A unique philosophy of pAtient-centred medicine ninth edition | JAnuAry 2013 | 858 pAges | 978-0-19-959118-3 | flexicover | ÂŁ29.99
Available now from www.oup.com and all good bookshops
Patients deserve better THE MAGAZINE FOR JUNIOR DOCTORS
Presenting History JuniorDr is a free lifestyle magazine aimed at trainee doctors from their first day at medical school, through their sleepless foundation years and tough specialist training until they become a consultant. It’s proudly produced entirely by junior doctors - right down to every last spelling mistake. Find us quarterly in hospitals throughout the UK and updated daily at JuniorDr.com Team Leader Matt Peterson, email@example.com Editorial Team Yvette Martyn, Ivor Vanhegan, Anna Mead-Robson, Michelle Connolly, Muhunthan Thillai, Michael Richardson JuniorDr PO Box 36434, London, EC1M 6WA
Tel - +44 (0) 20 7 193 6750 Fax - +44 (0) 87 0 130 6985 firstname.lastname@example.org Health warning JuniorDr is not a publication of the NHS, David Cameron, his wife, the medical unions or any other official (or unofficial) body. The views expressed are not necessarily the views of JuniorDr or its editors, and if they are they are likely to be wrong. It is the policy of JuniorDr not to engage in discrimination or harassment against any person on the basis of race, colour, religion, intelligence, sex, lack thereof, national origin, ancestry, incestry, age, marital status, disability, sexual orientation, or unfavourable discharges. JuniorDr does not necessarily endorse or recommend the products and services mentioned in this magazine, especially if they bring you out in a rash. © JuniorDr 2013. All rights reserved. Get involved We’re always looking for keen junior doctors to join the team. Benefits include getting your name in print (handy if you ever forget how to spell it) and free sweets (extra special fizzy ones). Check out JuniorDr.com.
very day 20 patients are harmed in the average NHS Trust across the UK. That’s the equivalent of two full double decker buses each week in the hospital where you work. This harm could be wrong site surgery, a simple fall on the ward, or a hospital acquired infection - all of which can have serious implications for patient outcomes. What’s more distressing is that we already know how to prevent half of these incidents of harm. Patients come into hospital expecting to improve, but with 1 in 10 suffering some sort of medical error or harm, we need to change this quickly. This month the Francis Report into the care provided at Mid-Staffordshire NHS Trust was published. It outlined how up to 1,200 patients had died as a result of poor care between 2005-2009. Even the Healthcare Commission, the governments own health watchdog, called the conditions “appalling” with patients left on soiled beds for days and being forced to drink water from vases as no nursing staff were available. Since the Mid-Staffs scandal was made public in 2009 Sir Robert Francis QC has been working on a series of recommendations on how to prevent a similar scandal ever happening again. The output of this £13 million inqury was a 1,782 page report with 290 recommendations. You can read our summary of the report on p9 and what the recommendations may mean for you as a junior doctor. We know that few doctors apply to study medicine for the money or the esteem. Most do so because they wanted to help ill and vulnerable people and don’t intentionally aim to harm patients. The Francis Report makes it clear that as an individual doctor you have a responsibility to improve the care you provide. On p11 we’ll help get you started in quality improvement as a junior doctor. If you’re looking to improve care for your patients make sure you check out our new website where you can find hundreds of articles and resources - all optimised for reading on your tablet or smartphone.
What’s inside 04 09 11 18
LATEST NEWS Francis Report Briefing Improving patient safety
Eccentric medical pioneers Courses and Conferences
Working part-time a guide
Tell us your news. Email email@example.com or call 020 7193 6750.
148 new doctors affected by “unacceptable” failures of UKFPO
octor and medical student leaders’ have called for immediate support for the 148 medical students who have had their first scheduled job suddenly changed following failures in this year’s application process. 148 final year medical students will be starting their first job as a doctor in a different part of the country following the rechecking of thousands of applications to this year’s Foundation Programme by the UK Foundation Programme Office (UKFPO).
“It is unacceptable that 148 medical students have had their first job as a junior doctor suddenly changed.” William Seligman Co-chair BMA’s Medical Students Committee
Eight students have been informed that they no longer have a firm job offer and instead will be placed on the Foundation Programme reserve list. “It is unacceptable that 148 medical students have had their first job as a junior doctor suddenly changed because of a chaotic failure in this year’s application process,” said William Seligman, Co-Chair of the BMA’s Medical Students Committee.
“In many cases, medical graduates will now find themselves in a completely different part of the country to where they were allocated a job less than two weeks ago.” The mass rechecking exercise occurred after the UKFPO and the Medical Schools Council found that errors had emerged in a machine-marking scanning system used to grade a multiple choice exam which is used as part of the allocation process. This was discovered just a day after more than 7,200 final year UK medical students were told where their first job would be. The BMA has stated that it will be writing to the Secretary of State to express concerns about how the situation was allowed to develop. It also says the UKFPO must stick to its pledge to conduct an “immediate, independent review of the application process and guarantee that the findings will be published in full”. “The UKFPO must ensure that students are offered proper support during this period, especially any who may have lost out financially. Students must not be left with the bill for broken flatshare agreements or other commitments that they have incurred through no fault of their own,” said Seligman. www.bma.org.uk
Pay and conditions
Pay increase of 1% for doctors ‘disappointing’ N
HS doctors will receive a below inflation pay rise of just 1% this year, following the recommendation of the Doctors and Dentists Remuneration Body. “As the Review Body has noted, doctors have made a significant contribution to the performance of the NHS during a time of huge financial pressure,” said Dr Mark Porter, Chair of BMA Council. “The net increase of 1%, which is below inflation, will be very
disappointing to doctors - especially after real terms pay cuts for many years - and will do little to improve morale.” NHS Employers opposed any rise at all saying a “pay increase this year was not necessary and would add additional cost pressures to NHS trusts”. The pay rise will become effective from 1 April 2013. www.nhsemployers.org
1 in 3 registrars say workload is “unmanageable”
ore than one in three (37%) frontline service delivery should not medical registrars have fall disproportionately on this group described their workload of doctors in training. If we don’t do as “unmanageable” in the larg- this we risk the next generation of est survey of UK hospital doctors consultants avoiding careers in acute published in the Royal College of medical specialties.” Physicians (RCP) report Hospital It also found that senior specialworkforce: Fit for the future? ist skills are not evenly distributed A further 59% describe their dai- across the country. Patients in Lonly workload as “heavy”. This com- don have almost double the number pares to less than 5% of general of consultants per head of populapractice registrars who believe their tion compared to the East Midlands. own workload is either heavy or The amount of patients requirunmanageable. ing general skills is increasing with The RCP is calling for urgent ac- the aging population. Frail elderly tion to resolve these issues to prevent patients’ needs are best met by geripatient care being threatened. atric specialities but in 2011 it was “The potential threat to patient not possible to fill 50% of consulcare is alarming. Physicians are now tant posts advertised in geriatric reporting that patients are at risk of medicine. being unsafe,” said Suzie Hughes, www.rcplondon.ac.uk chair of RCP’s patient and carer network. “The skills we train our “Medical registrars should not be doctors to have must be dedrowning under the weight of their veloped around patients’ workload - this is not conducive to good needs. If this is not urgently training or high quality patient care.” addressed, frail elderly people who require hospital care Dr Ben Molyneux Chair, BMA’s junior doctors will be poorly serviced by the committee NHS. We cannot risk providing substandard care to such a vulnerable group.”
