Maternity Training Needs Analysis and Training Matrix ...

Maternity Training Needs Analysis and Training Matrix Clinical GuidelineMaternity Training Needs Analysis and Training Matrix Clinical Guideline V3.0 Page 1 of 36
Maternity Training Needs Analysis and
Training Matrix Clinical Guideline
Maternity Training Needs Analysis and Training Matrix Clinical Guideline V3.0 Page 2 of 36
Aim/Purpose of this Guideline
1.1. To offer advice to staff on their mandatory training needs and how they may seek to undertake the training required. To be transparent regarding the identification of training needs to meet the demands of ensuring safe, effective provision of care. This TNA and training strategy is specific to midwives and also includes the multi-disciplinary team of Obstetricians at all levels, Maternity Nurses, Maternity Support Workers, Obstetric Anaesthetists and Paediatricians who work within maternity clinical area
1.2. This version supersedes any previous versions of this document.
2. The Guidance Royal Cornwall Hospitals NHS Trust (RCHT) is committed to the vision of the National Maternity Review Better Births Report to become safer, more personalised, kinder, professional and more family friendly. Education and training can break down barriers to providing safe care, creating an environment where all staff learns from error, patients are at the centre of care, treated with openness and honesty and where staff are trained to focus on patient needs. However, the right workplace conditions, motivation and opportunity must also exist in order to ensure sustained behaviour change (Health Education England, 2016). This training needs analysis (TNA) and training strategy, identifies the training required to underpin our commitment. To support this, RCHT maternity has successfully bid for Health Education England funding for safety training. Maternity services cannot operate in isolation from the rest of Royal Cornwall Hospital (RCHT), sharing many systems and procedures, therefore, this strategy should be cross referenced with RCHT Mandatory and Statutory Training Policy.
2.1. Training Needs Analysis
2.1.1. Clinical Negligence Scheme for Trusts (CNST) & Ockenden(2020) 2.1.1.1. The Maternity Safety Strategy set out the Department of
Health and Social Care’s ambition to reward those who have taken action to improve maternity safety. RCHT continues to follow the NHS Resolution Clinical Negligence Scheme for Trusts (CNST) scheme (NEW 2021). In order to incentivise
Data Protection Act 2018 (General Data Protection Regulation – GDPR) Legislation
The Trust has a duty under the DPA18 to ensure that there is a valid legal basis to process personal and sensitive data. The legal basis for processing must be identified and documented before the processing begins. In many cases we may need consent; this must be explicit, informed and documented. We cannot rely on opt out, it must be opt in.
DPA18 is applicable to all staff; this includes those working as contractors and providers of services.
For more information about your obligations under the DPA18 please see the Information Use Framework Policy or contact the Information Governance Team rch-tr.infogov@nhs.net
improvement in the delivery of best practice, NHS Resolution will be making a reduction in the CNST maternity contributions of trusts that are able to demonstrate compliance with the 10 criteria agreed by National Maternity Champions. Trusts who cannot demonstrate full compliance may be eligible for a smaller discount providing that savings are used to take local action towards meeting the criteria.
2.1.1.2. The criterion relevant to training is CNST point 8; evidencing
that 90% of each maternity staff group has attended an in- house multi-professional maternity emergencies training session within the last training year. Training should include fetal monitoring in labour and integrated team-working with relevant simulated emergencies and/or hands on workshops.
2.1.1.3. The training syllabus should be based on current evidence,
national guidelines/recommendations, any relevant local audit findings; risk issues and case review feedback, and include the use of local charts, emergency boxes, algorithms and pro-formas. There should also be feedback on local maternal and neonatal outcomes.
2.1.1.4. Maternity staff attendees should include: obstetricians
(including Consultants, staff grades and trainees); obstetric anaesthetic staff (Consultants and relevant trainees); midwives (including midwifery managers and matrons, community midwives: birth centre midwives and bank midwives; maternity theatre and critical care staff; health care assistants (to be included in the maternity skills drills as a minimum) and other relevant clinical members of the maternity team. PROMPT training, fetal monitoring training and point of care simulation are planned and all relevant staff groups will take responsibility to attend annually to meet CNST standards for their staff group.
2.1.1.5. During the COVID pandemic, the 10 criteria were amended
in line with the evolving situation and updates sent to Trusts. The most current update to Safety Action 8 issued in March 2021 requires Trusts to evidence that the maternity unit staff groups have attended an ‘in-house’ multi-professional maternity emergencies training session since the launch of the MIS year three in December 2019. Training resources will have been provided digitally or in person. The 90% threshold was removed from all safety action 8 requirements with the recommendation that Trusts commit to addressing any shortfall and facilitate local, in-person MDT training (including fetal monitoring) when this is permitted.
2.1.1.6. The Ockenden Report (2020) lists seven Immediate and
Essential Actions to help improve safety in maternity services across England. Essential Action 3 states that “Staff who work together must train together”. Trusts must ensure that
multidisciplinary training and working occurs and must provide evidence of it. This evidence must be externally validated through the LMS, 3 times a year. The PDM submits monthly and quarterly reports of training compliance to the HOM to achieve this.
2.1.1.6.1. Twice daily (day and night through the 7-day
week) consultant-led and present multidisciplinary ward rounds are taking place on Delivery Suite.
2.1.1.6.2. The HOM will notify the PDM of any external funding allocated for the training of maternity staff to ensure it is ring-fenced and used for this purpose only.
2.1.1.6.3. PROMPT, Maternity Update Day, Safeguarding
Level 3, Fetal Monitoring training day and practical mandatory Trust updates have been offered in-person and virtually throughout 2020/21 (Appendix 4).
2.1.1.7. Existing training has been reviewed to ensure fit for purpose
and identify any new training requirements for 2020/21. 2.1.1.8. The 5 days of training ran throughout January and February
2020 but all training ceased between March and May 2020.
2.1.1.9. From June 2020, all staff were able to access online training resources for newborn feeding and Baby Friendly Initiative, antenatal screening, safeguarding children Level 3, healthy pregnancy, suturing, fetal monitoring, bereavement, diabetes in pregnancy and Practice Supervisor and Assessor guidance.
2.1.1.10. A combination of in-house and CPD approved external
provider online resources were used including the e-learning for Healthcare, National Centre for Smoking Cessation and Training and Neoventa Education websites.
