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Emergency physician in-house challenge (EPIC)

In partnership with Health Education England, Pennine Acute Hospitals NHS Trust looked to improve training and service delivery in emergency care. Improving the engagement of trainees in a variety of educational activities not only benefitted the individual and the department, but delivered better patient care through enhanced learning.

Related themes

  • Front door/ Emergency Department
  • Change and empowering employees


The Emergency Physician In-House Challenge (EPIC) used motivation theories to improve behaviour and promote positive practices by doctors within the emergency department in order to improve productivity and patient care. EPIC was designed to reward trainees who took part in important educational, audit and teaching activities as well as the broad range of day-to-day clinical activities.

How they did it

The project saw trainees receive weighted credits for specific types of clinical work as well as educational activity including courses attended, lectures given, medical students taught, workplace based assessments (WBAs) carried out, procedures and teaching.

Trainees could access results to check progress and how they were comparing against colleagues, and were given incentives when they reached certain levels. Trainees were also fined credits for any negative behaviour such as being consistently late on a shift or if they were ever seen to rush through patients in order to increase their credit scores.

What they achieved

  • More WBAs were carried out and productivity levels increased. For example, prior to the pilot the minimum expected number of WBAs required for each FY2 doctor was six. Following the implementation of the pilot, there was a 25% increase by each participating trainee
  • Evidence shows that a large proportion of WBAs are carried out towards the end of a placement, which makes them less effective, because they are not formative. Early completion of WBAs was therefore encouraged through bonus weeks in which double points were awarded. The impact of the pilot was significant as during those weeks, the percentage increase, based on the weekly average, was between 69% and 466%
  • Improved satisfaction with:
    • educational input
    • the amount and quality of consultant supervision
    • opportunities to complete WBAs
    • overall experience at Royal Oldham Hospital’s emergency department
  • 94% of trainees rated EPIC as good or excellent

What they’ve said

“Good team atmosphere created by friendly competition and a good initiative to do WBAs/procedures. CONTINUE!” Trainee

“Really enjoyed being involved with EPIC, it definitely made me work significantly harder than I would have.”Trainee

Please look at the toolkit materials in the documents section below. The top tips and business cases have been developed by the BTBC team to support organisations to implement these changes and the case studies and project resources have been developed and approved by the project teams.

The top tips include lessons learnt that have been identified throughout the project. The business case will guide you through the management principles and communications and engagement activities. The case studies provide a detailed overview of the project. Feel free to adapt these resources to suit your projects.

Your organisation may have its own materials and templates that you can use or you may find the NHS Improving Quality (NHS IQ) learning handbook useful too.


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