Medical Masterclass The MRCP(UK) revision package from the RCP
Registrar training The RCP also warned that the training of medical registrars is highly variable and is too often compromised by the heavy workload. Only 38% of registrars feel that their training in general medicine was good or excellent. “Medical registrars should not be drowning under the weight of their workload - this is not conducive to good training or high quality patient care,” said Dr Ben Molyneux, chair of the BMA’s junior doctors committee. “Hospital services need to be redesigned to ensure that
>New, monthly website
subscriptions now available
> Choose the subscription that’s right for you
> Buy the one-month extension and keep your exam history
Purchase online at
I Hate Mondays
Bullying of NHS staff doubles in past year
lmost one in three (29%) NHS staff reported that they experienced bullying, harassment and abuse from patients, their relatives or other members of the public in 2012 - double that of the previous year. Worryingly one in four (24%) reported they had experienced bullying, harassment or abuse from either their line manager or other colleagues. “Aggressive management has no place in the NHS. Hospitals need to foster a culture that encourages staff to be open with one another, and where clinical care is always the top
priority,” said Professor Norman Williams, President of the Royal College of Surgeons. “Clinicians and managers working together must create a more open NHS where anyone feels able to speak out when there is unacceptable behaviour, so that bullying, harassment and abuse are stamped out, once and for all.” Just under two thirds (65%) of incidents of physical violence and forty-four percent of bullying, harassment or abuse cases were reported. www.nhsstaffsurveys.com
A&E departments see 4,000 patients per hour on Monday mornings - twice the typical number of hourly attendances during the rest of the week. The 2011-12 data published by the Health and Social Care Information Centre (HSCIC) show that A&E departments in England typically deal with about 4,000 cases per hour between 10-12pm on Monday mornings. A total of 17.6 million patients were seen in 2011-12, up from 16.2 million the previous year. www.ic.nhs.uk
GMC Chair first to revalidate Professor Sir Peter Rubin, Chair of the GMC, has become the first UK doctor to revalidate. Speaking of his revalidation he said: “I am delighted to be the first doctor in the UK to revalidate … I’ve had a number of patient and colleague feedbacks over the last few years and they’ve been helpful - partly in reaffirming all the things I do well and also in identifying what I can do better; none of us is perfect.” Professor Rubin is a Consultant Physician and Professor of Therapeutics at Nottingham University Hospitals NHS Trust. www.gmc-uk.org
Savvy Scottish GPs Patient care
New GMC guidance for assisted suicide complaints
ew guidance on how the General Medical Council (GMC) deals with complaints against doctors who may have helped patients commit suicide has been published. It also makes clear the factors that need to be considered in deciding whether a doctor should be disciplined. These include: • If the doctor knew or should have reasonably known that their actions would encourage or assist suicide • If a doctor had prescribed medication that was not clinically indicated or other practical assistance or information or advice about methods of committing suicide • The context and nature of support or information sought • The intensity of encouragement or assistance
The guidance will help the GMC decide if a doctor should face a fitness to practise hearing if they are alleged to have helped a person to die. “Where patients raise the issue of assisted suicide, or ask for information that might encourage or assist them in ending their lives, doctors should explain that they cannot do so because providing this information would mean breaking the criminal law,” the guidance recommends. The number of cases involving allegations relating to assisted suicide is very small. In the last 10 years there have been three cases in the UK. www.gmc-uk.org
Spending on drugs by GPs in Scotland fell by 11 per cent in real terms between 2004 and 2011, despite the volume of prescriptions rising by a third during that time, according to a report by Audit Scotland. This amounts to almost a £1 billion saving a year. It also suggests there is scope for further improvements and potential to save up to £26 million a year without affecting patient care. www.audit-scotland.gov.uk
No gifts please Doctors who graduate from medical schools with an active policy on restricting gifts from the pharmaceutical industry are less likely to prescribe new drugs over existing alternatives, according to a study published in the BMJ. The study of 14 medical schools with an active gift restriction policy found they more readily prescribed three newly marketed psychotropic compared to a control group. www.bmj.com
Junior docs today more likely to work closer to home
oday’s generation of junior doctors are more likely than older generations to train and work in the same region as their home, according to new research published in the Journal of the Royal Society of Medicine. The study which investigated the geographical mobility of UK-trained doctors found that 36% had attended a medical school in their home region. 34% of hospital consultants and GP partners settled in the same region as their home before entering medical school. “Compared with similar data we reported fifteen years ago, the relationships between location of career post and training post, career post and medial school and career post and original family home
have strengthened in recent UK cohorts,” said Trevor Lambert, a statistician from Oxford University who led the research team. The researchers believe the increasing percentage of doctors who stay local may reflect shorter periods of training such that doctors are less inclined to move to career posts afar from training posts. They also warn that the reduced geographical mobility is not sustainable as doctors increasingly have to go where the jobs are. jrsm.rsmjournals.com
Independent review of MRCGP exam results
he GMC has commissioned an independent review into the pass rates for different groups taking MRCGP exams this month. It follows concerns about failure rates for doctors who qualified outside the UK or Europe; concerns have also been raised about failure rates affecting black and minority ethnic UK trained doctors. Figures from the RCGP show that 65.3% of international graduates failed at their first attempt of the Clinical Skills Assessment (CSA) component of the MRCGP exam in 2011/12, compared with 9.9% of UK graduates. “This is a critical examination for doctors wishing to become GPs and it is vital that “We are determined to doctors, patients and employunderstand this issue.” ers have confidence that it is both fair and robust,” said Niall Niall Dickson Chief Executive, GMC Dickson, Chief Executive of the GMC. “The underlying causes for different pass rates among different groups of doctors are likely to be complex, but we are determined to understand this issue, which is why, as a first step, we have commissioned this independent review of the data.”
Further your clinical experience in Australia and New Zealand Would you like to embark on an adventure down under after completing CT1? Head Medical recruit to fixed term roles across a wide range of specialties and subspecialties. Gain exposure to a broad range of cases, work with multi-disciplinary teams and enjoy a varied and interesting workload. Whether you are seeking exposure to Paediatrics, Infectious Diseases, Maori Health or Emergency Medicine or just wanting to explore a different healthcare system – we will be on hand to provide advice and guide you through the recruitment process.
Contact our experienced team on +44(0)131 226 2200 or firstname.lastname@example.org
20 Alva Street | Edinburgh | EH2 4PY headmedical.com
Frontline Medicine in a Century of Conflict Imperial War Museum North
WM North, part of Imperial War Museums, in Manchester, is presenting a major new exhibition exploring the difference between life and death on the front line. Told through the words and objects of people who have faced extraordinary situations, this free exhibition is IWMâ€™s first to look at war and medicine. It reveals the life changing decisions made every day by the medics and soldiers currently in Afghanistan, as well as remarkable stories of people caught in harmâ€™s way over the last 100 years of conflict.
An injured Afghan child is brought to Camp Bastion, the British military base in Helmand, Afghanistan, for emergency care from British medical personnel. The child was one of a number of civilians who were caught in an explosion while travelling on Route 611, the main road through the Helmand Valley. The injured were airlifted by helicopter to Camp Bastion and, after being stablilised, were transferred to Bhost hospital, May 2007. Credit: Photographer Jon Bevan
The Francis Report A briefing for junior doctors Described as the worst UK hospital scandal of recent years, up to 1,200 patients were estimated to have died as a result of poor care at Stafford hospital. The £13 million Francis inquiry concluded this month and made 290 recommendations which will impact everyone working in healthcare. Here’s our briefing on what it means for junior doctors.
The scandal The ‘Mid Staffs scandal’, as it has been referred to in the press, happened between 2005 and 2009 at Stafford Hospital - part of the Mid Staffordshire NHS Hospital Trust. Francis in his inquiry said that the trust’s pursuit of foundation status was one of the initiators for poor care. The drive to achieve this status led to ruthless targets and financial cuts which compromised safety. The regulator, the Healthcare Commission, became alerted to the death rates which were abnormally high compared to other organisations. They identified a number of safety issues but progress was slow as the hospital dismissed some of the concerns as simply ‘coding errors’ and not safety issues.
“Food and drinks were left out of the reach of patients and many were forced to rely on family members for help with feeding.” A number of inquiries followed with each subsequent one discovering more shocking facts about levels of care at Stafford Hospital. Public outrage grew and a pressure group was formed to discover the truth. It called on the then Labour government for a full public inquiry. In 2010 the new health secretary, Andrew Lansley, commissioned Robert Francis QC to conduct a formal public inquiry. Francis was a barrister and had worked on other NHS scandals - including the Bristol Royal Infirmary Inquiry into cardiac surgery in babies.
