Welsh Research and Education Network
Hot topics in research and medical education, in Wales and beyond
WREN Christmas Quiz
Davide Paccagnella, ST4
The days are shorter, the wards are busier, but on the bright side…Christmas is approaching!
Take a quick break from work with something light, like a statistics quiz! (there is also some trivia in there, don’t worry)
There is often more than one correct answer, as you will see. It all comes down to perspective.
1. How might confounding factors be avoided?
a. They just can’t be avoided
b. By matching individuals in the groups according to potential confounders
c. By mixing all the data together
d. By clarifying everything beforehand
2. A study where neither the patient nor the researcher knows which treatment the patient has been randomised to receive, is called a:
a. Good study
b. Single-blinded study
c. Double-blinded study
d. Not a clue study
3. What is the “number needed to treat”?
c. Depends on the circumstance
d. Depends on how much the researcher wants to get published
4. How can the confidence interval be calculated?
a. By using the standard error
b. By asking a statistician for advice
c. By subtracting your own confidence level from the level of confidence you have in the Health secretary
d. It does not matter, so it is not worth calculating
5. Likelihood ratios can be multiplied by pre-test odds to give post-test odds. True or false?
d. Likelihood ratios are an old-fashioned concept and, frankly, irrelevant.
a. measures the proportion of true positives that are correctly identified by the test
b. measures the proportion of false positives that are incorrectly identified by the test
c. Is often undervalued in Medicine
d. Is always a waste of time, according to some people
7. Type 1 error can be defined as...
a. The first error a researcher makes
b. The incumbent US president’s interpretation of the election result
c. The rejection of a true null hypothesis as the result of a test procedure
d. The content of this entire quiz
1 – b; 2 – c; 3 – c; 4 – a + b can both be true; d – may be true, if you are that kind of person; 5 – b; 6 – a, c, d may all be true depending on your views; 7 – you should know this, but I will respect your opinion.
Dear colleagues and friends
The WREN blog is back!
As we all get ready to face a tough winter, let us learn to be kind to ourselves, and practice resilience.
Let's start by reading about AWEN (All Wales Wellness and Education Network), a brilliant initiative that has allowed trainees to remain connected with one another, and share knowledge on a virtual platform.
The second piece is a thoughtful and inspiring personal reflection, with practical advice on how to overcome stress and trauma.
Finally, we have included a brief reflection on the Digital Asthma Masterclass from September.
We hope you enjoy the read!
All Wales Wellness and Education Network (AWEN)
Andrea Misquitta, ST8
On behalf of the AWEN team
We really hope you have heard of AWEN by now- if you haven’t where have you been!! We are the All Wales Wellness and Education Network - a group of trainees and consultants hoping to improve your educational and wellness needs. We were born during this pandemic, when it became apparent that paediatric teaching had been put on the backburner in many places. We felt this was unsatisfactory for our training needs and so using the London School of Paediatrics as our inspiration, we launched AWEN. The trainee group is comprised of Tom Cromarty, Sarah Myers, Eve Bridgeman and me from the South and Jemma Wright and Kim Hallam from the North. We also have Assim Javaid on board as our ideas guy and Stacey Harris, who along with Sarah and Jemma is one of our wellness champions. We have tried to make this a trainee led initiative as much as possible, but it wouldn’t work without the support of the LPD’s in many trusts and our fantastic educational lead Pramodh Vallabhaneni.
We wanted an all Wales teaching programme to share out the load of teaching and enable us to ensure that teaching is happening 5 days a week, which is so exciting and something I’ve never experienced before and I’m almost at the end of training! Obviously due to COVID we are not able to congregate in our handover/seminar rooms as before to access teaching, so it is all being done virtually – however this is not such a bad thing and provides so much more flexibility, you can even tune in pre/post nights in your PJ’s from the comfort of your own sofa/bed if you want! It also allows those currently not working due to maternity/paternity leave and OOPE’s to stay in the loop.
We have been busy beavers behind the scenes, setting up the timetable, ensuring it is always updated with the latest links. Sending out a whole host of messages on WhatsApp to remind you of what’s happening. Trying to think about interesting topics as well as finding presenters (along with the LPD’s) or presenting ourselves. We have also been collating your feedback for the presenters. Not to mention trying to get our heads around the virtual teaching world and all the other "techy" stuff we have had to get to grips with – admittedly easier for some of us than others!!
