Regional Office newsletter Autumn 2016 Edition 14

Introduction I slept uneasily to-day service. I believe that we would atrial fibrillation stroke prevention during the night of have been way ahead in our specialist team. the referendum as I and acute medical services had this not had a suspicion that been the case. As you know the RCP has created our country might the Learning to Make a Difference vote to leave the European Union. Like some of you I have also been programme, which focuses on quality I wondered what effect that result on the other side of the patient bed improvement that all junior doctors would have on our health service. curtain. It was then very clear that little can take part in, instead of the Some may call me a sceptic, but I things make an enormous difference standard audit tasks that so often lead will be surprised if the result is more to patient experience. Good lines of to little change. If you have not already money for our NHS. If the overall communication, staff clearly aware done so I would encourage you to economy does suffer as some, if of their roles, patients aware of staff visit www.rcplondon.ac.uk/projects/ not most, economists predicted, roles (Kate Granger was so right, what learning-make-difference-ltmd, and to the opposite may be true. I suspect, a loss to us all but don’t forget her consider making use of the seminars. however, that one of the hidden legacy), evidence of good coordination Also, do encourage your juniors to take problems will be that the major in the team, and cheerful whole team part, as by achieving change they can political upheaval will take the focus ownership: these are things that help justifiably believe they are already off the NHS, at least to some extent. one to sleep more comfortably in the moving towards being a consultant. hospital bed. So perhaps we should In a smaller way this is what has not forget that small improvements In addition, the RCP’s Chief Registrar happened at the hospital trust, in health care may be easier to Project aims to create posts where where I work. For the entire time that achieve in a shorter time period, and, a more senior registrar can spend a I have been one of its consultants, if management are looking elsewhere, significant part of the time generating the Trust has been trying to make an they need to be done by us as doctors. improvement in quality, particularly uncomfortable decision about where in the acute medical care setting the major part of the hospital service For example, in our West Midlands ww.rcplondon.ac.uk/projects/future- should be located. I cannot count the pilot, which is outlined on page 8, hospital-chief-registrar). Again this number of meetings (private, board, the registrars made many simple may help the morale of junior doctors, public, and medical), the number of suggestions that would positively departments and teams, and improve newsletters and publications produced, affect the smooth running of the the lot of our patients in the future. As and the number of expensive outside acute medical department, improving far as I am aware, we do not yet have so-called experts that have been the care of patients and as well as the any chief registrars in our region: it involved over some 20 years, with as yet morale and job satisfaction of doctors might be that you can persuade your no resolution. Of course this has cost a and other healthcare professionals. Trust to help fund such a post, which large chunk of health service money, You can read other examples in this can provide excellent and more senior but as importantly it has consumed and newsletter. Hot off the press is the RCP registrar support for the acute unit constrained senior management and Excellence in Patient Care Awards 2016 as well as stimulating change for the has taken the focus away from our day- winner, The Royal Stoke Hospital’s better.

The articles in this newsletter represent the opinions of the individual authors, and do not reflect the opinions of the Royal College of Physicians. newsletter Autumn 2016 | www.rcplondon.ac.uk 1 West Midlands regional advisers Contents

Autumn 2016 Edition 14 Dr Kanwaljit Sandhu Dr Andrew MacLeod RCP regional adviser RCP regional adviser 4 Prioritising Dr Sandhu works as a Dr MacLeod works as a consultant nephrologist consultant endocrinologist 5 Doctors Against Forced at Royal Wolverhampton at the Royal Shrewsbury Organ Harvesting Hospitals NHS Trust Hospitals NHS Trust 6 JRCPTB update 8 Royal College of Physicians Dr Michael Cusack (RCP) West Midlands pilot RCP CPD regional adviser 9 Introducing your new GIM Dr Cusack works as medical director at Northampton trainee representative General Hospital 10 Just another cough…? 11 Medical Training Initiative 12 Update on the RCP Future West Midlands, Oxford and Thames Hospital Programme 13 Taking on the role of Valley regional office staff RCP tutor 14 Becoming an associate college tutor 15 Medical education in the Helen Flood Susan Pope Middle East Regional manager Regional manager 16 Service development / integrated care news 18 The Parkinson’s UK Excellence Network 19 AMU Clinical Skills Lab at Sue Cyprus Jayne Richards City Hospital Deputy regional manager Office assistant 20 Technology Enhanced Care Services The regional team are now developing the work of the Royal College 21 A coroner’s inquest of Physicians over both the West Midlands, Oxford and Thames Valley regions. Helen and Susan as a job share will lead the management of 22 Endoscopic full-thickness all regional RCP activity across this enhanced area. Sue joins the team resection (EFTR) permanently as deputy regional manager. Together, with Jayne we 24 Specialist clinics for alpha 1 aim to provide the highest standard of support to all our fellows and antitrypsin deficiency members. 26 The NIHR Clinical Research Network (CRN) 27 Alvecote Wood – a very attractive retirement! Have you applied for CPD/CME credits? 28 Voices of Medicine: a personal view Part of the regional office’s role is to award meetings, conferences etc with 32 Dates for your diary CPD credits. Applications can be made for regional ‘external’ meetings such as annual meetings, courses and conferences. If a meeting has a mixed 33 Conference Programme – 2017 audience ie physicians and surgeons, the application form is recognised by all royal colleges. 35 Useful Information

Many meetings are taking place without CPD credits. You can apply for approval on line by contacting www.rcplondon.ac.uk for further details. Or email [email protected].

2 www.rcplondon.ac.uk | newsletter Autumn 2016 The Chief Registrar Project is part You will say that you know, but this of the Future Hospital Programme, Last week I was worried to find is difficult when there are equal created and supported by the RCP. that one of our best registrars, who pressures upon ourselves. I agree. It is good to see that, as well as a undoubtedly has a sparkling career in While carrying out the pilot, it seems senior RCP officer, Dr Mark Temple, front of her, held an Irish passport and that the registrars felt that the most taking the whole project forward, we feels uncomfortable about what she successful departments were those now have a pilot site in our region at needs to do to secure her long-term where consultants were present up to Sandwell and Hospitals place in UK. It is our duty to support midnight and beyond. That may be NHS Trust (www.rcplondon.ac.uk/ and advise such colleagues as best as good in the short term, but in the long projects/outputs/future-hospital- we can during these difficult times. term we have to have strategies that development-site-sandwell-and- Hopefully they will have nothing to preserve our own health and our sanity. birmingham-hospitals-nhs-trust). If worry about, but complacency is never you have not already done so, have a an excuse. Enough of this doom and gloom. look at the details of this programme, Doom and gloom will put off valuable which offers a powerful way in which To contribute to our sorrows, at the colleagues from joining us, and worsen we as physicians can influence the same time as the referendum results our lot and that of our patients. After development of health service, hit us, we hear that our junior doctors many years the hands on practice with the benefit of our considerable have voted against the contract set of clinical medicine still gives me the knowledge about the problems that out by the government. It seems likely same buzz. I still find it as enjoyable need addressing and practical ways of that the government will go ahead and and we are very privileged to be able solving them. implement the contract without further to know and help our patients with negotiation. the support of the health service Before we try to forget the referendum, machine. Also don’t forget that do heed the words of Professor Jane humour, appropriately guided, may Dacre, our president, in doing our best As our president improve even the most serious of to support those among us who do not has said it is really situations. To quote our president currently hold a British passport: again, #medicineisbrilliant: don’t let important that we us forget that, and let us transmit our The NHS has greatly benefited from support our junior enthusiasm to juniors and the rest of fresh skills and insight and since the clinical team that we lead. its inception has been built on the colleagues to the outstanding contribution of physicians best of our ability. Dr Andrew MacLeod and other health professionals from RCP Regional adviser Europe and around the world. They You may agree that and others in the sector rightly are one way to achieve feeling anxious and confused about how welcome they are and will be in this is to do our the future. We all need to work hard to best to preserve urgently reassure our staff about how valued they are and ensure they have our clinical teams, the resources they need to do their and to continue to jobs. This is for us all to do; from those at the top of the NHS to the junior act as enthusiastic doctors working day-to-day with many other health professionals. We all need leaders. to do our bit.

