Background The Simpson Centre for Reproductive Health is a tertiary Obstetrics and Gynaecology unit. The trainee rotas were complex and conflicted between service provision and training. Following a Deanery visit a Trainee’s Committee was set up and rotas became trainee-led. The impact of rota design change has been followed closely since then.

Drivers for Change Patient safety concerns and reduced quality of care

• Senior issues accessing advanced training

• Undermining behaviour

• Juniors felt anonymous

• No team structure

• Deanery ‘red flags’

Objectives • Improve access to training opportunities

• Improve satisfaction with training

• Positively influence departmental moral

How did we implement change?

A trainee driven rota working group was established with senior support. Though this, provisional rota options were formulated and co-designed. Based on trainee feedback the following points were essential in the design:

• Rota template identical for all tiers creating ‘rota buddies’

• Emergency teams with all on call work in blocks

• Formation of elective teams given continuity of consultant trainers

• Senior trainees running senior rota

• Consultant responsibility for junior rota

Results The Scottish training survey (STS) was utilised as a validated tool to measure outcomes.

Team Culture Teaching Educational environment KEY

2016 2017 2016 2017 2016 2017 -†‘/-†“ 95% significant change in mean score

=no significant change in mean score

-†“ performing poorly/-†‘performing well above for this indicator

Foundation     =

GPST = = = = = =

O and G ST =   =  =

Lessons Learnt • The team structure gave a sense of belonging, and trainees felt valued.

• There was a change of culture away from undermining behaviours and towards shared training goals.

• Access to training opportunities was made equitably, and increased continuity between trainees and trainers.

• It has measurably improved training and departmental culture which has impacted positively on the delivery of care.