The inquiry Francis initially planned to present the results of his inquiry in early 2011 but the scale of the problem at Mid-Staffs meant that it became a number of smaller inquiries.
Your helping hand on the wards.
Gantz’s Manual of Clinical Problems in Infectious Diseases, 6e Myers, Moorman & Salgado November 2012 ISBN: 978-1-4511-1697-7 656 pp • 8 illus. & 207 tables Paperback
Handbook of Nephrology Leehey & Moinuddin March 2013 ISBN: 978-1-4511-7547-9 234 pp • 72 illus. & 30 tables Paperback
The Francis Report
A briefing for junior doctors The final report published this month was the fifth such inquiry. The ‘Francis Report’ was finally published on 6 February 2013 and based on evidence from over 900 patients and families. It ran to 1,781 pages in total and this was a summary of over a million pages of evidence recorded during proceedings. In total the inquiry cost £13 million. Speaking at the publication of his final report, Robert Francis QC said: “I heard so many stories of shocking care. These patients were not simply numbers they were husbands, wives, sons, daughters, fathers, mothers, grandparents.” “They were people who entered Stafford Hospital and rightly expected to be well cared for and treated. Instead, many suffered horrific experiences that will haunt them and their loved ones for the rest of their lives.”
“I heard so many stories of shocking care. These patients were not simply numbers they were husbands, wives, sons, daughters, fathers, mothers, grandparents.”
Pocket Medicine, 4e Sabatine September 2010 ISBN: 978-1-4511-0335-9 304 pp • 77 illus. Loose Leaf Binder
Available from www.lww.co.uk
For 15% off and free P&P, enter JuniorDr2013 at the checkout!
The Francis Inquiry stated that problems at the Mid-Staffordshire NHS Trust begin in 2006 when it was required to make a £10 million saving in order to achieve Foundation Trust status. This goal was only possible through cutting staffing levels further and using healthcare assistants instead of nurses. It also found evidence that this drive to save money also meant that the hospital wards were reconfigured in an untested way and concerns from staff about this new arrangement were neglected. Some disturbing incidents were recorded: • Basic observations regularly went unrecorded • Calls for help to use the bathroom were ignored • Patients were left for hours in soiled sheets
• Food and drinks were left out of reach • Family members were asked to help with feeding and personal hygiene • Patients went unwashed - sometimes for up to a month • Standards of ward cleanliness were extremely poor The report also strongly criticised regulators at all levels of the NHS and said they had ‘failed’ in their duty. Despite all the shocking findings Francis decided that Stafford Hospital should not be closed. He said that, while there is a lot of work required, the new management team has made a successful start. He additionally provided 15 specific recommendations for the Trust.
What does it mean for junior doctors? The Francis Report will have wide ranging implications across the NHS but it will likely take many years to have an effect. There are three ways it may impact us as junior doctors: 1. Duty of candour: The report says that all healthcare organisations and staff must be open and honest with patients. This means information must not be hidden or withheld in order to protect individuals or the organisation. It also says that gagging clauses stopping staff from speaking out should be prohibited. 2. Training: Francis outlined some key recommendations for training of all healthcare professionals. He said that no-one should be working in the NHS without registration and called for stronger training in patient experience for nurses. For doctors, the GMC has already announced it will increase the role of quality and safety training in the undergraduate and postgraduate curriculum. 3. Complaints: Francis recommends that complaints to regulators on provision of care which have been upheld should be published on the NHS organisation’s website along with the response.
Further information • Mid Staffordshire NHS Foundation Trust Public Inquiry website www.midstaffspublicinquiry.com • Francis Inquiry - Lessons from Stafford www.kingsfund.org.uk/Francis-Inquiry
healthcare improvement made simple
Five ways the BMJ Quality Improvement Programme can help you: Be your guide Weâ€™ll take you step-by-step through an improvement project to help you make a real difference for patients Work flexibly, faster and smarter Our programme allows you to work efficiently on projects as an individual or collaboratively as a team. You can also add a mentor for support. Easily meet CPD requirements Over 20 hours of exclusive BMJ Learning modules and webinars to support your work and certificates to contribute towards your CPD and revalidation
Get published Record, document and publish your work in BMJ Quality Improvement Reports journal - a new peerreviewed journal of quality improvement evidence Join a global community Connect and interact with the international improvement community through our exclusive webinars, social media and forum
Start making healthcare better. Register today for a one-year introductory subscription for just ÂŁ49.
How to run a Quality Improvement Project Effecting change in the NHS as a junior doctor can be a daunting experience. With limited power, influence and time it can seem an almost impossible task. Yet, as a junior doctor we get a unique insight into how we can improve patient care. In this article The Network’s Rob Bethune offers a few helpful suggestions that can help facilitate change. Establish a team This is crucial, you cannot do it alone. Most of us do four or six month placements and this is often not enough time to run a project. Get a team of 6-10 people who can rotate whilst running the project throughout the year and you’ll find things much easier. You’ll need as many pairs of hands as possible as good data collection is crucial and you need to make this easy and feasible for yourself. You can often get by with a little help from your friends but working in a team also makes it fun and gives you immediate motivation as your colleagues and friends will hold you to account.
The Model for Improvement There are a multitude of tools for improving quality of systems (Lean and Six Sigma are examples) but the most tried and tested model for healthcare is The Model for Improvement. I will describe it in more detail below using a current F1 quality improvement project as an example, but the diagram below shows the outline - make your aim, measure the thing you are trying to improve and then run a series of tests of change (the plan-do-study-act cycle).
Develop a structure to the project It is useful from the outset of the project to set specific targets. This will help focus your mind and enable everything to be done by the end of the year. The collaborative feature of this timeline is particularly important. If there are other groups in your hospital running quality improvement projects then make sure you have collaborative sessions with them. This will help all of you to learn from each other as well as providing motivation and support. FIG 1 - The Model for Improvement
What is quality? 12
Aim What is it you want to improve? It is really important to carefully define this at the start to help you develop a deeper and more profound understanding of the system. Our example project was trying to improve the effectiveness of weekend handover. They wanted 95% of jobs that were handed over to the weekend team to be completed by Monday morning. Measure ‘Data, data, data’ goes the drumbeat of a quality improvement project. Without it you will not be able to see if your changes are an improvement - but more importantly by getting really good data you will develop profound knowledge that will allow you really see what needs changing. Profound knowledge is often underestimated. We see problems on the surface and think solutions are obvious and often we just go ahead and implement them. These simple change efforts are often unsuccessful because we do not really understand the system we are dealing with. Once we have this knowledge then the changes are usually clear. Remember H.L. Mecken’s words ‘For every problem there is a solution, simple, elegant - and wrong’.
lthough ‘quality’ is discussed widely in many professions and industries, (the word is included some 360 times in Lord Darzi’s much cited NHS Next Stage Review Final Report1), it remains a slightly evasive concept. The focus on quality has been apparent in healthcare for much of the 20th century and is both political (used by different professions to advance their particular interests) and subjective (dependent on who is assessing it and what values and consensus are used). The popular definition of quality in healthcare that now dominates was produced by the Institute of Medicine and Committee on
(whilst working full time as a Junior Doctor) We have to be able to show that our solutions do make a difference so we plot our data on a run chart. In our example project the team collected data on how many jobs were being completed on a weekend (they sampled this data) and plotted the initial data before any tests of change on the graph below. As you can see they did this on five separate occasions to ensure the accuracy of their data.
