1st February 2016

CST Interviews

Surgeons from all over the country have descended on London this week to take part in the Core Surgery National Selection. Over ten days, 1340 junior doctors are interviewed through 3 stations: Portfolio, Management and Clinical. These are run as five 'circuits' across three floors of the Amba Hotel Charing Cross. Each station has two interviewers and an observer who could be a Consultant surgeon (eg the clinical lead for the circuit) or Senior Registrar or a lay observer. 

We start each morning gathered in our circuits to listen to a preparation video where @Humphrey_Scott reiterates the process before taking up our posts for the day. This was Circuit 3&4: 

Great care is taken to standardise the interviews so that every candidate can have the same experience. That was my job this week, as 'clinical lead' for my circuit I sat in on each of the stations, made sure there was no wide discrepancy between marks from the two panellists and checking up on any issues flagged up in the portfolios.

Data Protection

The commonest issue was patient identifiable data. You may think that just means names, but it also means hospital numbers so please check your logbooks. Imagine if, say on your way back from the interviews, you left your portfolio on the train. Your logbook details are then fair game to any passing Daily Mail "journalist" who has the name of the institution, date of procedure, hospital number, age and operation details. It's a very short step to get a name then a front page splash. 

We have to take those pages out and shred them on the spot. Nearly all of you are using elogbook - use the filters to generate anonymised data and summary sheets. Get into the habit, you'll be doing that for every ARCP. 

Thank you cards: black out the names of patients or sadly we will have to take those out and shred them too. As consultants, our entire appraisals @ASPHFT, a whole year's worth of collated data and professional development, can be rejected by the Responsible Officer if a single patient's name is even faintly discernible under the black marker pen (oh yes, he's THAT finnickety) so get used to the process.

There's still a week of interviews to go: good luck to all those candidates. It has been wonderful to see the standard of so many dedicated junior doctors, it's is fantastic to see.

LETB Visit 26th February

Quick update for all those who are on leave or unavailable to attend the Deanery Visit:

Trainees, particularly Urology trainees who have their ARCP in Brighton that day, the Visitors will take email submissions so @unclehester get in touch with me and I will pass on email details. If you're on nights or leave, you can do the same: I know @youngseokcho has already done so, thank you.

Educational supervisors, you can do the same. @HEE_KSS are particularly looking for any areas you've been struggling to develop improvement projects: they would like to help if they can.

Tackling Undermining @ASPHFT

You may know that a couple of years ago I was part of a pilot project with @HEE_KSS led by Dr Kevin Kelleher @fflintstone11 looking at trying to improve the trainee experience. At that time, Obs & Gynae was the speciality with the highest reported incidences of bullying & undermining & @RCObsGyn had initiated a network of champions through the Trusts to address it.

Once the pilot project came to an end I wanted to maintain the spotlight it had cast on addressing challenging behaviours. No one underestimates how hard it is to manage a bully in the department. The perceived easiest option, to sit it out (4 months just flies by, doesn't it?) doesn't help those of us here for the long haul improve the educational environment. And it does nothing for patient safety. 

I was this week alerted by one of our Educational Supervisors, to challenging behaviour exhibited towards a very junior trainee. I cannot ignore this, just as the Educational Supervisor could not ignore it. 

What annoys me is how this behaviour can go unreported and therefore unacknowledged as an issue, and this is what I want to change.

I have completed Datix reports on behalf of the trainee with their consent, withholding their name and I will update them on developments. Once a Datix is done, there is a time frame within which a response is required, but more importantly it is a record, a log of events and as such must be taken seriously.

Please come and tell me, or if not me your Educational Supervisor, if you are not experiencing a healthy working environment. I promise you, you won't be told as I was when I was training to 'put up or shut up'.

And if you're wondering why @DeanMichael1971 is shouting at @hine_jo in the illustrating photo, they very kindly staged a photo story for me for a presentation at last year's "Student & Trainee Voice" - he's a big softy really! 

