Letter from America

I went to my first American Geriatric Society Conference last week.  I’d been asked if I could speak about the delirium undergraduate education work to one of the specialist interest groups.  It also happened to be taking place in Orlando, specifically, Disney.

Not one to turn down the opportunity to visit the happiest place on earth I was also curious about how my colleagues across the pond approach Geriatric care.

Before going quite a few of my own colleagues asked ‘what exactly is it they do over there?  I mean, the US healthcare system is an ology one.  Do they just pick up people who fall through the cracks?’

I thought this was a little unfair. Even trying to define the role of a Geriatrician to some of our own UK ‘ologists’ is often met with blank looks.

Another question was why was I going ‘all that way for 4 days?  It’s not worth the hassle surely?’

I paused at that.  It’s true, it is a long way. I mean 9 hours on a plane with only movies, music and books to amuse you, no wifi (so no emails), free G&T and food.  Oh and some of the most gorgeous sunsets, sunrises and starry skies you’ll ever see.  Yes, it’s easy to see why some people would choose not to go.

All that aside the concept of travelling thousands of miles is not something I really consider a big deal anymore.  Since my elective in Medical School took me to Canada my view of the world has both simultaneously shrunk and expanded.  I mean how crazy is it that within the space of a day you could be on the other side of the world!

It’s not just travel that’s had this elastic band effect on my world view but social media.  It’s through this that I have had the pleasure of connecting and collaborating with so many amazing people.

This idea of connection and communication was what kept resonating as I attended the conference.

I’d been told American conferences were pretty big and this was no exception.  There was a constant hum of conversation as people moved from room to room.  It was exceptionally well organised – it even had an app! Everything was on it – downloads of abstracts, links to papers, a notes section which you could email yourself and you could even connect with other conference attendees.  Not knowing anyone I relied on good, old fashioned twitter to meet up with colleagues old and new.

The sessions were excellent too! One such presentation was on the healthcare needs of the older incarcerated population, in particular anticipatory care planning.  This is a topic that is rarely spoken about. The presentation demonstrated the gross misinformation and misunderstanding that surrounds this sensitive area.  A lot of it was in the language used and how education will be used to correct this.

It was probably why I then found myself at the session on the use of language (my favourite of the conference). The gist of it was how sometimes we can be quite flippant in our use of language. They spoke about how it’s absorption, both consciously and subconsciously, can lead to negative attitudes and behaviours towards older people.

You would imagine the people in the room would be vigilant to it right? Wrong! It wasn’t until some language was systematically broken down and dissected that we realised we can be guilty of perpetuating it too.  Not on purpose I might add but usually we’re either going so fast or not paying enough attention to realise.

‘Ceiling of care’ anyone?  How about treatment escalation plan as there should never be a ceiling of care…..

The AGS has many special interest groups reflecting the diverse, heterogenous speciality that is Geriatrics.  Happily education featured heavily – all interdisciplinary and all keen to share.

So what did I learn the most?  That we are all connected.  No matter how big the world is, or the conference, we can still find ways to come together to share common goals and aspirations.

education, geriatrics

A Whole New World

Three exciting things happened this week – I hosted my first ever Journal Club on Twitter, I attended the BMA Women in Medicine event and also presented at the Geriatrics for Juniors conference in Newcastle.

All very different but all with one thing in common – bringing people together.

My feeling over the past few months is that within healthcare there has been a creeping return to silo working. Whether it’s staffing on a ward area, the rota or teaching it all feels like people are in self preservation mode. It was nice to be pulled out of that for a while and see what was going on in the wider world

I’m not sure how many of you still run journal clubs at work?  They’re something that seem to have fallen out of fashion. I’ve got to be honest, in the past I didn’t like them.  For those who are unfamiliar, the premise was that some unfortunate soul was nominated to present a ‘topical’ paper at a lunchtime meeting.  This paper would then be dissected by the audience.  It was an opportunity for scientific ‘show pony-ism’ for the statistically minded. Usually I forgot to read the paper and when I did there seemed to be far too many statistics which I didn’t understand. I learnt nothing.

Years later I have come to appreciate their value in appraising evidence which is clinically relevant to my day to day work. I am still not keen however on the traditional design of a Journal Club.

What the @GIMJClub guys have done is take the same principal – ‘have paper, now discuss….’ and refreshed the format for a wider social media audience (#genmedjc)

In the week leading up to the Journal Club the paper and its supplementary links were shared across several social media platforms.  This allowed people the time and the flexibility to read it on a device of their choosing.  I must admit though, I still printed it off and sat with a pink highlighter pen – old habits!

The discussion was fast paced and hugely interesting. I learned loads!  The bonus part was it allowed people from all over the UK to take part from the comfort of their own home.

