Training Wales' future Physicians
Elizabeth Sharkey, Specialty Doctor, Cwm Taf Morgannwg University Health Board
Introduction
The Membership of the Royal College of Physicians (MRCP) exams are notoriously challenging, with the final Practical Assessment of Clinical Examination (PACES) exam requiring advanced clinical and communication skills.
Trainees in Wales have faced significant barriers, including a lack of local PACES training since before the COVID pandemic, forcing high costs to attend courses in England. This has led to low confidence among trainees, particularly in areas like Neurology, Cardiology, and Communication skills. With the Welsh health service under intense pressure, providing local support and training is crucial for retaining skilled doctors and ensuring high-quality patient care.
Methods
- Supported by senior consultants, the aim was to improve PACES exam preparation for trainees in Wales by creating a free course that replicated the carousel used in the exam with real patients, direct and meaningful feedback to candidates and a supportive environment to improve confidence. Collaboration with various teams and volunteers was crucial to success. Identified ‘confidence when sitting the exam’ as the key metric through a pre-course survey, with secondary outcomes including clinical case exposure and consultant feedback.
- Offered the course to Internal Medicine Trainees in Wales, blending bedside teaching, exam-like stations, and consultant-led feedback.
- Collected qualitative and quantitative data, capturing feedback verbally and electronically, using it to make real-time adjustments and identify future improvements.
Outcomes
- Re-established a free, high-quality training course for Welsh trainees, engaging patients, consultants, and multiple stakeholders.
- Improved candidate confidence scores from 3.36 to 5.9 post-course (out of 10).
- Exposed candidates to unique clinical cases and provided meaningful, directed feedback.
- Course was highly valued by participants:- Candidates felt the facilitators were knowledgeable and gave constructive feedback: Mean: 9.55/10. Candidates felt the cases were varied and helpful: Mean: 9.45/10
Learnings
- Practice issues such as venues and equitable access were challenging but overcame these with HEIW and health board co-operation, ensuring easier future course implementation.
- Pre-course survey identified focused learning needs, enabling targeted scenarios and materials.
- Gathering meaningful feedback was key. Involving volunteer patients meant that patients could also directly feedback to candidates.
What next?
Aim to replicate this course in each academic year and provide a similar patient-based, consultant-led course with direct feedback. With more experience, this can be expanded so more trainees can be involved at an appropriate stage in their career. Course will be adjusted based on feedback given by attendees.