Now what we really need is a little help from you – please attend the sessions when you can and participate if needed (it really does make a difference if people join in). We have had good numbers so far so please keep it up. Please complete the feedback form - the presenters are giving up their time to teach us and it is so important that we can give them something back in return. It also gives us a record of how many people are attending and what’s working and what isn’t. If 30 people actually attend teaching but only 10 people complete feedback, we don’t have an official record of actual numbers, which makes it really difficult for us to put forward a strong case for keeping this going in the long term. Please consider volunteering to be a facilitator, it will really help us make these sessions run smoothly and allow the presenter to just concentrate on teaching.
We have had some excellent sessions so far, including formal teaching, journal clubs, case discussions and excellent Friday grand rounds. Wellness Wednesdays have also been well received with lots of exciting things in the pipeline, including poetry, crafts, Makaton, and diversity. Neonatal teaching has been extremely popular too. We have heard that you are really enjoying being able to access teaching in areas you are not currently working. We are working on allowing you to catch up on sessions. Unfortunately recording hasn’t always worked and some sessions are not yet being shared due to confidentiality. The ones that have been recorded are on our Dragonflix YouTube channel and the links to them are on the archived sessions page of the timetable. If you subscribe to Dragonflix and request notifications, you will get a message when new videos are added. Some videos are added as unlisted so you may not see them on the channel page.
This is our teaching programme and it’s not often that we are in the driving seat, so we want to hear from you:
Most of all though, please tune in and enjoy!
Links and contact details:
Contact us via WhatsApp - Numbers available on Welsh Paeds Trainee Comms
Contact us via Email - AWENPaeds@gmail.com
Overcoming stress and trauma:
an idiot’s guide for junior doctors
Stacey Killick, ST8
Life is good. Life is bad. And life can be mediocre in the middle with nothing to moan about. As doctors, it is well recognised that we are strong people, determined and resilient and able to deal with a variety of stressors in our professional fields. But what about when it all gets too much? When the stressors are in both your professional and your personal lives and you feel that even the most ordinary of days can be a struggle, what then?
This year has not been my year. Not that it has been anyone’s year. But as far as years go, I can only liken it to falling down the stairs, over a banister and landing crash bang into a wheelie bin of clinical waste. The bad kind. I was doing specialty training as part of my HDU spin at a local tertiary hospital. I had had fertility treatment and had successfully fallen pregnant. Things were busy but things were good. Then all of a sudden, things changed fast. I went from having some lower abdominal pain to going to my local DGH and being diagnosed with a ruptured ectopic to going into full on haemorrhagic shock and being rushed into theatre. A tummy full of blood and one necrotic tube with blob later, I was kept in until my obs were better and then off I went home. Problem solved. No follow up I was told by the Obs and Gynae registrar, as all had been sorted.
I didn’t cry for 3 days. I was determined to get home. And then once there, I was determined to carry on like nothing had happened. And that was ok. Until it hit me. It wasn’t just the loss of a pregnancy, the loss of some of my fertility and emergency surgery. I had nearly died. It was all new I told myself, a few weeks of staying at home and then I would access all the help I needed. It seemed sensible at the time. And then COVID happened. I was then stuck at home, isolated from my family and friends, unable to see my GP, unable to access any counselling and unable to get any sense of normality back in my life. I was off for 3 months in total, and I used my time off to try to acknowledge and overcome the loss and trauma that I had gone through before returning back to work. To accept the order of events, the emotions and difficulties they have caused, and to get back into a good place. Since returning to work, I have been looking at the various sources of advice on how to cope with stress and trauma, how to cope, how to be more resilient etc. And the advice is fairly repetitive. Sleep for 7-8 hours a day, eat healthily, avoid/minimise alcohol and caffeine use, exercise regularly. If these things were so easy, wouldn’t we all be strutting around like Joe Wicks with a six-pack, a stethoscope, a big smile and a smoothie??
So. This is what I have learnt.
