Real-life story - how to complete a successful audit
Dr Amit Sud, core medical trainee, talks about an audit he carried out as in a foundation year 2 trainee. He has conducted many audit topics in clinical and non-clinical topics and has presented these at international, national, regional and local level.
The results confirmed my suspicion that different sites were delivering differing quantities of dedicated teaching for trainees, despite recommendations from the Foundation School.
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 one of the competencies to be fulfilled by trainees in foundation training and will help in further job applications.
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 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 to which one can submit work: discussions with your supervisor or searching the Internet are good ways to identify appropriate conferences.
My specialist job is now located in a different Local Education and Training Board. 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 and valuable lessons:
- an 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
- communicating your ideas and project to a wider audience can be a useful tool in developing a project
- this topic has provided an insight into a quality improvement process which I would like to implement in other disciplines