If you've been following the story of Dr Caroline Tan, http://m.theage.com.au/victoria/surgeon-caroline-tan-breaks-silence-over-sexual-harassment-in-hospitals-20150311-141hfi.html you'll know the Royal Australasian College of Surgeons @RACSurgeons has been forced to act strongly to overthrow the perceived culture of 'an Anglo-Saxon old boys' club' where surgeons have been described as 'eating their young'. And it wasn't  just pale, male surgeons either http://m.smh.com.au/national/senior-monash-surgeon-accused-of-bullying-20150522-gh7oi8.html

We owe it to our colleagues to create the best working environment we can, for better communication, for better team building and ultimately for the safest patient care.

Surgeon of the Week

We have a new arrival in the Rowley Bristow Orthopaedic Unit and a sad goodbye too: say hello to Spinal Surgeon Mr Vish Prasad and farewell to Fracture Clinic's Sr Ann Fletcher 

Vish was with us a Registrar and rejoins us having been a Consultant at Medway Maritime. He's married to @ASPHFT anaesthetic consultant Claire Cunningham.

February 12th is the last day in the Trust for Sr Ann Fletcher. I won't embarrass her here (I'll save that for her leaving party send-off) but there's no doubt she'll leave a massive void in the department.

Forthcoming Attractions

This year's ASiT @ASiTofficial 40th Anniversary Conference is fast upon us: if you haven't booked leave or your place in Liverpool, you still have time

http://www.asit.org/events/conferences/2016

25th January 2016

CST Interviews

Good luck to everyone going up for the CST Interviews over the next two weeks. From all the portfolios I've seen, you have  such good prospects: application numbers mean you have a 2:1 shot. But you're not just aiming to get a post, you're aiming to rank, as high as you can, so you can get the region you want. 

Keep calm, try and engage eye contact just as you would in any conversational situation (always a bit weird when you're talking to someone and they are staring at the wall behind you). And don't  forget to blink (again, weird when people don't). 

Think of your responses as having a beginning, middle & end. Bit like musical phrasing. Monotonous rambling kills interest, much better to have a direction. Practice: asks friends to video you answering a question, it can be illuminating. 

Your portfolios are an amazing record of your hard work and industry. The interviewers have 10 minutes to go through the whole lot. So think of that one thing, or things, you don't want to leave the room without making sure the interviewers have seen. That closed loop audit, that service improvement project you had, that poster presentation: draw it to their attention. Inevitably, things in the back 1/3rd of your portfolio can't get looked at as forensically as the stuff at the front, because of the time pressures. 

#PinkWednesday

We did our bit: thanks @unclehester for roping in passers-by into the spirit of the day, celebrating the part women play in the NHS (and not, as @thesundaytimes published, bringing about its downfall)

LETB Visit 26th February

Surgery, Anaesthetics & Medicine are the subjects of a Deanery Visit (now known as Local Education &Training Board) on Friday February 26th.

This Visit has been triggered by the results of last year's @gmcuk GMC National Trainee Survey. Surgery will be looked at by the Core Surgery Programme Director Miss Elizabeth Sharp @HEKSSspeciality 

All surgical trainees, CST and HSTs will need to be available between 11 and 12 for an informal discussion with Miss Sharp. I will circulate this information to your departments but you should make preparations to be available. This is your opportunity to share what's good or less than good about your training experience @ASPHFT and what might improve it. 

To my dwindling band of Educational Supervisors: it would be tremendously helpful if as many of you as possible could also attend. We all know the hurdles we face finding the time & summoning the energy to train in the current climate - and the acknowledgment, let alone recognition we get for it. Help me make the case for improving the quality and quantity of surgical education @ASPHFT and celebrating the great trainers we have here.

