Welsh Research and Education Network
Hot topics in research and medical education, in Wales and beyond
Dr Fiona Astill, Leadership Fellow
Leaders in Healthcare is a conference in association with the Faculty of Medical Leadership and Management (FMLM). It was a huge event with hundreds of attendees. Additional to the plenary sessions, much of the groups were workshop-based with themes around self, team, organisation and systemto choose from.
Personal highlights included:
1. Lord Victor Adebowale - possibly the most down-to-earth Lord I’ve ever seen who marched on to the stage and promptly announced he was here to “gob off at us” for a while! His speech was discussing the challenges that faced the health service and felt these were equity, access and technology. He talked about leadership not being about just your own organisation but that we have a duty as healthcare professionals to consider population health, and the need for a credible team. There is no right way to lead:
2. Military leadership – an interesting discussion from senior ranking officers in the army and the RAF, regarding the concepts of leadership and followership. Their advice for leadership and followership:
3. Forum theatre – this started off with us feeling a little apprehensive that we might have to get up and act. Luckily, actors were provided and the initial scene played concerned a conversation between a medical director and a chief registrar. The scenes were initially played, followed by discussion with the audience as to why what they had done did or didn’t work. It was quite enlightening to watch the situation play out and I think we could all remember a time when we’d been in a similar situation with a dismissive ‘leader’. Changing one’s body language, speech and attitude made a big difference to the conversation and ended with both parties satisfied.
‘Problems only exist in the absence of the right conversation’ Werner Erhard
4. Seven Transformations of Leadership – what differentiates leaders is not their personality, management style or leadership philosophy but their internal ‘action logic’ – reacting to their environment and challenges. http://hbr.org/2005/04/seven-transformations-of-leadership in case you were interested in finding out more about your current style?
5. Speed coaching – the FMLM organised a series of short sessions that attendees could sign up to, to discuss a problem or barrier in their own leadership style. Of the fellows that went I think we all found this valuable to an extent, and a current theme of this year is definitely to question yourself, and to be more aware of your own strengths and weaknesses.
6. Wellbeing – lots of workshops and talks around this topic. ‘Doctors as Second Victims’- in a room full of people 86% have had personal involvement in a near miss or adverse event. Of those 70% felt this affected them personally and professionally. We need to encourage open and transparent conversations about errors, without the blame. We need to be compassionate towards our colleagues and supportive.
Dr Davide Paccagnella ST3
WREN study days are best described as a regular opportunity to do exactly what we are all about: meet, make friends, network, and learn from each other. If you are new to Paediatric Training, or have recently moved to Wales, they happen twice a year and are an essential component of the work we do.
This autumn, we had some excellent speakers. Making a start was John Watkins, statistician working at Cardiff University and well-known in the world of medical statistics. It would be unfair to say that he taught us the “basics”, as I found myself reading up on quite a few statistic-related topics over the following days. What he managed to give us, however, was a very thorough overview beginning from the core elements of data analysis, all the way up to statistical tests and multivariate linear regression. In a word, intense! I cannot recall having been taught “Statistics” in a 2-hour session when I was at university. And it was not always easy to keep up, but my neurons enjoyed the early morning stimulation!
Next up, it was time to hear updates from ongoing projects around Wales. There is truly no limit as to what can be achieved if you put your mind to it. Multicentre trials have recently been completed in cooperation with PRAM (Paediatric Research Across the Midlands) and PENTRAIN (Peninsula Trainee Research Audit and Improvement Network). Details are on our website, and you can have a look to see what other trainees are up to elsewhere in the country – www.wrenpaediatrics.com;www.pramnetwork.com; www.pentrain.org.uk– exciting projects, trainee-led, getting national and international recognition!
Following on from this, Alex Richards, Cardiff University Paediatric Society (CUPS) president, introduced a new project – called WORLD CUPS (Working Paediatricians Overseeing Research Led and Delivered by CUPS). This is based on the idea paediatric professionals can request help from interested students, and vice-versa. Jordan Evans, ST8 Paediatric trainee, is the CUPS liaison and has already got multiple projects going. Involving students in research is vital, and I wish my medical school offered me anything that was even remotely similar! Interestingly, the Welsh National Student Paediatric Society Conference will take place on Saturday 1st February 2020 at the University Hospital of Wales, Cardiff. Paediatric professionals are needed to share experiences with students, and promote our specialties! What better chance to meet people and network? Have a look at https://www.facebook.com/events/788342174927002/
New projects and ideas are coming up all the time. And the potential to transform your idea into a multi-centre trial is always there. If you attended the study day, you might have heard about some of these projects. The best way to get involved, if you have a new idea, or data you have already collected, is to speak to like-minded people and get the ball rolling. We can help with that, especially if you are struggling to find enough people to take your project on at a local level.
To close off the day, we had the privilege to have two great lecturers. Firstly, Dr Martin Edwards, Consultant Paediatrician at UHW, provided us with a practical guide to systematic reviews and meta analyses. Personally, I came to the realisation that performing a systematic review does not have to be regarded as a complex, unachievable task. Certainly, it requires patience, and knowledge of how to research and analyse evidence. But it did not discourage me from thinking that yes, it could be done. Just think how often we, as clinicians, base our decisions on evidence from meta-analyses – all the time, I would say. It is therefore imperative that we develop a good understanding of how it all works, and contribute to this essential area of research.
Last but not least, Dr Ian Wacogne, the edition editor of Archives of Disease in Childhood – Education and Practice, and consultant paediatrician in Birmingham, very kindly visited us in Bridgend for the afternoon. He talked to us about “how to write”. And what a talk it was! Firstly, he engaged us all in an honest discussion about the type of readers we thought we were. So think about it: are you a systematic reader (do you read in a structured, organised manner)? Or perhaps you are a “just in time” reader (if you manage to extract the information you need at the last minute); you could also be an “on the bus” reader, and enjoy taking in small amounts of information at a time. When we write, it’s good to know who we are writing for – what is our target audience? Most importantly, do we have anything interesting to say, and would we enjoy reading what we wrote? Those of you familiar with the journal edited by Dr Wacogne will know that it can be a pleasant read in a number of different situations, and that it has something for everyone. So why not write? Submitting an article can seem daunting but there is plenty of guidance on https://authors.bmj.com/
In conclusion, I hope I have convinced you to attend the next WREN study day, which will take place on 19thMay 2020!
Dr Celyn Kenny ST3
This year’s Autumn WPS clinical meeting took place on the 8th of November at the famous Celtic Manors sister hotel, the beautiful, Coldra Court Hotel. I can see why its described as a ‘Celtic convenience’, located at the gateway between England and Wales, the Coldra Court Hotel is close to glorious Welsh countryside and is situated just off the M4 motorway at Junction 23 and really is a hidden gem.
WPS meetings are recognised and renowned for their educational presentations, from medical students to consultants, and as a great way to network professionally, and of course socially, with our Paediatric Colleagues. They also bridge the gap between Hospitals not only on the M4 corridor but also with our colleagues in the far away land of North Wales. This was even more evident this year as we were also joined by our Paediatric Anaesthetic colleagues, making it an extra special multidisciplinary networking event. As said by the chairman himself Dr David Tuthill “It is a meeting that appreciates Junior Doctors on their journey through training from medical student to higher training”.
The day started with a welcome talk from the president that then led into the introduction of the first guest lecturer Dr Hannah Gill. Hannah, who originates from Wigan, is a Consultant Anaesthetist at Bristol Royal Hospital for Children. She moved to Bristol to work on an RCT administering Xenon to term babies born in poor condition and completed a PhD studying the dose-response relationships of Xenon and volatile anaesthetics in immature rodents. How refreshing it was to hear a talk titled Anaesthetic neurotoxicity: does it exist, in such a strong Wigan accent.
Then the presentations began. The first session saw a range of topics from post-operative analgesia to medication errors then to respiratory distress in the newborn. Focus was given to the experienceof introducing minimally invasive surfactant therapy on a neonatal unit; theuse of MIST which is interchangeable technique as LISA therapy and how numbers of intubations and oxygen requirements have been reduced following this introduction on a Neonatal Unit; this in turn may lead to the reduction of BPD. This talk led nicely to Chris Course’s hard work on re-auditing the Improvement on the management of respiratory distress syndrome in preterm infants across Wales. Chris has done so much for research projects across Wales and should be commended for all his hard-work and dedication. Following this it was time for coffee and the mingling with colleagues began!
