Distance Learning Project - Supporting flexible trainees in Psychiatry.
Ann Poyner, Project Officer and Aileen
Wood, Training and Development Co-ordinator
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Research has shown that flexible trainees in psychiatry are a high calibre group who perform at least as well as full time trainees in MRCPsych examinations (Herzberg and Goldberg 1999). Flexible trainees are doctors in training, working in a less than full-time capacity. The majority of flexible trainees are women who train flexibly for reasons relating to childcare. In autumn 1999 the North Thames Deanery ran a series of appraisal training seminars, in which it became apparent that flexible trainees were complaining of lack of access to information technology training and inadequate skills in using electronic information sources. This echoes the findings of a general lack of access reported by full time trainees in psychiatry (Kotak and Butler 2001).
The North Thames Deanery and its' successor organisations are committed to improving training opportunities for flexible trainees in all specialties and to overcoming prejudice about flexible trainees and their training. The North Thames Regional Library and Information Development Unit (LIDU) proposed a millennium year pilot project to support flexible trainees in psychiatry in their use of computers and information skills development. The Deanery supported and funded this project.
In autumn 1999, 20 trainees who had declared difficulties in accessing information technology (IT) skills training were contacted by the Deanery. Thirteen expressed an interest in the project but one later withdrew. At the initial project meeting on 28 February 2000, there was great excitement amongst the twelve flexible trainees who had responded to the invitation to join the project. It became clear that the project was timely and innovative in its tailoring of training to individual needs.
The trainees were working in the
following areas within psychiatry: adult psychiatry/community (4), old
age psychiatry (4), child psychiatry (1), psychotherapy (2), education
and professional development (in a mental health context) (1). All trainees
were working flexibly for childcare reasons and with the exception of one
trainee who had teenage children; the other eleven had pre-school or primary
school children. Two trainees gave birth during the year.
The aim of the project was to provide one to one information skills training at home for the flexible trainees taking part in the project, enabling them to improve their IT and searching skills and gain confidence through their continued use.
To complement this, a workshop programme
was offered to facilitate small group learning. The Project Officer appointed
by LIDU worked from home and the project was conducted via informal networking.
At the end of the project the flexible trainees would be able to
A laptop computer and printer were provided for the project participants to use during the project. The project ran from February 2000 to January 2001 i.e. one calendar year and was funded to allow 4 individual home visits; these intensive sessions averaged 2-3 hours, sometimes longer and were supplemented by half-day workshops.
A first personal meeting was set up with each participant. The existing skills and project expectations of each participant were assessed. A questionnaire was completed to record this data as a base line for later comparison. A brief and basic tutorial on Microsoft Windows software and some advice on using Microsoft Word software were given. They were advised to register with Doctors Net (www.doctors.net.uk), a free service run by doctors for doctors, which gives access to a wide range of information sources and web links including the full text Cochrane Library.
It became very clear on the first visits that most of the group had very limited computer literacy. They requested and needed more help with understanding the Windows software environment and word processing. They also expressed an interest in learning about Microsoft PowerPoint software. These requirements were built into the project programme. About half of the group lacked email communication. Eleven out of the twelve made Internet connections quite early on in the project, often using the shareware software from their home computer.
Subsequent visits attempted to cover the electronic searching skills agenda. Each trainee expressed a preference about the order in which to cover the various project topics, often in relation to a particular work issue. Some participants preferred a passive learning process of being shown databases and Internet sources of information and how best to search them. Others wanted to engage in immediate active searching for specific information, based on their current clinical work. Whilst this gave answers, the principles of how to construct searches and evaluate information sources were in danger of being overshadowed.
The one to one tuition on offer, allowed the trainees to admit their shortcomings and ignorance in private and determine their individual training requirements and pace of learning. The Project Officer offered telephone support throughout the project and encouraged the flexible trainees to make contact between visits. Notes on issues raised and covered at each visit were kept.
On the fourth visit, an evaluation
questionnaire was completed. This mirrored the initial questionnaire in
an attempt to quantify progress. The trainees were also asked to complete
an exit evaluation exercise task (see Table 1).
There was very positive feedback
from a workshop held early in the project period giving tuition on PowerPoint
software and the Cochrane Library. The participants enjoyed each other's
company and the opportunity to share experience and problems. Some trainees
felt more able to ask questions stimulated by small group work. Four more
half-day workshops were offered in the autumn of 2000 covering Word and
PowerPoint software, the Cochrane Library, Internet information sources
and how to search PubMed. Those attending the workshops were given training
notes and topic specific exercises to complete. Attendance at all the workshops,
together with four personal visits gave each participant the opportunity
for nine training sessions. Only one trainee managed to achieve this. Others
were able to attend between two and four workshop sessions and unfortunately
two trainees failed to attend any.
Due to the flexible nature of the trainees' contracts and pressure of non-work commitments, it should be noted that not all trainees completed every part of the course or evaluation programme and the numbers and the percentages stated reflect the numbers who fully participated in each area evaluated.
Only 1 trainee (8%) had never used a computer before, 4 trainees (33%) used one occasionally, 6 (50%) used one regularly and 4 (33%) had access to a personal computer at work. Eight trainees (67%) said that they felt reasonably confident using the Window's operating system before the project commenced and 7 (58%) had used Word prior the project. Only 1 trainee (8%) had used PowerPoint. 4 trainees (33%) had previous training and all 12 trainees (100%) had used Medline on CD ROM but only 1 (8%) had used a web version of Medline. Only 3 trainees (25%) had attempted the use of the Cochrane Library.
