skills in new second year paediatric residents. Asexpected, confidence in activities requiring a higherlevel of skill, such as dealing with difficult personal-ities, did not improve immediately, but may increasein time. Although our findings were limited by asmall sample size, we plan to incorporate thisleadership training into our residency programmecurriculum and to follow resident leadershipdevelopment longitudinally.

Correspondence: Meta T Lee MD, MSEd, University of Hawaii John ABurns School of Medicine, Office of Medical Education, 1960 East-WestRoad, Biomed B-102, Honolulu, Hawaii 96822, USA. Tel: 00 1 808 9565086; Fax: 00 1 808 956 4461; E-mail: meta@hawaii.edu.

doi: 10.1111/j.1365-2929.2004.01867.x

A transition programme for junior doctors

Phil Rosengarten, Leissa Kelly & Debra Nestel

Context and setting Experienced paediatric staff(consultants and nurses) noted that high anxiety ofjunior doctors interfered with performance, espe-cially at the beginning of rotations. Paediatric staffidentified potential sources of anxiety and a needsassessment was conducted to elicit a perspective fromjunior doctors. Although the junior doctors’ per-spective overlapped with that of experienced staff,junior doctors identified more knowledge and fewerskills deficits and placed emphasis on life-threateningconditions. In recognition of the importance oftransition to new environments, junior doctors weregiven protected time on their first day to attend aprogramme that addressed their perceived needs.Supporting junior doctors may ultimately minimiserisk to patients.Why the idea was necessary The programme aimed toaddress the needs of junior doctors. The rationalewas that adult learners must perceive educationalinterventions to be relevant to their immediateneeds. By addressing the self-perceived needs ofjunior doctors before those identified by experiencedstaff, anxiety levels would more likely be reduced andperformance enhanced. This would lead to earlieradjustment to the paediatric unit, leaving juniordoctors more time in their rotation to extend theirclinical skills.What was done A 1-day programme was developed,based around themes identified by junior doctors. Amultiprofessional team led sessions that used diverseeducational methodologies based on principles ofadult learning. This also provided an opportunity forjunior doctors to meet paediatric staff in a non-threatening environment prior to commencing ward

duties. In order to implement the programme,funding was obtained from the regional healthauthority to cover the cost of consultants attending tojunior doctors’ ward activities for the day. Theprogramme has been conducted for 2 rotations andwill continue to be implemented.Evaluation of results and impact All paediatric staff(n ¼ 16) and junior doctors (n ¼ 4) completedwritten evaluations after the first rotation. Mostjunior doctors reported feeling more confident as aconsequence of the induction. None were less con-fident. Experienced staff reported less anxiety andgreater overall competence earlier in the rotation inthese junior doctors than in those in previouscohorts. The consultants reported better under-standing of the role of junior doctors as a conse-quence of covering for their ward activities.Although there are difficulties with self-report data,the results suggest that the programme was successfulin supporting junior doctors in transition to this unit.Elements that contributed to success were prioritisingand dealing with learners’ needs before others andproviding protected time on day 1.Future evaluations could triangulate feedback byincluding patients’ views well as those of paediatricstaff and junior doctors. The educational strategy ofthe transition programme may contribute to a moreactive approach to structured learning within the unitfor all paediatric staff. Group interviews may uncoverthese and other benefits that are hard to quantify.Finally, assessing the impact on patient safety isdifficult but relevant critical incidents could beevaluated to inform the transition and continuingeducation programmes in paediatrics.

Correspondence: Dr Phil Rosengarten, 122 David Street, Dandenong,Victoria 3175, Australia. Tel: 00 61 3 9791 4344; Fax: 00 61 3 9794 9174;E-mail: p.rosengarten@southernhealth.org.au.