FIG 2 - Run-chart
Quality Health Care in America (2001); this portrays safety, effectiveness, patient-centeredness, timeliness, efficiency and equity as the six â€˜pillarsâ€™ of quality in healthcare. Simply evaluating quality represents just one end of the quality continuum which includes quality assurance, and quality improvement. The latter, popularised by a number of quality improvement evangelists in the late 20th century (such as W.E. Deming and Philip Crosby), had its roots in managerial and industrial sectors before being applied to healthcare. Perspective is also important: a key distinction is that between
patient quality and professional quality. In the former, the patientsâ€™ perception of a service could be deduced by counting complaints, or rating service attributes for example. When professional quality is considered, the professionally assessed needs of patients represent the standard which should be met. So, whether you are trying to measure it, assure it, or improve it, quality in healthcare is a slippery but increasingly relevant force for improvement.
How to run a Quality Improvement Project The plan-do-study-act-cycle (PDSA) Now you have your background data collection and a deeper and more profound understanding of the system (weekend handover in our case) you are ready to make some changes. These are done in the form of a PDSA cycle. The PDSA cycle is as simple and intuitive as it sounds; come up with a plan, trial it out on one day, study the effect and act upon the result. One of the keys is to trial the change over a short time period in one area. If it works you can spread it but if it doesnâ€™t and needs refining then you can do that easily.
As junior doctors we are in a unique position to see the problems and affect the solutions.
FIG 3 â€“ Run chart example
If you implement your idea widely from the beginning (as we have seen so often in healthcare!) and you get it wrong it is expensive both in terms of time and resources to undo it. Make your first tests small. In our example (see the next run chart below) they did several PDSA cycles, improving the handover sticker in the notes as well as unifying the Excel spreadsheets used to pass the information on. Through a series of small scale changes with continuous data collection the effectiveness of weekend handover increased dramatically (and for the managers out there this was free!). Improving the systems in which we work is crucial to improving the care we give to our patients. As junior doctors we are in a unique position to see the problems and affect the solutions. Rob Bethune, Surgical Registrar, Severn Deanery Acknowledgements. Izzy Mark and Joanne Hooker and the rest of the weekend handover group at North Bristol NHS Trust, for their data.
Learning to lead
FROM JUNIOR DOCTOR TO CONSULTANT
Many of the challenges facing new consultants in the emerging NHS lie in the realm of leadership and yet junior doctors often report feeling unprepared to lead. The time when the sole function of a doctor was to provide clinical care has passed.
s a junior doctor you can develop your leadership competencies by being proactive and consciously assuming greater responsibilities around leadership activities; the Medical Leadership Competency Framework provides a range of practical examples of opportunities for learning and development. Establish clinics, participate in management meetings and volunteer to undertake additional leadership responsibilities; closely observe selected role models in order to identify effective leadership behaviours; attend a postgraduate leadership course so as to gain exposure to unfamiliar scenarios and new theoretical models and identify your personality and leadership styles by completing selfassessment questionnaires. Additional opportunities for leadership development, both pre- and post the transition to consultant grade are outlined below and learners are encouraged to blend learning opportunities. Each development tool and method has its own advantages and disadvantages and the right approach will depend upon individual and organisational circumstances and goals.
Opportunities for leadership development
• Action learning - working as part of a small group of peers or an ‘action learning set’ to address real life problems, develop solutions and take action • Coaching - a time-limited, goal-orientated, one-to-one developmental relationship based on real work issues • Developmental work assignments learning from ongoing work initiatives and integrating these experiences with each other and strategic organisational imperatives • Mentoring - a long-term, open-ended, one-to-one developmental relationship in which a senior colleague supports the personal and professional development of a junior colleague • Leadership within a team - motivating team members, leading through change, confronting poor performance, delivering results (by achieving objectives) and encouraging and supporting the professional development of team members • Networking - creating interdependent and often mutually beneficial
relationships; • Self-directed learning - taking responsibility for finding, managing and assessing one’s own learning eg. basic internet research, reading leadership books and journal articles, attending and contributing to networks and forums • Shadowing - provides opportunities to observe and understand an unfamiliar part of a system without being required to act • Workshops and masterclasses - timelimited learning sessions focused on specific topics which provide opportunities to gain up-to-date information, develop particular skills and to share learning; workshops delivered by experts in their field are called masterclasses Developmental experiences are likely to have the greatest impact when they can be linked to or embedded in your ongoing work. You should adopt a cumulative approach to learning, considering basic concepts and local systems early on in your training and complex concepts and wider systems when more established. Regular, accurate and honest appraisals, grounded in the Medical Leadership Competency Framework, can offer insight into your leadership strengths, abilities, gaps and developmental needs as you progress in your career. Seize opportunities to reflect,
individually and with colleagues, and to promote deep learning as a means of realising positive changes in your thinking and behaviour. When confronted by a new leadership framework or approach it is helpful to ask “how does this apply to my situation” and “how can I do things differently in the future?”. A significant temptation for a newly appointed consultant is to accept every leadership role and opportunity that is offered; this approach, however, is an inappropriate use of resources, limits teamwork and team development, fails to foster the skills of others and may increase levels of stress. Conversely over-delegation risks establishing unrealistic expectations and stretching individuals beyond their competencies to the detriment of patient care and team well being. Dr Michael Hobkirk Michael is the Lead Consultant for Chichester Child and Adolescent Mental Health Service and the Specialist Advisor for Leadership Development at the Royal College of Psychiatrists. Reference: NHS Institute for Innovation and Improvement, Academy of Medical Royal Colleges (2010) Medical Leadership Competency Framework, 3rd edn. http://www.institute.nhs.uk/images/documents/ Medical%20Leadership%20Competency%20Framework%203rd%20ed.pdf.
Summary • Leadership is a key component of your professional development and an ongoing process • Reflect upon your leadership competencies and learning needs using the Medical Leadership Competency Framework as a guide • There are numerous informal and formal opportunities for leadership development • Strike a balance between taking on new roles and delegating work to others.
Medicolegal Advice - in association
Standing up for Improving patient safety is no doubt at the forefront of everyone’s minds following the Francis Inquiry. Charlotte Hudson reflects on the challenges doctors face in ensuring that good quality of care is delivered.
he GMC’s Good Medical Practice states that patients must be able to trust doctors with their lives and that doctors must make the care of patients their first concern. The Francis Report found serious failings in leadership and culture in the Mid Staffordshire NHS, which Inquiry chairman, Robert Francis QC said went right to the top of the health service. A doctor’s first priority is to ensure that patients are well cared for and safe from harm. The Royal College of Physicians says: “The provision of good care is a fundamental part of what it means to be a doctor. This includes seeking to address instances of poor practice where patient safety may be compromised, raising these concerns with hospital management and sector and professional regulators where necessary.” Following the report, a statutory duty of candour on providers will be introduced whereby the NHS will have to be honest about mistakes and report treatment or care that they believe has caused death or serious injury. Following the governments response to the Francis report, Dr Stephanie Bown, Director of Policy and Communications at MPS, said: “MPS has long held the view that while you can mandate disclosure, legislation cannot deliver the attributes of high quality and open communication such as empathy, sincerity, and comprehensiveness. A culture change is what is needed.” “We will be further highlighting to government that despite the understandable appeal of a legislated duty, this will not achieve the objective of effective open communication.”
Raising concerns In December, the GMC introduced a confidential helpline for doctors to raise concerns about patient safety, which allows doctors to blow the whistle on poor care to the GMC for the first time. Since its inception, 12 allegations of a “very serious” nature have been investigated, involving complaints that raise a question about a doctor’s fitness to practise and risks to patient safety. The helpline was introduced on the back of the GMC publishing new guidance in 2012, Raising and Acting on Concerns about Patient Safety, which sets out doctors’ duty to act when they believe patients’ safety is at risk, or that patients’ care or dignity is being compromised. The guidance makes it clear that doctors have a duty to put patients’ interests first and act to protect them at all times – this overrides personal and professional loyalties.
Improving patient safety The Department of Health’s policy on patient safety says: “Improving patient safety involves assessing how patients could be harmed, preventing or managing risks, reporting and analysing incidents, learning from such incidents and implementing solutions to minimise the likelihood of them reoccurring.” Working as a doctor is a risky business; it is hectic, sometimes stressful, and often involves working long hours. You may worry about receiving a complaint or claim, and find yourself asking: “How do I prevent making errors and ensure my patients are safe?”