1. Learn to say no
This is a hard one for us as problem solvers and as dedicated workers, but do you know what? It is ok to just do your basic job for a period of time and not take on any extra if that is what you need to do. There are times when we can do revision, take on extra projects and prepare lots of teaching. But equally there are times when you can’t. And to say “I’ve got a lot on over the next few months and I feel a bit overwhelmed so I am looking to just do the basics for a while and then start doing extras” is just fine. I’m not good at saying no, but giving yourself that bit less to do when already feeling overwhelmed is priceless, it has really helped and we are absolutely justified to ask for that.
2. Assess and adjust your social media
The internet can provide us with so much: forms of contacting others, sources of news, amusement as well as teaching resources and revision aids. Professionally, you only find what you access. But personally, such is the way that through the likes of Facebook and Instagram, there is so in the way of political ranting, new issues and concerns from our fellow professionals as well as those that pose their breakfasts for photos and brag about their wonderful lives. It can make us feel intruded upon our time off away from work, and it can make us feel inadequate, and even sometimes resentful. So have a good think: do I need all of this? What in the words of Marie Kondo ‘brings you joy ‘? Select what you want. And the rest, either delete or take time out from. Being off during COVID, I found myself reading the news endlessly, worried about my colleagues and feeling guilty for not being there. I also found myself looking at others, their stressing about what seemed absolutely minute and also seeing pregnant women and baby adverts everywhere I went. So I gave myself a 2-month social media holiday with minimal reading of current affairs. And it gave me the time I needed to focus on me and not worry about the rest of the world and nor to feel judged by it. Worth a thought.
3. Speak to those at work
You will not be the first person to struggle and you will not be the last. Have a think about your team, who you know and decide who would be best to speak to. Naturally, we identify mentors that suit our own personality, who we are and how we work, and it may be that they would be the person that you would find it easiest to first speak to. It would be good to let your educational supervisor know too, but perhaps in the interim, having somebody who can help you is better than no one. They may be able to re-assure you, to guide you, to advise you. Or perhaps even just listen if that is what you need. Acknowledging the struggle is one of the hardest things to do, so even this first step is massive. Do it.
4. Consider additional sources of support
Within our jobs, we have access to Occupational Health. We have access to the PSU (Professional Support Unit). And we also here within Wales have access to HHP. This is Health for Healthcare Professionals. It is a free and confidential service that you can access (www.hhpwales.co.uk and 0800 0582738) whereby you speak about the issues that you are having, and they can arrange various types of support. You explain a bit about you, you are put in touch with someone close to where you live and as it is for health professionals, they work into the evenings and around your rotas and the waiting time is minimal. Priceless. CBT for me has been one of the biggest game-changers. It is not for all, but through this my perspectives have changed and I feel a lot stronger to tackle what life throws at me. Think about it. Try it even. What have you got to lose?
5. Look at your time management
It is easy to fall in to the trap of doing work related things on your days off. To finish a weekend on call and to have a week day off only to realise you have a list full of rubbish jobs to do that will take up a lot of the day, resulting in you returning to work and not feeling as though you had a break. I went to a course last year, and they chatted about time management and it made me think, could I be more constructive with my time? And the answer was yes. I now make a list of crappy jobs and I allocate one or two things to every weekday. Can I on a Tuesday just reply to that one email, ring the dentist and put the washing machine on? Yes I probably could somewhere throughout the day. The result: you mostly CAN squeeze these things in, and then when you have an off day, it is free/a lot more free having cleared throughout the week what would have taken a decent bit of time all in one go and ruined your day. The same can be with work related things also, max out your working days and squeeze in to enjoy your off time. The equivalent of the boy at school who did his homework whilst there and then went gallivanting in his own time. It can help and it gives your mind-set that feel of time that is free and is yours to do with as you feel. It won’t work for all, or perhaps entirely, but give it a go, I was surprised myself.
6. Consider speaking to your GP
I say consider because it won’t be for all. But consider it. We are doctors, but we are also patients. And it is worth thinking about if we too need help medically. We preach about mental health, about the associated stigmas, about accessing help if you need to. Well, practice what you preach. If you need help, there is no shame in it, no one needs to know about it and if seeing your GP and considering additional forms of support or even medication helps your quality of life, why would you not. It is an option to not be ignored.
7. Speak to your friends and family
It sounds basic I know, but we don’t always do it. There is the fear of feeling as though you are whinging, or one of my favourite sayings, having a ‘pity party for one’. And yes, we all know people that are worse off than ourselves and situations more dire than our own. But that does not take away from the stresses or the struggle and the fear in our own lives. And although we carry on and perhaps bottle it all up, it is good to just let it out and just rant sometimes. To have our own five minutes. Do it. You would listen to others without judgement, so let them.
