Trainees who make a difference

Since being appointed as an RCP college tutor at Conquest Hospital in Hastings, I’ve had to deal with several challenges that we haven’t seen beforehand: the first doctors' strike in 40 years, the imposition of new contracts, and ever-changing e-portfolios and deanery and GMC demands. I decided to take on the role as I have always had an interest in education and mentoring but little did I realise the issues that would be hurled in my direction. However, taking on the role has given me the opportunity to help trainees and produce changes that have not only provided new educational opportunities, but enhanced the junior doctors’ experience in my trust.

As college tutors we are sometimes perceived as the policemen of the trust or deanery, but I’ve managed to dispel this impression over the years, mainly through our quarterly local faculty group (LFG) meetings. The LFG is a forum where the juniors can voice their concerns, and directly engage with the medical faculty / consultants face to face. Inevitably with any group there are the few people who remain disgruntled about pay, hours, etc, no matter what is done or modified. However, on the whole, it is nice to have trainees that truly want to make changes and liaise with management and seniors to ensure a positive, productive and mutually beneficial working environment.

In this blog I have the opportunity to introduce two trainees who have made a real difference in the last 6 months to junior working within ESHT:

• Firstly, I interview our new chief registrar, Dr Deshan Weeraman, who works cross-site in ESHT but is mainly based in Eastbourne. Dr Weeraman has taken on this new role and demonstrated what a difference it can make.
• Secondly, I have asked our associate college tutor (ACT), Dr Geoffrey Watson, to comment on his role and the challenges he has faced with trainees at Conquest Hospital.

Dr Deshan Weeraman, chief registrar

You are now the chief registrar at the trust. This is a new role: could you explain what sort of things you have been expected to do, and what you think of the role so far?

The chief registrar role at East Sussex Healthcare Trust was started following the Francis report into the failings at Mid Staffordshire. It was felt that there was less engagement between the junior doctors and senior management at Mid Staffs, which led the trust to introduce this chief registrar role to facilitate communication and tap into the great resource junior doctors provide.

I think there are a lot of problems facing junior doctors these days, partly caused by the low morale you mentioned regarding the junior doctors’ strikes and contractual issues. It is clear that we need to improve morale among the junior doctors because there is a huge strain being placed on the system and in particular on us as doctors.

The role of chief registrar has been difficult because I have had to juggle a busy clinical job with taking management experience days, as well as helping trainees across two different sites. It has been challenging, but it has also been rewarding at the same time. It has given me an insight into the plight of some of our junior doctors and how they are coping tremendously well with some of the stress placed upon them. I have tried my best to facilitate some changes that can hopefully improve practice, and some other changes that hopefully will improve morale.

I think giving the trainees a voice is one of my most important roles. With this in mind, I have regularly attended SHO [senior house officer] registrar and foundation year teaching days so I can find out what problems are on the shop floor. My findings from these events have led to a lot of the projects that I am now involved with.

Could you explain some of the new initiatives you’re now involved with? How do they differ from what you've been involved in before?

My initial project was with regard to the new junior doctors’ contract. This meant that, in spite of new restrictions, I was able to ensure that there was a trainee involved in designing the workload timetable so that our foundation and core medical trainees were not just given too much service provision but that they also had the chance to spend time in clinical based training, as well as fulfilling the service commitments required.

Another project I have been involved with is to do with medical handovers, improving upon the current Friday handover process. To help develop this, I am in the process of setting up a simulation of how to improve the handover skills of all our junior doctors.

I am also involved in the hospital committee, which has been trying to improve the service. We are currently looking into some IT solutions to see whether this could improve our out-of-hours experience and the handover process. This is based primarily on the experiences of our junior doctors and shows the insight that a junior doctor can bring to management committees. I have also sat in on board meetings and been present during recent GMC visits to the trust. It was interesting to hear the views of other junior doctors and find that they feel better for having a junior doctor working in senior management.