Surgeon Fundraiser of the Week

Max Fax surgeon Alex Creedon is this week sporting half a beard for the Stroke Association @thestrokeassoc 

On Sunday, he had his half shave and will be sporting it for the week so please have a look at his @JustGiving page and support him: 

https://www.justgiving.com/alex-creedon

Forthcoming Attractions

Some interesting events coming up @RoySocMed (including the Trauma Symposium starring @ASPHFT surgeons) and @RCSnews

18th January 2016

Junior Doctors' Strike

Tuesday was the Junior Doctors' Strike @theBMA. Pretty much everyone pulled together to ensure our patients were safe on the day: congratulations to those who took the trouble to plan ahead and reallocate resources.

There were some grumbles: let's not name the one or two who, faced with Fracture Clinic for the first time in a decade, took umbrage - they were by far the minority. I love that Matron Kelly Irvine felt she was "awash" with Consultants & was struggling a little to know what to do with them all. Special mention to @bobpeet1 Chief Operating Officer Bob Peet who took Cathy Parsons @cparsons007 and I seriously when we highlighted potential issues ahead of possible December strike dates and co-ordinated a pragmatic response throughout the hospital.

Lovely feedback from our Admin staff who spent the day liaising with patients about rearranged care. Ronnie Elliott @nannyrons told us every single patient she spoke with expressed support for the junior doctors, which was lovely to hear.

Wednesday and we were back to normal working. I went on an @RCPLondon course held at Frimley Park, hearing about the new GMC requirements for revalidation as an Educational Supervisor.  As with all ARCP/ Appraisal information collection, it's much better done prospectively and a considerable amount of material is required. I came away with the major concern that many Consultants currently in that role may look at the demands the GMC have stipulated ...and wash their hands of it. A topic for our next LFG @humphrey_scott & @jacquelin_joyce: how can I retain our existing AESs? 

There's a long history here of medical education #meded being undervalued & ignored. Making it even harder for my tiny band of committed enthusiasts to stay accredited when their teaching time has already been busted down to squat in aggressive rounds of job-planning, could see really great teachers walk away. Looking forward to your constructive thoughts on retention!

Before I get depressed about educational headaches to come, let's turn to celebrating what we have...

Surgical Trainer of the Year 2016

We have a victor! Despite many juniors having a very elastic definition of a deadline, I have collated all the citations and come out with a 'winner'

This was never going to be about numbers of votes: there would be a mismatch across subspecialties and that couldn't be fair. Instead I looked at quality & depth within the citation, and matched that with my own experience of engaging with the educational process in the Trust

So... *drum roll* ... @ASPHFT Surgical Trainer of the Year 2016 is... Consultant Urologist Bill Dunsmuir *wild applause* 

I'm all about celebrating success: here is part of the citation that won him Top Gun

 

"Mr Dunsmuir is a fantastic trainer, who seems to live and breathe teaching.  Every clinical situation, he makes into a learning opportunity, from theatre, ward rounds and even more difficult situations in A&E.  He is always careful to check a trainee’s experience level and then assists only as much as is necessary.  He is a rare gem of a trainer as he initiates and requests work based assessments at every encounter. Practically, he is full of expert tips that I have found invaluable, and his feedback has always changed my technique for the better.  Even when ‘examining’ in a regional skills competition, he could be spotted teaching candidates wherever possible."

We also have some Highly Commended runners up: Robin Cole, Humphrey Scott and Jon Trickett so bravo to you all, certificates and citations will be on their way to you.

Finally... CST Interviews

If you are attending the CST interviews in a week's time and you haven't already... PLEASE COME AND SEE ME WITH YOUR PORTFOLIO

I can't help you after the event but I think there is lots I can do to help you during. And those I've seen already but required quite a bit of reworking: let me glance over the improved version if you can.

#pinkwednesday #likealadydoc

If you saw that extraordinary article by professional-pundit-despite-having-absolutely-no-knowledge-of-the-subject Dominic Lawson in the Sunday Times this weekend, you'll see that all the ills of the NHS and in particular the origins of the dispute leading to the Junior Doctors Strike lie in the fact that there are too many women in medicine. http://www.thesundaytimes.co.uk/sto/comment/columns/dominiclawson/article1656813.ece

Oh yes indeed, we have been catapulted back to the 1950s. 