Using Storify, I was able to capture the main points reflecting a happy couple of hours of educational community.

This energy followed me to the Women in Medicine BMA event a couple of days later (#BMAWomenMedicine). The workshops I found the most useful were those on Less Than Full-Time (LTFT) working.  It struck me that people were somewhat left to get on with it when it came to LTFT working.  As someone who has trained and currently works, correction, is paid less than full time it is a subject close to my heart.  We are seeing a change in the workforce with more people choosing to work flexibly where possible.

The BMA have recognised this and have introduced the concept of ‘LTFT Champions’. An informal go-to person to ask advice on the practicalities of LTFT working and to also  provide local guidance.  It’s something I’m looking to introduce to Forth Valley in the coming months.

To round off the week I was asked to present at the Geriatrics for Juniors conference (#G4J17).  The guys at @AEME are heroes of mine. Not only have they advanced Geriatric education they have raised the profile of the speciality a million fold.

On a cold Saturday in Newcastle ~200 mostly junior doctors attended a day of very entertaining presentations on the different facets of Geriatrics. To my mind this reflects the growing interest in our speciality, which I hope ultimately translates into more people training as Geriatricians.

What continues to impress me most about @AEME is that they not only recognised the need for a different way to deliver Geriatric teaching but they went out and did it.  They also managed to attract like-minded individuals to give up their time and contribute too – whether through a Connect event, a Podcast or their newly formed Mentor network.  Silo working just does not exist in their world.

Now of course you don’t have to go to these lengths to get out and talk to people. Pick up the phone, email (yes, I said it; its still a convenient communication tool), grab a coffee together or meet up with other specialty colleagues before a lunchtime meeting. One of my colleagues is trying to do this very thing by booking an area next to the lecture theatre.

Either way just get out there, people. You’ll be amazed by what you find….

Dementia, education, Uncategorized

All that matters to me


This week I was invited to talk to care home staff at Erskine.  It was part of a series of talks to raise awareness about delirium, mobility issues in those with cognitive problems and dementia.  In addition to these clinical talks were two from a relative and carer perspective.  One was Tommy Whitelaw (@tommyNTour) talking about his mum Joan.  The other was given by a family member of a current resident.

I must say when I saw that relatives were speaking I thought: ‘Wow! That’s quite a brave thing to do.  I wonder how the staff will react?’

I’m all for putting my head above the parapet but not many others are.  It can be incredibly difficult to hear feedback, no matter how constructive, without first putting it through a defensive filter.

That said I found what they had to say both incredibly moving and challenging. I don’t mean that critically either.  When you work in your own tiny eco system of healthcare you can desensitise or even forgot how a simple turn of phrase can inadvertently upset a person. To hear that your mum is ‘too good’ for a care home after you’ve spent months anguishing over the decision can bring back feelings of guilt.

We were also reminded to take the time to remember that this person is a mum, a dad, a brother, or a sister.  This person will never be a resident or a client to a family.  They are people with stories and lives of their own.

It was these talks that had the greatest impact for me.

You see we talk a lot about being person centred but if feels like being in an echo chamber at times.  What do I mean by that?  Well, it tends to be people working in the health service talking about the need to be person centred.  I rarely hear the patient or relative perspective in these meetings.  It’s also started to feel a little competitive:

‘And the prize for person who talks the most about person centredness goes to…..’

I personally feel that it you were you wouldn’t feel the need to go on about it so much. You would just be.

So what makes the difference then?  Tommy and I spoke about some of the people he’s met over the past few years.  It’s quite a list although I got the impression that those who have affected him the most are those on the ground, so to speak.  For all the pledges and promises of funding from on high it seems to get stuck on the way down to those who need it most.

As Tommy said caring is not seen as a career to aspire to. Even those working in the care home sector will struggle to get access to adequate training and education.

We have created this culture so we alone are responsible for changing it. I don’t want to hear people talking about what they should do.  I want to see them actually doing something!

I’ve always been a believer in the concept of small steps of change. You are however investing time and effort in a very distant future so it does require patience.

Looking around the room after Tommy spoke and seeing many in tears, it was clear that a difference had been made.  And that’s all that matters……

education, Uncategorized

Learning to fly…

Loch Lomond

After 18 months of hard work the first paper I’ve ever properly written up was finally submitted.  It wasn’t a solo effort by any stretch of the imagination.  I was lucky enough to work with James Fisher and Andy Teodorczuk in putting it together.

I’m also under no illusion that it has a long way to go yet and may not even be published at the end of the day. However the sense of achievement once I clicked submit was amazing!

