IMT - Ethics - Teaching Issues

Question 1

Teaching issues (Endocrinology): Past 4 weeks consultant stops you attending weekly IMT teaching due to staffing pressures. What issues does this scenario raise?

Answer 1

• Training vs service imbalance: repeated missed protected teaching
• Risk to curriculum progression: competencies/WPBAs, ARCP evidence, exam prep
• Patient safety: chronic understaffing → unsafe workload, rushed reviews, delayed care
• Wellbeing/burnout: persistent pressure + loss of restorative/educational time
• Fairness (justice): trainee being singled out; inequitable access to training
• Governance/culture: recurring pattern suggests systemic staffing or departmental culture issue, not a one‑off emergency
• Professional/contractual duties: department has obligation to support education alongside service

Question 2

Teaching issues: How would you approach this situation? (Use I‑SPIES(R))

Answer 2

I – Issue
- Repeated loss of protected teaching due to staffing → training risk + possible safety/culture problem

S – Seek information
- Clarify urgency today: is this a true clinical emergency or routine pressure?
- Confirm teaching is mandatory/protected and the local expectation for cover
- Understand staffing gap: who is off? what alternatives exist?

P – Patient safety
- Ensure ward is safe: identify high‑risk patients, prioritise urgent reviews
- Avoid unsafe practice through fatigue/overload; flag any immediate safety concerns

I – Initiative
- Speak to consultant promptly, professionally: explain impact on ARCP/curriculum and that this has been 4 weeks
- Offer solutions: swap cover, redistribute jobs, request locum, cross‑cover, consultant/SpR step‑down, adjust clinic/WR timing
- Propose a practical plan: protected teaching is default; exceptions only for true emergencies

E – Escalate
- If unresolved: inform Clinical Supervisor/ES (same week) + rota coordinator/ward lead
- If ongoing: escalate to TPD / college tutor/Director of Medical Education as per local training structure

S – Support
- Acknowledge consultant pressures; keep tone collaborative
- Ask for support in protecting training while maintaining safe service

(R) – Reflect
- Keep a brief paper trail (email summary) and use exception reporting for missed training/unsafe staffing

Question 3

Teaching issues: How would you explain your position to the consultant in question?

Answer 3

• Choose a calm moment; be respectful and solution‑focused
• State facts: 4 weeks missed + teaching is weekly IMT requirement
• Link to outcomes: ARCP evidence, competencies, safe progression to registrar level
• Emphasise balance: “I want to support the ward, but repeated loss of teaching isn’t sustainable.”
• Offer options: locum/cross‑cover, job prioritisation, consultant/SpR step‑down, rota tweak for teaching day
• If needed: agree a short‑term compromise today (if genuine crisis) but set expectation of a fix before next session
• Close with clarity: you will document/exception report missed training to ensure it’s addressed

Question 4

Teaching issues: How could you report this issue if the consultant remained unsupportive?

Answer 4

• Create a paper trail: email summary of dates missed + request for protected teaching
• Submit exception reports for missed training (and any late finishes/unsafe staffing)
• Speak to Educational Supervisor / Clinical Supervisor early
• Escalate to Training Programme Director / college tutor / DME if pattern persists
• If there are immediate safety concerns: involve clinical lead/site management per policy
• Keep it factual, confidential, and focused on solutions + safety

Question 5

Teaching issues: Do consultants have a contractual obligation to help facilitate teaching for junior trainees?

Answer 5

• Yes: supervisors/consultants have professional responsibilities to support education, feedback, and fair assessment
• Training posts are expected to provide learning opportunities and protected teaching where scheduled
• Repeatedly preventing attendance without mitigation risks training quality and can be escalated via training governance
• Acknowledge reality: workload pressures exist, but systems should protect training while maintaining safe care