Regardless of your gender, wear pink on Wednesday & send a selfie to @thetimes & @thesundaytimes #pinkwednesday. The profession is a better place for having the brightest & best, even if some of them happen to prefer skirts.

11th January 2016

Junior Doctors' Strike

I am very aware that some of our non-clinical colleagues and even some of our local medical seniors are uncomprehending of the reasons behind strike action juniors are about to take, so here's T&O junior doctor Ben Dean @bendean1979 explaining the current situation very well:

https://www.youtube.com/embed/F_HpNMWZBvs

And here's a helpful piece from Kailash Chand @KailashChandOBE and JS Bumrah outlining the issues: http://www.theguardian.com/healthcare-network/2015/sep/29/jeremy-hunt-stop-bullying-junior-doctors-new-contract?CMP=share_btn_tw

I realise I don't have to explain the situation to trainees but I have been taken aback by some corridor conversations I've had with senior staff members and what they think the dispute's about (eg thinking it's a conventional pay dispute: they are not asking for more pay, they're asking not to have a pay cut) so thought these links would be a helpful resource.

At time of writing, the strike is set to go ahead on Tuesday. The contingency plans first drawn up for the potential action days in December have been put in place again.

I would like to thank our Admissions Office who again have been contacting patients and rearranging operation dates (I know some of my patients certainly appreciated having their procedures a couple of weeks early). They have worked tremendously hard ensuring the impact on our elective patients has been minimised.

Social Media Lesson

Interviews for CST & HST are coming up. There's no time when interviewing candidates on such a mass scale to surf the interweb, but there is time to do that ahead of Consultant/GP partner interviews, so I'd like to ask you again to think about your social media profiles.

The first question David Elliott asked me at my @ASPHFT Consultant interview was 'what would I find if I put your name into Google?'. I had never thought to check at that point but I've never had a Facebook account & Twitter is a recent development for me, so I had no real skeletons.

It will have taken Sun journalists all of 60 seconds to trawl social media to find evidence of the Moët Medics lifestyle:

http://www.thesun.co.uk/sol/homepage/news/6850988/Luxury-lifestyles-of-junior-doctor-strike-leaders.html

None of the photos the (alleged) journalists pulled up are bad, by any stretch of the imagination. But it does serve to highlight that all our unlocked lives are open to spin and interpretation - so be aware. Don't let your Consultant/GP partner interview be prejudged. Think ahead and curate what people see about you.

Here is the GMC Social Media Guidance: 

http://www.gmc-uk.org/guidance/ethical_guidance/21186.asp

I understand that to be under such strict rules even in your personal life is an onerous burden and takes the fun out of it - but if you describe yourself as a doctor or allude to your profession even indirectly, you are on show as a healthcare professional.

Congratulations of the Week

Well done CT surgeon (Mr) Dan Rossiter for winning the Training Programme Directors' Poster Prize at the @HEE_KSS Core Surgery Prize Day held at Maidstone General Hospital @MTWnhs on Friday:

Health Education England: Kent, Surrey and Sussex

The LETB website has changed to be unified under the Health Education England masthead. Confusingly, it is not the first or even second choice on a Google search and many of the links you might have accumulated in the past most likely don't work anymore. This includes links that look like "kssdeanery.org". If you're on social media, you'll see their Twitter handle has gained an extra "E" @HEE_KSS but the surgical one remains the same @HEKSSspeciality.

Here is the weblink as it is now: https://hee.nhs.uk/hee-your-area/kent-surrey-sussex

... and the @ASPHFT pages can be found here: http://www.doctorsintraining.org.uk/

Surgeon of the Week

(This is a personal triumph as I have been hunting down this one since this blog began, so I am indebted to Foundation Programme Director Tayo Johnson for retaining a vice-like grip on him to let me get the shot. He has literally run away from, up till now. Run. I kid you not.)