2.1.1.11. In-person PROMPT training resumed July – October 2020
with social distancing measures and appropriate PPE in place. In addition to practical obstetric multi-professional training, the day incorporated practical moving and handling and adult basic life support training (Appendix 5).
2.1.1.12. To ensure staff are trained to identify the risks and symptoms
of mild to severe perinatal mental illness and to ensure women with Perinatal Mental Health issues are appropriately cared for, the Perinatal Specialist Midwifery Team have developed training which is incorporated into annual mandatory maternity training.
2.1.1.13. Additional specialist midwifery teams have been established
to support women and develop training to support staff including a Women Requiring Extra Nurturing (WREN) team, a Perinatal Mental Health team, a Birth Reflections team and the Heron team providing additional care for black and Asian service users.
2.1.1.14. Birth Reflections and Perinatal Mental Health training have
been incorporated into the online mandatory Maternity Update Day in 2021. Trauma Informed Care training delivered by the WREN team has been offered to all maternity staff.
2.1.1.15. PROMPT training is undertaken at RCHT and at point of
care on the Isles of Scilly on an annual basis. The PROMPT training includes pre-hospital PROMPT for community midwives and paramedics and all Obstetricians, Anaesthetists, Midwives, MSW’s, core ODPs for maternity and core maternity theatre staff are expected to attend with the aim of 90 % attendance to meet CNST. The training includes Obstetric emergencies, neonatal basic life support, learning from Serious Investigations and from Health Safety Investigation Branch (HSIB) reports, fetal monitoring in labour and human factors.
2.1.1.16. Human Factors (HF) training provides awareness of the
interactions among humans and their relationship with machines, procedures, the environment and other people. Human Factors are included in PROMPT skills sessions and are included in the point of care simulation debrief. Additional mandatory Human Factors training for all clinical staff was introduced Trustwide between January and March 2021.
2.1.1.17. A monthly rolling SIM programme has been identified as
essential to build on skills developed in PROMPT. The obstetric SIM lead, anaesthetic department, the Trust SIM team, Practice Development Midwife, Clinical Skills Facilitators and clinical teams collaborate to deliver ward based SIMS. These SIMS have continued in clinical areas throughout the COVID-19 pandemic.
2.1.1.18. Cannulation competency for both acute and community
midwives is now mandatory. Confirmed competency across both staff groups is between 95-97%. All newly qualified midwives have cannulation competency set as part of their preceptorship programme.
2.1.1.19. Annual update training in PROMPT –CiPP (Care of the
Critically Ill Pregnant Patient) is being co-produced by the
PDM, anaesthetic consultants, Clinical Skills Facilitator Midwives and obstetric consultants for all staff that completed the Enhanced Level 1 Care programme with Plymouth University in 2019.
2.1.1.20. The mandatory Maternity Update Day is regularly reviewed
by the Practice Development Midwife (PDM) to expand specialist specific areas. These are reviewed to address local themes and issues identified, update national guidance, ensure evidence based care and feedback from the Maternity Voices partnership.
2.1.1.21. Midwives are required to complete Resuscitation Council UK
Newborn Life Support (NLS) training every four years. NLS resumed face to face in 2021 but with limited candidate numbers to facilitate social distancing. A need for more midwives to be trained as NLS instructors by completion of the General Instructor Course has been identified to support PROMPT and basic newborn life support training and SIMs. The PDM will continue to work with the NLS faculty to ensure midwives are recommended for Instructor Potential.
2.1.1.22. In line with the Ockenden Report, a Personalised Care Plan
(PCP) has been developed in collaboration with the LMNS, Kernow MVP and RCHT. A training need has been identified for all staff using the PCP. The Personalised Care Plan is intended to be used at every contact with service users to facilitate conversations and informed consent.
2.1.1.23. PCP training will be delivered face to face by the PDM and
MVP to Community Team Leaders and Ward Managers who will then cascade train their teams.
2.1.1.24. Consultants to support midwifery/ MSW teams re
conversations around maternal choice caesarean section.
2.1.2. Specifically targeting community midwife training 2.1.2.1. To specifically target training for obstetric emergencies, in
the community setting, the annual PROMPT day groups community midwives together in a training team with 2 SWASFT ambulance crew to teach obstetric emergencies in community setting. Maternal collapse, eclampsia, obstetric haemorrhage, shoulder dystocia, cord prolapse, newborn basic life support and vaginal breech emergencies are taught using a combination of drills and hands on technique teaching (e.g. for shoulder dystocia) and discussion of human factors within the debrief.
2.1.2.2. Community based SIMS coordinated by Community Team
Leaders take place within the community bases when activity permits. Registers are sent to the PDM. Group SIMS have been postponed during the COVID-19 pandemic.
2.1.2.3. In addition, the SIM team/PDM will provide point of care SIM
in the community setting in addition to PROMPT training for Penrice, Central and North team and the Isles of Scilly. This has been postponed during the COVID-19 pandemic.
2.1.2.4. The PDM, Community Matron and Advanced Neonatal
Practitioners have implemented a rolling programme of NLS update training in community bases whilst face to face training on site is suspended due to the COVID-19 pandemic. Training in community based NLS scenarios is delivered by the ANNPs to community midwives and Team Leaders.
2.1.2.5. A community midwife has undertaken PROMPT train the trainer’s course and is now the training link lead for community teams. This role includes planning and undertaking SIM in the community setting and attending community team meetings in the capacity of community link PROMPT trainer to ensure learning from PROMPT is embedded into practice.
2.1.2.6. Training for the use of Misoprostal is embedded in the
monthly PROMPT training for Community Midwives with their Paramedic colleagues and cascade training undertaken through team meetings with team leaders and deputies.
2.1.3. Newly Qualified Midwives, Trust Preceptorship and Staff New to
the Trust 2.1.3.1. To ensure new staff receive the support they need to
undertake the training week, online training and safely acclimatise to the a new area of working or working as a newly qualified Midwife, the Practice Development Midwife sets a four week supernumerary induction programme for staff to undertake including;
Euroking,
Enteral nutrition of neonate
Cannulation
MAXIMS
EPMA
MOSOS CTG central monitor training
theatre competency
during the four week supernumerary period.
2.1.3.3. All new and existing staff should have completed the appropriate PAS/CORE training module on the CITS training portal.
