5th October 2015

Trainee Talk

This week I got to catch up with Aphiwat Luangsomboon, our CT2 currently working in Breast Surgery (see here on the left, with Seok Cho, our T&O CT2):

Aphiwat was at Eastbourne for his first year and joins us still looking out for the speciality that will suit him best. Like many trainees, Aphiwat has struggled with the concept of ISCP but we had a good session getting to grips with it and I hope he can now embrace the Portfolio as a means of showing off his hard work. Good luck to Aphiwat, and to Sophie @sophiehfwrigley, both sitting MRCS B on October 14th.

The Trauma List was a good chance to catch up with Seok @YSeokC who was stepping up this week as we approach HST (registrar) changeover. Here are his thoughts:

"Core surgical training @ASPHFT has overall been a very positive experience for me. I think the most notable aspect is how supportive seniors and staff have been. I’ve worked with very helpful registrars and I think this is has been very important having entered the first stage of surgical training, allowing a smooth transition from F2 to CT1.

"I think the biggest difficulty in CST was trying to balance theatre and clinic time with ‘service provision’ – i.e. helping out with ward jobs. Although JCST guidelines do state you need all the theatre and clinic exposure as much as possible in order to get through the ARCP and meet the educational requirements, this is not always understood by your fellow junior doctors who are on the wards doing ‘admin’ jobs. This was particularly noted during one busy surgical speciality, where there were 2 locum doctors and me covering the whole service, and six consultants. Additionally, we were required to prepare for the weekly MDT and Friday meetings (looking at past and upcoming theatre lists and rota) which took up quite a lot of time.

"Fortunately, T&O team in ASPH has an abundance of junior doctors so I’ve had the luxury of being in theatre and regular fracture clinics. Consequently the learning experience has been superb, and in fact I have applied to stay in ASPH for the CT2 year for another year of T&O. There has also been great mentors within the department."

Surgeon of the Week

Another new(ish) face for you this week: Mr Ioannis Polyzois, Upper Limb T&O surgeon. Ioannis joined us at the beginning of the year but really it is a homecoming as he was previously our Upper Limb Fellow before training further at the Reading Shoulder Unit. 

I'd like to point out that the extremely good-postured Sr Leynie Lugtu is actually standing on tiptoe as she felt very tiny next to our Greek Colossus

Forthcoming Attractions

If MRCS is looming on your horizon, here's an OSCE course at RCS @rcsnews:

If you are looking for guidance on writing up your projects, here's one on how to write a surgical paper:

If those milestones are behind you, here are some core-level courses on how to use that camera:

28th September 2015

This week I've been on a course on site, learning about being a Case Investigator. This is a role to investigate facts when looking into concerns regarding healthcare professionals and maintaining high professional standards (MHPS).

Last year I was involved in a pilot scheme commissioned by @HE_KSS looking into Bullying and Undermining, and this week's course was a natural extension, looking into how  concerns such as this are researched and addressed. 

Here are DME Dr Peter Martin (my educational boss!) and Divisional Director of TASCC & DTTO (ie amongst other things, Surgery, so my clinical boss!) ENT surgeon Mr John Hadley on the course with me:

It was a highly though-provoking few days. In the Trust at any one time 6-7 healthcare professionals are going through this process and it's so important to treat everyone involved with care, compassion and professionalism. 

This Week's Headlines

When I started this blog, my primary aims were to engage and inform my junior colleagues training in surgical posts. As Surgical Tutor, I'm finding it nigh on impossible to adopt the position of RCS England and make no comment on the #juniorcontract that could be imposed in August 2016 by @NHSEngland.

My bad.

So apologies to @asphft but I cannot avoid reference to headlines such as these:

Full article: 

http://t.co/sv4bebBsK1

Full article: http://www.independent.co.uk/life-style/health-and-families/health-news/numbers-of-nhs-doctors-registering-to-work-overseas-could-reach-unprecedented-record-10511755.html

We are going through turbulent times. All I would say to you is - be informed. Read first hand. Always better to make a decision based on the whole paper, not just the abstract.

