Clinical Governance - a term that has been part of the current jargon of NHS modernisation for some time - all health professionals should be aware of and an active participant in it.

In reality many doctors have felt that this has been part of government driven targets, rather than a genuine attempt to improve the quality of health care, they have therefore been reluctant participants. We are sure you have all heard the complaints and groans that arise when all clinical work is cancelled for a compulsory audit meeting. The irony of this is that for clinical governance to work, health professionals themselves have to drive it.

Clinical governance is part of the generic curriculum for specialist registrars (SpRs) in medicine and they will be asked about their experiences and training in it at annual reviews and penultimate year assessments.

We undertook an anonymous questionnaire of geriatric registrars in three regions; the North West, Mersey and West Midlands, to find out what their experiences of Clinical Governance and Clinical Effectiveness were to date. Fifty-five SpRs took part and although this was not a large or randomly selected number, we believe it is representative of many SpRs, and maybe even some consultants’, experiences. Being subjective, the questionnaire does not give any indication of the quality of training that had been received. The year of the respondents was skewed towards those in the first 3 years of specialist training. Responses were similar between the three regions.

Only 35% of the doctors had any clinical governance training. The majority of examples of training were trust hospital based.

The Results
Audit, unsurprisingly was where most had experience, with 84% having completed an audit project to implementation, although only 53% had completed a full audit cycle. This may reflect the frequent movements of SpRs between trusts and hospitals not having established audit ‘cycles’. However, only 13% had attended Caldicott awareness training (see box below).

SpRs felt more confident about doing literature searches, defining key search terms and critically appraising research articles (82%). Research methodology days and regular ‘Journal Clubs’ have encouraged this.

Most were aware of care-pathways (91%) and guidelines, but there was much less experience of developing them for their own clinical practice.
Large gaps were evident in complaints procedures (despite many knowing something about local hospital procedure), risk assessment and management and the ability to investigate a critical incident.

There may be lack of awareness by doctors of the large scope of clinical governance and clinical effectiveness as the majority of training has focussed on audit alone.

This survey reflects the patchy training provided in this area, and it is suggested that Regional Specialty Advisors and Programme Directors incorporate all elements into one of their training days on a regular basis.

The results of this survey have certainly encouraged us to go back and introduce different sessions into our specialty training days, and we would suggest this should become standard.

Examples of how to do this well should be shared between us so that clinical governance improves our practice, rather than taking us away from it.

Dr J Beavan, Dr S Briggs
and Dr C Turnbull