This week's shy superstar is Consultant Urologist Sachin Agrawal. Sachin is yet another colleague who was here as a junior and came back to stay, which says something about a hospital I think. In fact Sachin & I were juniors in T&O together over a decade ago. 

Sachin has been the mastermind behind the expansion of the trust grade posts at F3/CT level, improving manpower and thus patient safety that has been rolled out across Urology, Surgery and T&O. He's a terrific Trainer and a stalwart of the Surgical LFG.

In an aside, it is no accident that Urology has featured heavily here in this section. Urology is the only Department to have received Green Flags in the @gmcuk National Trainees Survey and provide constant support at Surgical LFG (local faculty group) meetings. My Urology colleagues can always be counted on to support educational events, giving up their spare time to do so and between them have garnered the most responses for nominations for the Surgical Trainer of the Year 2015 Award - which will be announced later this month. I am grateful to @SuzRankin for kindly agreeing to award the accolade.

So big round of applause to all our Urology colleagues and my grateful thanks!

Forthcoming Attractions

A date for the diary @RoySocMed Trauma Symposium 2016:

https://www.rsm.ac.uk/events/events-listing/2015-2016/sections/orthopaedics-section/org06-trauma-symposium-2016.aspx

This meeting is organised by @ASPHFT's own Jon Monk @jonny_monk and stars David Elliott @davidsimonellio amongst the fantastic speakers on this 3 day trot around the hot topics in Trauma. Get on and quickly book your spot as we are right up against the 6/52 booking notice deadline

4th January 2016

✨Happy New Year!✨

I hope Christmas & the New Year brought you some opportunity to get together with loved ones & take a break, however short, from the intensity of working. Before we know it, the moment has passed & we're back into the swing of the academic cycle. 

Next up in the calendar is the Core Surgical Training Day, on Friday in Maidstone, where apart from a morning of trainees' presentations & posters, our own Arshad Khaleel will be talking you through the interview process for Higher Surgical Training. 

My thoughts however are with the upcoming Core Surgical National Selection, across the last week of January and the first week of February. The National Selection is run by @HEE_KSS, in particular @HEKSSspeciality, and are taking place again at the Amba Hotel Charing Cross...

...and the dates are here: http://www.ksseducation.hee.nhs.uk/recruitment/2016-interview-dates-venues/
I've put my #portfoliopreparation tips on social media before but I think it bears repeating and I hope you find it useful.

The single most important thing you can do ahead of the interviews is seek out your @RCSNews Surgical Tutor, taking your portfolio with you. Don't be shy. 

I thought I had seen everyone ahead of the interviews last year, encouraged portfolio polishing, rehearsed responses and celebrated success - only to find two weeks after they were done an unsuccessful F2 found me who I could have supported. So - don't be shy.

Portfolio Preparation

Your portfolio is the physical manifestation of your career to date & your hopes & dreams for your career ahead. It represents You. There is no point dressing smartly in a new suit if your portfolio is thrown together haphazardly. 

Interviewers have less than 15 mins to go through your portfolio before you go in the room. It helps to make this time as easy as possible for them:

1) Good quality binder: doesn't have to be leather but probably shouldn't be a Poundland special 

2) Four rings better than two for turning pages easily and keeping the portfolio secure. The overstuffed lever arch that cascades plastic wallets to the floor is not a good thing to see

3) Good quality plastic wallets that don't lift print. Cheaper packs (eg those that come in 100s) go crinkly...

... and don't show off certificates etc very well. The better ones hold your work almost as if laminated. Looks more professional. Never put in more than two sheets of paper into a wallet (ie front & back). There is no time to take papers out & go through them in the interview.