2.1.3.4. The 12 month Newly Qualified Midwife maternity
preceptorship programme has been restructured in 2020 to give preceptees the opportunity to consolidate intrapartum skills to support the Continuity of Carer model. Preceptee midwives now spend 8 months on the intrapartum floor (Truro Birth Centre and Delivery Suite) and 4 months on antenatal/postnatal/DAU (Wheal Rose). Team Leaders/Line Managers act as Preceptors.
2.1.3.5. Where a training need is identified, staff can self-refer via
form or email to the Practice Development Midwife or Clinical Skills Facilitator midwives to develop a support plan.
2.1.3.6. An additional supernumerary week on the Neonatal Unit is
added to the four week induction for all new staff joining the Wheal Fortune core.
2.1.3.7. The Trust preceptorship programme runs concurrently and
all newly qualified staff are enrolled on appointment to the Trust. The PDM works collaboratively with Trust Clinical Practice Educators to arrange at least one bespoke midwifery themed preceptorship day per year as part of this programme.
2.1.3.8. Feedback from post registration midwives completing their
preceptorship are reviewed annually by the PDM to feedforward and improve the programme for the new preceptee cohort. The latest revision includes specialist midwifery specific training to include antenatal screening, bereavement care, safe guarding children, adults and risk and perineal repair.
2.1.3.9. Continuous Infusion Pumps are now in use on Delivery Suite.
An online epidural training package has been revised to include administration of and care for women when using the continuous infusion. New staff undertake an online learning package and the assessment with a requirement to have 3 epidural administrations observed and signed off.
2.1.3.10. A new theatre competency pack for new starters and preceptees is being developed by the PDM, Clinical Skills Facilitators and Trust Clinical Practice Educators.
2.1.3.11. The 12 month Newly Qualified Midwife maternity
preceptorship programme has been restructured in 2020 to give preceptees the opportunity to consolidate intrapartum skills to support the Continuity of Carer model. Preceptee midwives now spend 8 months on the intrapartum floor (Truro Birth Centre and Delivery Suite) and 4 months on antenatal/postnatal/DAU (Wheal Rose).
2.1.3.12. Fetal monitoring training forms part of the mandatory training
for all new midwives, obstetricians and preceptees. In addition new staff are allocated time during the supernumerary period with the Fetal Monitoring Specialist Midwife for training to use ST analysis equipment and software.
2.1.4. Newborn infant physical examination (NIPE)
Public Health England requires those undertaking NIPE examinations must have training accredited by a Higher Education Institution (HIE) and complete an annual NIPE update training and an annual NIPE practical competency assessment (NIPE Screening Handbook 2021). 2.1.4.1. The PDM will collaborate with the Antenatal and Newborn
Screening Specialist Midwives to roll out a further programme of NIPE training for midwives who do not currently hold the qualification.
2.1.4.2. The Antenatal and Newborn Screening Specialist Midwives
will identify those staff requiring NIPE training, co-ordinate annual update training and practical competency assessments for staff with an existing accredited NIPE qualification and coordinate NIPE SMART training (electronic NIPE database).
2.1.4.3. The PDM will co-ordinate delivery of training courses with the University of Plymouth and support preceptees to complete the required 40 NIPE checks within their preceptorship period (if they have completed the NIPE theory module as part of their BSc Midwifery).
2.1.4.4. Preceptee midwives with no prior NIPE training will be encouraged to attend a training course with the University of Plymouth.
2.1.5. Saving Babies’ Lives Care Bundle v2 (SBLCBv2) 2.1.5.1. Smoking cessation training is included in the annual
mandatory maternity update training.
2.1.5.2. Growth Assessment Protocol (GAP) was implemented at RCHT maternity as part of our commitment to reducing
stillbirth. Compliance with GAP has reduced. The PDM is in contact with the Perinatal Institute to provide a register of compliant staff and develop a training plan for those that require updating.
2.1.5.3. Electronic fetal monitoring training was identified as a training
need with the introduction of ST analysis. All staff that care for women in labour are required to undertake an annual training and competency assessment on cardiotocograph (CTG) interpretation and use of intermittent auscultation.
2.1.5.3.1. No member of staff should provide intrapartum
care without evidence of training and competence within the previous year.
2.1.5.3.2. All midwives, acute and community and all obstetric doctors must attend an annual fetal monitoring/wellbeing study day which includes competency assessment.
2.1.5.3.3. All midwives including bank and obstetric
doctors who work on the labour ward have annual ST analysis training, assessment and update.
2.1.5.3.4. It was identified that training can best be
embedded by multidisciplinary CTG review sessions and the Fetal Monitoring Specialist Midwife has made provision for this.
2.1.5.3.5. Staff who provide intrapartum care in the
hospital must attend at least four case review meetings annually; individuals who have not completed their training or passed the competency test will have one to one training with the fetal monitoring specialist midwife to identify particular training needs to enable them to successfully complete their training.
2.1.5.3.6. The fetal monitoring specialist midwife
facilitates interactive MDT CTG case review meetings weekly. Clinically significant cases are discussed with a debrief which includes themes, human factors and learning needs identified.
2.1.5.3.7. All maternity staff were invited and encouraged
to attend the ‘Monitoring May’ fetal monitoring learning events hosted by Mid Yorkshire Hospitals Trust during May 2021. This will continue annually as available.
2.1.6. Staff wellbeing 2.1.6.1. RCHT Maternity is using the A-EQUIP model to provide
Restorative Clinical Supervision (RCS) to midwives. This is built into the preceptorship programme and all preceptees are offered a minimum of one RCS session.
2.1.6.2. The patient Safety Midwife will identify midwives who are involved with a serious investigation (SI) to be contacted by the PMA team and offered a minimum of one RCS session, more if needed.
2.1.6.3. A team of 7 PMA’s are accessible to provide RCS to
Midwives involved in HSIB investigations, regular RCS for Midwives who are core on the Antenatal Ward and providing bereavement care, midwives returning from long term sickness and anyone who requests RCS.
2.1.6.4. A Lead PMA has been in post since January 2020 as
strategic lead for all 4 aspects of A-EQUIP to support midwives resilience, retention levels, advocacy, support. Undertaking RCS has been shown to positively impact retention of staff, staff well-being and a significant reduction in stress and burnout, improving team dynamics. To expand delivery of this service and facilitate changes further training and recruitment
2.1.7. Complementary Therapies
2.1.7.1. RCM accredited water birth study days were offered to midwives and MSWs in 2020 and will also take place in 2021.
2.1.7.2. An RCM accredited Biomechanics for Birth study day was offered to midwives and MSWs in 2020 and will also take place in 2021.