Database searching skills and search techniques data
Four (33%) trainees rated themselves as complete beginners and 8 trainees (67%) stated they could do basic searches. A detailed breakdown of pre course and post course and post searching techniques is shown in Table 2 and demonstrates the markedly enhanced skill range developed through the training package.
Evaluation of the use of the Internet pre and post training showed that 9 trainees (75%) had used email prior to the course and 12 (100%) used it after the course. Only 2 trainees (17%) had used the PubMed database prior to the course and 10 (83%) were able to use it by the end of the training period. Most of the group used of Doctors Net effectively and became confident about exploring various Internet sources of information. The Cochrane Library was searched regularly.
Most trainees had attempted basic word processing before the project but those able to benefit from the workshop sessions on Word, improved their range of skills significantly.
One trainee (8%) had used PowerPoint before the course and 8 out of 9 trainees (89%) who received PowerPoint training were skilled in its use after the course.
The trainees in this project had
a shared background with competing work and domestic pressures and tight
schedules, which allowed limited time and flexibility to include library
use or skills development as part of their regular work pattern. The age
range of the trainees, being mid thirties plus, reflected a common experience
of receiving little or no computer training whilst at medical school. There
was a home computer available to most trainees but this was generally seen
as the husband's computer related to his professional use, and in most
instances there was very limited access to it. Most trainees however, did
have basic Medline searching skills and word processing skills prior to
the project. The main value of the training can be seen as enhancing the
use of search techniques, which play an essential part in the delivery
of evidence based healthcare. Additionally, trainees became familiar with
the Cochrane Library and PubMed databases plus Internet sources of information.
It was noticeable that those in the group that did manage to attend workshops
made greater progress overall. The pressures on the trainees were such
that only 8 trainees (66%) were able to schedule all 4 personal home visits.
It is suggested that the list of tasks set out in Table 1 could
a useful evaluation tool for IT skills
training for College Tutors and NHS Trusts.
The key feature of this project was the liberating impact of the trainees having a dedicated computer to use. This was central to the development of their confidence and skills. There was an opportunity for personal use of software and the Internet but the important application of enhanced skills to their work situation was most valuable. Being able to respond to a request from a senior colleague 'to do something computerised' without feeling totally lost or being able to initiate improved presentation of their work represented a big leap forward. Much of the trainees work was highly confidential and knowledge that computer held data was safe in their hands was very important. The portability of laptops enabled them to be used at work. Most of the trainees worked in situations where access to computers or an information service was limited. The NHS computing infrastructure serving the flexible trainees was virtually non-existent.
The flexibility of home visits allowed participants to plan their working pattern and determine visit dates, maximising the time they could allocate to training. It was quite noticeable that on their fourth home visit trainees made significant progress.
The intensity and stresses in the lives of the flexible trainees can be barriers to regular reinforcement and implementation of what they were learning and the trainees voiced concern that their learning momentum might slow down when the project ended.
Those who completed the evaluation exercise did not regard it as being too onerous, despite earlier expressed misgivings about being tested. In fact, they were pleased with their efforts. The exercises set at workshop training sessions proved very useful in focussing attention on various aspects of the software packages or databases being used. One participant said that doctors are notorious for putting things off and therefore perhaps they should have been pushed into completing set tasks at regular intervals during the project.
All flexible trainees felt that continuing
support would be valuable and suggested the following; drop-in sessions
in Central London for informal advice with some-one familiar; making a
help line contact available; making refresher opportunities available to
re-cap on topics covered during the project and possibly, individually
booked sessions for mediated searching help on specific subjects.
Ideas for the Future
The Library Information and Development Unit staff has gained more experience of delivering individual training and workshops. It is planned to develop this project into a larger one based on workshop activities (which are clearly more cost effective) to deliver IT training to trainees, whose personal circumstances have rendered them disadvantaged in accessing training in these skills. These groups include flexible trainees in other specialties, refugee doctors and others who have trained in developing countries. It is planned that future work will consist of a 5 module basic training skills package, delivered to groups of 10 trainees in a workshop format over a set period of time. It is estimated that these workshops can be run economically at a cost of approximately £30 per trainee per day, which compares well with the cost of commercial courses. The 5 modules will comprise of: 1. Microsoft Windows training - 1/2 day. 2. Microsoft Word training - 1 day. 3.Microsoft PowerPoint training - 1/2 day. 4. Basic Internet / email training - 1 day. 5. Database search techniques - 1 day. The cost of providing such training would fall well within most trainees' study leave allowances.
Based on project experience, participants in a future training programme would be required to have access to a computer at home or work. This would allow them to gain maximum benefit from the training given.
The workshop exercises and training
notes prepared for use during the project may be developed to introduce
a more formal learning framework for the programme, with set work introduced
for completion between workshops. They could also be mounted on the Deanery's
website as a package of distance learning tutorials.
Herzberg, J. & Goldberg, I. (1999) A survey of flexible trainees in psychiatry in the North and South Thames Region. Psychiatric Bulletin, 23, 616-618.
Kotak, A. & Butler, R. (2001)
Do trainees have adequate access to computers and computer software. Psychiatric
Bulletin, 25, 31-32.
Table 1. Evaluation Exercise
Table 2. Searching Techniques