So here are some references. The DDRB itself:

https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/445742/50576_DDRB_report_2015_WEB_book.pdf

The call to arms from @theBMA: http://m.bma.org.uk/working-for-change/junior-and-consultant-contract/junior-doctor-contract-negotiations-home

... and blogs from @coffeeheadaches: 

https://coffeeheadachesblog.wordpress.com/2015/09/23/why-are-nhs-doctors-angry-about-their-new-contracts/

... and from @PsychiatrySHO:

http://wp.me/p3Gft2-yNQ

Here are the Royal College positions:

@RCSNews http://ow.ly/2bvkUl

@RCSEd http://www.rcsed.ac.uk/the-college/news/2015/september-2015/response-to-the-proposed-new-junior-doctor-contract-in-england.aspx

@RCGP

http://www.rcgp.org.uk/news/2015/september/rcgp-demands-cast-iron-guarantee-on-junior-doctors-contract.aspx

@RCoANews https://www.rcoa.ac.uk/news-and-bulletin/rcoa-news-and-statements/joint-statement-the-rcoa-and-ficm-the-proposed-trainee#.VgAowpq20mg.twitter

@RCPlondon 

http://dmtrk.com/1V12-3N5RE-CBDMKJN66C/cr.aspx

@RCObsGyn http://ow.ly/Szaqt
@RCPsych http://bit.ly/1FZU8ts

@bota_uk http://goo.gl/CA6NGX

Surgeon of the Week

This week's superstar may be an unfamiliar face but you can bet newbie Consultant Spinal Surgeon Oscar Garcias-Casas is already making a big noise. A Consultant in Spain for 12 years already, Oscar started with us nearly a year ago to work with Chris Schofield ahead of Chris's retirement from the NHS. He is seen here with Clinical Specialist Physiotherapist Mary Burns:

Oscar has expanded the Spinal Service @ASPHFT allowing more spinal patients than ever to be looked after closer to home. He will be joined in three months by another new colleague (more about that another time). His patient training methods have already won praise from our junior teams.

Forthcoming Attractions

BMJ Careers Fair

Business Design Centre October 23-24th

http://careersfair.bmj.com/registration/careers-fair 

21st September 2015

Portfolio Pains

This week I thought I'd delve into the world of Surgeons' Portfolios @JCST_Surgery. Whether you call it Eye Ess Sea Pee, ICECAP or (if you're getting close to the ARCP) something more fruity and Anglo-Saxon, it is here to stay and if steered correctly provides magnificent evidence of your flowering career.

Whilst it is mandatory for Core Trainees to sign up to it, I encourage all our non-training SHOs to stump up and sign up. It demonstrates commitment, documents your CPD and its presence in your interview portfolio shows you've taken your career seriously.

So I met this week with some of the Core Trainees @ASPHFT to review their ISCPs for the first 2/12 of their posts. Here are Kamran and Daniel, both CT1s...

... and unsurprisingly at this early stage their portfolios seemed bereft of WBAs, tumbleweed drifting through the vast empty spaces of their 'evidence'... !!

It is a steep learning curve but once you get the hang of it, it becomes second nature to log everything you do.

Getting started

First up: open your ISCP to everyone. Meet early with your College Tutor who will set up your Global Objectives. This doesn't have to be face-to-face BUT I do like to clap eyes on everyone early on to get a handle on you and what you need and get your placements/supervisors validated.

Next: set up an early meeting with your Assigned Educational Supervisor to establish your Learning Agreement. This is the means by which topics are generated.

Topics

Ah, topics. "Linking topics" is a key indicator of progress at ARCP. Core Trainees should be selecting just the Core Training topics (2013). Don't forget this same ISCP is used for HST so there will be therefore topics appropriate for Higher Training. Core trainees are after the generic modules. 

Work based assessments

WBAs: in @HE_KSS you need 40 per year, equally spread between CBDs, CEXs and DOPs. In the rush of excitement at being in theatre, of course you all clock up logbook figures (approx 200 needed) and generate PBAs but these are not wanted at Core ARCP: it's DOPs you need.