newsletter Autumn 2016 | www.rcplondon.ac.uk 3 Prioritising

When I wrote my first article for to improve the lot of the medical who work to the medical model, this newsletter it was an essay registrar; to make it a more attractive as well as in other areas of clinical on change, having not long taken and indeed an aspirational position work. To achieve this, we need to over this role. Now, two years in, again. The RCP has several initiatives train our trainees in the terminology I have learned that being head to this end but local engagement and methodology of quality of school is all about setting the of tutors, consultants and medical improvement, but more, we need to agenda and juggling competing directors will be required. We have train our trainers in this and in the priorities. I am also aware that developed initiatives to give core ability to assess trainees undertaking this readership goes beyond our medicinal trainees nearing the end these projects. trainers and trainees, to those who of their training the opportunity to make decisions about the delivery act as the med reg in a planned, Finally, the development of of healthcare. supervised environment. We are simulation training is also on my working on developing this, both in priority list. This includes both So this year I will be discussing our a simulated setting and in real life. immersive, hi-fidelity simulation and priorities and hopefully setting In parallel, we need to make the the low-fidelity and procedural skills the agenda for the coming and whole of physician medicine a more aspect. This is not necessarily a new subsequent few years. attractive career choice and not concept – I can remember when I just for those specialties that do not and my fellow aspiring med registrar One of the biggest challenges we participate in the unselected take. were trying to pass our MRCP and face is recruitment in to medicine, would test each other in the Doctors’ and particularly to the role of Shape of training (SoT) is maturing Mess by imagining clinical scenarios medical registrar. For doctors of my and likely to start in the next few and working through ‘what would generation, becoming the ‘medical years. Implicit in it is that core you do next’. registrar’ was ‘it’! To become one of medical training (CMT) will morph these heroic, quasi-mythical beings into a three-year internal medicine It is going to be a busy few years…. was the pinnacle of ambition. Seen training scheme with a subsequent as fulfilling the most important (in most cases) four years of specialty Philip Bright position in a hospital out of (and training. Head, Postgraduate School of Medicine within) hours, the medical registrar Health Education West Midlands was the person to whom everyone Encompassed within SoT is the turned and who made the decisions. concept of competencies in They were supported in their role by practice (CiP) in which trainees are a team they worked with closely and determined to be ‘trusted’ to various who in turn aspired to the position. levels in undertaking the elements that make up the role of a consultant So what changed? physician. Is it that we took away the authority and the team, while still requiring the The completion of a quality work, and in many cases demoted improvement project (QIP) is now them to just one of the clerking required in CMT and Foundation. ‘monkeys’? Whatever the reason, It will soon be a requirement of all relatively few now aspire to the specialty training and in all parts of position at a time when many trusts postgraduate (and undergraduate) now try to employ two or more medical training. Equally, it will be resident medical officers out-of-hours. required in the training and in the So priority number one has to be roles of those non-doctor clinicians

4 www.rcplondon.ac.uk | newsletter Autumn 2016 Doctors Against Forced Organ Harvesting

Solid-organ transplantation This suggests a simple semantic organisation that has been is the treatment of choice for trick of re-classification allows the campaigning for over a decade to eligible patients with end-stage procurement of organs from executed draw attention to the crimes against organ failure but prolonged waits means some desperate patients prisoners to continue. Second, there humanity committed in China and seek transplantation through is no mention of stopping organ has been nominated for the 2016 unconventional routes. The World procurement from prisoners of Nobel Peace Prize in recognition of Health Organization estimates that conscience, something which has their efforts. The work of DAFOH 10-15% of global transplant activity never been officially acknowledged to continues to the present day and (around 120,000 solid organs) is occur by China, but which appears to involves engagement with medical either illegal or unethical.1 While cases of organ trafficking and be the primary source of deceased- and transplantation societies, global transplant tourism are widely organ donors. Finally, the lack of any political bodies and human rights reported across the world, they robust organ donor framework makes activists to help bring this heinous pale in comparison to allegations it unclear who or where the organ practise to an immediate end. An that the Chinese authorities are donor sources are and how China has important role for DAFOH is to sanctioning nationwide forced been able to maintain a steady rate of simply raise awareness of this issue organ procurement from executed prisoners, including prisoners of organ transplantation activity by their among non-transplant professionals conscience.2 own figures over the last few years and the lay public to ensure that all (although independent validation of avenues of pressure are maintained Focus on China both organ donor and transplantation on China to conform to international It is alleged that tens or hundreds of activity in China is lacking). ethical practise in the field of thousands of executions have been organ procurement, donation and undertaken on demand to supply However, recently published transplantation. organs for rich or well-connected reports suggest that there is a vast consumers (both within China transplantation infrastructure in China Adnan Sharif and ‘transplant tourists’) since the designed to facilitate tens of thousands Consultant nephrologist Queen Elizabeth publication of the Matas–Kilgour of transplants annually.4 For example, Hospital Birmingham report3 nearly a decade ago. Although the Tianjin Transplant centre (which Secretary Doctors Against Forced Organ China claims to have ceased procuring is one out of 169 approved transplant Harvesting organs from executed prisoners as of 1 centres) is reported to have performed January 2015, there are lingering doubts 5,000 transplants in 2015, which Additional resources regarding the veracity of these claims. would leave 5,000 transplants to the If you wish to hear more about this remaining 168 transplant centres if topic, visit youtu.be/WxoAVomnZ70 First, the announcement was not claims of 10,000 solid-organ transplant followed by abolishment of the 1984 annually are correct. The discrepancies References 1. Shimazono Y. The state of the provisional regulations which permit in such figures suggest that the lack of international organ trade: a provisional organ procurement from executed any transparent audit or governance picture based on integration of available prisoners. The subsequent result is in China limits any scrutiny of genuine information. Bulletin of the WHO an environment of legal ambiguity, organ donor or transplantation activity. 2007;85:901–80. 2. Sharif A, Fiatarone Singh M, Trey with officials announcing an end to T, Lavee J. Organ procurement from organ procurement from executed Doctors Against Forced Organ executed prisoners in China. Am J prisoners while the legal framework Harvesting (DAFOH) Transplant 2014;14:2246–52. 3. Matas D, Kilgour D. Bloody Harvest – continues to permit the practice. It Maintaining the highest ethical The killing of Falun Gong for their organs. is unclear if prisoners are still being standard is critical for solid organ 2009; Seraphim Editions, Woodstock, ON, used as organ donors, as previous transplantation and bringing an Canada. Available online at: organharvestinvestigation.net/index.html. statements from China suggest end to forced organ procurement 4. Kilgour D, Gutmann E, Matas D. prisoners would still be allowed to of executed prisoners in China is Bloody harvest/the slaughter: an update. donate organs in their new organ an absolute priority. DAFOH is an Available online at endorganpillaging.org/ donor system as ‘voluntary citizens’. international non-governmental wp-content/uploads/2016/06/Bloody_ Harvest-The_Slaughter-June-23-V2.pdf. newsletter Autumn 2016 | www.rcplondon.ac.uk 5 JRCPTB update Response to Shape of Training mapping exercise

The Federation of Royal Colleges of Physicians of the We have proposed 14 learning outcomes or ‘Competencies UK submitted its original response to the Academy in Practice’ (CiPs) for internal medicine that cover the key of Medical Royal Colleges (AoMRC) Shape of Training professional activities expected of a fully trained physician. mapping exercise on 12 October 2015. For each CiP we have described four ‘levels’ at which a trainee may be judged to be performing. Ascribing a The response made the following key points: specific level to each CiP for each trainee will allow progress to be gauged and related to the tasks that are actually 1. We support the need to restructure aspects of the performed in the clinical workplace and to the level of training of physicians to support the management supervision or ‘trust’ that the task must be performed of acute medical emergencies, chronic disease under. management, comorbidities, complexity and the needs This is not an alternative to competency-based education, of an ageing society. We also recognise an opportunity but an evolution of that concept that can usefully translate to begin the process of service and education competency into real-life clinical practice in a simplified transformation but are not seeking to alter the current and more authentic way. A recent article of mine for length of training. BMJ Careers gives further information on our proposed 2. We recognise that there are many ways to better approach.1 support the acute medical take and acute care, within the hospital and the community. These are specialty Given that this approach is significantly different from dependent, but with an expectation that specialties will the current system and may have a significant impact have knowledge of the acute take, contribute to the care on training and education practice, we are exploring its of acutely unwell patients, and have the skills to do that. feasibility and acceptability in the UK NHS setting in a 3. Changes for training in all specialties will be aligned controlled way before considering implementation. CiPs with the General Medical Council changes to Generic have been agreed for a proof-of-concept study, which Professional Capabilities and a new approach to will evaluate the ability of a trainer to make ‘entrustment assessment. decisions’ in a real-life setting. There are 88 trainees 4. The curricula will allow simpler and more regular taking part in the study with their educational and clinical updating to accommodate the needs of patients and supervisors, making a total of 235 participants overall. new innovations in treatment. In particular we want Training sessions were held in June 2016, and trainees and maximum flexibility in the early years to permit more supervisors will complete the forms and a feedback survey pluri-potential training and for later training to ensure in July. The study team will then analyse the data, and the appropriate development and maintenance of skills and evaluation will be completed by October 2016. competencies. An Internal Medicine Committee has been formed and Development of a new internal medicine curriculum now meets bi-monthly, with trainee, lay and employer representation. At present, we are on track to make a Meanwhile, JRCPTB, in conjunction with MRCP (UK), has curriculum submission to the GMC in spring 2017. begun development of a new internal medicine curriculum on behalf of the Federation. An integral part of this work Information for trainees on the proposals and how this involves the development of a supporting assessment may affect their training in the future can be found on the system as well as consideration of the new GMC Generic JRCPTB website Professional Competencies. The present curricula are based (jrcptb.org.uk/new-internal-medicine-curriculum). on achieving a large number of individual competencies that are assessed throughout training by a variety of different methods.

6 www.rcplondon.ac.uk | newsletter Autumn 2016 Statement from the presidents of the Royal Colleges of Physicians

The Presidents of all three Royal Colleges of Physicians recently met to discuss progress with the new Internal Medical Curriculum. All three were not only pleased with the progress that had been made, but reinforced the overall vision that the key attribute for doctors training in Internal Medicine is to ensure that they will have the capability to care for an acutely unwell patient in their scope of practice.

It is essential that the curriculum should address clinical complexity and the frequent presence of multiple co- morbidities. Together with these details, proficiency in chronic disease management as well as the development of general professional attributes are all important aspects of training in internal medicine. These capabilities will be assessed through a much simplified and more authentic process focused on professional judgment and the outcomes of training.

Proposed outline model for physician training

Internal Medicine Stage Certification Specialist Post-CST 1 training (3 years) Specialty training credentialling Selection Selection (indicative 4 years) Foundation Mandatory items training • Acute medicine Medical • Acute take (2 years) Registrar Internal Medicine Stage 2 • Outpatients (in specialty) • Geriatric medicine CPD • Simuation Internal Medicine Stage 2 (acute take)

MRCP (UK) SCE/KBA

Workplace-based Assessment

@JRCPTB

Professor David Black Medical director, JRCPTB

References 1. Black, D. An end to box ticking: an overhaul of competency based education. BMJ Careers 2016. Available online at careers.bmj. com/careers/advice/An_end_to_box_ticking%3A_an_overhaul_of_competency_based_education.

newsletter Autumn 2016 | www.rcplondon.ac.uk 7 Royal College of Physicians (RCP) West Midlands pilot: enabling the medical registrar on take

The medical registrar is the key disseminate as widely as possible in emergency departments and and most responsible resident their trusts. It is planned that the full GPs. This would enable them to who is involved with acute overview report will be available on control the flow of acute medical medical admissions to our the West Midlands regional page of patients, with regular updates hospitals, particularly overnight, the Royal College of Physicians (RCP) being given to the registrar – at weekends and during bank website. especially regarding seriously holidays. As many readers will ill patients who have high early know, we have been conducting a The key findings are as follows. warning scores (EWSs) pilot project that endeavours to Good consultant support was present - an easily accessible board enhance support for the medical and much valued in all the trusts that (preferably electronic) that registrars in our region while they were visited. The registrars considered displays information about all are on the acute take. that such support was essential for patients in the acute medical morale and constructive learning. unit, with timelines, EWSs, The aims of the project were to gather • The registrars had detailed when the patient was seen by ideas and examples throughout the knowledge of the current situation grades of doctors and pending region and to form a template that in the acute medical unit and they investigations may be applied to individual trusts to made valuable and considered - support to minimise the need enable and support the registrar, in suggestions for improvement. for the registrar to clerk patients; order to improve the efficiency and It would be very important to for example by physician effectiveness of the acute medical include registrars in any plans for associates or advanced nurse take. improvement or change. practitioners if there is a paucity • There was much evidence of of foundation and core trainee In February 2015, 128 registrars active and ongoing improvement doctors from throughout the West Midlands in the acute medical units in our - formal, robust and structured helped to create a draft best practice region. Where improvements handover between night and day checklist of systems to support the were present, they mostly resulted teams with key nursing and other registrar on the acute medical take. from excellent leadership by acute relevant healthcare professionals We have now visited 13 of the 19 medical consultants. and including, if possible, a acute hospitals in the West Midlands. • Key changes that registrars felt representative from the outreach The aims of the visits were to give an would support them in their role high dependency team update on the project; to refine the in the acute medical unit, and by - good clinical IT, with access to template and include any new ideas inference improve the efficiency computers and printers, so that and suggestions; and to produce a and safety of the acute take, were electronic discharge summaries report for each particular hospital, to as follows: are completed and pending encourage best practice with ideas for - nurses to take over responsibility investigations and important improvement but also to acknowledge of initial investigations (blood tasks are logged with easy access developments that might help other tests, simple X-rays and to doctors and nurses; and hospitals in the region and elsewhere. electrocardiograms (ECGs)) as electronic means of keeping lists Before each visit, all relevant medical well as insertion of cannulas, of patients so that registrars can registrars were sent an e-questionnaire according to simple clinical follow clinical progress to obtain so that we could prepare for the visit algorithms at the front door of good instructive feedback and collate as many views as possible. the acute medical unit - good access to essential clinical Individual hospital summaries have - senior nursing staff to take over examination tools, which are now been sent to college tutors to triage and phone contact with often worryingly absent at the

8 www.rcplondon.ac.uk | newsletter Autumn 2016 moment; for example, using a contact with college tutors and experience. dedicated clinical examination medical registrars to find out • We are very grateful to all the trolley. whether progress has been made college tutors and associate • The overview report lists and to ask them to help to keep college tutors who have provided the trusts that were felt to up the pressure for change for enthusiastic support for the provide particular examples the better. We hope that trusts project, and to the registrars of good practice, so that will realise that such changes themselves for giving their time. clinical managers can contact are likely to enhance efficiency relevant trusts when an area of of the take, professional time Dr Andrew MacLeod improvement is needed. with the patient, and thereby RCP Regional adviser • We are now making further patient safety and the patient

Introducing your new GIM trainee representative

My name is Abi and I am very I am passionate about implementing I am passionate grateful to the West Midlands changes to improve the training and trainee committee and our current leadership skills of GIM trainees. I about implementing trainee representative for giving am hoping to use this opportunity to me this wonderful opportunity changes to improve put forward the interests of trainees to represent the hard working the training and general internal medicine trainees before the GIM training committee in the West Midlands. and will create a platform to promote leadership skills of medicine among the foundation I came to United Kingdom a decade year doctors so that more and more GIM trainees. ago from India, following which I choose medicine as their future completed my foundation training in specialty. Please feel free to contact me on the Yorkshire Deanery. I then came [email protected] and find or to our wonderful, vast, diverse and I would like to take this opportunity follow me on twitter @abi_gupta. multicultural West Midlands Deanery to thank our current trainee and completed my core medical representative, Amie Burbridge, who Dr Abhishek Gupta training. Currently I am an internal has done a fabulous job for us for ST4 in Geriatrics and general internal medicine and geriatrics trainee living the past few years and made an medicine in Birmingham. immense contribution to this role. Russells Hall Hospital

newsletter Autumn 2016 | www.rcplondon.ac.uk 9 Just another cough…?

I made a mistake. It was a The experience has led me to need to show us that in the future, Monday morning; I was the acute question where this ‘blame culture’ admitting our errors is normal and medical registrar doing a ward has come from. It is certainly not that we should not hide behind the round. I reviewed the first patient, healthy and does no favours to any shame that our mistakes make us taking a history of shortness of health professional, but it is one that feel. breath, cough and generalised appears to be all pervasive in the abdominal pain. I examined the NHS. I encourage each trust to introduce patient, listened to her concerns a meeting – a safe place where staff and formulated a diagnosis and We are perfectionists and we expect can talk about mistakes they have management plan. A routine our colleagues to be the same. This is made. Our senior clinicians, including case of a lower respiratory tract unrealistic and dangerous, as it sends leaders of the medical royal colleges, infection and constipation; I soon a message that if we make a mistake, need to share with us their mistakes moved onto the next patient. we cannot admit to it for fear of and experiences, reducing the being judged. This results in more blame and shame culture that we all A week later I received an email mistakes being made. experience when we make an error. from the medical director informing me someone had submitted an The Duty of Candour states that incident form against me for a The Duty of we need to inform and apologise to missed diagnosis. Feeling sick, I was Candour states that our patients if we make a mistake taken back to that Monday morning. that leads to significant harm. My What I thought was a simple lower we need to inform patient survived, but it was a long respiratory tract infection had turned and apologise to and difficult recovery for her and for out to be bowel obstruction, resulting me. I went to see her on the ITU; I in an emergency laparotomy. The our patients if we explained who I was and what had patient was on ITU and not doing happened. The only thing she said well. How could this happen? I had make a mistake was ‘Thank you’. thought I was a good doctor. Not that leads to anymore. My confidence hit rock Dr Amie Burbridge bottom. significant harm ST7 in Acute internal medicine, Sandwell and West Birmingham NHS The case was investigated and I We need to develop a culture where Trust felt like a scapegoat. I was blamed we are encouraged to admit our RCP Trainee committee representative for and had little support. Instead of mistakes; where we can speak freely the West Midlands learning from my mistake, I became and openly, without fear of being introverted; fearful of making judged. Let us not see mistakes as another mistake, I over-investigated failures, but as learning opportunities each patient I saw, took far too long that we can reflect on, enabling us and began to question every decision to grow both as a person and as a I made. clinician. The leaders of the NHS

10 www.rcplondon.ac.uk | newsletter Autumn 2016 Medical Training Initiative: a bridge between UK and international physicians

The Medical Training Initiative to provide a robust service and can For further information, potential (MTI) scheme, a 24-month minimise costly locum expenses. candidates and employer trusts training programme for In return for this, we can help the should contact the MTI programme international physicians, was international physicians to develop teams in the colleges via the established in the NHS by the specialised skills and services that will following emails: mti@rcplondon. Department of Health in February be of benefit in their home countries, ac.uk (RCP London), s.mcglnn@rcpe. 2009. The scheme aims to fill the which in turn further develops our ac.uk (RCP Edinburgh) and mti@ SpR vacancies in the NHS acute reputation and links within these rcpsg.ac.uk (RCP Glasgow). medical services with qualified countries. international physicians or trainee physicians and to provide these Working together with the colleagues physicians with specialised skills across our partner trusts in the Dr. Moe Oo and exposure to new situations. Black Country Alliance, we plan to Consultant physician, The Academy of Medical expand the MTI scheme to create an Sandwell and West Royal Colleges (AoMRC) is the established training programme in all Birmingham Hospitals responsible professional body for three Trusts in the near future. NHS Trust the scheme. The West Midlands has a strong Two MTI fellow posts (SpR tradition and reputation for training equivalent) have been created with and education in medicine. We believe Dr. A Ariyawansha this scheme: international training that colleagues across the region will MTI fellow, fellowships in general medicine and increasingly see more and more merit Sandwell and in medical specialties. Both posts in the MTI scheme, and we would like West Birmingham are recognised as training posts by to facilitate connection between them Hospitals NHS Trust Health Education West Midlands. and international colleagues who Dr Anuruddha Ariyawansha, a have areas of mutual interest. Finally, consultant physician in general let us leave you with some comments medicine from Sri Lanka, was from Dr Ariyawansha, the first MTI successfully appointed as SWBH’s fellow in SWBH: Mr. Terry Whalley first MTI fellow in November 2015. Programme director, Dr Ariyawansha is now working in the I have received excellent learning Black Country acute and general medical service opportunities through this initiative. Alliance while acquiring specialised skills in When I return to Sri Lanka, I will chest medicine. share the knowledge, skills and competencies that I have learned Early experience confirms to us that here with my colleagues with a view through this initiative we can better of improving the clinical practice in enable our acute medical workforce the region where I work.

newsletter Autumn 2016 | www.rcplondon.ac.uk 11 Update on the RCP Future Hospital Programme

The Future Hospital Commission providing space for physicians to share is piloting the chief registrar role to (FHC) report, 1 published in 2013, their stories of clinically led quality determine the skills, protected time set out a bold, far-reaching vision improvement or service redesign, to and training needed. The pilot will for a new model of clinical care that stimulate debate and inspire others. be led by the RCP vice president for will be familiar to many fellows education and training, Dr Gerrard and members. The Future Hospital Programme (FHP) followed – its aim Future Hospital development sites Phillips, and evaluated by the University being to develop and implement This aspect of FHP now comprises of Birmingham. The first cohort of this vision with a focus on driving eight sites. The first sites, recruited 21 chief registrars commenced the real change in the way services are in late 2014, were Betsi Cadwaladr training programme set up by the delivered and structured in hospital in North Wales, Mid Yorkshire, East RCP education department and and local communities. Lancashire and Worthing, with all four the Faculty of Medical Leadership While a core strand of the FHP is a investigating the impact of novel care and Management in September commitment to implement new models models in the frail elderly. 2016. Training will include quality of care with development site partner improvement methodology to enable hospitals and healthcare services, the In spring 2016 a further four chief registrars to lead and mentor programme goes far beyond ‘road development sites launched, following peers to deliver quality improvement testing’ care models. Realising a radical a call for partners to evaluate new projects within their own acute trusts. vision for healthcare appears daunting models for delivering integrated in the current context of the recent specialist care. This includes Sandwell Get involved NHS budget ‘reset’, the junior doctor and West Birmingham Hospitals, • If you’d like to tell us your story, contract dispute and wider concerns where the focus will be on a new you can download a submission about the workforce and quality of integrated approach to respiratory form at www.rcplondon.ac.uk/ care. However, many of the ideas and care, with enhanced consultant-led projects/future-hospital-your- recommendations put forward in the care in hospital linked to consultant stories or contact the FHP team original FHC report emerged from outreach and integrated working in the at: futurehospital@rcplondon. examples of good practice already community. Two sites are located in ac.uk. implemented by NHS clinicians. Key the North West: the Central and South • To join the partners network, visit to the success of the FHP catalysing Manchester respiratory service and www.rcplondon.ac.uk/projects/ sustainable, widespread change to North West Paediatric Allergy Network. future-hospital-partners-network. healthcare delivery is the development At the final site, the team at North West • If you are interested in submitting of platforms to share the results Surrey CCG and Ashford & St Peters a paper to the Future Hospital of innovative practice from NHS Hospital are implementing locality Journal, visit www.rcplondon. clinicians, alongside other evidence- hubs to support integrated care for ac.uk/education-practice/library- based research, debate and analysis. frail older people. For all sites, an early journals/future-hospital-journal. The Future Hospital Journal shares success has been the development contributors’ innovation and evaluation, of regular structured learning events enabling readers to distil findings involving multidisciplinary teams and Mark Temple applicable to their own patients. The patients from each site, providing the Consultant physician and nephrologist Future Hospital Partners Network opportunity for teams to advance their Heart of Foundation Trust is an evolving community of peers, projects through networking, sharing Future hospital officer, RCP London academics, organisations and patients learning and inspiring each other. who champion the Future Hospital References vision and communicate via a website, Piloting the post of chief registrar 1. Future Hospital Commission. Future blogs and monthly newsletter. An important recommendation hospital: caring for medical patients. In addition, the aim of the ‘Tell us in the FHC report was the need to London: RCP, 2013. Available online at your story’ initiative is to collate case establish new, senior leadership roles www.rcplondon.ac.uk/projects/outputs/ studies from the front line services, to enhance delivery of care. The FHP future-hospital-commission.

12 www.rcplondon.ac.uk | newsletter Autumn 2016 Taking on the role of RCP tutor – successes and challenges so far

The previous encourage aspiring college tutors to an excellent simulation suite used for RCP tutor left attend annual reviews of competence multi-disciplinary training for medical for pastures progression (ARCPs) – this can be an students, foundation doctors and our new. I have eye-opening experience that highlights colleagues in anaesthetics. always been a common barriers to successful keen educator completion of CT1 and CT2. Locally there has been massive and I had been uncertainty about the future of our deliberating about applying for the There are a number of changes that Trust and the Alexandra Hospital in role, having been encouraged to have recently taken place or are particular, but acute and specialty do so by previous trainees (what round the corner. As part of Shape of medicine remain following an acute an endorsement). A couple of my Training (www.shapeoftraining.co.uk) services review. I have found it colleagues had held the post in the a new internal medicine curriculum is useful to trawl through trainees’ job past, while others did not feel the set to roll out in 2018. Also new on the evaluation survey tool (JEST) reports same urge as I did – some viewed it block are high fidelity simulation and to see where we can improve. There as a poisoned chalice. skills lab training; quality improvement have been no patient safety concerns projects as opposed to audits; and the raised here so far this year. Everyone is I bit the bullet. I was appointed at increase in the minimum numbers of pulling together to keep our patients interview in November 2015 and clinics by the end of CMT training from safe. succeeded in having one programmed 24 to 40 by the end of 2016. These activity (PA) provided in my job plan. all present challenges for smaller Our Trust has recently appointed an This unusual victory (my predecessors hospitals which we must consider as associate director of education to had, and many other college tutors opportunities. The difficult balance oversee all matters educational for are having, trouble getting the time between service provision and training the multi-disciplinary team. I envisage allocation provided and recognised) is an age-old dilemma (although I working closely with him to develop was possible partly because I had consider every clinical encounter a CMT teaching and training. We will stopped performing diagnostic potential training opportunity) and get over the inertia engendered by coronary angiography recently. rota gaps can present an enormous our acute services review – then the issue for the provision of safe patient future for medical of training here will As the core part of my role, I review care and a challenge in planning be brighter. e-portfolios regularly and meet with teaching sessions, rotas and clinic trainees to offer guidance, deliver attendances. We need to link up with Dr Dzifa W Abban weekly PACES teaching, and complete our neighbours in order to design Consultant cardiologist, workplace-based assessments and deliver high quality training Alexandra Hospital for core medical trainees (CMTs) programmes. The hospital already has Redditch and specialty trainees (STs) – the current job description mentions supervision of the training of CMTs Key resources for new and aspiring RCP tutors and STs in general internal medicine. I have had to get to grips with all • Key resources for new and aspiring RCP tutors the requirements for trainees and • Quality criteria for core medical training (CMT) (published by the JRCPTB) with current medical training and jrcptb.org.uk/cmtquality. education initiatives from the GMC, • ARCP decision aids (published by the JRCPTB) Health Education England and the jrcptb.org.uk/training-certification/arcp-decision-aids JRCPTB, and try to work out their inter- • Recognition and approval of trainers (published by the GMC) relationships – are they a partnership gmc-uk.org/education/10264.asp or who is really in charge? I would

newsletter Autumn 2016 | www.rcplondon.ac.uk 13 Becoming an associate college tutor

How we became associate college encouraged to add interesting cases, tutors in a strictly confidential manner, thus We became associate college tutors streamlining the process of identifying (ACTs) in August 2015. Having suitable patients for exam practice. prepared together in a small group and successfully passed PACES during The project has received excellent CT1, we identified a lack of regional feedback which has been formalised support in preparing for MRCP exams. by an auditing process showing clear We explored ways to develop a improvement in trainee satisfaction. framework to help improve this for Moreover, pass rates by completion our peers. Following discussions with of CT2 in Coventry and Warwickshire our local RCP tutor we discovered the have improved from 56.3% to 77.3% ACT role. At the time the job was not over its first year of operation. clearly defined. We recognised the requirement for us to act as a link Undertaking MRCP PACES is often between trainees and the RCP tutor, a daunting prospect. Raising but also saw the potential to work with local awareness of this project the tutors as catalysts to develop our has reassured trainees, including planned ‘PACES mentoring’ project. foundation trainees, who have been to identify local training issues. In We agreed that we would work encouraged by the support on offer, developing a close relationship with together as ACTs to represent all core thus influencing their decision to our RCP tutors we have been able to medical trainees (CMTs) across the pursue core medical training in the successfully address these concerns as region of Coventry and Warwickshire. region. well as gain an insight into managerial processes. Furthermore, attending What is ‘PACES mentoring’ Our advice to prospective ACTs regional and national meetings offers ‘PACES mentoring’ is a regional peer– Core medical training requires hard an ideal opportunity for networking peer mentoring scheme, supported by work and determination. Although and exchange of ideas. a digital forum using the WhatsApp trainees are often demoralised by the mobile messaging app, founded by lack of training opportunities available, Our role as ACTs has been hugely us in September 2015. Volunteers there are several avenues by which rewarding and we have enjoyed who have successfully navigated the we as trainees can make a change. In working together alongside our MRCP series are recruited to offer our experience becoming an ACT has RCP tutor to improve the training one-to-one support to those preparing provided us with the resources and experience and morale for our local to sit PACES. This enhances learning support to implement such a change. colleagues. We have now identified opportunities for those preparing for The Royal College of Physicians is two CT1 colleagues to pass the baton their exam and offers a platform for currently redefining the role to clarify on to. We hope they will be able to mentors to develop their teaching what is involved, making it easier to continue and further our work. and leadership skills. Furthermore, undertake. However, flexibility will be it stimulates team working and maintained to allow the role to be Dr Richard Jerrom, CMT2 networking among trainees and tailored to satisfy local trainee needs. Dr Tayeba Roper, CMT2 encourages continued learning for With effective organisational and University Hospitals Coventry and mentors. A WhatsApp group was communication skills it is possible to Warwickshire NHS Trust established at the same time as a fulfil this role without it interfering with support forum for both candidates clinical work. Look out for the new job and mentors to share information description, which is published on and coordinate revision sessions. In We have found that holding regular the RCP website, or contact addition, members of the group are junior doctor forums has helped us [email protected]

14 www.rcplondon.ac.uk | newsletter Autumn 2016 Medical education in the Middle East – dispatches from Doha!

