Case-study - audit
This case-study has been written by a Core
Medical Trainee, Dr Amit
Sud, who is currently working in
London. He carried out the
following audit as in a foundation year 2 trainee in a different
deanery. He has conducted many audit topics in clinical and
non-clinical topics and has presented these at international,
national, regional and local level.
Audit constitutes one of the pillars of clinical governance
and is the method by which improvement can take place. Topics may
be clinical or may cover wider issues in Medicine such as service
provision or training. The audit process is an ongoing cycle
involving identifying standards, observing practice and comparing
such practice to standards, implementing change, and observing new
practice. The successful completion of an audit has the
potential to make a difference to patient care and to provide
insight as to how a quality improvement process can take
place. Furthermore, the completion of an audit is a
competency expected to be fulfilled by trainees as early as
foundation training and will help in further job
applications.
I have had previous experience in completing audit cycles in
clinical topics. For example, I conducted an audit on the
completion of physiological observations on an acute medical ward.
In this article I hope to outline the process I have taken to
completing an audit on a non-clinical topic.
I conducted an audit on the provision of
teaching for foundation trainees at different sites within a
Foundation School in the UK. I chose this audit as I noticed
a discrepancy between the availability of formal dedicated teaching
between different sites within the same Foundation School. In
addition, this topic appealed to me as I have an interest in
medical education. I created a proposal and
submitted this to the Foundation School Director whom I
identified as a potential supervisor: he was supportive and
provided expert guidance. I first identified standards and
devised a way of collecting data: in this a case I decided to
design a questionnaire, which could be distributed to
representatives across different sites. One has to ensure the
pro forma for collecting data is clear and contains the necessary
data fields required to obtain a complete data set. The
hardest and longest part of the audit was waiting for responses:
this required a high level of organisation and perseverance to
ensure complete and accurate data were collected from different
trusts. Analysis of the results required minimal statistical
analysis: more statistical knowledge may be required for different
topics and support is available in local audit
departments.
The results confirmed my suspicion that
different sites were delivering differing quantities of dedicated
teaching for trainees, despite recommendations from the Foundation
School.
The next step in the cycle was to
ascertain why this may be the case, to communicate my results and
to implement my recommendations. I produced a report which
was submitted to the Foundation School and I presented my work at a
national conference: this served not only as an opportunity to
improve my presentation skills but also to discuss ideas and
solutions with others. Furthermore, I was approached to write
this article based on my presentation at the conference.
There are many conferences which one can submit work to:
discussions with your supervisor or searching the Internet is a
good method to identify appropriate conferences.
My specialist job is now located in a
different deanery. However, I hope that after my
recommendations have been implemented, I can work with another
trainee within the region to perform a re-audit.
This experience has taught me a number of
important valuable lessons. Firstly, audit topic can concern
a number of different topics, not necessarily clinical and work
well when the topic is one that interests you: motivation is
important for successful completion of an audit. Secondly,
communicating your ideas and project to a wider audience can be a
useful tool in developing a project. Finally this topic has
provided an insight into a quality improvement process which I
would like to implement in other disciplines.
Please note the content and
opinions expressed in all case studies are those of the writer and
do not necessarily reflect the views of NHS
Medical Careers.