8. Do something you enjoy each week
I was on a leadership course and there was a retired matron who had gone into management talking about resilience. Crazy. Loved her. She spoke about resilience being like a reservoir. And that if it was 80% full, you would have room for a bit of rain and even some heavy rain. But if it was 95% full even at the beginning, how would manage if any extra rain came your way? It made sense to me. About looking at life and deciding to get less worried about things, to clear areas of concern up etc. And then came question time. And someone asked her what she had learnt that was the most useful and that she wish she had realised earlier. And she her answer was to do something you love. To keep up with something that you enjoy no matter what, because to have that small fragment of happiness and to be that person that you are is so important. One hour a week she said, just one hour out of the 168 hours in a week. So I thought about it. I love reading; always have, and I kept books for the time that I had annual leave. Yet the rest of the time, I didn’t allow myself to read because I was too busy and it is a distraction. Yet I love it, the escapism it offers. And so I now read at least once a week. I also, when writing/typing during night shifts and in the evenings when cooking, listen to old albums that I love, ones that I can put on and know all of the words and sing to. Even if it is a Vengaboys album. It is small, it is meaningless, yet it is so easy and it makes you happy.
9. Reward yourself
Life was so much more straightforward when you were 12, being given your pocket money to spend on yourself, spending hours on choosing which sweets and CDs to buy from Woolworths. Perhaps even £5 if you had a good school report. And then life got real. Before you knew it you were holding numerous bleeps with a less than fully staffed team, bills coming out of your ears, exams to revise for, 2 audits that you’ve been asked to do and that’s without any issues in your personal life. So I ask: when did you last treat yourself? Genuinely spoil yourself for doing such a good job in adulting just by trying? Go for it. A spa day. Some new clothes. That drum-set that you always promised yourself that you would buy when you were big and had the money. Life is tough. And it isn’t always that kind. Why not treat yourself as recognition of how hard you work and how hard you try? Me; I have bought lots of books to read, some expensive face cream (not getting any younger) and also a few pieces of jewellery just because. Finish some night shifts from Hell: breakfast of your choice and some pointless houseplants from Sainsbury’s on the way home. Finish an essay: buy that jacket that keeps cropping up on Instagram. Every now again in between all the big things, we deserve to treat ourselves and pat ourselves on the back. Did you know Amazon do 3 kg bags of Haribo? Well they do….
10. Look at your perspectives
An easy statement. And not so easy to do. But by changing your perspectives you can change your whole outlook on life. One of the best things I got told was to look at what was bothering me: could I change it, was it something so great that I needed to worry about it or change it? And if not, let it go. I am much more decisive about what to worry about now.
I don’t pretend to be a shining example. I still have sad days, I still have bad days and I still have the odd day where I just need to take time out. But these were the things that I found the most useful. No one wants to end up stressed or struggling or in a bad place, but it is life and just sometimes we do. My suggestions won’t be for everyone, and that is ok. I just wondered if anyone would benefit from reading something that is honest, genuine, practical and pre-tested. I hope this offers some help and I wish you all the best.
DIGITAL ASTHMA MASTERCLASS 2020:
New frontiers in children's and young people's asthma
4th September 2020
Davide Paccagnella, ST4
This event happened a while ago, but it was too good not to share.
All virtual, but so compelling that I felt like being there in person.
The variety of speakers and topics made for an excellent learning opportunity, even for medical students or non-medical professional. This was because even the more complex themes were explained and discussed by extremely knowledgeable people, who were able to make them accessible.
Asthma is one of the most common paediatric presentations - I’m sure most paediatric health professionals will feel comfortable dealing with an acute exacerbation, and many others will have experience in chronic asthma management.
Prior to attending this event, I felt a degree of confidence when thinking about asthma management – but I soon realised that there were so many more elements to think about, so many more issues to address, so much more to understand, when faced with an asthmatic child.
It would be difficult to summarise the day – every speaker was truly excellent. So I thought I’d share some of the topics that specifically caught my interest and gave me food for thought.