It is just seven from and teach on is amazing. months since I said goodbye Qatar is a tiny country with massive to the West ambitions, and this is particularly Midlands on apparent in healthcare. The a chilly grey corporation has embraced the high November day standards of various international and flew to Qatar to take on a role accrediting bodies, mainly those of the in Hamad Medical Corporation, USA. The language may be slightly which is the country’s publically different but the aims and outcomes funded health system. are all familiar to me from the NHS and Health Education England! Outside work it’s a good life; I am not My original brief was to look after working the long hours I did in the UK undergraduate education in two Pushing through systems and and there is no ‘on call’ expectation. medical schools, one well established standards of patient safety, quality The sun shines every day and we have and running a New York-based and training that took many years to bought an old but hardy 26ft sailing curriculum, the other brand new and evolve in the USA and UK, here, in a boat. Nothing beats sailing in reliable very much a proud Qatari initiative. country with much younger systems, warm dry weather with friends, I also have a lead role on continuous very different cultural norms, and accompanied by about 50 dolphins professional development, part of a tremendous health care pressures in Doha Bay! The call to prayer from truly inter-professional team charged within the indigenous and expatriate the local mosques has simply become with implementing a completely new populations, cannot have been part of life’s fabric. I am trying to learn system of CPD accreditation from easy. I suspect they would not have a little Arabic and to cook with local March 2016, with the aim of setting managed it without considerable spices. However, in June, as I write, the high standards for educational, funding, as was available in the recent temperatures are around 45oC and administrative and ethical aspects of ‘oil boom’ years. Just as I arrived in rising; life would be quite impossible educational activities for all registered the country, however, oil prices took without good air conditioning. health care professionals across Qatar. a dive, public funding was drastically Ramadan has just started and cut and Qatar now faces maintaining neighbours and colleagues are As always seems to be the case, these hard-won accreditation coping without even water in these in both healthcare and education, standards despite tough budgets temperatures, cheerfully telling me its that role has quickly broadened to and ‘austerity’ measures. This is of fine! The bars are closed for the holy include much more, including aspects course something those of us from a month, coffee shops and restaurants of the graduate medical education UK NHS background are more used are closed all day, and all public eating programmes, new simulation facilities, to than most! Many very familiar and drinking during daylight hours and various strategic and quality problems are emerging; for instance is banned. The aspect of this I am elements for medical education within the emergency department at Hamad finding toughest? Not alcohol, but the organisation. I also enjoy busy General Hospital is one of the world’s coffee! rheumatology clinics with our two busiest (yes, honestly much busier fellows (think ‘senior registrars’) with a than any I have ever encountered Dr Maggie Allen case-mix I would never see in the UK in the UK!), and over the past six Associate director of medical education, (leprosy and familial Mediterranean months staffing cuts have left trainees Hamad Medical Corporation fever for instance). The ethnic mix of reeling with the workload and with the population is so diverse here; the reduced supervision/ training. ‘Plus ça breadth of clinical material to learn change...’

newsletter Autumn 2016 | www.rcplondon.ac.uk 15 Service development / integrated care news

Ensuring Quality in the Respiratory and Sleep Physiology Department

The Improving Quality in standards to ensure that we were We applied to the accreditation Physiological Services (IQIPs) compliant. Prior to commencing process once we had demonstrated programme is a professionally SAIT we felt that we were a good the required standard on the SAIT. led accreditation programme department and that the process Initially our application was planned designed to improve the quality, should be straightforward for us. to be made in November 2013; care and safety of physiological We quickly realised that while we however, this was delayed until March services. It was developed by the did undertake the majority of the 2015 due to circumstances outside Royal College of Physicians and required processes, often they of our control. We were assigned an is delivered and managed by the were not documented or there was assessment manager on 12 March United Kingdom Accreditation no written procedure in place. For 2015 and at this point agreed a Service (UKAS). example, we were confident that staff web-based submission date of 27 all introduced themselves to patients, November 2015 and assessment On 7 April 2016, the Department explained investigations to their visit for 29 February to1 March 2016. of Respiratory Physiology and Sleep patients, advised them of what would The purpose of the on-site visit is at University Hospitals Coventry happen following their investigations to observe practice and facilitate and Warwickshire became the first and arranged ongoing investigations assessment of those activities not centre in its discipline to gain IQIPs if they were required. However what amenable to assessment via the web- accreditation. we didn’t have was a documented based tool. It verifies that documents procedure for this or an audit to uploaded to the web based tool are The process of accreditation begins ensure that the policy was consistently being consistently implemented and with self-assessment. Centres use the applied by all staff. To overcome this allows assessment of documents not Self-Assessment and Improvement we developed a departmental patient uploaded (for example those that are Tool (SAIT) to evaluate and assess care policy and also implemented confidential). their service. This tool allows services an annual departmental patient to identify areas of good practice satisfaction survey which checked Our service was and areas that require development. whether or not staff were adhering to Once services can demonstrate that the patient care policy. commended for they are delivering at an appropriate several aspects, standard they can apply to enter This became a theme across the SAIT including our annual the IQIPs process. This is a four-year assessment – we were performing accreditation cycle with an annual at the required level but there was continuous positive self-assessment and improvement not always a protocol in place and airway pressure process. we did not audit adherence to (CPAP) support group protocol. We had protocols in place Our department registered with the for the performance of our diagnostic meeting and our SAIT in April 2013. This was our first investigations but had neglected to fast-track diagnostic exposure to the requirements of do this in other areas, as we had not sleep service for accreditation and we spent several appreciated the importance of doing months working our way through the so. occupational drivers.

16 www.rcplondon.ac.uk | newsletter Autumn 2016 Service development / integrated care news

In addition our departmental starting the accreditation process we it is consistently applied. Changes peer review process for continual felt that we were providing a good need to become routine and everyday assessment of competence was service to our patients; however, by practice and not ‘just in case we have highlighted as excellent practice. undertaking self-assessment and an audit’. For example, departments Following the assessment process accreditation we identified gaps in our sometimes overlook the lunches in the department had mandatory policies and procedures that we were the drug fridge or the nice shiny new recommendations that needed to unaware of. Our service is much more diamond engagement ring being be addressed prior to successful patient-focused as a result of this worn in clinic; however, to be sure that accreditation. Examples included process. good practice is consistently applied, publishing an up-to-date changes need to become a habit. The departmental structure, providing We recognise that we continually need whole team needs to be fully on board evidence that bariatric chairs had to assess and modify our service to and to understand the importance been ordered for our sleep clinic and continue to improve and the IQIPs of undertaking the process so that altering room layout on one site to accreditation process will facilitate this. everyone supports each other and ensure the safety of staff working It hasn’t been easy and a lot of time recognises the requirement for making alone. and effort has gone into completing changes to practice. the process, but it has been worth it As a department we are really proud for the obvious improvements that it Joanna Shakespeare, of our IQIPs accreditation. Every has brought. Clinical scientist/service manager, member of the team has actively University Hospitals Coventry and contributed to the process and we If we were to offer advice to other Warwickshire NHS Respiratory Sleep Service have seen the improvements that services it would be to ensure that it has made to our service. Prior to where change to practice is required,

Mindfulness Course for medical patients and for staff, Good Hope Hospital, Sutton Coldfield For seven years we have been running a mindfulness-based stress reduction course as described by Dr Jon Kabbat Zinn at Good Hope Hospital. By practising yoga and meditation, the two most important elements of this course, I have seen improvements in my own health, as well as having more energy. I am calmer, less easily upset and happier. Patients who have attended have seen improvements in symptoms of irritable bowel syndrome, chronic fatigue, fibromyalgia, asthma and eczema. Patients with neurological disease including MS and Parkinson’s have found benefit too.