Communication To prevent errors, it is important to firstly identify the reasons why they occur. A breakdown in communication is quite often responsible. Good communication is fundamental to patient care – between all members of the healthcare team and their patients. In today’s team approach to delivering healthcare, communication has to extend to more people and there are therefore more opportunities for it to fail. Communication between primary care, secondary care and social and voluntary services should be seen not as a chain, but as a communication net, within which any one member may need to communication with any other. Patients need and should be given, thorough explanations of symptoms and treatment options, together with any potential risks. Failure to adequately explain this can cause patients to question a doctor’s competence, and could bring your fitness to practise into question. 16
with the Medical Protection Society
patient safety During the King’s Fund Francis Inquiry conference Robert Francis QC quoted Florence Nightingale: “The very first requirement of a hospital is that it should do the sick no harm.”
Handovers Effective communication with colleagues is also important when handing over care of a patient to another doctor. The next doctor needs to be able to easily take over from where you left off to enable good continuity of care.
Managing risk The Royal College of Physicians’ (RCP) strategy for quality states that continuous improvement in the quality of care is the responsibility of all physicians. The College says with quality now looking certain to be the principle driver of service improvement over the next few years, the RCP is well-placed to support this agenda.
References General Medical Council, Good Medical Practice – http:// www.gmc-uk.org/guidance/good_medical_practice.asp Royal College of Physicians, Patient safety – http://www. rcplondon.ac.uk/policy/improving-healthcare/patientsafety General Medical Council, GMC launches confidential helpline for doctors to raise concerns about patient safety – http://www.gmc-uk.org/news/14222.asp General Medical Council, Raising and Acting on Concerns About Patient Safety (2012) – http://www.gmcuk.org/guidance/ethical_guidance/raising_concerns.asp Department of Health, Patient Safety – http://www. dh.gov.uk/health/category/policy-areas/nhs/patient-safety/ Royal College of Physicians, RCP Strategy for Quality – http://www.rcplondon.ac.uk/policy/improving-healthcare/ rcp-strategy-quality BMA, GMC trainee survey highlights safety concerns – http://bma.org.uk/news-views-analysis/news/2012/july/ gmc-trainee-survey-highlights-safety-concerns
Conclusion The GMC’s annual survey of trainees in 2012 found that one in 20 junior doctors had concerns about patient safety, prompting junior doctors’ leaders to insist that patient safety concerns raised by trainees must be fully investigated. If you have any concerns about patient safety it is your professional responsibility to raise them. If you don’t feel comfortable raising concerns with a senior colleague, the GMC’s confidential helpline is there for you to use. MPS is the world’s leading medical defence organisation, MPS has a wealth of online resources putting members first by providing professional support for doctors, from magazines to factsheets, and expert advice throughout their careers. handbooks and booklets. To access the MPS supports members through the world’s largest resources visit – http://www.medicalpronetwork of medicolegal experts. We have a unique team tection.org/uk/advice-and-publications/. of more than 100 specialist lawyers and medicolegal We also hold a number of comadvisers (doctors with legal training). munication workshops that can be accessed here – http://www.medicalproWe are also committed to sharing our experience with members to help them avoid problems and provide the very tection.org/uk/education-and-events/ best care for their patients. The educational portfolio available courses-and-workshops. includes publications, conferences, lectures, presentations, workshops, E-learning and clinical risk assessments.
MPS members who would like more advice on the issues raised in this article can contact the medicolegal advice line on 0845 605 4000.
www.mps.org.uk The Medical Protection Society Limited. A company limited by guarantee. Registered in England No. 36142 at 33 Cavendish Square, London W1G 0PS.
Working Part-Time: A growing number of junior doctors are investigating flexible working as a way of achieving a better work-life balance. In this issue foundation doctors Emma Tyson and Ellie Galloway discuss the process of applying for less than full time training (LTFT) after switching from full time to part time working and share their experience of a successful slot share. Brought to you by
s of April 2011 there were 3777 trainees working less than full time (LTFT) in the UK - 6.6% of the total number of doctors. Although 95% of these were women there were also a significant proportion of male doctors would also like to work LTFT in the future. Helped by the changing demographics of the medical profession and demands for greater flexibility along with better work-life balance, the opportunities for LTFT have increased over the last decade.
So who can work part-time? All trainees are eligible to apply to train less than full time and any ‘well founded reason’ which would prevent someone training on a full-time basis would be considered. Doctors who wish to train LTFT mainly fall into two categories which have been defined by the deaneries as Category 1
• Trainees with a disability or in ill health (may also include those on in vitro fertility programmes) • Trainees (both men and women) with a responsibility of caring for children • Trainees with a responsibility for caring for an ill/disabled partner, relative or other dependant
manage the out-of-hours between them. Slot share partners are not expected to cover unexpected absence, such as sickness or maternity leave of their slot share counterpart. The deanery can sometimes provide the additional funding for slot shares where the total hours worked between the two trainees is greater than a 100% full time equivalent. This can act as an incentive to the employing trust as they can end up with more clinical time, however the availability of this funding can vary between deaneries. In general slot share trainees need to work at least 50% WTE and this may involve sharing with a different person on each rotation.
“Job sharing is a perfect solution that enables progression as a doctor without compromising family commitments.”
How it works
Trainees may train less than full time from the outset or transfer from full-time to LTFT (and back again if required). Most LTFT trainees now work part time as part of a ‘slot share’ arrangement with the remainder managing to carry out reduced sessions in a full time post.
The initial process of applying for LTFT is fairly standard nationally and, although not complicated, it is a fairly paperwork heavy process. At a local level, once you’ve got deanery approval, there is a little more variability as some trusts may be able to be accommodating than others. My FY2 post was at the Royal Surrey in Guildford and the coordinator there could not have been more helpful. There are two main issues that need to be resolved - firstly finding a suitable job share ‘other half ’ and secondly finding a job that lends itself to less than full time workers. My job share partner Emma and I are currently working in A and E along with nine other SHOs. The shifts are each ten hours long and follow a fixed nine week rota with some weeks comprising 70 hours and others just 30 hours. We are treated as one person so simply divide the line between us. Emma works half of the shifts and I do the other half plus three extra shifts over the nine week period thereby increasing my hours up to the 60% of full time that I am contracted for. A and E is the perfect place to work less than full time as continuity is not an issue.
• Unique opportunities for their own personal/professional development eg. training for national/international sporting events • Extraordinary responsibility eg. a national committee • Religious commitment - involving training for a particular religious role • Non-medical professional development (eg. management/law/ fine arts courses)
Slot sharing is when two trainees share one full-time post and 18
MEDICAL STUDENTS Support
We were very fortunate that we were allowed to choose our own
S4D_Ad_Print.pdf 1 30/08/2012 16:40:37
a Guide shifts as long as we covered our allocated line of the rota. We particularly liked the fact that this allows us to be an integrated part of the team and also experience the full range of shifts - neither of us would feel that we had truly worked in casualty if we hadn’t had our fair share of intoxicated Saturday night patients and rugby injured Sunday ones. The reduced hours that Emma and I work means that we have much more flexibility for swapping shifts for child care reasons. Whilst this is obviously beneficial for the two of us it has had the unforeseen advantage that we are invariably able to perform shift swaps with others. It is extremely difficult for the full time SHOs to swap duties due to the almost impossible task of finding a replacement shift that does not clash with the duties they are already rostered for. We are both really pleased that we are able to help in this way. Another concern that we both had was that we would be adversely affected by our reduced exposure to cases. Although we clearly do see less patients than our full time colleagues, we do have the time (and energy!) to read around the interesting cases that we have seen. Emma and I also meet weekly to discuss the patients we have treated so that we each get the benefit of learning by experience - albeit indirectly. If one of us is unable to attend formal teaching we take notes for our ‘other half ’.