Every clinical interaction you have can be a WBA. Once you grasp that, it ceases to become a challenge to find the numbers. I tell my supervisees I expect to open my email every morning to be showered with the confetti of validation requests. I know it is possible, as their predecessors have done it. No biggie.

For CBDs and CEXs, on call and in clinics are fertile ground. Bear in mind half of each group of WBAs must be with a Consultant. T&O juniors must attend clinic once a week as part of their educational contract but I exhort all of you to try that, in your other specialities. 

In T&O @ASPHFT all juniors are supernumerary (ie not even the registrars have their own template) which means there is time to train. Clinic is where you learn pattern recognition and decision making - every opportunity for case-based discussion.

Journal

The journal section is the ideal place to document (in real time) your reflective practice. Even if it's just a line about what went well or what tips you picked up, an interesting scenario etc. We must all demonstrate reflection for appraisal and revalidation. ISCP gives you somewhere reliable to store it. Try and use it as a work diary. I use it as College Tutor to document ad hoc meetings outwith the three set pieces.

Don't get fed up with the ISCP/portfolio process: it is easy to accuse it of being a tick box exercise but if you grasp the opportunity it offers with both hands it can be a fantastically useful tool to document your daily practice in one place.

Surgeon of the Week

Manish Kothari is this week's training hero, seen here with Sr Zenia Bolauro 

Manish is a Breast Surgeon here @ASPHFT and one of my my most recent additions to the Surgical Faculty Group family. Currently a Clinical Supervisor he is going through accreditation to be an AES and is also a qualified Appraiser so has much to offer us as well as his enthusiasm and evident enjoyment of the job.

Paper of the Week

How could I pass up the chance of drawing your attention to this seminal work, "Are Surgeons Psychopaths?" In the Bulletin this week: 

http://publishing.rcseng.ac.uk/doi/full/10.1308/rcsbull.2015.331

Forthcoming Attractions

This week I'm focussing on the CCrISP course: Care of the Critically Ill Surgical Patient. Doctors in CT1/2 and above can take this course and it is an essential requirement for HST eligibility. It is not open to Foundation Doctors.

Looking at @RCSNews site, these are fewer in number and quickly booked up in comparison with other mandatory courses. Here are the more local ones that still have places:

Quick plug to the registrars for the @RNOHnhs Stanmore Shoulder Meeting:

https://www.rnoh.nhs.uk/health-professionals/courses-conferences

14th September 2015

It's been quite surprising to see how few Foundation trainees are choosing to proceed directly onto speciality training and I've wanted to try and get a handle on this for a while. This week in theatres I was joined by Dr Sinthuja Visahan who is working as a locum with us in T&O. Sinthu is contemplating a career in Pathology and will be applying for run-through training later this year. I was interested to hear her perspective on the preparation med school gives you for making career choices 

"I am currently a SHO in Trauma and Orthopaedics, St Peters Hospital. As is the case with almost half of junior doctors who’ve graduated in recent years, I chose to take a year out after my foundation years for a variety of reasons. 

"After completing my FY1 year, I wasn’t sure on which training programme to apply for and still felt that I had only been exposed to a limited amount of specialities. I personally feel the recruitment process for speciality training can be rigid and rushed although I do appreciate that some people know quite early on which career they wish to go onto. I also feel that once a you do choose a speciality, focusing on career goals do outweigh things you may really love to do in your life such as travel/spend time working abroad which is something I aim to do towards the end of the year and this seems to be the case for many of my friends taking a year out post foundation years. 

"I feel taking a year out (depending on the specialty you wish to apply for) can be very beneficial in furthering your knowledge, experience or even just having some time out to enjoy life a little!"

Sinthu's not alone in wanting to take time to get work into perspective. We are facing a workforce crisis as junior doctors vote with their feet

A policy I find quite harsh is the effective 'banishment' of trainees if they change their minds about career commitment. Turning down for example ACCS or GPST because you need time to reassess or there's been a change in circumstances comes with the awful warning that you can Never Come Back. 