2.1.7.3. A total of 58 staff are fully trained across acute and
community. Further 21 still receiving support to complete full training (sign off). 18 members of trained staff have retired/long term sick. Face to face TMA training has been suspended since March 5 2020 in light of COVID-19. Formal request submitted on 8th June to restart.
2.1.7.4. The TMA Lead Midwife will attend update training during
2021 to revalidate.
2.1.8. Infant Feeding 2.1.8.1. RCHT has full Baby Friendly Initiative (BFI) accreditation with
the next reassessment due in January 2022. The Trust is committed to achieving BFI Gold status.
2.1.8.2. All Infant Feeding guidelines were updated during 2020 to incorporate updated, evidence based guidance and a training need identified.
2.1.8.3. Updates to clinical guidelines are cascaded to staff via the
joint PDM/Patient Safety monthly newsletter.
2.1.8.4. The PDM and Infant Feeding Team leads have collaborated to produce an updated infant feeding training pathway for 2021 (Appendix 6).
2.1.8.5. Face to face infant feeding practical skills reviews took place
between January 2021 and May 2021 but have been discontinued due to COVID-19 training restrictions. Plan to resume face to face as soon as possible. Not offering face to face training will delay BFI re-accreditation and BFI Gold Standard attainment.
2.1.9. Student Midwives
2.1.9.1. In 2021 a link lecturer from the University of Plymouth (UoP) has been appointed to support staff and midwifery students in practice. University of Plymouth midwifery students transitioned to an electronic ongoing record of achievement (e-OAR) in September 2019 and a training need was identified.
2.1.9.2. The PDM and University of Plymouth staff offered online interactive e-OAR training sessions throughout 2020 and 2021.
2.1.9.3. The PDM, UoP and Wheal Rose Ward Manager are collaborating to implement a collaborative learning in practice (CLiP) model on the antenatal/postnatal ward in 2021. Staff and student training will be required to support this.
2.1.9.4. The PDM, UoP, Wheal Fortune Ward Manager and Neonatal
Team are collaborating to implement a new training programme for student midwives and existing staff around the use of neonatal nasogastric (NG) tubes in 2021.
2.1.10. MSW training
2.1.10.1. As part of the HEE MSW Transformation Programme all MSW skills were benchmarked and recorded by the MSW Transformation Lead to inform a rolling training programme. This information was reported nationally to HEE and an MSW Practice Development Lead will be in post from September 2021 to facilitate skills passport completion in line with the HEE MSW Transformation Programme, monitor training compliance and support MSW professional development.
2.1.10.2. MSW core skills have been mapped to the Health Education England MSW Transformation Programme criteria. The MSW Practice Development Lead is responsible for monitoring and ensuring MSW mandatory training compliance and will keep records of any supplementary training completed by MSWs.
2.1.10.3. All MSW new starters have a five week supernumerary
orientation plan prepared by the PDM. This includes four weeks of training/clinical experience and a further week on the Neonatal Unit.
2.1.10.4. An updated MSW skills passport has been developed and is
completed by all MSW new starters as part of the five week supernumerary orientation plan.
2.1.10.5. Training has been delivered to all community based MSWs
after a training need was identified to support continuity of carer. Community MSWs attended a full day of training on caesarean wound care, neonatal jaundice, sepsis, weighing babies and taking and recording maternal observations.
2.1.11. Additional Training
2.1.11.1. Neonatal Infection Screening The PDM, Clinical Skills Facilitators, Delivery Suite Ward Manager and Neonatal Consultants collaborated to design and introduce an updated neonatal infection screening pathway to risk assess neonates requiring IV antibiotics within one hour of delivery enabling mothers and babies to remain together on Delivery Suite. 2.1.11.1.1. A training need was identified for the new
pathway and training in the new clinical checklists, SOP, Patient Group Directives and IM administration of antibiotics to neonates was cascaded to all Delivery Suite core staff.
2.1.11.1.2. The Clinical Skills Facilitators provided tea-
trolley and 1:1 training for staff. Regular audits of administration of IV antibiotics within one hour were undertaken by the Consultant Neonatologist with excellent results. Neonatal infection screening training will be extended to Wheal Rose during 2021.
2.1.11.2. PERIPrem Project
2.1.11.2.1. Newborn brain injury rates include preterm and term cases. To date, a large amount of work has focused only on term babies. PERIPRem is a care bundle of 11 interventions for both the mother and preterm baby (less than 34 weeks)
that will, when delivered by the perinatal team, optimise neonatal outcomes.
2.1.11.2.2. The project is aimed at proactively managing
the risk of brain injury and mortality in preterm babies and combines elements of the BAPM Toolkit, MatNeoSIP Bundle, Saving Babies’ Lives V2 and the Maternity Incentive Scheme (CNST).
2.1.11.2.3. The PERIPrem Bundle has been developed
through the creation of a cross organisational partnership work. The bundle consists of eleven elements, each identified as central to reducing brain injury and mortality in extreme preterm (<27 weeks) and preterm (<34 weeks) birth.
2.1.11.2.4. Training and awareness of all the bundle
elements and the changes in practise needed to achieve these elements has been facilitated by the Fetal Monitoring Specialist Midwife for the full perinatal multidisciplinary team since September 2020 and remains ongoing.
2.1.11.3. Postnatal care for community MSWs
Training has been delivered to all community based MSWs after a training need was identified to support continuity of carer. Community MSWs attended a full day of training on caesarean wound care, neonatal jaundice, sepsis, weighing babies and taking and recording maternal observations.
2.1.11.4. Tea Trolley training
The Clinical Skills Facilitators will deliver monthly tea trolley training on a focussed topic identified from audit or patient safety themes and will support new training pathways using tea trolley training.
2.1.11.5. Medical Devices
A requirement for refresher training for new and existing medical devices has been identified. The Clinical Skills Facilitator midwives have undertaken face to face training across all wards for new Baxter pumps during 2021 and collaborated with the Neonatal Team to deliver blood gas analysis machine training to staff on Delivery Suite and Wheal Fortune.
2.1.11.6. ROTEM
The PDM and Anaesthetic Specialist Trainee have collaborated to develop training for the Rotational Thromboelastometry (ROTEM) machine on Delivery Suite. This was planned to be delivered during 2020 but has been
postponed due to COVID. ROTEM training will be carried over to 2021.