doi: 10.1111/j.1365-2929.2004.01868.x

Peer observation of clinical teaching

Heather Fry & Clare Morris

Context and setting Peer observation of teaching isincreasingly promoted as a strategy to enhancepractice. Observation provides a means of focussingon teaching and engaging in reflective, constructiveand analytical discussion with peers. At the authors’institution peer observation of teaching has severaldimensions. It is used as part of continuing profes-sional development, is part of quality assurance, isnormally required during the probationary periodfor inexperienced lecturers, and is used formatively

really good stuff

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and summatively within our accredited (college-wide)Certificate of Advanced Study in Learning andTeaching (CASLAT).Why the idea was necessary Teaching observation isusually targeted at lectures or small group teachingand often does not occur on clinical sites. There arewell developed procedures, schemes and observationrecord sheets for the former contexts, as well as agrowing expectation among university employees ofparticipation in observation schemes. The medicalprofession is also placing more emphasis on trainingfor teaching.At Imperial College London, CASLAT is increasinglyattracting staff from the Faculty of Medicine, inclu-ding National Health Service (NHS) teachers. This,among other factors, raised the question of theappropriateness and desirability of observing clinicalteaching (i.e. medical teaching with real or simulatedpatients in NHS settings). It was generally regarded ashighly desirable for CASLAT participants to have theoption of observation of clinical teaching where thiswas part of participants’ jobs.What was done The first stage involved consultingwith key staff in the Faculty of Medicine and ourlinked teaching and district hospitals; this flagged-up possible ethical and practical issues andinformed development. The next step was todevelop a series of guidelines for good practicewhen observing clinical teaching. These weredesigned to guide the clinical teacher beingobserved and those undertaking the observation.They include an orientation to NHS-based teachingand have 3 key dimensions: informed consent,patient confidentiality, and the best interests of thepatients involved (including patient selection andpreparation, and conduct during clinical teachingobservations). The third step was to develop aclinical teaching observation record sheet. Thistakes the form of a series of questions in 6 sections:setting the scene; structuring the episode forteaching and learning; developing expertise andprofessionalism; concluding the session; teachingcontext; and enhancing practice. These questionsguide the observer and the subsequent discussion.Equally, they can be used by clinical teachers as away of interrogating their own practice andidentifying development needs.Evaluation of results and impact The guidelines andobservation record sheet have been well receivedand approved for use. Participants in CASLAT arepiloting these in both formative and summativemodes. The number of usages has not yet gener-ated sufficient data to report, and they are likely toaccumulate slowly. Consequently, the authorsdeveloped a feedback questionnaire that can be

completed by any user. ‘Really Good Stuff’ providesan opportunity for us to invite others to use theobservation guides and provide feedback onprocess, instruments and impact. The record sheetsand feedback proforma can be found at: http://www.imperial.ac.uk/educationaldevelopment/opportunities/openlearning/peerobservation.htm.

Correspondence: Heather Fry, Centre for Educational Development,Imperial College London, Seminar and Learning Centre – MezzanineFloor, Sherfield Building, Exhibition Road, London SW7 2AZ, UK.Tel: 00 44 20 7594 8780; Fax: 00 44 20 7594 8783; E-mail: h.fry@imperial.ac.uk.

doi: 10.1111/j.1365-2929.2004.01869.x

Maximising training opportunities

Fiona Anderson

Context and setting The aim of this ‘LearningTogether Project’ was to produce a competency-based learning package for senior house officers(SHOs) on an 8-week placement in a neonatalintensive care unit.Why the idea was necessary The training andintegration into the workforce of SHOs, who makeup the largest group of junior doctors in the UK, hasbeen a cause for concern amongst senior medicaland nursing staff for some time. This has been theresult of considerable changes to the service-basedtraining of junior doctors. These changes have beendue to the introduction of the European WorkingTime Directive and the UK’s New Deal for JuniorDoctors, resulting in a considerable reduction in thenumber of hours junior doctors work. This hashad a direct effect on SHOs’ exposure to clinicalexperience, supervision and service-based trainingwhich are fundamental in ensuring their fitnessfor practice.What was done Because SHOs spend as little as8 weeks in this particular clinical placement, it wasimportant that the project focused on core skills andknowledge in which the demonstration of compet-ence was achievable within the short timeframe. Ourproject focused on the following areas:

1 conducting a training needs analysis to identifycore competencies;

2 identifying a suitable assessment tool to measureclinical competence;

3 introducing preceptorship for SHOs in the clin-ical area, with preceptors selected from middlegrade medical staff and clinical nurse specialists,and

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