… and the negatives
Support4Doctors is an online portal of information for UK doctors. It offers specialist advice and support for doctors and their families on career, health and financial issues. The site also offers a database of organisations that can provide further help. Support4Doctors is a project of the Royal Medical Benevolent Fund. The RMBF is the leading UK charity for doctors, medical students and their families. We provide financial support, money advice and information when it is most needed due to illness, age, bereavement or disability. C
Being out of sync with other trainees does have disadvantages. The main one being the need to find a job to cover the ‘gap’ between the end of FY2 and starting core training. Although neither Emma nor myself are at this stage yet I can see that it may be problematic. We have also found that although we are less than full time there is still the need to fit in formal training/audits etc and this has meant that we sometimes need to come in to work on our days off. Finally, working reduced hours mean receiving a dramatically reduced salary.
Words of advice If I could sum up how to make a successful slot share work well it would be that there needs to be good communication, fairness and flexibility in division of work. On balance, job sharing is a perfect solution that enables progression as a doctor without compromising family commitments. We would thoroughly recommend it. If you want to find out more about flexible working and get advice from other trainees visit the careers section at JuniorDr.com. References 1 Analysis of the bi-annual survey of less than full time training 1st November 2010 - 30th April 2011. West Midlands Deanery - www.westmidlandsdeanery.nhs.uk/ LinkClick.aspx?fileticket=wD 2 Women and medicine, the future. June 2009 Royal College of Physicians - http:// www.rcpsg.ac.uk/FellowsandMembers/RCPSG_projects/Documents/Flexible%20 Working/RCPLondon_Summary_Report.pdf 3 British Medical Association Cohort study 1995, eighth report - http://www.bma.org. uk/healthcare_policy/cohort_studies/cohort8.jsp 4 Kent, Surrey, Sussex Deanery LTFT Policy - http://kssdeanery.org/sites/kssdeanery/ files/KSS%20Less%20Than%20Full%20Time%20Training%20Policy.pdf
Each year the RMBF helps hundreds of doctors, medical students and their dependants. The RMBF's help ranges from financial assistance in the form of grants and interest-free loans to a telephone befriending scheme for those who may be isolated and in need of support. For beneficiaries in particular financial need the RMBF can arrange money/debt management advice and in cases where it is appropriate the RMBF may also be able to help with return to work support. The RMBF is committed to leading the way in providing support and advice to members of the medical profession and their dependants. To find out more about our work, or how you can get involved visit the RMBF website.
www.rmbf.org Registered office: 24 King’s Road, Wimbledon, London SW19 8QN. Tel: 0208 540 9194. A charity registered with the Charity Commission No 207275. A company limited by guarantee. Registered in England No 139113
MEDICAL STUDENTS support
WIN an iPad
Your chance to WIN a new 32GB Apple iPad 3G*. Wesleyan Medical Sickness specialise in providing tailored financial advice to medical professionals. Our iPad competition is exclusive for medics. To enter visit www.wesleyan.co.uk/ipadcompetition *Terms and Conditions apply. See entry form for details. Model shown for illustration purposes only and may differ from actual prize. Wesleyan Medical Sickness is a trading name of Wesleyan Financial Services Ltd, which is authorised and regulated by the Financial Services Authority. Wesleyan Financial Services Ltd is wholly owned by Wesleyan Assurance Society. Registered No. 1651212. Head Office: Colmore Circus, Birmingham, B4 6AR. Telephone calls may be recorded for monitoring and training purposes. HD-AD-15 (02/11)
Focus on Finance - in association with Wesleyan Medical Sickness
Protecting your finances from harm
s a junior doctor, it could be easy to dismiss the prospect of being unable to work because of illness or injury as something that only happens to older colleagues. However, as a doctor, you know anyone could be struck down by illness and be unable to work at any time of their life, which could have serious implications for their finances. This is why an income protection policy should be an integral part of any financial plan right from the start of your career, as it will enable you to maintain your standard of living should anything happen to you.
What to look for when buying income protection
When buying income protection you should ensure the policy is specifically tailored to your needs and provides all the key benefits you require if you need to claim. For example:
What keeps doctors off work?
Wesleyan Medical Sickness has analysed almost 5,000 income protection claims made to it from 2002 to 2012. The single most common complaint that kept doctors off work over the past decade was psychological disorders such as depression (23%). This was followed by musculoskeletal disorders (19%), cancer (11%) and heart conditions (10%). More than a quarter (28%) of all the income protection claims made to Wesleyan during that time were for periods of illness that lasted longer than a year, and, of those, the claims lasted an average of almost seven years. Three quarters of claims were made by doctors between the ages of 40 and 59. While this may seem a long way off at the start of your career, it is important to take out income protection as soon as you can rather than waiting until later in life as it could potentially make it more difficult to find cover. Why you need income protection
If you work in the NHS and fall ill, the
maximum amount of sick pay that can usually be claimed is six months full pay, followed by six months half pay after five years continuous service. Remember, this only takes into account your NHS work, not any private work. If you work wholly in the private sector, any sick pay you are entitled to will be determined by your employer. Income protection policies are generally based on your full earnings and will pay you a regular tax-free income, typically up to 50% of your pre-incapacity level. Most policies pay out until you are well enough to return to work, are no longer suffering from a loss of earnings (such as if you start receiving your pension), you reach the maximum age for your policy, or you die. Without an income protection policy, once your sick pay stops you may have to draw upon any savings you might have or, if eligible, rely on state support. The Employment and Support Allowance currently pays out a maximum of £105.05 a week, which is likely to be some way short of your regular income.
• Ensure the policy includes an ‘own occupation’ definition, meaning it will pay out if you are unable to carry out your specific job. If the policy states ‘any suited occupation’, it won’t pay out if you are able to carry out other types of work based on your knowledge and experience. • Check the scheme offers ‘permanent’ protection, meaning the terms on which it is offered will remain unchanged until the policy expires or you retire, whichever comes sooner. • Think about the right deferred period for your needs. Premiums are normally cheaper if you wait longer before benefits are paid, so you might choose to defer payments until other sources of income, such as sick pay, have expired or reduced. • Review your policy regularly as it may be impacted by any changes in employment conditions and salary increases that occur throughout your career. Conclusion
Any time you are off work without receiving an income could leave you financially vulnerable. A financial adviser with understanding of the medical profession will help ensure you are protected and have adequate cover in place.
The above information does not constitute financial advice. If you would like more information or need specialist financial advice, call Wesleyan Medical Sickness on 0800 358 6060 or visit the website at www.wesleyan.co.uk/doctors.
Specialist financial services for doctors • Savings and Investments
• Retirement Planning
• Motor, home and travel insurance
• Life and Income Protection
Motor, home and travel insurance is arranged by Wesleyan for Professionals.
0800 107 5352 or visit www.wesleyanmedicalsickness.co.uk Wesleyan Medical Sickness and Wesleyan for Professionals are trading names of Wesleyan Financial Services Ltd, which is authorised and regulated by the Financial Services Authority. Wesleyan Financial Services Limited is wholly owned by Wesleyan Assurance Society. Registered No. 1651212. Head Office: Colmore Circus, Birmingham B4 6AR. Telephone calls may be recorded for monitoring and training purposes.