2.1.11.7. Nasogastric tubes A training need for siting, care of and feeding via nasogastric tubes has been identified for student midwives, Transitional Care and Delivery Suite staff. The PDM and Clinical Skills Facilitator midwives are collaborating with the University of Plymouth, Wheal Fortune Ward Manager and Neonatal Team to implement a new training programme consisting of online learning and observed clinical competency.
2.1.11.8. Following a series of falls in Maternity, Patient Safety has
identified a training need for staff caring for women who are mobilising after an epidural. The Clinical Skills Facilitator Midwives, PDM, Anaesthetic Consultant and Improvement Practitioner for Falls, Dementia and Delirium have prepared online learning and developed a proforma for use prior to women mobilising post-epidural.
2.1.11.9. Inclusivity
Improving inclusivity within maternity is an important focus and training needs have been identified in this area. An inclusivity training agenda will be developed by the PDM in collaboration with the MDT senior management team, the LMNS and Kernow Maternity Voices Partnership throughout 2021.
2.1.11.10. Fit testing
After receiving appropriate training, the PDM and Clinical Skills Facilitators undertook and recorded outcomes for FFP3 mask fit testing for new and existing maternity staff throughout the COVID-19 pandemic. Since March 2021 fit testing has been resumed centrally by Trust Health and Safety. Fit testing can be booked by calling x2471 or 07788 380523.
2.1.11.11. Fluid balance
Following an audit report, a training need around fluid balance chart completion and calculation has been identified. The PDM, Audit Midwife and Clinical Skills Facilitator Midwives have created an updated fluid balance chart and developed a training programme for staff that will include ‘tea-trolley’ training in clinical areas with supplemental online training as needed.
2.1.11.12. VTE
Following an audit report, a training need around VTE risk assessment completion and calculation has been identified. The PDM, Audit Midwife and Clinical Skills Facilitator Midwives have developed a training programme for staff that will include ‘tea-trolley’ training in clinical areas and will
collaborate with the Community Matron to deliver this in community settings.
2.1.11.13. Nervecentre/e-obs
In anticipation of a new software system to replace the Swiftplus programme, all acute staff with responsibility for editing/updating information on the Nervecentre dashboard staff will be expected to complete the online Nervecentre training via the CITS Online Portal.
2.1.11.14. e-Notes
The e-Notes initiative has gone live and all staff who work with health records must undertake one of three training packages available via the CITS IT Training Portal. Staff with responsibility for tracering health records must also complete a face to face session via MS Teams. The IM&T Training Team will monitor training compliance.
2.1.12. Core Skills
2.1.12.1. Midwives work as either core staff in specific area or rotate to all areas. Specific skills are required of staff who request to be part of the core team. Core skills for each area are as follows;
Antenatal ward
Intermittent auscultation
Birth unit
Fetal Monitoring (intermittent auscultation)
Delivery Suite
Intrapartum CTG analysis using ST-analysis and competency test pass mark 85%
Cannulation
Completion of on-line epidural training with test passed and 3 sign off episodes of administration of epidural analgesia and follow up care
Regular attendance at weekly CTG meetings on labour ward
Suturing competency
Transitional Care ward
Administration of neonatal intravenous antibiotics
Newborn Infant Physical Examination (NIPE)
2.2. Definitions / Glossary
2.2.1. Mandatory training is defined as training requirement that has been determined by the Trust for staff to undertake. This training ensures that staff are able to undertake their duties safely and efficiently. It minimises risk and ensures that external standards are met. Mandatory training requirements are not the same for each staff member and may relate to a specific team or professional group.
2.2.2. Statutory training – can be defined as training that the Trust is legally required to provide as defined in law or where a statutory body has instructed organisations to provide training on the basis of legislation.
2.3. Booking attendance for mandatory and statutory training
Staff are allocated to a training week and are responsible for booking their own book attendance on mandatory and statutory training through their ESR account for day one, three, four and five. A user guide can be accessed via: http://intra.cornwall.nhs.uk/Intranet/AZServices/E/ElectronicStaffRecord/ESR.as px. During the COVID-19 pandemic, Team Leaders and Ward Managers have allocated study leave to complete online mandatory training. New starters in the Trust complete their annual mandatory and statutory training as part of their corporate induction programme. Any additional maternity specific mandatory training will need to be booked via ESR on completion of Trust corporate induction. The Practice Development Midwife will support with this and ensure where possible it is part of the one month supernumerary programme. If you need help with your username and/or password please call CITS on 01209 88 1717. If you need help after logging in please get in touch with the Employee Support Team on 01872 25 5148 or by email at Rch-tr.employeesupport@nhs.net
2.4. Role of subject specialists
Subject specialists are responsible for;
Ensuring that training sessions for their subject area are up to date and reflect the needs of the learners as well as best practice
Updating sessions annually or as directed by latest evidence
Responding to evaluation and taking action to make changes accordingly
2.5. Role of staff members
Individual staff members are responsible for;
Prioritising attendance at mandatory and statutory training and completing their mandatory and statutory training within the required timeframes to ensure on going compliance
liaising with their line manager to agree release from normal work duties to enable attendance at mandatory and statutory training
Informing both the Employee Support unit and their line manager of an inability to attend booked training (e.g. in the event of sickness absence or increased operational pressures)
Completing training evaluation forms to enable the continuous review and development of courses.
To keep records of their attendance at all training as evidence of attendance.
2.6. Ensuring attendance at mandatory maternity training days
2.6.1. Midwives, MSW’s and Maternity Nurses
ESR will email reminder to staff booked on PROMPT and Maternity Update Day and Midwives Update Day
The Matron is responsible for informing the PDM of the start date of any new midwife in advance of their start date; the new starter will then attend the Trust induction days and be given an appointment to meet with the PDM to ensure training requirements are agreed. All new staff are allocated their training week within their month supernumerary induction period and are expected to undertake all relevant online training in this period.
2.6.2. Update day for Maternity Support Workers
Regular update days are provided throughout the year for MSW to attend; these days provide Trust core training and in addition maternity related competencies. The dates are advertised through team leaders, and they take responsibility for booking the MSW on the days and ensuring attendance. Attendance at the days is then recorded on the MAPS system.
MSW providing Transitional Care (TC) requires specific training. A work pack has been designed and implemented by CSF for MSW in collaboration with the neonatal team and postnatal ward manager (New 2019)
2.6.3. Obstetric Consultants, staff grades and doctors in training
It is the lead Obstetrician for obstetrics responsibility to ensure that all relevant members of the obstetric team attend relevant training. Individual training portfolios confirm that all training and competency requirements have been met.