I hugely benefitted making up my own Basic Surgical Rotation. After house jobs I did 6/12 posts in A&E, T&O, Urology, Vascular, Breast & Endocrine, Colorectal, ITU and back where I started, with T&O again. I am grateful for the experiences in every single post and would absolutely do it all again. 

Now, it seems like a race. Core training applies an enormous amount of pressure to achieve a ton of targets in the two years. If MRCS isn't achieved early, or before you start, it becomes an additional mountain to the two closed loop audits, the 300-odd logbook numbers, the 80+ WBAs, case reports and projects - there is no time to enjoy the job. No time to test the water and see if this or that speciality is The One. I do feel sad about that.

With limited exposure to the different specialities in medical school (did you know, for example, there are 68 different hospital-based specialities?), a year of Foundation training where you are supernumerary, making a life-changing career application just weeks into your second year with the threat that if you make the wrong commitment and leave you can never return, it is no wonder that junior doctors are bailing after FY2. It's more surprising to me that so many stay.

Surgeon of the Week

A true educational Titan  here (I feel a fanfare of trumpets is appropriate at this point) - this week it's Foundation Programme Director and Breast Surgeon Mr Tayo Johnson. Here he is with Sr Rekha Menon:

Tayo is fiercely protective of all his Foundation trainees, making sure @ASPHFT is doing its bit to support them through these two years. He is a stalwart of the Surgical Local Faculty Group where his incisive analysis cuts to the chase. And his laugh- he has a laugh that can shake the building.

Forthcoming Attractions

On the theme of exploring career options, I found these 'taster' courses at the Royal Society of Medicine @RoySocMed

And in the spirit of learning for pleasure, here's a free experience at the Royal College of Physicians @RCPLondon

7th September

Always good to have a refresher and this week Consultant Mandatory Training came round again for most of us in T&O. Just as we were going over the principles of Information Governance, elsewhere in the NHS a sensitive data breach took place, showing how easy it is for this to happen: 

http://www.bbc.co.uk/newsbeat/articles/34130294

Mandatory Training is also the chance for Consultants to go over resuscitation skills, with Mr Khaleel, Mr Chana @RishiChana and Mr Michael @DeanMichael1971 clearly enjoying themselves:

Resuscitation Officer Paul Wills introduced us to the Lifesaver app, which tests your skills and has increased non-medics' confidence in approaching emergencies: Lifesaver Mobile by Unit9

https://appsto.re/gb/xeHYL.i

Self-directed learning

Medicine across all specialities is a process of life-long learning. A popular misconception, regular evident through the @gmcuk GMC NT Survey, is that teaching is only thought to have taken place if it is didactic and lecture-style.

Once out of medical school, every single patient interaction offers an opportunity for learning. Senior colleagues talking at you is often the least efficient or interesting way of gaining knowledge. 

There has been a substantial increase in posts at SHO-level in all the surgical specialities @ASPH. This offers an unparalleled chance to get to out-patient sessions, go the elective and emergency theatres, spend time with our radiologists whilst reporting, learn to put casts on with our plaster technicians, get to understand the process of taking and interpreting nerve conduction studies, get stuck into an audit project that interests you... 

... or you could have long lunch breaks.

There is so much out there, with interesting skilled people keen to share their knowledge and enthusiasm for what they do, it would be a waste not to maximise your educational time with us.

I'm looking forward to seeing from your portfolios how you take advantage of this time to broaden the practical, clinical depth of your knowledge. 

Surgeon of the Week

This week I'm introducing Mr Shashi Irukulla @nulife_surgery seen here with our Bariatric Specialist Nurse Sr Natasha Smith

Shashi is an Upper GI, laparoscopic and Bariatric surgeon, and is the local Programme Director for our Higher Surgical Trainees in HEKSS. He is currently redesigning our local teaching programme, hoping to start grand rounds and I will update you here of local sessions.

Forthcoming Attractions

ATLS® is a multidisciplinary course enabling a standardised language of trauma care across the specialties. Open to FY2s and above, it is an essential requirement for CST applications and needs revisiting every 5 years, so courses get booked up pretty far in advance. Here are courses that as of 6th Sept still had places available, till the end of the year: