“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

EPIFFany F1Doctor WritingWhat?

EPIFFANY (Effective Performance Insight for the Future) is an innovative approach to training healthcare professionals such as junior doctors, proven to support big improvements in performance of complex tasks such as prescribing. It adopts principles used by Team Sky to win the Tour De France four out of the past five years – for example making small changes to the way individuals are educated, by giving and receiving constructive feedback and embedding team working.

Developed by the University of Leicester and the University of Nottingham in collaboration with Health Education England East Midlands, it has been pioneered at Leicester General Hospital and at Boston Pilgrim Hospital.

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.


EPIFFANY was developed in response to evidence showing junior doctors make double the prescribing errors of other health professionals. Traditionally junior doctor training takes is highly-pressured and participants can feel unsupported. EPIFFANY delivers improvements in team working, face-to-face teaching and feedback to realise large gains in individuals’ performance.

What’s the impact?
  • Increased prescribing performance of junior doctors by 50% across a 4 month rotation at Leicester and Boston
  • Increased prescribing performance of junior doctors by over 50% across a 4 month rotation in Pilgrim Hospital Boston’s General Surgery speciality
  • 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 amongst doctors
  • Increased junior doctors’ wellbeing and self-confidence so they consider remaining in the East Midlands to continue their personal and professional development
  • 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
  • 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.

What’s next?

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