To meet CNST standard 8 all Consultants, staff grade obstetricians and obstetric doctors in training must attend PROMPT annually, their attendance date will be allocated by the Lead Obstetrician and
medical staffing coordinator liaising with the individual medical secretaries if required and booked via ESR (New 2019).
2.6.4. Anaesthetists
It is the lead Anaesthetist for obstetrics responsibility to ensure that all relevant members of the obstetric anaesthetic team attend training. Individual training portfolios confirm that all training and competency requirements have been met.
To meet CNST standard 8 all Consultants and relevant anaesthetist in training must attend PROMPT or a multi-disciplinary SIM annually, their attendance date will be allocated by the lead Anaesthetist and is responsible for collecting compliance numbers for CNST.
2.6.5. Paediatricians
It is the role of the consultant paediatrician with responsibility for training to ensure that all relevant members of the team attend training. Individual log books confirm that all training and competency requirements have been met.
2.7. Non-attendance at mandatory training
Following each training session the PDM or admin person responsible for the training will input the attendees into the training database system and then identify any staff member who has not attended. The PDM or person responsible for the training will send an email to the staff member and the staff member’s team leader and a new date must be booked via ESR. The database will be amended accordingly. Staff who are unable to attend booked face to face training must ensure that their place is cancelled. This can be achieved by telephoning the ESU on 01872 255148 or by e-mail: rch-tr.EmployeeSupport@nhs.net Staff who fail to attend booked sessions where they have been allocated paid study leave will be recorded as having taken unauthorised leave and may be subject to disciplinary action. For staff who fail to attend a second time, without an acceptable reason, the midwifery matrons will be informed and asked to investigate the reason for non- attendance. In exceptional circumstances it may be necessary to evoke disciplinary action against a staff member for persistent non-attendance at any mandatory training.
2.7.1. Training Database.
2.7.1.1. The training spreadsheet is held by ESR on a secure shared folder. These are in an electronic format and are stored on the Trusts server. ESR records all training and can provide training statistics. ESR data input has been affected during the COVID-19 pandemic due to ESR staff redeployment. A supplemental database has been maintained by the PDM during the COVID-19 pandemic.
Blood Transfusion Practitioners.
2.7.1.4. It is the responsibility of each individual to book via ESR and attend these days, and it is the staff member’s team leader or manager to ensure this training is completed.
2.7.1.5. The Lead obstetrician is responsible for monitoring the
attendance of obstetric doctors within the Trusts maternity service.
2.7.1.6. The lead anaesthetist for obstetrics is responsible for
ensuring all new anaesthetists have achieved the necessary compliance before working unsupervised.
2.7.1.7. The consultant paediatrician responsible for training ensures
all new paediatricians have achieved the necessary compliance before working unsupervised.
2.8. Ownership and Responsibilities
Midwifery specific mandatory training provision is co-ordinated by the PDM, Training Faculty and Learning and Development Department. Delivery of training may be undertaken by a range of staff within the Trust. This ensures that subjects are taught by experts where necessary. This section gives a detailed overview of the strategic and operational roles responsible for the development, management and implementation of the policy. It includes details of the groups and committees, as well as individual responsibility.
2.8.1. Head of Midwifery (HOM)
The Head of Midwifery will ensure that the training needs analysis is implemented. Receive and act upon any information from the maternity Patient Safety forum in relation to problems with attendance at mandatory training days.
2.8.2. Deputy Head of Midwifery (HOM)
The Deputy Head of Midwifery will deputise for the head of midwifery to ensure that the training needs analysis is implemented. Receive and act upon any information from the maternity Patient Safety forum in relation to problems with attendance at mandatory training days.
2.8.3. Midwifery Matrons for inpatients and community services These roles have the responsibility for ensuring the Midwifery, Nursing and Maternity Support Worker staff attends training as indicated in the training needs analysis. Ensuring that all new staff attends the corporate induction training and any staff new to the maternity services receives a local induction programme and maternity mandatory training sessions as described in the training needs analysis.
2.8.4. PROMPT Faculty
The Maternity Training Faculty is a multidisciplinary team who meet quarterly. Following the Training in PROMPT, feedback forms are reviewed to drive the training program to include training identified via Patient Safety or driven by national excellence in practice. The faculty ensures training is nationally benchmarked, evidence- based, and relevant to the needs of the service and is delivered in a consistent and informative manner. Any training needs identified by the Patient safety Meeting and Maternity Forum will be discussed at the PROMPT faculty meetings for example: results from audits, learning from incidents, complaints, claims and information from any other sources.
2.8.5. Maternity Forum
The Maternity Forum is the committee responsible for promoting high quality, safe care within maternity services. The training programme will be developed by the maternity training faculty at the end of each year and received by the Maternity Forum. Throughout the year the MF will identify any training needs that arise from audits, incidents, complaints and claims, an action plan will be developed, for the inclusion in the training programme. On a quarterly basis the PDM will report to the Maternity Forum on compliance with midwives training and any problems with training delivery.
2.8.6. Practice Development Midwife (PDM)
The PDM has the responsibility for the planning and coordinating of the education and training sessions for post-registration midwives to meet the strategic aims of the Maternity Service and in line with key national reports. This role consists of developing the content for the training sessions as identified in relation to the needs of the maternity service in the community and hospital environment. The PDM will also provide support for new midwives or midwives wishing to consolidate a new skill, in the clinical setting. The PDM chairs the Maternity Guidelines Group.
2.8.7. Clinical skills facilitators (CSF) The CSF’s work closely alongside midwives and maternity support workers to help them develop clinical skills at direct point of care. The CSF’s role provides significant hands on support to newly qualified staff, new to the Trust staff and those who are undertaking practice development plans.
2.8.8. Patient Safety Midwife
Chairs the weekly Patient Safety meetings and bi-monthly the Maternity Forum (MF). Patient Safety Midwife works with the PDM to identifying new training requirements identified through complaints, PALS, incidents and claims, and receive quarterly reports on the compliance with training. Patient Safety Midwife is deputy chair to Maternity Guidelines Group.
2.8.9. Team leaders/ward managers Team leaders are responsible for ensuring that their team is allocated to training and that MAPS reflects each staff member’s attendance at the mandatory training, so that no clinical commitments are allocated. Community team leaders book their staff via ESR for training. Non- attendance at a mandatory training session, due to unexpected clinical need, must be agreed through the Matron. Team leaders will be responsible for investigating non-attendance at training and will ensure attendance at the next available session.
