In this month’s guest blog, Dr Khalid Ali, consultant neurologist at the Grange University Hospital in south-east Wales reflects on the challenges of opening a new hospital during a pandemic and his decision to become RCP college tutor.
The NHS has been through a lot over the past couple of years. The COVID-19 pandemic has caused emotional and physical distress to society and the NHS, leaving us anxious, sleep deprived, angry and exhausted. I worked in a patient-facing role reviewing stroke and neurology patients.
Aneurin Bevan University Health Board (ABUHB) is a large NHS health board in south-east Wales, covering some of the most deprived areas in the country, with a high prevalence of chronic disease in a community of more than 600,000 people. The health board has always traditionally been known as an attractive place to practise medicine, with down-to-earth, hardworking clinicians and a great sense of community and belonging.
However, in November 2020 – in the middle of the pandemic – a new state of the art 450-bed specialist critical care hospital was opened by ABUHB, with major reconfiguration and redistribution of clinical services from three acute hospital sites to four, but without significant numbers of extra staff to support the changes. This created a new reality, one in which our previously harmonious and united clinical staff became fragmented, and rotas were stretched thinly across multiple sites. The environment is extremely challenging: staff are tired, goodwill is gone, people are lonely and feel marginalised by the system. The grinding service pressure means that we completely neglect the creative and entertaining (or ‘non-service’) aspects of our medical careers. The tribe has been shattered.
It was at this stage that the RCP role of college tutor for this brand-new hospital became available.
I have always had a passion for teaching. I have been involved in medical education for years prior to the pandemic. I approached previous college tutors for advice (initially with a great deal of apprehension, considering all my existing professional and personal commitments). I reviewed the job description. The role of the RCP college tutor is broad, with no clear outcome measures, although there are some firm targets. With some hesitation, I decided to give it a go.
Where do I start?
Reflecting on the big picture, I saw a fragmented, upset, anxious, but still proud workforce. A workforce that has been decimated but continues working in difficult and isolated circumstances. Considering this dire situation, three principles came into my mind: justice, wellbeing and training. I made sure that everybody was aware of these three principles: my aim was to bring everybody together, create a new culture and develop a lasting legacy for this new environment.
Justice and wellbeing can be achieved by acknowledging that things are not right. Being able to listen without prejudice is vital to giving an objective, balanced assessment and advice. I have an open-door policy. Working closely with young and aspiring associate college tutors (doctors-in-training), we managed to persuade the health board to monitor rotas which led to a change of banding. We introduced a wellbeing service with Schwartz rounds and access to professional wellbeing support. We tried to reach out to the silent majority through surveys, aiming to build an objective assessment of training, wellbeing and working circumstances. I could not have done any of this without the help of all the associate college tutors and the medical staff.
Training is a crucial issue. Staff are exhausted, both emotionally and physically, and because they are now working across multiple sites, we needed to focus special attention to reignite a culture of education. Working hand in hand with the RCP associate college tutors and the postgraduate education department, we managed to restart the medical grand round and the internal medicine training programme. Both are growing in popularity and achieving good attendance. We introduced case presentation competitions, external speakers and a Christmas quiz to help people learn together and build their knowledge. Colleagues are encouraged to speak their minds and ask questions. The medical grand round has become a platform for reflection and discussion.
I feel that my role as RCP college tutor is to create a culture of care and encouragement, and this is done by being fair, transparent, working hard and anticipating the challenges ahead. I encourage my junior colleagues to speak up and let everybody know what they are thinking. I hope this fire will enable the aspiring doctors of the future. The role of RCP college tutor is about being organised, driven and structured, but most importantly, it is about being passionate.
Dr Khalid Ali
RCP college tutor, Grange University Hospital
Aneurin Bevan University Health Board