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….


A Change Is Gonna Come

This week I met up with Jenni Burton (@JenniKBurton) she’s one of the smartest people I know and I love when we get time to have a proper catch up.

Predictably as two medics we got to talking about all things work related. In particular education, training and rotas

I’d been involved in meetings this week about how the medical rota was running.  It’s no secret that we’ve had problems and I’d come on board in recent months to help.

Managing a rota can be a bit of a poison chalice to be honest.  There’s a constant tension in trying to deliver both training and service so it can seem that no one is ever happy!

Of course what doesn’t help is some people going down memory lane and thus any discussion turns into the Four Yorkshireman, Monty Python sketch.

‘You were lucky to work 100 hours a week,  we used to work a 100 hours a DAY!’ 

I think that with any rota it’s important to acknowledge that in many ways things have got better.  However we are working in a different culture.  One where the focus seems to be on the training experience and less about the work itself. I don’t think the balance is quite right.

So I think we need to be honest about what we can and can’t deliver training wise while trying to maintain a proper service.

It occurred to me as we were talking that while I spend a lot of time ‘clarifying understanding and expectation’ with my patients and their relatives, I don’t always extend that to our junior medical staff.  What I mean by that is clearly defining expectations and explain some of the decision making process.

As an organisation we need to be up front about saying there are two choices:

1. The best training experience you will get is not through going on umpteen courses, it is by being at work.  Going on ward rounds, getting to clinic, talking to relatives, running the acute take etc. This is enhanced by continuity i.e. keeping you on the same ward most of the time. In order to deliver that it is going to mean compromise.  In this case fixed annual leave, less study leave and few swaps.

Or you can have this experience:

2. You get to go to all your study leave, have your holidays when you want but the overall team will be spread extremely thin.  The compromise here is you accept that you will be moved around a lot to cover gaps.  You may even have to do more on calls.

You cannot have both.

There is a service to run and sick patients who need doctors of every grade to look after them.  There’s also the fact that you also get paid for this and quite well, relatively speaking. That in itself comes with professional T&Cs that come with taking on this job.

It’s not just Forth Valley that haven’t got the rota quite right yet. I do think we need to try different things and see what works.  Jenni was telling me that when she worked in Leicester they offered exit interviews for trainees.  I think this is a great idea and much better then the trainee surveys (they always seem slightly out of date and skewed depending on the number of replies).

Potentially real time change could be achieved by allowing trainees to shape and deliver their training while keeping it in line with local needs.

What we don’t need is a talking shop where we are seen to be engaging with trainees but won’t follow through with the difficult conversations or decisions.  Of course none of this should be done in isolation.  It is as important to have these discussions with Consultant and Nursing colleagues.  I don’t really think we have really acknowledged that their role is also changing as we have more gaps/less trainees.

I do believe we will ultimately get this right. It may be a long time coming but I do believe a change is going to come…

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….)’


Back to the future…

In recent years we’ve grown accustomed to talking about education in medicine and the tension that exists between service delivery.

I get really frustrated by this.  To my mind the two are intertwined.  I accept that some training has to be done separately e.g. procedural skills, advanced life support etc.  There is however a large proportion of it that can and should be done as part of everyday working.

I was trying to cast my mind back to when I was a Senior House Officer (a somewhat misleading term that is now redundant). In terms of training and education there was no defined program.  Sure a couple of times a week we had an X-ray meeting and a talk from the Consultants but that was essentially it.

Only when I became a Registrar did a teaching program begin.  I’ll be honest I wasn’t a fan.  It took me away from the ward and the clinics.  While I didn’t realise it then I think on reflection it took me away from what I considered to be the real learning.

It was also around this time that the full effects of the European Working Time Directive began to kick in.  Rotas were becoming increasingly fragmented.  Continuity of care on the wards was being lost in order to populate the on call rota.  We were also being told that we had to go to teaching days or we would not be signed off at the end of the year i.e. we would not be allowed to progress in our speciality.

Throughout all this we had to deliver safe care to our patients.  It was at the end of my Registrar years that I began to think ‘surely there has to be a better way?’

I’ve always had an interest in education but a watershed moment in my career was when I did the ‘Doctor as Educator’ course run by the RCPLondon.  It properly got me thinking about not just the what we teach, but the how and the why.

Education is the foundation from which any service in medicine should be built on.  Not just as lifelong continuing professional development but as a clinical governance issue.  I also believe that a term that should be made redundant is the idea of ‘training posts’ and ‘service posts’.  If we truly believe that patient safety is at the heart of what we do then all doctors have the right to education regardless of post.  We massively contradict ourselves by separating the two out.

Where the argument becomes muddied is we continue to deliver education programs that simply do not fit the requirements of the service or the doctors working within it.  I found this paper interesting in its perspective on Generation Y or Millennials:

We need to support but also challenge our current workforce educators to think a little differently. There are educational moments everywhere.  Not all of them requiring huge amounts of time either.

We need organisations to keep up with technology which needs investment in connectivity.  There needs to be access to online educational resources, an ability to connect with other learners and most of all the ability to share resources and information in real time.

The shared learning experience begins with connection and not separation…..