Following the caffeine ingestion, the presentations continued and again a great variety of topics were seen. A focus was given to Paediatric Palliative medicine, an area I would definitely like to learn more. Fran Norris presented on Advancing access to advanced care plans which was very informative and she was commended by going on to win one of the WPS awards. Safeguarding also featured heavily with our very own Assim Javid presenting his work on burns which he completed during his academic ST3 year. Assim spoke of the influence of causative agents and mechanisms of injury on anatomical locations of burns from scalds and contact burns in children less than 5 years old. This age group is recognised as when most burns happen and he opened our eyes to when safeguarding concerns arise. Enthusiastic and engaging to his audience Assim rightly went on to win the trainee award. Well done Assim!
Before lunch the second guest lecturer was Dr Jayne Sutherland, an Anaesthetic Trainee in the Wales Deanery (ST6) with an interest in global health, medical education and paediatric anaesthesia. ‘Take a deep breath and open your eyes’, a talk focused on Jayne’s year in Zambia as part of her out of programme experience. She told us some frightening figures of how 5 billion people lack access to surgery world-wide and that 143 million additional surgeries are required annually to meet this demand.Zambia, a low economic country,is facing an uphill struggle with an expanding population. Jayne worked with theZADP charity and told us of her role with the charity; teaching, initiation of mentorship, battling to get the basic services required and learning all this through the politics and hierarchy. What she gained from this experience was a greater understanding of the politics of safe surgical provision, a bucketful of experiences, huge job satisfaction, new perspective, new coping strategies and the importance of taking time to stop and disconnect. Following this was our time to stop and disconnect for lunch!
Following a fantastic buffet lunch with choices aplenty there was no post prandial lull as Mr Oliver Jackson, Consultant Paediatric Surgeon at the Noah's Ark Children's Hospital for Wales, took to the stage. He moved to Cardiff in July 2018 and since his arrival has been at the forefront of Paediatric Surgical advances in Wales and the services now offered to the children of South Wales. A talk entitledHidden Surgery, Visible Results – How laparoscopic paediatric surgery in Cardiff is helping our patients; Mr Jackson took us on a journey of the evolution of laparoscopic surgery. The talk started withthe question “who are the Surgeons?” and was a great introduction to the new surgical team at UHW. We then learnt of the new services offered at the Children’s hospital and how the transferable skill of laparoscopic surgery has led to the surgical advancement of these services. A laparoscopic technique is now being offered for procedures such as pyloric stenosis, inguinal hernia repair and even Neuroblastoma. This talk was so inspiring it made me reconsider my career path and channel my inner Meredith Grey (for a total of five minutes!)
Then came the third set of presentations and it was clear to see that wellbeing would play a big role. A presentation which stood out for me was one given by Fiona Astill on the Evaluation of burnout in paediatric staff. As Paediatric trainees we could take so much from this,69.2% of staff in Wales at risk of burnout,what can we do to improve our work-life balance? Protective factors are key to help reduce this risk with supportive colleagues and good managers playing big roles. In a world, full of shortages and increasing rota demands we really must remember the importance of these factors.
This led nicely onto the final talk “The three emotional systems” by Dr Nicole Parish, a Clinical Psychologist working within the Noah's Ark Children's Hospital for Wales.She started with a game of ‘stand up’ where we stood up if we had felt certain emotions or experiences at work. Then Dr Parish went into the main body of her talk which was describing the three emotional regulatory systems. The first, the threat system, where we get our motivation and strong physiology. However, it can make us more likely to recognise negative behaviour even in a room full of positive, and jump to conclusions because of this threat system. This goes back to the primitive part of brain and its often easy to get stuck in this threat system. Next came the drive system which is related to evolutionary need to forage and our need to hunt such as pursuing our goals. Which is highly relatable to us within medicine as we strive to achieve our goals. However, this can get exhausting which led into the importance of the third system, the soothing system. This is our feel-good system and the need to be relaxed and calm that leads to the feeling of being safe and content. Within the context of hospital medicine, we will see a lot of threat and sometimes are unable to think of things in a constructive way and are more likely to be angry and critical of ourselves. Dr Parish highlighted the importance of balance and the need of all three systems for this as they all are beneficial in their own way. It is important to think if there is an imbalance how we can help each other through and it is often the soothing system that’s missing. It is a necessity that we take time to stop, think, reflect and show gratitude to ourselves and reinstate this balance.
The evening was brought to a close with a three-course meal and a much needed social! A fantastic day full of variety and wonderful topics from medical students to Consultants and of course with our Anaesthetic colleagues adding to it. The next meeting has just been confirmed May 22nd2020; who will join me in making the journey to The Quay Hotel in Deganwy, North Wales?!
Dr Annabel Greenwood