The results of our study demonstrate that this programme significantly improved participants’ confidence in a broad range of core surgical topics which also translated to day-to-day perceived clinical performance. Presenters and supervisors received excellent feedback, with free-text comments highlighting the importance of the post-presentation discussion in clarifying key concepts, local guidelines or to explore the topic in greater detail. This indicates that our use of small group tutorial-style sessions with a discussion moderated by a surgical registrar or associate specialist was effective in maintaining interest and facilitating group learning. This has also had the collateral effect of raising awareness of local diagnostic and management pathways for newly rotating junior doctors.
Junior doctors who taught during their rotations overwhelmingly reported that the programme improved their skills as a clinical educator which is a core competency of the Foundation Programme (12). Free-text comments from participants also suggested that these sessions augmented their teaching attendance hours, a minimum number of which must be recorded on their e-portfolios to pass their ARCP, indicating that the programme had helped fill potential gaps in the generic Foundation teaching programme.
One of the early challenges of the programme was to maintain teaching quality and secure senior supervision. The use of a three-tiered leadership framework enabled junior doctors and surgical registrars take greater ownership of their clinical education, improved engagement as participants became more invested in supporting their peers and has ensured continuity.
During this programme’s 16-month study period, there were four handovers among lead junior doctors, two handovers among lead registrars and one overseeing consultant. The natural overlap in rotations for registrars, core surgical trainees and Foundation doctors has meant that there was always an individual engaged with the project, enabling staggered handovers, protecting continuity of the programme and preventing any sessions from falling through. All 12 sessions have been successfully delivered in each rotation and the programme is still ongoing in webinar format during the COVID-19 crisis.
The use of a Google Drive™ has been instrumental in facilitating an easy and effective handover. This drive included; a list of teaching topics, session registers and sign-up sheets, individual session feedback forms, overall programme feedback forms and certificate templates on completion of teaching sessions. Handover occurs when teaching leads for the next rotation have been identified and ensures that the next 12-week rolling programme can begin on time. We also incorporated a buffer period of 4-5 weeks in the 4-month rotation to account for delays in start times between rotations, bank holidays, clinical emergencies and sickness. This flexibility allowed additional sessions to be organised, if required, before the end of the rotation.
Participant ratings for the programme as well as supervisors and presenters remained consistently high throughout the study period, with 4 different groups of Foundation doctors having now engaged with the programme. This suggests that the use of electronic resources coupled with structured, staggered handovers has helped sustain the programme and maintain its effectiveness.
Several studies have shown that the outcome of near-peer programmes is as effective as consultant- and faculty-led teaching and are potentially more popular among trainees, possibly due to proximity in age and experience (13–17). Designing and participating in such programmes also provides trainees with teaching opportunities, enhances their knowledge of the subject and develops their communication, presentation and leadership skills. This may also have the added benefit of engaging trainees to take a greater interest in the specialty, particularly in the context of Foundation training where doctors have not sub-specialised. In the long term, the formal incorporation of these programmes can also improve overall trainee satisfaction with their rotation. This programme was also highly cost-effective; all participants taught or attended voluntarily, sessions were held at the hospital’s main lecture theatre and no additional funding or equipment was required.
We are encouraged by these positive results but are also cognisant of the limitations of this study. Over 70% of respondents had taught during the programme which may have introduced an element of bias in their evaluation of the programme. To reduce bias, we anonymised all feedback and actively encouraged suggestions for improvement which were followed through in successive iterations. Furthermore, our evaluation of post-session clinical knowledge and confidence is based on a subjective self-assessment. The use of pre- and post-session multiple choice questions (MCQs) could be used in future iterations of the programme as an objective measure of participants’ knowledge.
Adapting the programme for COVID-19
The COVID-19 pandemic introduced new challenges to the programme including the cancellation of all face-to-face teaching, increased work demands and rota changes resulting in fewer junior doctors in hospital at any given time. We have responded by using an online video conferencing platform to adapt this into a virtual teaching programme using the same teaching structure. We also advertised the programme on social media platforms to make it more accessible to doctors and medical students whose centres did not provide an alternative to face-to-face teaching. Participants now only require an internet connection and a computer or mobile device to access teaching anywhere, and sessions can easily be recorded for future use or for those unable to attend. We have also been able to expand our target audience from junior doctors rotating in the surgical specialties to medical students, interim Foundation Year 1 doctors and junior doctors from other specialties. This virtual platform remains in its infancy and was born out of necessity; future research is needed to compare the efficacy of a virtual approach with the face-to-face small group programme described above.