4) Extra Wide Dividers: regular dividers do not stick out beyond the wallets 

5) Order the tabs in the order of the checklist so that all your achievements can be quickly verified

6) Demonstrate your evidence of teamwork and leadership with one or two photos. The colour pops as you skim through and attracts the eye. Helps to show you as a well rounded human being

7) Reflection is how we learn. Include some notes you've made on something that went well and something that could have gone better. You will inevitably be asked to describe such situations so it helps to be prepared to talk about these events.

8) Logbook summary needs to be in there, preferably signed by your AES so make sure that's done ahead of time. E-logbook doesn't let you show any patient identifying details: if you are not using the e-logbook summary, make absolutely certain you are not using any patient identifying material in your summary

9) Include thank you cards & testimonials but if they are from patients you must blank out their names. You have to be this vigilant for consultant revalidation so it is a good habit to get into.

10) Fill every category. An audit I am sure will have done double duty for you as a presentation and a poster so put it in all those slots that apply, if that's what you've done

11) Don't pad it out. One portfolio I remember going through was filled with blank sheets of paper - I pulled out 37 all told. It doesn't help. Likewise don't print out your entire Foundation eportfolio as that looks like filler as well. The assumption is that by being there you have achieved your Foundation competencies.

 12) Identify your USP, that thing in your portfolio that you are most proud of, that thing you don't want to have left the room without making sure they have seen it. Be prepared to talk about it and why you're so pleased to have that in your body of work. Make sure you know where it is so you can find it quickly for them

There's formal advice here from the HEKSS @HEKSSspeciality website, who are the coordinators for Core Surgery National Recruitment: 

http://www.ksseducation.hee.nhs.uk/recruitment/interview/interview-prep/

Personal Presentation

Advice on this can often be taken the wrong way, so I apologise if you don't like this section.

For surgical training, you are applying to join a profession with certain standards born of adversity. Things like infection control, meticulous technique, adherence to defined evidenced-based pathways, these are all the bread and butter of surgical consultants. 

It will inevitably generate a negative first impression if the candidate comes in apparently only able to see out of one eye...

... or with both eyes visible but weighted down with extra lashes (will that end up in my wound?)...

...or dressed as if they have accidentally ended up in the Amba Hotel Charing Cross after a night of partying. I have seen all of these things, I really have. Of course nobody says anything, that would in itself be unprofessional. But the negative impression has been generated before a single question has been asked. 

That, I'm afraid, is life.

About the Interviewers

Around the end of November, HEKSS puts the call out to all consultant surgeons to volunteer to interview. The interviews run for 10/7 and are highly labour-intensive. It is not something people can do year in year out, and it's tough to combine with HST interviews (most Trusts kick up a fuss about so much professional leave). Therefore the people interviewing you may do it infrequently and alternate with a completely different grade.

Why am I labouring this point? To let you know it is perfectly OK to query the questions you were asked if you feel them to have been inappropriate (aimed at HST-calibre candidates for example). 

But you have to do it on the day. 

There is nothing I can do if you decide the following day or week that you weren't given a fair crack (though we did push last year with limited success). 

There are lay observers on every floor who pop in and out of the interviews who will raise a metaphorical eyebrow if they think the questions are wandering off point. There are clinical observers too, usually senior registrars, who can also reign things in. But if they're not in the room with you, and you feel things have not gone fairly, you should feel empowered to say something to the floor coordinator in the day.

For a £10 fee, you can request your score sheets: interviewers are encouraged to take notes especially verbatim of responses that were particularly good or bad resulting in an outlying mark:

http://www.ksseducation.hee.nhs.uk/recruitment/afterinterview/feedback/

🍀 Good Luck! 🍀

I am always struck at CST Interviews at the number of talented junior doctors we have in the UK who will excel at whatever they set their mind to and have chosen a career in  Surgical Specialities. It makes me so reassured for the future of our profession: I wish you all the very best of luck. 

If luck doesn't favour you and you need another year to build your logbook & portfolio a bit more, @ASPHFT can still support you with a number of trust grade core-level surgical vacancies arising in August - so don't panic, we will get you there