This post is the opinion and experience of the author
It was around 10 years ago now that I joined the STP in medical physics. It was a very interesting time: for me as it was my first full-time job and in a field I’d wanted to work in since I’d heard about it; and also for the healthcare science community. The STP was brand new; this was the first year it had run in most specialisms.
Old systems had been replaced and not everyone was happy about it. Scientists are problem-solving innovators, but they can also be a stubborn bunch! I often found myself being forced to defend the value of my training scheme to my supervisors in the tearoom. I did and still do agree with the principles and methods of the STP, though am very much aware that there were plenty of mistakes made in the implementation.
Issues with the new STP
Like many of my colleagues I joined the STP having done well in uni and with considerable ambition. I had plans to climb the career ladder as quickly as I could. This made me very proactive in trying to stand out, so I volunteered to help with projects that weren’t relevant to my competencies.
If I had to sum up what caused my bad experiences in one word it would be: competencies. The greatest cause of all my stress on STP was getting competencies reviewed in a timely manner. The STP lends itself to ongoing small assessments. Under the old training scheme in my specialism, all assessment was based on a big portfolio reviewed externally towards the end of the process. My supervisors were unaccustomed to receiving many shorter submissions to be completed as we went along. I dutifully prepared my work and tried to submit work as I went along; in many cases being verbally assured that the work was adequate and that review was a formality. At the request of my supervisors this was often done informally, submitting work via email for approval before moving a final version onto the Online Learning and Assessment Tool (OLAT). All too often I would never hear back on that email.
Well into specialism, much of my rotation work had not been looked at by assessors. Most took months to get any feedback. Some competencies took over two years before getting to the first feedback! I kept on trying to chase competencies and ask for feedback as often as I could. I lost a lot of time to chasing competencies. And what was worse, they sometimes came back with corrections forcing me to revisit work done months before. It stung even more for those competencies I hadn’t allowed myself to worry about after being verbally assured all was well and the assessor’s sign-off would be a formality. And sadly with my new focus on getting those competencies sorted my early proactivity came back to haunt me! My supervisors fed back that I used to be so proactive and was now obsessed with competencies.
I made plenty of mistakes in dealing with all this. Still thinking of that ambition and desire to have it all under my control, I did not involve my training officer (who worked in another specialism, so I didn’t see them all that often). I wanted to handle it myself with those who had my work to look at. I didn’t acknowledge my own mental health issues: high achievers just get this under control right?
What’s changed for me?
Reading this post back as I arrive at this section, it seems I hated my time on the STP. I have to remind myself that this is supposed to be a post about bad experiences so I will add that I also have many fond memories of the STP. And in the end I did complete!
In the years since I struggled with episodes of low mood, some of which left me struggling to function in a day. I attended a course on Cognitive Behavioural Therapy (CBT) with a local charity and how that opened my eyes! Looking back to those times I was clearly struggling with periods of anxiety and low mood, which I managed to hide at work but left me tired and disinterested in other aspects of my life. Now I know some of the techniques to help get through it, and happily do not struggle nearly as much as I once did. I do not know how much of my perception of those difficult times was brought on by my experiences of the STP or the state of my own mental health at the time. In practice I’m sure it was a combination – neither would have helped the other.
I have also had the opportunity to reflect on my experiences a little later in my career as I became involved in the delivery of training and assessing competencies myself. I remember well the first time it took me weeks to provide any feedback on a competency. One very apologetic email to a trainee but an understanding/encouraging response that I was still one of the quicker reviewers in the team! I made sure to be quicker the rest of the time, it was a terrible feeling to become what had caused me so much trouble not that long before.
So I know how busy things get now, and how easy it is to forget or assign a low-priority to training. But I also think that when you interact with a trainee you are being a leader. And our approach to leadership must be to take proper care of those in our charge. Having had a bad experience does not justify facilitating it for others. As innovators in healthcare it should inspire us to make things better. To that end I always tried to quietly check in on the trainees and advocate for them in departmental meetings. I could offer the informal advice that a training officer dare not! Like who the slowest are to look at competencies, and who to quietly move the competencies to when they take ages to come back. Working with trainees has become one of the most fulfilling parts of my career; helping to support the future of our profession is such a privilege and will be of service to patients long after our careers end.
What’s changed for the STP?
And whilst the management of the STP is certainly far from perfect, I do believe there have been many improvements since it was introduced, so credit to the National School and the healthcare science community is due for that. We now have things like:
- Train the trainer resources – assessors need to know what input is expected from them.
- Regional trainee networks – allowing trainees to form a community and seek support from each other.
- Mid-term reviews – so experiences like mine would be picked up earlier and could be corrected.
- The National School actively promotes mental health on their website and twitter account, pointing to resources and support.
Whilst the STP will always need ongoing improvement, these are encouraging steps forward and I hope will lead to more.
My advice for trainees, trainers & training centres
My advice for trainees to protect your mental health and experience on the STP is:
- In a controversial opinion, don’t be too proactive! Your STP work will keep you plenty busy. My approach when I got involved as a trainer was that if it’s not relevant to a competency then I shouldn’t ask a trainee to do it. I would advise trainees to politely decline the offer of any work if it cannot be linked to a competency.
- Get your competency submissions online at an early stage. Make an evidence trail that you are doing your work, then you have an auditable record of when you completed and when it was reviewed.
- Seek external help early on when things are not working out as planned. Go to your training officer, the National School, whoever you need to! Don’t suffer in silence.
My advice for trainers to help and lead your trainees would be:
- Be timely with reviewing your competencies! Training is not something which just happens, it requires input from trainers. And that includes assessment.
- Remember that you may only see a few competencies, but you are contributing to a mammoth effort to get dozens signed off. So you can have more impact than you realise when taking so long with competencies.
- If you don’t have time to look at competencies, the best thing you can do is admit it! The sooner you tell the trainee that you won’t be able to help this time the sooner they can start looking for someone else.
- If you do end up taking a long time to review a competency, please respect the fact that the trainee will now have to revisit work done a long time ago whilst possibly having move to a different rotation. And this is through no fault of their own. So if you must demand corrections, keep them to the minimum.
And now to training centres; please look after your trainees! You have a responsibility to the next generation who will replace you in caring for patients. I would strongly encourage all training centres to consider some of the following suggestions:
- Implement a training policy which includes expectations for a reasonable turnaround time to provide feedback to trainees.
- Have a training officer willing to enforce this policy. Someone who will be on the trainee’s side when it’s needed
- Include an escalation procedure; for sure trainees should chase competencies themselves in the first instance. But if that doesn’t work they will need help and support. When should a trainee report delayed feedback to a training officer? What must they do to help? When should a competency be re-assigned to a different assessor?
The editors would like to stress that you can and should contact the NSHCS (via firstname.lastname@example.org) if you are struggling. All emails are triaged to the appropriate people who are able to help, all contact is treated fully confidentially and a properly trained member of staff will respond to you. The National School has appointed a Training Support Case Manager dedicated to the wellbeing and support of trainees