“EPIFFANY is a fantastic example of supporting and enhancing junior doctors’ education and training.  It’s been demonstrated to improve prescribing behaviour, wellbeing and keep patients safer while in hospital through a safety culture.  We’re thrilled that something supported by HEE across the East Midlands is now being rolled out to more areas and would like to see it taken up further and across the whole of England.”
Jill Guild, Head of Quality and Education for Health Education England, East Midlands


EMAHSN EPIFFANY Project-1_255EPIFFANY (Effective Performance Insight for the Future) – is an ‘insight and awareness raising’ approach to educating healthcare professionals such as junior doctors. The approach leads to a large improvement in performance on complex workplace tasks, such as prescribing complex medicines.

EPIFFANY affects these improvements by making small changes to the way individuals are educated, receive feedback; work as a team; and use clinical decision support technologies for work or study, much like the principles used by Team Sky to win the Tour De France.

The approach creates a safe learning environment, using simulations including real outpatients for junior doctor-patient encounters complemented with principles of human factors and educational theory like self-regulated learning.  EPIFFANY is effective at improving prescribing competence for those taking part, and impacting positively on junior doctors’ confidence, well-being and attitude to work.

EPIFFANY has been successfully undertaken in 2 East Midlands NHS trusts and is in the process of being evaluated at 3 further trusts for sustainability to enable wider adoption.  It is also being evaluated overseas in New Zealand at Waitemata and Canterbury District Health Board hospitals and has recently spread to Greater Manchester AHSN who have identified 2 hospitals in their region.

Challenge/problem identified

A GMC study conducted across 19 hospitals in North-west England found there were 8.9 medication errors every 100 prescriptions made by healthcare professionals. This figure is similar to the East Midlands and there is evidence which showed junior doctors made twice as many prescribing errors compared to other prescribing healthcare professionals, whilst conducting the vast majority of prescribing.

Traditionally the training of junior doctors takes place in high-pressure environments and it is reported that they often feel unsupported at work.  Opportunity to receive regular and constructive developmental feedback during junior doctor training is limited and there are currently few effective interventions for reducing prescription errors.

Actions taken

EPIFFANY was developed by EMAHSN EPIFFANY Project-2_268Dr Rakesh Patel (now University of Nottingham) and Dr William Green (University of Leicester), initially being piloted in 2013 at Leicester General Hospital’s, John Walls Renal Unit, University Hospitals Leicester NHS Trust.

EMAHSN, Health Education England East Midlands (HEE EM) and Pfizer assisted with an additional rollout at Pilgrim Hospital Boston, United Lincolnshire Hospitals NHS Trust, in 2015-2016 for all junior doctors working in general surgery and orthopaedics.

EPIFFANY delivers improvements through high, ecologically valid simulations, face-to-face teaching and feedback to realise the large gains in performance made by individuals. Clinical decision support is also made available on mobile devices.

Impacts/ outcomes

  • Increased prescribing performance of junior doctors by over 50% across a 4 month rotation at Leicester General Hospital’s, John Walls Renal Unit
  • Increased prescribing performance of junior doctors by over 50% across a 4 month rotation in Pilgrim Hospital Boston’s General Surgery specialty
  • Analysis showed a 60% increase in prescribing performance of junior doctors across a 4 month rotation in Pilgrim Hospital Boston’s Orthopaedic specialityEPIFFANY
  • Reduced prescribing errors of junior doctors at in Leicester General Hospital’s, John Walls Renal Unit and Pilgrim Hospital Boston’s General Surgery and Orthopaedics’ across all severity grades
  • Improved satisfaction with education and training among junior and trust grade doctors
  • Increased junior doctors’ wellbeing and self-confidence so they consider remaining in the East Midlands to continue and develop themselves personally and professionally
  • Promoting pharmacists as educators by incorporating pharmacists in the team, and empowering them to give individualised feedback
  • Won the EMAHSN’s Innovation Award 2015
  • Cost avoidance in medication errors as well as potential bed days and litigation
  • Shortlisted for the BMJ Awards 2016 – education category www.thebmjawards.bmj.com
  • EPIFFANY local team at Boston’s Pilgrim Hospital received United Lincolnshire Hospital’s Quality and Safety award for EPIFFANY (April 2016)
  • Commission on Education and Training for Patient Safety report includes the EPIFFANY project.

“Pilgrim Hospital’s figures are now in line with national averages and comparable to a GMC study conducted across 19 NHS Trusts in the North West of England which is a fantastic result and something the team are really proud of.”
Dr Rakesh Patel, EPIFFANY Educational Lead and Clinical Associate Professor in Medical Education, University of Nottingham

Plans for the future

With funding and support from EMAHSN, Health Education England East Midlands (HEE EM) and Pfizer:-

  • Evaluate models of EPIFFANY across further sites in the East Midlands (including Sherwood Forest Hospitals NHS Trust) to inform the best approach to scale-ability
  • Scale the EPIFFANY across all acute trusts in the East Midlands as an approach to delivering personalised education and feedback to all junior and trust grade doctors
  • Produce and evaluate a toolkit to facilitate spread and sustainability of EPIFFANY

Which national clinical or policy priorities does this example address?

  • Medicines optimisation
  • Patient safety
  • Spreading best practice

Start and end dates

2013/14, 2014/2015, 2016/2017 Foundation Year 1 and 2  trainees and ongoing rollouts

Contact for help and advice

Dr William Green
E: epiffany@leicester.ac.uk 

Chris Taylor, East Midlands Academic Health Science Network
E: chris.taylor@nottingham.ac.uk

Find out more

EPIFFany – Effective Performance Insight for the Future from EMAHSN on Vimeo.