising pathology. This also supported knowledge of but also normal view on commonly presented injuries which required skeletal X-rays. Additionally, this process enabled the team to identify areas where further teaching was needed.  

Learning from each one - case study

Training level: All levels

Setting: Ward

What prompted the change? A proportion of trainees were new to paediatrics and not familiar with terminologies used in daily ward rounds or many conditions which commonly presented in that demographic area.

What happened? Each doctor on the ward round was assigned a number of patients and tasked to prepare their notes for the ward round. They were additionally asked to identify a lightening learning point (<1 minute). After the daily ward round a board round is undertaken to ensure that medical and nursing staff are clear of the management plans and outstanding tasks. Within this time for each patient a learning point was relayed for team learning. This point could relate to the clinical aspects of the case such as giving a brief definition of the main diagnosis/ condition or social aspect such as explanation of the meaning and reasoning for the type of social meeting which was being arranged. Where significant broader learning from a case was identified this was translated into weekly case presentations. 

How did this support training and trainees? This ensured that even when patients presented with seemingly common cases learning areas were identified and helped to further inspire more teaching and learning. 

Case presentations - case study

Training level: All levels

Setting: A&E, Ward, Clinic

What prompted the change? Opportunities for collective learning were being missed as a high number of interesting cases were coming through the department

What happened? Each trainee was assigned to present in Regular case presentation meetings. It was encouraged that trainees should base presentations on patients from the recent days. This was to encourage learning from potentially each and every case seen even if this was not considered as classically "interesting". Focus could be on the clinical and non-clinical factors relating to that case. 

How did this support training and trainees? This facilitated trainees to reflect on everyday encounters and be more creative in finding learning where time constraints applied. 

Quiz time - case study

Training level: All levels

Setting: Any clinical

What prompted the change? Opportunities for collective learning were being missed as a high number of interesting cases were coming through the department

What happened? Regular weekly or bi-weekly quizzes were constructed following clinical encounters. Factors from anonymised cases formed the basis of a set of clues which then were shared amongst the team in order for trainees to submit their suggested investigations, diagnosis and subsequent management plan. Following a set time period the answers to the cases were given and useful associated resources including articles, journals and Free-open access resources were shared to facilitate further learning. 

How did this support training and trainees? Teaching and learning was presented in a fun and engaging way and allowed creative ways to share research findings and current best practice resources.

What did we learn today - case study

Training level: All levels

Setting: Any

What prompted the change? Recognition that in busy clinical environments trainees may lose sight of learning opportunities.

What happened? Incorporation into the end of day handover huddle brief consultant led discussion of "what did we learn today".

How did this support training and trainees? This enabled trainees to highlight any learning points they had encountered, but also enabled the consultant to draw out learning that the team may not have recognised. Comments kept brief to maximise learning without delaying other activities.

Any practical tips? Include all professionals in huddle - nurses, allied health professionals and other who may recognise different learning points that trainees would benefit from considering. Could also work in clinic settings where the clinical team meet at end of clinic to consider their learning. 

A training presentation

Dr Laura Kelly and Dr Segn Nedd have created a presentation you can use in your teams, aimed at trainers and trainees, to start a conversation on how you can embed learning from each patient encounter

Download presentation at bottom of this page

Dr Laura Kelly and Dr Segn Nedd are trainee paediatricians. Laura is an ST6 and PGHAN Trainee at Birmingham Women and Children's Hospital and is also the chair of the RCPCH Trainees Committee and Segn is ST7 and PEM Trainee at Queen's Medical Centre. Segn is also a representative on the Trainees Committee and on the Equality, Diversity and Inclusion Member Reference Group.

Find out more about what to expect from Progress+