Dr Mark Levy spoke about the Global Initiative for Asthma (GINA) 2019 recommendations that might significantly change the way we manage asthma. Have a look below, and if you’re interested you can read the article in full: https://erj.ersjournals.com/content/53/6/1901046?fbclid=IwAR08fRes-HOveXiSx3RBqK3kVFP2sp34AfwXgUG7myIlaWpmZsdQtrDwWKM
Dr Jen Townsend introduced us to the wonders of Beat Asthma, the ultimate (in my opinion) online resource on asthma management – covering everything from BTS guidelines to school leaflets, from individual children’s stories to a video on how to use a turbohaler. Have a browse and see for yourself: www.beatasthma.co.uk
Professor Gary Connett spoke about the importance of the placebo effect when treating asthma, and how it needs to be harvested to maximise results. Together with Professor Mike Thomas, he also looked at the role of dysfunctional breathing in asthma management – which Professor Thomas spoke about at length. It makes for an interesting read: https://www.frontiersin.org/articles/10.3389/fped.2018.00406/full
Professor Ian Sinha’s account of the social determinants in paediatric asthma struck a chord with me. It’s only a matter of time before anybody who works with children and young people realises, the degree to which social inequality affects physical and psychological health. We all see it, but what can we do? No easy answer, but I think that making an effort to understand the wider social context, and becoming an advocate for our patients, is a good start. On this note, Professor Sinha has recently co-authored a piece on Child poverty, food insecurity, and respiratory health during the COVID-19 pandemic, which I found interesting:
Professor Andy Bush covered a very topical issue, looking at the effects of the COVID-19 pandemic on asthma management. Some of the reflections made echoed across the virtual conference room – we have all experienced changes in the management of most (if not all) medical conditions as a result of the pandemic; the outpatient setting has certainly seen major changes (with telephone/video consultations booming) but adaptations have been made to the acute environment too.
Here is something to reflect on: are the changes you have witnessed beneficial for patient care? Do they go far enough, or perhaps have they gone too far?
Whilst the pandemic inexorably carries on, we all still have a chance to improve systems and drive change.
With ARCP around the corner naturally the portfolio panic sets in. With the current pandemic, many face to face courses as well as the RCPCH conference have been cancelled. We have all witnessed a big drive in virtual meetings and also online focused learning. Zoom is now our new found best friend!
We are fortunate in our Welsh Deanery with the development of an interactive and variable weekly teaching schedule with the introduction of AWEN (All Wales Wellness & Education Network) set up by trainees for the trainees. A big thanks to Andrea and her team for keeping us going with ample opportunities to learn and also reflect to ensure our curriculum needs are met for the ever nearing ARCP. https://docs.google.com/spreadsheets/d/e/2PACX-1vSAJDgw2xhvpCmkz5fipUqOh-ZhXTFKmXtBFldFiRXuv3utP4UGUPXOOFCnSdi2MK2Hs33iKg-DUJim/pubhtml
On the RCPCH website there are lots of online e-learning opportunities to ensure we as trainees are up to date as well as keeping us engaged with training needs. Through Compass we have the access to many different online courses with a big variety of topics. From Safeguarding to Acute Paediatrics to Prescribing. There really is something for everyone. This also includes Foundation trainees who have an interest in Paediatrics; plenty of CV building ideas to keep you in the game and strengthen your future application.
Imaging in cases of suspected physical abuse in children
Celyn Kenny ST3
When it comes to managing children, who have experienced suspected physical abuse, ensuring correct imaging modes for that specific case is crucial in enabling effective investigation of complex cases. Recently, we have seen a change in the modalities of imaging used in a Safeguarding medical with the role of Skeletal Surveys now being the gold standard.
This online course aims to provide an overview of the principles behind the guidance used in imaging when it comes to cases of suspected NAI. With the use of practical demonstrations and advice it informs us on how to obtain the best possible quality images within the necessary timeframes
Aimed at Radiologists, Nuclear Medicine technologists, Radiographers and of course Paediatricians. Thus, raising the question of how good is our understanding, as budding Paediatricians, to the reasoning behind why we request these imaging modalities and can we improve and expand our knowledge and create a better working partnership with our Radiology colleagues. The RCPCH also encourages A&E staff, community-based health professionals, safeguarding lead professionals as well as all individuals involved in the imaging process to complete this e-learning.
