Empowering trainees through understanding learning theory and changes in medical education.

Empowering trainees to think critically about decision making should result in the National Health Service (NHS) being more efficient and cost effective, thereby reducing the wastage of precious NHS resources on unnecessary investigations, treatment, and consequently putting patients at risk. There is a major shift from acquiring knowledge to critical analysis and synthesis of information for decision making. Trainees must understand how healthcare systems function and consequences of their decisions on budgets and patient care. Equally, faculty need to appreciate that their role is changing from information provider to facilitator of learning through feedback and supervision, role modelling, and innovator of learning approaches. A survey of 100 postgraduate trainees from the Severn Deanery was conducted on SurveyMonkey in March 2020 and January 2021.  The survey consisted of eight questions focusing on trainee responses to participation in clinical decision-making in the inpatient setting. An additional question on communication with the patient was included in the second iteration. With a response rate of 80, only 35% of trainees had their findings regularly verified by the consultant. One third of trainees reported that decisions were made by the consultant without asking their opinion on investigations or management. It was unusual for trainees to have any interaction with patients on consultant ward rounds and to understand the rationale for the requested investigations. The poor consultant trainee interaction represents a serious lost opportunity for experiential learning with real time feedback. Training programmes should support trainees being given opportunities to nurture analytical, problem-solving skills, dealing with uncertainty among other attributes of patient management. Trainees need to become competent through the art of critical thinking and develop a professional identity. Through this they develop confidence and competence leading to better patient outcomes, and prevention of the depletion of healthcare budgets.