Making the best of it in
Sierra Leone FY2 Dr Mikey Bryant is in Sierra Leone with healthcare charity Mercy Ships. He has been volunteering in a children’s clinic for a year in a country where one in five children don’t live to see their 5th birthday. In this regular column he gives us an update on his experience.
t’s another early start, only this time I’m not going straight to the clinic. Instead, I’ve been asked to travel to the north of the country to lead a course in emergency triage and treatment for sick children. I climb out of the ‘poda poda’ (a minivan taxi) after a six hour journey wedged between two goats and a crowing chicken and I am instantly hit by the heat and barrenness of the town. I soon realise upcountry Sierra Leone is a completely different prospect to the capital Freetown. Gone is the hurried mess of slums dotted with disrespectfully overpriced restaurants for the elite rulers, long past are the coloured market battlefields with their noisy bartering and aggressive sales pitches. Here, I feel a bit like I’ve just walked into a town in the 19th century American Midwest at midday, complete with tumbleweeds drifting across a suspiciously deserted road - the normal residents slightly hidden and wary of strangers. There seems to be just one road and the hospital is on it - the only building of any particular size in the town. The hospital superintendent, a doctor with about two years post-grad experience as far as I can work out, shows us around doing his best to make light of the government hospitals shortcomings. “We will have oxygen in the ICU soon” and “we won’t always have share the ceftriaxone doses between the children” being some of my favourite quotations. It isn’t long before the inevitable tragic patient crashes the tour, as a distressed looking child is rushed in with his conjunctivae as pale as the sand outside. We all spring into action; everyone has seen severe respiratory distress secondary to malaria so there is no delay in getting some treatment started despite the hospital’s lack of malaria test kits and a working blood bank. Eventually a transfusion is improvised using blood from the child’s dad, who proves eager to help once he understands the implications of what is going on.
MEDICAL STUDENTS Diaries
“There are still some disturbing oddities, including one extremely eccentric woman who refuses to accept that anterior fontanelles aren’t used for breathing.”
“I am horrified to watch her pick up the baby by the leg and wave her back and forth hopefully.”
Soon after that we get the chance to meet the nurses who want to learn about triage, and at last we see something promising. I’m impressed by the enthusiasm and turnout, as the small room is packed out. There is a huge appetite for learning here. Given the huge gulf in nursing education as a result of the war’s devastation so many of the hospital staff have gleaned precious morsels of knowledge from textbooks dating back to colonial times as well as simply learning from older staff on the wards. As a result, there is a lot of knowledge that seems just a little off, like odd doses of ceftriaxone
and rather large fluid doses. As soon as I start explaining about the importance of maintaining babies’ airways, an excited ripple goes through the audience as they realise they are going to get a chance to practice on some of the model babies we’ve
brought. Taking them out of the box makes me feel like Mary Poppins unpacking her never-ending suitcase. It’s here that the knowledge gaps really start showing. When I give a scenario to one nurse about a newborn with neonatal asphyxia I am horrified to watch her pick up the baby by the leg and wave her back and forth hopefully. I try to intervene but am told that this will “help get air into the lungs and wet stuff out”. It takes a little while to go through the reason why this doesn’t work, but when I succeed there are smiles all round as understanding dawns. Soon there are more eager questions about what to do in all sorts of situations and we find ourselves dealing with very Sierra Leonean problems, such as what to do when your primary health unit has no masks for ventilation, or how to deliver fluid boluses when you have no giving sets around. Later we have a chance to ask some of the nurses what they think of what we have taught them. In between the politely enthusiastic comments, there are still some disturbing oddities, including one extremely eccentric woman who refuses to accept that anterior fontanelles aren’t used for breathing, instead sticking to a theory that maybe babies in Sierra Leone are “made differently”. I’m impressed by the hospitality, and amazed by how much productive learning can be done without Powerpoint or e-learning modules. On the way back to Freetown, sweating into the exposed foam on a ripped seat of a ‘poda poda’, I reflect on the simplicity of knowledge being passed on through partnerships and word of mouth. Until recently this was how learning worked, no fuss, none of the tick box exercises that plague so many of the learning opportunities in British training. I can only hope that the knowledge being passed on in that little tinroof hut saves lives and is remembered. Read Mikey’s blog online at www.juniordr.com
The journey to becoming a doctor Sixth former Carla Barberio dreams of being a doctor. We were all there once struggling with exams, trying to perfect UCAS forms and longing to swing a stethoscope around our necks. In this new regular column we follow Carla as she starts out on her path to becoming a doctor.
re you ‘with it’ enough to do photocopying?” That was just one of the questions I was asked on my first ever day of work experience at my local hospital. Being only sixteen and quite apprehensive I felt as though I was either in the way or out of the action. I had been told to wait in an office and was starting to feel abandoned when suddenly a sharp-tongued nurse burst in and demanded this of me. My first day, spent in A&E, was not the most informative. Luckily for me the following few days, spent in the surgery, ante-natal, cardiology and paediatric departments, were far more pleasurable experiences. My next experience was at a GP surgery which could not have been more fun. Thrown straight into the thick of it I was given the opportunity to accompany the GP to the funeral directors to fill out a ‘crem form’. Despite my Mum’s absoCarla Barberio lute shock and horror when I texted her, I had no hesitation in agreeing to the visit as I was keen to gain first-hand experience of all aspects of a GP’s role - and so I was cheerfully introduced to the recently deceased Mr Smith. Later that day, I shadowed a healthcare assistant whose main duty was to take blood. Much to my delight, this culminated in her asking if I would like to take her blood, with permission. I was elated after taking three phials on the first attempt - although I pity every single person who I regaled with this story over the next few weeks. The rest of the week was spent shadowing the community matron, GP and nurse, with a day at the pharmacy. Collectively this probably made it my favourite placement. I absolutely loved volunteering with St John Ambulance as this brought me into contact with a wide cross-section of the community. My first duty, at a rugby match, found me standing next to a keen supporter nicknamed “The Roarer”, for reasons that soon became very clear. In between roars, he made brave attempts to explain the rules to me. Thankfully, there were very few casualties needing attention that day. My next duty was the complete opposite - a school sports day. The most difficult challenge there was distinguishing between those who were genuinely ill or injured and those just trying to ‘skive off’ and have a go on our couch. I also tried to involve myself in other enjoyable community activities which included lifeguarding, teaching swimming and helping in a Moroccan Berber village. I took on the philosophy of saying yes to any opportunity of interacting with the community, in hope that it might just prove to those admissions tutors that I had the right personality to become a doctor. My final experience, watching a replacement knee operation at the Royal National Orthopaedic Hospital, left me absolutely convinced that Medicine is the career that I would love to pursue. The only hurdle now is the interview. Watch this space!
MEDICAL STUDENTS Diaries
Top five eccentric medical inventors Some of the greatest advances in medicine were spearheaded by some of the most eccentric characters. Ben Chandler reviews his top five eccentric medrepreneurs. Horace Wells (1815-1848) Wells was an American dentist with a dislike for inflicting pain on his patients. His flash of genius occurred at a travelling show where he observed an audience member injure their leg while under the influence of laughing gas (nitrous oxide). Wells noted that the person experienced no pain and realised that this gas might also bring to an end the pain of dental surgery. In his first experiment he took the gas himself for his own tooth extraction and subsequently used it on a number of patients. A month later he staged his first public demonstration but unfortunately the patient was not sufficiently anaesthetised and cried out in pain when the tooth was extracted. The audience were not impressed and booed Wells from the stage. After some time promoting his work in France Wells returned to the USA and continued researching anaesthetics. Unfortunately on one occasion whilst taking chloroform he became deranged and threw acid over two prostitutes, later committing suicide once he realised what he had done.
Alexis Carrel (1873-1944) Alexis Carrel was a gifted surgeon, who was awarded the Nobel Prize for devising methods of suturing blood vessels, as well as developing an aseptic technique that was used extensively throughout the First World War. However, he was a controversial character, firstly drawing criticism amongst some medics for publishing a book about miracle cures at Lourdes, and later for his political views and eugenics work. He died in 1944 having been accused but never tried for collaborating with the Nazi party in occupied France.
James Barry (1792-1865) Barry was a surgeon with the British Army and an early pioneer of the caesarean section. History suggests that Barry was actually a woman, born Margaret Ann Bulkley. Barry is likely to have been the first British female doctor. She is alleged to have hidden her sex to allow her to follow her chosen career in medicine. It was only following her death that her true identity was discovered when underneath her gentlemen’s garments was the body of a women.
Christiaan Barnard (1922-2001) Known as the “film star surgeon” Barnard became an overnight celebrity when he performed the first human heart transplant in 1967. Always pushing the boundaries of possibility, he also transplanted primate hearts into humans on two occasions (one from a baboon and one from a chimpanzee). His private life resembled that of a modern celebrity with rumours of numerous affairs with famous women. He married three times, twice to fashion models - the final time to a girl young enough to be his granddaughter.