The course itself has five modules which are very easy to work through. Module number one is an introduction, giving us a flavour of the modules and highlighting the importance of the understanding and reasoning behind specific imaging modalities. The second module looks at the process of making the referral for imaging. Here we learn what are the requirements and information necessary to ensure the correct images are taken within the necessary timeframes. Producing the images is discussed in the third with a strong focus on ensuring necessary images are taken with minimal possible radiation exposure and of course patient distress. The fourth module focuses on the role of the Radiologists in reporting the images and stresses the importance of how findings should be documented. Follow up is the focus of the fifth and final module and how we can play an active role in ensuring this does not get missed.
Was it useful?
Completing the modules was informative with a nice flow and not time consuming. I have learnt the importance in the reasoning behind images and their importance in certain age groups. What I have found most useful is how important key parts of history is on requesting the appropriate investigation. This aids the reporting process for the radiologists and the ability to make a clearer picture in deciding is this injury caused by NAI or not. What was useful about this course was it had areas focused to the role of each member of the MDT within the process of investigating NAI and how important a collaboration is with your colleagues in complex cases.
Would I recommend?
I did find there was a lot of guidelines from the Royal College of Radiologists and the Society and College of Radiographers which were wordy and heavy on occasion and may be too in detail for what we need. However, on the whole it was very straight forward to work through and I have learnt and reflected on the importance of knowing which modality is needed when and why. This can only help in completing future child protection medical case reports and also boost my confidence when it comes to the dreaded discussion with Radiologists. To add to this there is a lovely certificate on completion that can be uploaded straight away to your portfolio!
REVIEW: E-learning ‘Paediatric Prescribing Principles 2016’
By Dr Gemma Ford – Foundation Trainee with interest in Paediatrics
What is it?
The Paediatric Prescribing Principles e-learning is a succinct, three-part e-learning resource that takes you through the fundamental aspects of prescribing safely for children and young people. Each module is said to take 20-30 minutes; however, you are free to work through it at your own pace.
1stPart - Drug Metabolism: This, for me, was the longest module of the course. It is split into five sections, each full of useful physiology, pharmacology and worked clinical examples. It is rich in science, and I shamelessly enjoyed being taken through the detailed pharmacology. It acted partly as revision, and partly as a great foundation to paediatric physiology, and introduction to the rest of the course. I spent over an hour on this section, but I am a junior doctor who hasn’t done paediatrics since medical school, therefore enjoyed taking my time with it.
2ndPart – Adverse Drug Reactions: This part was much shorter, taking me about 30 minutes. It started with the physiological changes from neonate to adult, and why children are at increased risk from ADRs. It then worked through some specific examples of common ADR’s in paediatrics, their physiological explanations and clinical presentations.
3rdPart – Prescribing in Paediatrics: This section was shorter again and gives you the chance to practice prescribing for children whilst familiarising yourself with the BNFc. The content was mostly generalised good prescribing guidance and therefore not exclusively relevant to paediatrics – therefore a useful revision for any speciality.
Is it easy to work through?
Who is it useful for?
Medical Students – The content is very accessible and would be useful for anyone learning or revising paediatrics, neonatology, or revising for the PSA.
Foundation trainees – As mentioned, I am a foundation trainee with an interest in paediatrics, but have not yet had a paediatric job. I can honestly say I feel more confident going into my paediatric post having done this course, as prescribing for kids is not something I have done much of previously, and paediatric physiology seems like a semi-distant medical school memory. PLUS – you get a nice certificate to add to the portfolio.
GP trainees – New to paediatrics or starting a GP job having spent the last years in adult medicine? This would be a great refresher and safety check, prior to assessing and treating children. It is not hospital specific and therefore applicable to anyone that treats children day to day.
Paediatric trainees – As I am not one (yet?!), I am unsure of how much of this is bread and butter to you who do this day in, day out. However, I can imagine that revising pharmacology of the drugs that you commonly prescribe, and enforcing good prescribing principles, is never a waste of time?!
How do I find it?
If my rambling has not put you off and you are keen, as I was, to have something other than loaves of banana bread, to show for time spent in lockdown; go to the RCPCH website àeducation and careers àcourses àonline learning and podcasts àbrowse or search for ‘Prescribing’.
