Challenges to an Uninterrupted Intern Learning Environment.
Newly qualified doctors gain the clinical experience required to transition from medical students to junior doctors in a graded and supervised manner during their intern year. The National Intern Training Program has been designed to provide educational support for this transition. Attendance at on-site dedicated intern educational sessions is a requirement of the Medical Council, who are cognizant that this is often an unstructured and challenging learning environment. While it is highly recommended that these sessions are bleep-free and protected, 70% of interns surveyed said that bleep-free teaching did not occur in their hospital1.
The adverse impact of continuous disruption and distraction during educational sessions is well established2. Thus, the Mid-West Intern Network implemented a bleep-free policy in 2013 which was discussed with all Ward Managers. Subsequently, interns were advised to turn pagers off for the duration of their dedicated teaching sessions (two 1-hour sessions per week), with urgent calls to be addressed by another team member or if unavailable, to access the On-Call Interns (whose bleeps remain on during teaching). Despite implementation of this policy, many bleep interruptions were still noted on an ongoing basis. We decided to observe teaching for a period to quantify and determine the nature of these bleeps. Interns were asked to continue ‘usual practice’ for 2 sessions (i.e. bleeps either on or off). On average, 7 bleeps were recorded per session, averaging one interruption every 8.5 minutes.
Over 4 educational sessions, interns were instructed to leave their bleeps on to quantify the number of attempted communications during the 60-minute session. Bleeps occurred on average 14 times during a session (an average of one interruption every 4.3 minutes) with the majority deemed by the intern as non-urgent (90%). The maximum number of bleeps for a session was 22 (one bleep every 2.7 minutes). This study reveals that there is failure to comply with the no-bleep policy for non-urgent queries in University Hospital Limerick. More surprisingly, when given a choice, many interns despite being informed of the bleep-free policy for intern teaching (excluding the on-call interns), chose to leave their pagers on for this period. Senior team members also contacted interns via mobile phone during the sessions. Following this study, we have arranged a bi-weekly announcement over the hospital intercom to remind nursing staff/team members about the bleep-free intern teaching sessions but we have found both senior and junior doctors’ behavior challenging to change. Hence, a culture shift will need to occur before on-site educational sessions are truly interruption free.
E Wong, L Griffin, K Betts, M O’Connor
Mid-West Intern Network, University Hospital Limerick, Dooradoyle, Co. Limerick.
Dr. Eleanor Wong
Department of Medicine, University Hospital Limerick, Dooradoyle, Co. Limerick.
- HSE Medical Education and Training. Implementation of the Reform of the Intern Year, Second Interim Report, On the implementation of recommendations of the National Committee report on the Intern Year, Phase 2: July 2010 – July 2011[Internet]. Dublin: Health Service Executive; 2012[cited 2016 April 26th]. Available to download from: http://www.lenus.ie/hse/handle/10147/218911
- Hutchinson L. ABC of Learning and Teaching. Educational environment. 2003;326:810–812.