Clearly you’re enjoying the role. How do you think it will help your future career, and would you recommend it to others considering becoming a chief registrar?

I think it’s essential for our future career. The position of chief resident has existed in the United States for a long time now, and it is a prominent role that is well thought of by junior doctors working there. In the UK, it gives us a chance to dip our toes into the management structure and, more importantly, facilitate change within the NHS. It can take a long time, but it is worth learning these skills now as we only get limited management experience during our training.

Junior doctors are the future of the NHS, and if we do not learn how to make changes now, we won’t be able to in the future.

Future Hospital chief registrar scheme

The RCP's Future Hospital Programme is piloting the role of chief registrar to determine the skills, protected time and training needed to support this new leadership position. The 2016–17 chief registrar yearbook showcases the fantastic improvement projects that our first cohort have led and through which they have achieved great successes.

Dr Geoffrey Watson, associate college tutor

Can you tell us more about your role as an associate college tutor (ACT)?

I have been given the great opportunity to be the associate college tutor for Conquest Hospital, representing the specialist trainees / registrars in medicine in the trust. Having spent the last 3 years in research at Imperial College London, I was keen but also intimidated to return to NHS working life. This 3-year break has really opened my eyes to the extreme pressure NHS workers are now under, delivering world-class care with dwindling resources, with patient attendances increasing year after year. Despite patient care being our number one concern, it is essential that medical training is not compromised.

This role as an ACT allows me great exposure to medical trainee doctors, allowing frank, peer-level discussions on the pros and cons of both training and the service provision aspects of the role – and in particular if they have deep concerns regarding patient care. I am able to then collate this feedback and anonymously present these comments to the senior physicians, managers, administrators and trainers representing the medical directorate during our LFG quarterly meetings. We are then able to have a constructive discussion, and try to adjust points and implement change, even if the improvements are only small initially. I only took up the post in October of last year, so will be able to report back later in the year on the progress I have made.

What challenges have you encountered with the new ACT role?

I have been qualified for a while now, with time taken out for research and medical charity work in Kenya and Myanmar. From my perspective the difference in junior doctors graduating from medical school now is quite significant to ‘back in my day’. Firstly, they are much better doctors when they start F1 compared to my cohort. They have cannulation and blood gas skills that my generation essentially learned on the job via trial and error. They understand the patient journey better.

However, one of my biggest challenges is understanding the new mentality. This has manifested itself in junior doctors striking, and the understanding that doctors stick to their hours much more strictly than we did. If there is a problem, the more recently graduated doctors are very active to voice this. I am pleased they voice their concerns, as this is the right thing to do. There are ‘moaners’ out there, but the majority of them want the best for their patients and are refreshingly happy to question and interrogate systems, pathways and guidelines as a result.

Describe your view of the ACT role in education, local faculty groups and dealing with conflict resolution, say between senior colleagues and trainees?

Despite progress in medicine, technology, changes in guidelines, I believe most conflict and challenging clinical scenarios boil down to communication. My current acute issue is the stroke pathway in our trust, and I am getting feedback from junior doctors about this. The stroke unit is an exceptional facility but, because we are a split site trust between Eastbourne (stroke unit) and Hastings (my hospital), strokes we want to refer are having a sub-optimal service purely because we cannot communicate with their busy team when needed. In this current climate of thrombolysis windows etc every second counts in regard to infarcting brain tissue. We are raising this at our LFG next month but through proactive junior doctor feedback I am meeting heads of medical directorates to address this as soon as possible.

Our region has the oldest population per capita in the country and, given 700 acute de novo strokes per year through the front doors, this is a major issue that the ACT and LFG have a chance to sort out quickly. This situation was escalated appropriately and solutions were found which would not have been possible without this interface between junior doctors, senior clinicians and trust management.

If you would like to become a college tutor or an associate college tutor in your hospital, please download the RCP role description and express your interest to your postgraduate medical education department manager.