28th February 2016

LETB Visit

This week saw our LETB @HEE_KSS visit. Surgery, Medicine & Anaesthetics/ICM were being assessed and I'd like to thank all the trainees & trainers who came along to share their thoughts with the visiting team.

It was one of those rare opportunities where I get to see all my CSTs in one spot (bar Seok who was on nights)

L=>R Dan, Aphiwat, Kamran, Asad & Sophie

It was also a chance to catch up with fellow trainers, another rare event which highlights to me how much we work in our own little silos with hardly any interaction between the directorates. 

We made the most of it and of course we'll have a full debrief next week at the Surgical LFG but I can give you the main points here.

Surgery on the whole came out ok, generating a supportive training environment. General Surgery did good from the trainees, feeling well supported with good handover. T&O had highlighted the situation the on call consultants are in, either being off site during that on call day and/or off site the following morning at Ashford, & this was queried by the visiting team as not best practice. This ties in with uncertainty from the visitors over whether all the patients have a consultant review every day - ironically the weekend is the time they are most likely to have a consultant review within 24 hours whereas weekdays with elective pressures that may not be the case. Probably not what Jeremy Hunt would expect to hear.

The 50% reduction in Educational Half Days was also brought up as a negative as was the lack of training time allocated in consultant job planning. The biggest message was the weight of service provision at the expense of education and a perceived disconnect between service & education 'at senior board and divisional level'.

I'm really grateful to everyone to came to give their views and help us improve the training environment here. A full report I believe has gone to the Chief Executive, who I think has to provide a response in five days. I have video of the Surgery part of the feedback (saved me making notes!) which I'll show at LFG on Thursday.

Mind the Rota Gap

On Weds March 2nd I'm going to take a snapshot of medical staffing in Surgery for the 24hrs. I want to know how many substantive posts we have and how many locums/gaps. I'll repeat this in April, after the Locum Cap comes fully into action, to see if we have an increase in gaps. The Cap is intended to block locum earning at 55% above the substantive rate. In practice this means a reduction of ~£10 an hour.

I would love to know the data in other specialities. If you can help with that, that would be great. It is a fairly political audit, but an audit with a closed loop in a month nonetheless so come and talk to me.

There is a perception on social media that with the cap the same across the board locums will prefer the less busy specialities leaving gaps in eg A&E harder to fill. 

Already there is anecdotal evidence of Cap-busting rates on offer. I saw one Trust is offering £60 per hour for FY2 cover. True market forces in action, you could say.

Follow the hashtag #mindtherotagap for news on gaps emerging all over the place and how other Trusts are responding to the crisis. For example Addenbrookes has closed its books to new cardiology referrals as they have insufficient doctors to treat the ones on their books in a timely fashion.

NHS Staff Survey 2015

Results of the survey done at the end of last year are now out:

http://www.nhsstaffsurveys.com/Page/1044/Latest-Results/Acute-Trusts-A-to-I/

Tutors of the Week

The best bit about Friday was that I got to meet and brainstorm with @jbbince Dr Jackie Ince, College Tutor in Medicine, seen here with Tayo Johnson, Foundation Programme  Director

It could be quite dangerous if we meet more often as we fired loads of ideas off each other and made great plans to change the world. 

And finally...

You may remember late last year @ASPHFT hosted the Regional Heat of "Are You Cut Out For It?" the surgical skills competition for @RCSnews the Royal College of Surgeons (England). The two we judged to be the best that night, Ana & Jen, were in the Finals at the College on Saturday where they were Runners Up! Very proud of them both 

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

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