2.8.10. Fetal monitoring Specialist midwife The role involves developing robust systems of fetal monitoring; this includes consistent training for all staff providing intrapartum care in the classification of CTG and systematic assessment of fetal physiology in response to intrapartum stresses and hypoxia (including competency assessment). Training extends to the use of fetal ECG and Analysis. Provide one to one feedback when need is identified at Patient Safety meeting. Provide feedback to the maternity Patient Safety forum. Measure the effectiveness against key performance indicators.
2.8.11. Community training link Midwife The community link trainer is responsible for supporting the PDM with training for community midwives and leads a programme for teaching obstetric emergencies out in the community setting and in team leader meetings.
2.9. Maternity mandatory in house training
The maternity service aspires to achieve 95% attendance (after excluding staff on long term sickness and maternity leave). The maternity services aim is never to cancel training due to high clinical activity or staffing shortages, however, if this does occur, this should be agreed by one of the Matrons/HOM and the database amended accordingly.
3. Monitoring compliance and effectiveness
Element to be monitored
Lead Practice Development Midwife
Tool Monitoring of attendance and completion of PROMPT and Maternity Update Day using the ESR system.
Frequency Quarterly reports to Maternity Forum
Reporting arrangements
The report will be received at the Maternity Forum where an action plan will be agreed and monitored if required.
Acting on recommendations and Lead(s)
Practice Development Midwife
Via midwifery team leaders meeting, PDM/Patient safety newsletter, safety brief
4. Equality and Diversity
4.1. This document complies with the Royal Cornwall Hospitals NHS Trust service Equality and Diversity statement which can be found in the 'Equality, Inclusion & Human Rights Policy' or the Equality and Diversity website.
4.2. Equality Impact Assessment
The Initial Equality Impact Assessment Screening Form is at Appendix 2.
Appendix 1. Governance Information
Document Title Maternity Training Needs Analysis and Training Matrix Clinical Guideline V3.0
This document replaces (exact title of previous version):
Maternity Training Needs Analysis and Training Matrix Clinical Guideline V2.0
Date Issued/Approved: 18th June 2021
Date Valid From: June 2021
Date Valid To: June 2023
Directorate / Department responsible (author/owner):
Brief summary of contents
Defines the training needs and analysis for maternity staff at RCHT to provide safe effective care. Training Strategy is a tool to guide education and training for post registration midwives at Royal Cornwall Hospitals NHS Trust Maternity Services
Suggested Keywords: Training need, CNST, Okenden,
Target Audience RCHT CFT KCCG

Medical director
Maternity guidelines Care Board Group
General Manager confirming approval processes
Mary Baulch
Name of Governance Lead confirming approval by specialty and care group management meetings
Caroline Amukusana
Related Documents:
National maternity Review Better Births 2016 NHS England Saving babies Lives a care bundle for reducing stillbirth 2016 NHS England Maternity Safety Training catalogue 2016 DoH Safer Maternity care 2016 RCHT Mandatory and training Policy (2016) RCHT Maternity Patient Safety strategy (2016) Midwifery 2020 Delivering expectations (DoH 2010)
Training Need Identified? Yes
Publication Location (refer to Policy on Policies – Approvals and Ratification):
Internet & Intranet Intranet Only
Document Library Folder/Sub Folder
(Name and Job Title)
2009 1.0 Initial document Jan Clarkson Maternity Risk Manager
2010 1.1 Training sessions updated for year Jan Clarkson Maternity Risk Manager
2012 1.2 Monitoring compliance added Jan Clarkson Maternity Risk Manager
1st January 2014
Elizabeth Anderson Practice Development Midwife
7th February 2017
1.4 Training has been reviewed to meet the aim of the maternity transformation programme. New training includes fetal monitoring, ST analysis, NIPE, childbirth emergencies in the community, PROMPT, Robust and human factors. The change of name from Maternity Risk Forum to Maternity Forum, training to be booked via ESR, K2 to be replaced by fetal monitoring lead midwife training.
Sarah-Jane Pedler Practice Development Midwife.
14th September 2017
1.5
Training reviewed to further optimise safety and meet the needs of the service. Plan developed for staff training in Head 346 assessment and escalation of acutely ill adult, Human Factors, NIPE, waterbirth, and aromatherapy. Epidural competencies will be added as a regular two yearly update. Further GAP training to be explored and the preceptorship programme and new starter inductions are being reviewed. PROMPT training has replaced TOME and a regular SIM training programme at point of care.
14th March 2018
1.6 Minor updates to highlight specific training for community staff. See new 2018 in body of the document
5th April 2018
1.7 Updated with cannulation and Misoprostol see new 2018 in body of document
10th August 2018
Updated to include training for professional midwifery Advocate (PMA) role, new CNST standards, on-line epidural training, skills identified for midwives applying to be core in specific areas
October 2019
June 2021 3.0 Reviewed and updated to include updated Ockenden and CNST recommendations
Rachel Mullins Practice Development Midwife
All or part of this document can be released under the Freedom of Information
Act 2000
This document is to be retained for 10 years from the date of expiry. This document is only valid on the day of printing
Controlled Document
This document has been created following the Royal Cornwall Hospitals NHS Trust Policy for the Development and Management of Knowledge, Procedural and Web
Documents (The Policy on Policies). It should not be altered in any way without the express permission of the author or their Line Manager.
Appendix 2. Initial Equality Impact Assessment
7. The Impact Please complete the following table. If you are unsure/don’t know if there is a negative impact you need to repeat the consultation step. Are there concerns that the policy could have a positive/negative impact on:
Protected Yes No Unsure Rationale for Assessment / Existing Evidence
Section 1: Equality Impact Assessment Form
Name of the strategy / policy /proposal / service function to be assessed Maternity Training Needs Analysis and Training Matrix Clinical Guideline V3.0
Directorate and service area: Obstetrics and Gynaecology
Is this a new or existing Policy? Existing
Name of individual/group completing EIA Rachel Mullins, Practice Development Midwife
Contact details: 01872 25 5019
1. Policy Aim Who is the strategy / policy / proposal / service function aimed at?
To ensure all staff are aware of mandatory training for maternity services and the individual responsibilities of each staff group
2. Policy Objectives To ensure all relevant staff attend mandatory training for maternity
3. Policy Intended Outcomes
Compliance monitoring tool
All staff working in obstetrics and all patients
6a). Who did you consult with?
b). Please list any groups who have been consulted about this procedure.