If you wish to do this course yourself or have a patient who is well motivated to practice then please refer to me, Dr Sukhdev Singh. The eight-week course is run three times a year on Thursdays from 4.30–6.30 pm in the hospital gym. There is no charge for the course. For further information email [email protected] or telephone 0121 424 9882.

Dr Sukhdev Singh Consultant gastroenterologist, Good Hope Hospital

newsletter Autumn 2016 | www.rcplondon.ac.uk 17 The Parkinson’s UK Excellence Network in the West Midlands: saving time and making progress

The West Midlands Parkinson’s lead for improving medications fractures) by educating patients and Network has just convened management, Dr Paul Worth, to talk care staff about bowel and bladder its third annual meeting. This at our launch meeting. Inspired by management, hygiene, hydration and steadily growing multidisciplinary his work in East Anglia, our network bone health. Our annual data pack group, comprising neurologists, members worked to ensure that an of comparative hospital episodes psychiatrists, elderly care, emergency box of all commonly used statistics (HES) data (at trust and psychologists, therapists, nurses, drugs in Parkinson’s is available 24 CCG level) allows network members dieticians, pharmacists, managers hours a day in acute trusts to avoid and commissioners to keep track of and even the occasional surgeon, ‘drug not available’ ever appearing variables such as admission rates, was set up to share best practice, on drug charts as a reason for drug lengths of stay and costs. Other innovations and guidelines, omission. Dr Sally Jones, consultant themes being worked on include develop regional pathways and physician at Heartlands Hospital, and palliative care, management of encourage equity of service across her team have taken things further Parkinson’s in care homes, mental the region. The ultimate aim, by developing a quality improvement health in Parkinson’s and regional of course, is a better and more project focusing on staff education, guidance for both non-oral therapies equitable service for those with early identification of Parkinson’s and falls. Parkinson’s and their carers. inpatients and using the electronic prescribing system to remind nursing By putting in the right service at the The network meetings are designed staff to administer medication. This right time, we believe that services will not only to be a forum for discussion resulted in dramatic improvements in not only improve in quality but also be and education but also a means by patients receiving medication on time more cost effective. Anyone interested which annual action plans for service across the Trust (76% receiving drugs in joining the West Midlands development can be generated. within 30 minutes of prescribed time Parkinson’s Network can email us at Guidance, documents and leaflets compared to 48% previously across [email protected]. can be shared rather than each local the whole trust, with even greater service reinventing the wheel. Sharing improvements on the initial target ideas and innovations with other ward) as well as significantly reducing networks can also stimulate a series drug omissions. of small changes that can have a big impact. We all agree that our services should be moving towards more As an example, poor medications anticipatory models of care rather management for people with than reacting to crises. Nursing and Parkinson’s who are admitted to therapy colleagues in the network hospital is a national problem, are developing self-management Dr Andrea Lindahl Dr Lucy Strens resulting in increases in morbidity, and lifestyle programmes as well as Consultant neurologists, University length of stay and even mortality. Parkinson’s education programmes for Hospitals Coventry and Warwickshire Parkinson’s UK launched a campaign those newly diagnosed, empowering and Joint Leads of the West Midlands to ‘Get it [medications] on time’ people with Parkinson’s to manage Parkinson’s Network as long ago as 2006. A number of their own condition. We are working medications management audits towards reducing avoidable across the region demonstrate that emergency admissions of people this is an area in which we can all with Parkinson’s (often due to urinary improve. We invited the national infections, constipation, falls and

18 www.rcplondon.ac.uk | newsletter Autumn 2016 AMU Clinical Skills Lab at City Hospital

AMU and acute medicine Teaching in chunks of 15 minutes is all the AMU and apply them in real is enriched with learning that it takes to make an ‘on call’ shift time. For example, if a patient needs opportunities for trainees at all fruitful, enjoyable and memorable. a lumbar puncture, our trainee will levels across all clinical teams. Having such a facility within the AMU practice the procedure within the lab Learning topics might range from closes the bridge between simulation and then carry out the procedure for managing pulmonary oedema and and real-time apprenticeship. the patient straight after. Afterwards, sepsis, to leadership skills and how successful or not, they will come to deal with difficult patients, to The lab holds extensive equipment back to the lab and re-practice the managing flow. However, evidence ranging from lumbar punctures, chest procedure for further consolidation. reveals that these opportunities drains and central venous puncture Figure 1, depicts the importance are being missed in reality due to kits to an ultrasound machine and of having a close-knit relationship time pressures resulting from high a patient simulator called ‘George’ between the real work environment flow, high acuity and increased with numerous murmurs and chest and the simulated environment and pressures for discharges, leading sounds. In addition an area where having such a facility aims to bring to rushed post-take ward rounds presentations can be given and down this line of separation. Studies exacerbated by inconsistent small group teaching sessions and and clinical practice reveals this leads approaches from consultants. simulated scenarios can be conducted to competence and confidence. is available. As an educationalist and a champion This AMU clinical skills lab will enable for acute medicine, one of the items There is clear evidence that if skills trainees to be taught in a high acuity on my ‘bucket list’ of things to do are not practiced again and again environment during their service/on as a consultant was to create an they are lost; many trainees attend call duties and to be empowered with AMU Clinical Skills lab that sits within courses and skill simulations on topics essential skills and knowledge and the AMU. Seven years later – it has such as acute life support but do not the prompt ability to consolidate. Not happened. We now have an AMU skills get the opportunity to practice these only will this raise morale, improve lab embedded within the unit. new ’learned’ skills, knowledge and on-call experience and empower but behaviours. Not only is this inefficient ultimately result in increased quality Why do we need this? Working within and costly on resources but we are of care for our acutely unwell patients. acute medicine is highly stressful often creating trainees who are falsely I believe this is a first in the UK and and fast-paced, leaving little time for overconfident, as they have achieved we aim to review the impact of this learning to occur; more importantly, the tick box exercise on paper that initiative. AMU environments are not conducive cannot be applied in real time. I see to learning. Having a dedicated this in my daily practice. facility within the unit which is freely Dr Sarb Clare accessible 24/7 enables our staff to One of the key benefits for this facility Clinical lead acute medicine have effective learning experiences. is for trainees to practice skills within Sandwell and West Birmingham NHS Trust

Figure 1. CLINICAL ENVIRONMENT AMU

Identify learning Re-apply Review Continue needs skill

Simulator based Further practice Practice

AMU CLINICAL SKILLS LAB

newsletter Autumn 2016 | www.rcplondon.ac.uk 19 Use of Technology Enhanced Care Services (TECS) to empower patients and enhance adherence to diabetes treatments

