49 A trainee led quality improvement project to increase satisfaction of junior doctors in a high volume neurosurgical unit

The Department of Neurosurgery in Oxford University Hospitals NHS Foundation Trust is a tertiary referral centre which treats approximately 1500 neurosurgery inpatients per year. Feedback from junior doctors in the General Medical Council (GMC) National Training Survey 2018 revealed low rates of trainee satisfaction. To investigate the underlying cause, an anonymous online questionnaire was designed which collected data on various aspects of junior doctors’ experience in the department. Questionnaire responses from 12 out of 16 junior doctors identified problems with frequent overtime work, excessive administrative tasks, lack of protected training opportunities and variable levels of senior supervision on the ward.To reduce overtime working, the rota was re-designed to improve staffing levels in afternoons/evenings and a formal handover meeting was introduced. A departmental teaching programme with weekly seminars on the management of neurosurgical conditions and neuroanatomy was developed. This was supported by the introduction of a neurosurgery curriculum aimed specifically at junior doctors.The role of a ‘Ward Registrar’ was enhanced to provide structured support, supervision and training to junior doctors. This project has highlighted the value of a local questionnaire in seeking anonymised, honest feedback from junior doctors and encouraging engagement in the QI process. We anticipate that the frequent turnover of junior doctors in the department will pose a challenge for the project. It is therefore being linked to formal quality improvement training and a local peer support hub to ensure sustainability. Low levels of trainee satisfaction are likely to be multifactorial in nature and can be effectively investigated with a structured online questionnaire. By identifying key areas of concern at a local level, targeted QI projects can be designed and led by trainees, with an overall improvement in satisfaction, working hours and training opportunities.