Setting

This audit is not service-specific and spans all directorates where psychiatric trainees work.

Background

Safety for psychiatric trainees is a key indicator in the quality assurance of a training scheme. This has repeatedly been emphasised as an important issue by the Royal College of Psychiatrists (1999, 2006, 2008) and in recent psychiatric literature (Dibben et al, 2008).

Standards

Standards were obtained from the Royal College of Psychiatrists’ Council Report 134, Safety for Psychiatrists (2006). This augments the previous Royal College of Psychiatrists Council Report 78, Safety for Trainees in Psychiatry (1999). The following standards were of particular relevance:

ᐅ induction and safety training (e.g. de-escalation and breakaway)

ᐅ use of an alarm system

ᐅ lone-worker policy

ᐅ guidance/debriefing in the event of an assault

ᐅ environmental safety aspects of interview rooms (e.g. panic buttons, door opening outwards, inspection windows)

ᐅ safety of on-call accommodation.

Method

Data collection

As the above standards should be met for all trainees, it was necessary to identify all trainees within a programme. This can be done by contacting the relevant medical staffing department or medical education department.

A survey was developed with the aim of obtaining information directly from trainees about whether standards were being met, including the opportunity for trainees to comment about the reasons why standards were not met.

In order to obtain the highest possible response rate and ensure ease of distribution, a web-based survey tool was used. The survey could then be sent electronically to all trainees within the programme. Alternatively, postal questionnaires may be sent.

It is likely to be necessary to send email or written reminders to help ensure a high response rate.

Data analysis

Responses were analysed not only for the extent to which criteria were being met, but also for the stated reasons given by trainees as to why criteria were not met in their particular situations. Sub-analyses examined specific clinical situations where the meeting of standards varied. Examples included in-hours compared with out-of-hours working, and prison settings compared with outpatient settings.