Werner Forssmann (1904-1979) Forssmann eventually became a urologist but in his earlier career he made his name by pushing catheters into places other than the urethra. His defining experiment was in 1929 when he inserted a catheter 65cm into his own cephalic vein before calmly walking up two flights of stairs to have an X-ray taken showing the tip in his right atrium. He published his feat along with suggestions for its use. However not everybody was impressed, and following disciplinary action for his self-experimentation he quit cardiology and pursued a career in urology. His work was eventually followed up and in 1956 he was awarded a Nobel Prize.
Writing in the Notes bling
e piece on Dear Editor, entioned in th m t no g in th One t? Gambling ing (Wanna be bl m ga al ic og pathol e propensity 26; p15) is th s Is n; io ct di pathologiwith ad drugs to cause t is on ag e in m of dopa control disorother impulse d an g in bl m Parkinson’s cal ga nts treated for tie pa in s) D C ss legs synders (I metimes restle so or ) D (P e diseas d PD patients of agonist-treate 4% -1 13 e. drom pulsive gamICD, and com e on t as le at p develo udy 50% of 5%. In one st t ou ab ts ec aff e. The only bling 00,000 or mor $1 st lo d te ec aff those or preferably t is to reduce en tm ea tr e tiv effec pefully avoidagonist use, ho e in m pa do al syndrome stop onist withdraw ag e in m pa do e ing th the way. (DAWS) along Niall Quinn Neurology, of Clinical Professor
Square NHNN, Queen
hen your hospital food tastes like the remnants of a liposuction procedure and the price bears more resemblance to the cost of a PICU incubator things start to take the biscuit. Here’s our regular column of the best and worse hospital essentials you’ve reported:
A trip to the dentist would be cheaper at,
Northwick Park Hospital, Brent
Teeth-tastic prices at,
£1.99 Jacket potato with cheese
Torbay General Hospital, Devon
Maybe just stick to butter at,
Royal London Hospital, London
Say cheese at,
Santa’s haemorrhoids Dear Editor, I have to point out an err or in Dr Fairytale’s medical examination of Santa (Medical report - Mr S Claus; Iss 27; p2 4) in your Christmas issue. The assumption that Santa’s haemorrhoids were caused by sitt ing for long periods of time on his cold, hard sleigh seat are incorrect. There is no evidence that cold or damp surfaces cause haemorrhoids. It’s more likely to be all those mince pies he eat s each time he pops down a chimney which make him obese and cause resultant enlargement of his rectal veins.
Rue Dolph FY1 Lapland
going to be and doctors are ts en ud st al ic ed If m ing online (1 r jobs by search fo e bl ita su as assessed media during aff check social st ns io iss m ad d the pubin 10 the profession an ) p4 ; 27 s Is g; in what a docshortlist r expectations of ei th ge an ch to ueaky clean, lic need sire that we’re sq de e Th . be ld ts certaintor shou e poor judgemen ak m r ve ne d an cebook phoflawless use a drunken Fa ca be st Ju . ue tr n that person ly isn’t rnet doesn’t mea te in e th on s ar to appe rgeons. e most skilled su eld can’t be one of th Name withh
London CT Surgery,
‘Writing in the notes’ is our regular letters section. Email us at email@example.com.
£1.19 Hot chocolate (Regular)
Ashford Hospital, Kent
Burns your wallet as well as your mouth at,
Kidderminster Hospital, Worcestershire
Lucky chocolate is good for you at,
QE II Hospital, Welwyn Garden City
Next issue we’re checking the cost of a pocket sized pack of tissues, small mixed salad and one slice of toast. Email prices to firstname.lastname@example.org
Tameside general Hospital 42 inch full sky TV with movies and sports subscriptions; two broadband computers; lockers available at monthly cost; pool and ping pong table; shower and toilets; extensive sofas and seating; unlimited supply of microwave meals out of hours; unlimited tea, coffee, toast, cereal and biscuits; numerous mess nights out; mess charitable fund where a proportion of mess profits is donated to a ward based charity on a monthly basis. All for £10 a month!
THE MEDICAL COURSE AND CONFERENCE DIRECTORY
s doctors we hate scouring the web to find where and when we can attend the next exam revision course, training event or conference.
We think they should all be in one place - which is why we launched EventsDr. com as part of the JuniorDr network.
We’re aiming to build the most comprehensive database of medical events. Below you’ll find just a selection of the full listings at EventsDr.com.
MRCP part 1
Leadership, Management & Personal Development Training
Consultant Interview Skills (Includes access to online resources) Insights Intensive - Understanding the Implications of the White Paper
3-day Clinical Management & Leadership Management Excellence for Junior & Middle Grade Doctors Communication Skills for Junior & Middle Grade Doctors Foundation Course in Leadership & Management for FY Doctors View all courses at:
Win Over A £1000’s Worth Of Training!
3 Day Clinical Management & Leadership Course worth £699+VAT! Advanced Communication Skills e-Learning course worth £275+VAT! Just register your details to enter!
Courses you should know about!
Got an event to add? Do it free at EventsDr.com
Forthcoming PasTest Courses MRCP 1 • 15 - 19 April
• 26 - 28 April
London Working in partnership with
MRCP 2 PACES • 18 - 21 January
• 25 - 28 January
• 26 - 27 January
• 23 - 26 May
• 25 - 26 May
• 28 - 31 May
Sat 25 May
• 1 - 2 June
• 3 - 6 June
MRCPCH 1 • 30 Jan - 1 Feb
• 29 - 31 May
• 19 - 20 January • 26 - 27 January • 25 - 26 May
MRCS Part B Pastest
Sat 27 April
• 1 - 2 June
Kingston Hillingdon Kingston
MRCS B OSCE • 27 - 28 April
MRCPsych CASC Revise Now
Others Leadership & Interview Skills ISC MEDICAL
Interview Skills Oxford Medical
Essentials of Medical Management and Leadership ISC MEDICAL
Management and Leadership Course for Doctors Oxford Medical
Essentials of Medical Management and Leadership
Sat 21 April
Wed 17 April
Sat 18 May
Quality and Safety International Forum on Quality and Safety in Healthcare Patient Safety Congress
Mon 21 MAY
Hammersmith Interview Course Interview preparation for all grades by interview experienced Consultants 12th January 16th February 16th March 13th April more on website Get a great CV / Application, prepare properly, find out how to succeed at your next interview. Be taught by Consultants who interview – on the
Interview Course Your career depends on it More information & booking on website www.medicalcommunicationskills.com
email@example.com Get our updates on LinkedIn, fb & Twitter
07906 191 616
MEDICAL PROTECTION SOCIETY PROFESSIONAL SUPPORT AND EXPERT ADVICE
The right choice because we put you first We pride ourselves on our commitment to giving you the highest quality service. Our whole ethos is focused on putting your needs first and doing our best to help you in whatever way we can.
n We regularly consult with members and listen to their views to improve the quality of the services they receive. n We constantly monitor our performance to ensure we are meeting our own high standards. n We aim to be as accessible as possible, which is why we have three offices across the UK and a team of 100 medicolegal advisers and specialist lawyers around the world to support you. n 97% of members who used MPS say they would recommend us to their colleagues. MPS is the worldâ€™s leading medical defence organisation, putting members first by providing professional support and expert advice throughout their careers.
can find out more about the support we provide by visiting: www.mps.org.uk/JuniorDr
can sample some of our support and publications by registering their details at: www.whymps.org.uk
T: 0845 718 7187 E: firstname.lastname@example.org W: www.mps.org.uk The Medical Protection Society Limited â€“ A company limited by guarantee. Registered in England No. 36142 at 33 Cavendish Square, London W1G 0PS, UK. MPS is not an insurance company. All the benefits of membership of MPS are discretionary as set out in the Memorandum and Articles of Association.