That said it was a project that pushed me well out of my comfort zone.  I’ve always liked the idea of being involved in academic medicine but thought I wasn’t really a good fit for it.  I have many preconceptions about my academic colleagues. For one they are very smart.  They make it look easy.  Also they must be very patient people given how long  research projects can take to bring to fruition.

It also seemed I was making similar assumptions about myself – I get bored easily. I like detail but only so much. I have no patience.

Here’s the thing though, while my own personal attributes may be based on the gazzilion psycho-analysis questionnaires I’ve done over the years, they are by no means set in stone.

Over this past year or so I have become much more patient. No really, I have! I still have a low boredom threshold but it’s definitely higher than it used to be. However the ability to spend literally hours on detail is something that I have come to enjoy.  I’m not sure it’s fair to say my brain has slowed down but it definitely has an ability to concentrate for longer.

I think I may’ve managed to modify some of my fundamental personality traits.

Now you could argue that will happen when you are doing something you care passionately about.  I’m not so sure.  I have seen people work in the same way, doing the same thing their whole lives and I don’t remember seeing any fundamental change happen to them. I’m not even convinced they were all that happy either but that’s just my opinion…

I think you need to slightly step out of your comfort zone.  It could be that you work in the same speciality but perhaps try a different facet of it like I have with the delirium education work.

Or you could be like some of my colleagues who have moved their work environment to say the community or ED.  Some are changing hospitals but staying within the same Health Board. I also know colleagues who have taken up work with the Scottish Ombudsman, GMC and the Scottish Government.

I’m pretty sure if you asked them 20 or even 10 years ago what they would be doing in the future, it wouldn’t be what they are now.

This idea of a mobile workforce has been around for a few years now.  However how doctors define their working career is beginning to evolve.  The challenge for organisations is how to adapt to this.

Perhaps we all need to challenge preconceived notions of ourselves from time to time. Try something new or just a teeny bit different from the norm.  Who knows what you might be capable of…..

education, nhs, Uncategorized

Man (or woman) in the mirror….


Last night I went to see the Lego Batman Movie – it was hilarious! Like most multi layered kids movies there was something for everyone.  The main message however was around reflection. Just incase it wasn’t obvious the soundtrack included Michael Jackson’s ‘Man in the Mirror’ just to hammer the point home.

So as I start the week as faculty on the RCPSGlasgow Clinical Education Certificate course, reflective learning was very much at the forefront of my mind.

The course itself is targeted at all grades from FY2 upwards and across the medical and dental community.  We had 12 delegates on the course predominately dental and surgeons.  The aim is to teach several aspects of clinical education including things like the clinical environment, techniques on delivery and feedback. Throughout the course reflective practice is incorporated at every opportunity.

One of the big questions on the first day was how do we turn superficial learners into deep reflective learners? Or to put it another way how do we facilitate the transfer of learning from the classroom to the real world?

It prompted a fair bit of discussion.  There was general agreement that we should be moving away from didactic teaching to a more applied, problem based learning.  This isn’t exactly a new concept. Quite a few medical schools have done this already with varying degrees of success. Most agreed that at undergraduate level a balance needs to be struck but how do you incorporate reflective learning? More to the point what are you reflecting on at this level?

So mulling on this we moved to the postgraduate world where the problem seems to be the other way round.  I had previously commented that in my experience doctors ‘expect to be taught’. There are teaching programs across the specialties with defined learning objectives delivered by senior medical staff in a lecture style.  Departmental teaching is also pretty didactic (with the odd bit of discussion at the end, usually Consultant lead).  Even conferences are turn up, sit down, listen, tick your CPD box, move on.

Where is the reflection?

Now I appreciate that CPD diaries and e-portfolios do ask us to reflect ‘what did I learn?’ but do they really capture those practice changing moments? Or is the reflection merely dictated by the predefined learning outcomes?  Do I really care at the end of the day…?

I think proper reflection should at its heart have continuous professional development and patient safety. There is the process mapping and dissection of a clinical skill or scenario.  What I like to call the mechanics of learning.  I think though what we struggle with in the medical profession is the softer side.  For example we spoke about different learning styles.  To some a this was a revelation in itself.  Are you a visual or an auditory learner? Do you operate in the cognitive or the psychomotor domain?

For me the discussion brought out other thoughts. I came to the conclusion that I need to come out my comfort zone and use learning techniques that I find hard.  If we believe that education should be taught through the learner perspective I think I might be disadvantaging them by only using techniques that come naturally to me.

And so this is why I love education at the end of the day.  It has the power to challenge preconceived notions and learn new skills but most of all it has the power to refresh the mind.


‘If you want to make the world a better place

Take at yourself and then make that


(nah nah nah nah nah nah nah nah nah….)’