Workforce Patients Local groups
Other
x
Please record specific names of groups: Obstetrics guideline meeting Care Board Group
c). What was the outcome of the consultation?
Agreed
Characteristic
X
X
Pregnancy and maternity X
Sexual orientation (bisexual, gay,
heterosexual, lesbian) X
If all characteristics are ticked ‘no’, and this is not a major working or service change, you can end the assessment here as long as you have a robust rationale in place.
I am confident that section 2 of this EIA does not need completing as there are no highlighted risks of negative impact occurring because of this policy.
Name of person confirming result of initial impact assessment:
Julie Walton (Audit midwife)
If you have ticked ‘yes’ to any characteristic above OR this is a major working or service change, you will need to complete section 2 of the EIA form available here: Section 2. Full Equality Analysis For guidance please refer to the Equality Impact Assessments Policy (available from the document library) or contact the Human Rights, Equality and Inclusion Lead india.bundock@nhs.net
Appendix 3. PAW Training Matrix 2019 Training
Delivery method
156 PROMPT
Maternal collapse
Learning from Health Service Investigation Board
Delivered as a monthly rolling programme
Midwives MSW Maternity nurses Theatre team Obstetricians Anaesthetists
Annually PROMPT team ESR
156 Maternity Update Day
Midwives MSW Maternity nurses
Health lifestyle
Newborn feeding
Infection prevention and ANNT
ESR
4 hour training with CTG
specialist Midwife
Online epidural competency (7.5 hour CPD)
4 hour intrapartum fetal physiology session and competency testing at 85% achievement to pass On line fetal ECG ST analysis training and competency
All midwives and obstetricians
testing at 80% achievement to pass Attend 4 multidisciplinary CTG meetings
Day 5) Safeguarding Children Level 3, perinatal mental health and Women with complex needs and adult level 2 safeguarding (7.5 hour CPD)
Email Suzie & Bernie on rcht.maternitysafeguarding@nhs.net
Delivered as a monthly rolling programme
Midwives Annually Safeguarding lead midwives
rcht.maternitysafeguardin g@nhs.net
Plymouth University
Midwives Initial training followed by annual update e learning update https://cpdscreeni ng.phe.org.uk/lea rning or https://poertal.e- lfh.org.uk/
Plymouth University
New starters, midwives, nurses working in obstetrics, maternity support workers and paediatricians
Once then annual update on Maternity update day
Newborn feeding coordinators
once then annual update on
Blood transfusion practitioners and
competencies
competency for new staff, followed by annual update. Bloodhound e-learning is undertaken once as long as staff accesses the blood fridge a minimum of annually.
of blood and administration of blood
Maternity Update Day
trained assessors manager for face to face and update at Maternity Update day or contact nicki.jannaway@nhs.net
Newborn Life Support
Contact Sharon Mclaughlin at the post graduate centre to book sharonmclaughlin@nhs. net
Head 346 assessment and escalation of acutely ill adult.
Learning and Development department
Learning and Development department
Enhanced level 1 Care programme University of Plymouth (New 2019)
4 day course, OSCE and examination
Delivery Suite co- Ordinators, Core midwives on Delivery Suite
Plymouth University
All midwives Once Lead Educator for Learning and Development
ESR
Face to face All midwives As required CSFs
Maternity Support Specific Training
Maternity support workers Annually CSF for MSW Zoe Locke
Advanced paediatric life support (APLS) or Newborn life support (NLS) provider course
Resuscitation (UK) Newborn Life Support (NLS) course/APLS
Consultant paediatricians and advanced neonatal nurse practitioners (ANNP)
4 yearly NLS provider
Advanced paediatric life support (APLS) or Newborn life support (NLS) provider course
Resuscitation (UK) Newborn Life Support (NLS) course
Paediatricians in training On commencing in post
Newborn and infant physical examination
1:1 teaching sessions within clinical areas.
ST1 & ST2, F2, GP Core trainees, paediatric specialist trainees and ANNP
once In house training by ANNP’s, senior trainees and Consultants
Appendix 4. PAW Training Matrix 2020/21
Training
156 PROMPT
Maternal collapse
Learning from Health Service Investigation Board
Jan 2020- Feb 2021 Delivered as a monthly rolling programme
Midwives MSW Maternity nurses Theatre team Obstetricians Anaesthetists
Annually PROMPT team (in- house)
ESR
PROMPT
Appendix 5. Combined PROMPT, Moving and Handling & Adult Basic Life Support programme July-October 2020
Maternity Learning & Development Week PROMPT
08:15 Registration
09:35-10:05 Eclampsia Management Lecture Theatre
10:05-10:15 Coffee break
11:15-11:45 Human Factors & sharing/discussing learning from HSIB & SIs Lecture Theatre
11:45-12:30
(20 mins)
Shoulder Dystocia
12:30-13:00 Lunch
Clinical Skills Lab
KSpa G01
KSpa G01
Clinical Skills Lab
Appendix 6. Updated Infant Feeding training pathway 2021
WELCOME NEW STARTER TO
Step one – During INDUCTION/ORIENTATION Read Welcome Pamphlet from Infant Feeding Team (IFT).
Step two – During INDUCTION/ORIENTATION Register with e-Learning for Health found at http://www.e-lfh.org.uk
and complete HCP 08_02 Infant Feeding Part 1 Breastfeeding and HCP 08_03 Infant Feeding Part 2 Formula Feeding
Once you have completed these, send your e-certificate to rcht.infantfeedingteam@nhs.net
Did you train at BFI accredited University and NHS Trust within
the past 4 years?
Step 3 - During WEEK 1 OF WORK
Please book to attend our 2.5 hour short skills workshop, directly with our Infant
Feeding team via rcht.infantfeedingteam@nhs.net
You should ensure you have the
opportunity to observe a full, effective breastfeed prior to attending your short
skills workshop.
training University and
Trust and qualifying year, along with you Ecertificates from Step 2
Please book a staff audit/practical skills review directly via the Infant Feeding Team
rcht.infantfeedingteam@nhs.net and the next available date will be offered to you.
TRAINING CHECKLIST
Welcome Pamphlet
Observe full, effective breastfeed
Skills Workshop (If required)