Introduction An effective induction is a crucial welcome for trainees. When done well, it will encourage them to utilise many learning opportunities available and ensure a smooth and supported transition to working in a complex, unfamiliar environment. (GMC Report 2020)

Effective induction improves trainees’ satisfaction, performance, mental health, attendance, and they will feel welcomed and valued. Make clinical errors less likely which in turn improves patient safety. Increase retention and recruitment.

Background I started my higher specialist training in General Adult Psychiatry in Nottingham (East Midlands Deanery) in August 2021 and there was no trust induction organised for HSTs. Having completed my Core Psychiatry training in a different Deanery, I was new to the Trust and the Deanery. Being new to the trust, remote working during the pandemic and no formal trust induction on the top meant that several higher trainees felt isolated and unsupported. I raised these concerns and shared the challenges with my Educational Supervisor who suggested that I lead on a QI project to improve the induction process for Higher trainees.

Aims and objectives of the research project or activity To set up an effective Induction programme for future Higher Specialist Trainees in Nottinghamshire Healthcare NHS Foundation Trust.

Method or approach I started with scoping exercise and reviewed the literature and policies around induction and found a key report from the General Medical Council (GMC) published in June 2020.

I discussed my project idea with Dr Kehinde Junaid (DME) and Dr Deepa Krishnan (Consultant Psychiatrist, QSIR Associate) who agreed to supervise me and provide supervision with QI methodology. I carried out a stakeholder analysis and after discussion with medical education department, medical staffing and DME it was agreed to set up an Induction Programme in collaboration with all stakeholders.

Following the initial stakeholder analysis, I devised a survey based on the GMC (2020) report. Survey was sent to all the HSTS working in the trust and mixed methods (qualitative & quantitative) approach was used.

Findings After group and individual emails and multiple reminders, 50% of total HSTs completed the survey in 2021. Overall, the results of the 2021 survey showed very poor satisfaction and most trainees said they didn’t receive any induction. 50%-90% of HSTs did not receive information in 2021, in most of the key areas even after one month of starting work.

Several consultation meetings were held with stakeholders between May to July 2022 to plan changes. Two key deliverables were agreed:

1. Induction Booklet (delivered through this current project, I updated the original induction booklet offered to core trainees, FY and GPST doctors. I added sections relevant to higher trainees in close discussion and collaboration with medical education & medical staffing)

2. A bespoke induction for higher trainees (Although this was delivered by Medical Education & medical staffing team, I played a crucial role in ensuring that there is a trainee voice in designing the agenda for the induction programme)

New Induction plan implemented in August 2022. I carried out a post-implementation survey to assess impact of change. Results of survey showed improvements in all areas of induction. I have presented the comparative results of induction surveys in 2021 and 2022, to stakeholders and it was agreed:

1. To continue with bespoke induction programme for higher specialist trainees (led by medical education and medical staffing)

2. To update Induction Booklet (due to some changes in trust sites, trust leads and areas to be covered during on-calls).

Revised Induction plan was implemented in Aug 2023.

Key messages Leading this project has helped me:

To learn about QI project management & the importance of early stakeholder engagement for a sustainable change.

To make an improvement in important skills such as communication, team working, leadership and management.

In organising a sustainable induction programme along with induction booklet for future HSTs.

Attaining DrQI training from our trust QI team.

Next steps are are reviewing this year’s post implementation survey results and sharing these with stakeholders to plan changes accordingly for induction programme in future.