RCPCH e-learning is with Compass, which is free to access for members, and can be accessed by non-members as explained below.
Stay safe and happy e-learning!
I recently spoke at the Cardiff and Vale SAS (Speciality, Associate specialist and Staff grade) staff forum. The forum was attended by about 15 current SAS doctors and their day included talks from the medical director, amongst other leaders in the organisation. I concentrated on the medical engagement work I had done last year as a Welsh clinical leadership fellow. As a part of that year I conducted a Survey of current medical engagement levels. My aim was to include any non-consultant doctors who would not been previously included in the medical engagement survey conducted in 2012 and 2016.
I wrongly considered all non-consultant doctors to be labelled as “junior doctors”. This was more than just an error in nomenclature, as it highlighted my ignorance in understanding the important roles of different medical staff working in the organisation. SAS doctors are neither Consultants nor Trainees, but a separate and highly important group. Paediatrics has a large number of SAS doctors supporting the service in both ward, outpatient and community settings.
The numbers in Cardiff and Vale (CAV) Health Board:
They are one of the most diverse branches of practice in the health service, make up 20% of the workforce in some areas, and play a pivotal role in the provision of hospital services.
I, like many others at all levels of healthcare organisations, had neglected to understand or recognise the incredible work and experience SAS doctors have gained through their distinguished careers. Specialty, Associate Specialist and Staff Grade (SAS) doctors are a key part of the paediatric workforce but are often undervalued and are reducing in number. SAS doctors are senior clinicians with at least four years training in paediatrics, are not a consultant and are not currently in specialty training. This new report from the RCPCH outlines the latest workforce data on SAS doctors in paediatrics and gives recommendations for how employers and workforce planning bodies can better support this essential group (1).
SAS doctors are an important part of the paediatric workforce with nearly 800 whole time equivalents working across the UK. Most work in community child health, many in key roles such as Named Doctors for Looked After Children and Medical Adviser for Adoption. Furthermore, there is an average of one SAS doctor on every general paediatric rota in the UK – vital for the maintenance of services and reducing gaps.
During my session on medical engagement, we had a number of really interesting conversations on the causes of SAS disengagement as well as potential remedies for improvement. I was interested to hear that many of the doctors in the room had > 20 years’ experience in their respected specialities. Many of these individuals felt under-appreciated and undervalued. Most of my recommendations to improve medical engagement generally, focus on organisations and senior leaders creating cultures where all staff:
1. Feel valued
2. Have a voice
3. Are listened to!
One of my favourite questions to ask anyone about medical engagement (if not about most things in life) is;
“If money was no object, what is one thing would you do to improve ……. SAS engagement?”
When individuals are not constrained by the normal instinctive barriers which inevitably suppress innovation and freedom of thought, individuals and teams come up with some fantastic ideas. The interesting part is that many of these do not require much investment at all. E.g.
“I would make sure that the clinics that I run (and have done for 10 years)
are in my name instead of a consultant”
“I would make sure that SAS doctors are given the accreditation
and recognition for the work they have done”
“I feel like I have a huge amount of experience in the speciality, can contribute to the decisions being made on a strategic level and just want to have my voice heard”
“I would really love healthcare staff to stop thinking I’m not a consultant,
therefore, I cannot be experienced!”
SAS doctors often fall victim to ‘Gradism’– facing lack of recognition, higher levels of bullying and, in some cases, being denied the development opportunities and incentives given to other branches of practice (3)
The same themes came out of the discussions with SAS doctors as those from discussions with Foundation Doctors and Trainees; “We want to feel valued” and for organisations to really show this ‘Actions speak louder than words!’. Forums, where different groups are represented, encouraged to speak, listened to and then those views acted upon, can make massive positive steps towards creating a culture of improved medical engagement.
To see the ‘Full Engagement Survey Report’ click here or this link
To see the Summary and Recommendations click here or this link
For more information on SAS doctors: check out these two excellent articles
The Hidden Heroes of the NHS (2)
RCPCH: Supporting SAS Doctors (1)
The report recommends a number of measures for workforce planners and employers including:
Although the charter was published in 2014, a 2017 survey revealed that 53% of SAS doctors were not aware of it and 65% didn’t know if it had been implemented by their employer.
Covid 19: Addressing the Nation
Dr Annabel Greenwood