Introduction information. This information can be Measures of success included the In Sandwell and West Birmingham accessed by clinicians through any following: Hospitals NHS Trust (SWBH), device connected to the internet, e.g. • Significant ease of enrolment prevalence of diabetes and social a computer in the surgery, a tablet into FLO from outpatient clinics deprivation is high, especially or smartphone. It’s relatively cheap (evidenced by month-on-month within the large ethnic minority to implement and works for patients increase in FLO enrolment). (South Asian and Afro-Caribbean) with even a basic mobile phone. • Increase in compliance and population. Non-compliance is understanding of medications a major stumbling block in the Each pilot trust committed to an initial evidence from patient survey and management of diabetes and blood minimum of 12 months active but free BP improvements). pressure. Given the above issues, usage of the STH/Flo service, inclusive • Improvements in BP as a result we took the opportunity to become of 37,500 texts. Subsequently, this of adjustment and/or addition became part of the West Midlands process would cost the trust or clinical of BP agents in 27/100 (27%) of Academic Health Science Network commissioning group (CCG) £10,000 patients who continue to have Integrated Care Flo Exemplar for a maximum of 37,500 texts over follow-up with FLO. project by piloting the Simple the next year (8p/text message). • ‘White coat hypertension’ Telehealth/Florence (STH/Florence) diagnosed in 46/100 (46%) of our mobile phone texting service. Results so far patients, enabling reassurance of In SWBH, 100 patients have enrolled patients and GP and discharge Our main aim was to improve for BP monitoring and 26 for blood without unnecessary follow up. adherence to blood pressure (BP) glucose and insulin reminders since • Significant patient satisfaction treatment by engaging patients April 2014. We have adjusted BP (from survey and patient in their own health through medications (for example, added comments). text reminders and regular a new agent or increased dose) • Reduced clinic and hospital visits encouragement. in 27/100 (27%) of patients and (107 outpatient appointments discharged 46/100 (46%) patients avoided), saving patients What is FLO? with good BP control, either having crucial time, freeing up health Florence (FLO) is a mobile phone just monitored their BP or following professionals and saving £11,663 texting system for healthcare that medication adjustment. against a total cost of £2,329 for texts advice and collects patient using Flo text messaging at 8p per text (net savings £9,334). Patient preference – responses to the question ‘Do you prefer to text your readings to Flo?’ FLO messages for blood pressure were very motivational and helped me increase my

Yes No Unsure activity levels and improve my YES – 99% NO – 1% diet.

20 www.rcplondon.ac.uk | newsletter Autumn 2016 Conclusions patients outside of traditional face-to- Due to an increase in our local clinical Using Flo on my face care to improve outcomes. engagement with FLO, uptake in our trust is continuing to grow, with tablet is so easy & This STH text messaging technology new teams set to join – pharmacy, convenient; I am can be easily applied in any NHS respiratory, paediatric diabetes, trust or CCG for long term disease haematology and occupational partially sighted management, as has been shown therapy. We plan to involve the acute and can enlarge the within our own trust. All that is sector as well, to achieve faster clinical required is basic funding, motivated outcomes, improve team productivity text. I use Flo for BP and interested staff, willing patients and release non-urgent capacity. and periodic blood who can use a mobile to text messages and, most importantly, Patients are very satisfied with this group testing which organisations ready to innovate and convenient texting service and have I have found very experiment with newer and smarter given very good feedback. FLO results ways of working. in much better utilisation of resources helpful recently and clinician time and is a clinically changing from Dr Parijat De effective and cost-effective model Consultant physician & clinical lead of care delivery. FLO is innovative basal insulin. diabetes & endocrinology and recognises the need to support Sandwell & West Birmingham NHS Trust

A coroner’s inquest – is like an examination, so prepare, prepare and prepare!

All healthcare professionals are likely to attend or You may be approached or contacted by the media after provide evidence to a coroner’s inquest at some stage the inquest; however, we would strongly recommend during their career. The coroner’s office will contact speaking to the communication department of your Trust doctors or other professionals via the legal/complaints before speaking to the press or media. department of a trust to ask them to write a report or statement on the care provided to the patient. At the end of the inquest, the coroner will come to a conclusion. In some circumstances, there may be a need to The coroner is usually very keen to ensure that lessons adjourn for the coroner to consider all the evidence or ask are learnt from ‘events that may have contributed to a another witness to attend before delivering the verdict at a patient’s death’ and to establish what measures will be later date. undertaken to improve practices and prevent such events from occurring in future. If any relevant special measures Once the inquest is completed, reflect upon it and include have already been taken prior to the inquest or there are the reflection in your e-portfolio or appraisal folder. plans in place, then this should be shared with the coroner. Details of any internal investigation (for example via an Dr Shahid A Kausar incident and adverse event reporting system such as Datix) Consultant physician in stroke, geriatrics and general (internal) that has been completed or is in progress should also be medicine, Russells Hall Hospital shared with the coroner. Dr Mazhar Chaudri Consultant respiratory physician, Russells Hall Hospital

newsletter Autumn 2016 | www.rcplondon.ac.uk 21 Endoscopic full-thickness resection (EFTR) for colonic lesions: team in Dudley pioneer innovative technique

The team at Russells Hall Hospital, be necessary in a another subset nationwide among three major Dudley, are among the first in of cases; for example, non-lifting centres including Russells Hall. Joint the UK to use a pioneering full lesions or neoplasms arising from data were presented at the National thickness resection device (FTRD), layers deeper than the submucosa British Society of Gastroenterology which removes the need for are difficult if not impossible to treat meeting in Liverpool in June this year invasive surgery in patients with with conventional techniques due and won the first prize in this category. pre-cancerous bowel tumours or to the increased risk of perforation. polyps that cannot be removed EFTR with secure defect closure offers Professor Ishaq, who has performed endoscopically. a minimally invasive approach for the procedures on four patients so those lesions. Also, the diagnostic far, said the procedure marked a The procedure, performed by yield of full-thickness resection ‘milestone’ as many patients would Professor Sauid Ishaq, a consultant specimens may be higher than that no longer be faced with major in gastroenterology and advanced obtained with EMR or ESD and may abdominal surgery and the risk of endoscopy, along with Mr Anthony therefore help to determine the most requiring a colostomy bag. Kawesha, a colorectal surgeon at appropriate therapy for the patient. Professor Ishaq commented that Russells Hall Hospital (Fig 1), involves However, EFTR has not entered until now, there have been limited placing a cap over a flexible thin routine endoscopic practice due to the endoscopic options to deal with early tube – a colonoscope – and attaching lack of safe techniques and devices. cancer limited to the mucosal layer a novel clip to the tip. The whole due to the risk of complications such procedure takes around 35 to 50 The new FTRD is the first as perforation and bleeding and minutes to complete and patients interventional device for combined possibility of inadequate depth of return home the same day. full-thickness resection of colonic excision with standard endoscopic lesions with closure and cutting of approach. ‘But this device enables us Advanced techniques like endoscopic tissue in one integrated procedure. to secure the surrounding area with a mucosal resection (EMR) or The technology is based on the bear-like “claw” clip before removing endoscopic submucosal dissection well-established over-the-scope-clip the diseased tissue, which means we (ESD), in which treatment is limited (OTSC®) system and was developed can protect the bowel and remove to the superficial layers of the in Tuebingen, Germany. It enables that risk.’ gastrointestinal (GI) wall (namely the the endoscopist to resect all layers mucosa and submucosa), are well of suitable lesions including serosa, Professor Ishaq is on the EFTR established methods for endoscopic resulting in valid histologic evaluation trainer faculty along with Professor resection of gastrointestinal of one en-bloc specimen according Thomas Gottwald, who pioneered neoplasms. However, the rate of local to residual tumour classification (see the procedure with colleagues at the recurrence after EMR of advanced Fig 2). The design of the FTRD system University of Tuebingen in Germany. nonpedunculated adenomas has ensures that the transection of the In the UK the procedure has been been reported to be 16% in a recent tissue happens only after the defect submitted to NICE for evaluation and prospective, multicentre study1 and has been closed completely. At no a National Registry is in the process of endoscopic re-treatment of these time will the abdominal cavity and being set up. lesions can be challenging because bowel lumen be in contact. of scarring and fibrosis. Hence, For further information, please endoscopic full-thickness resection Professor Ishaq and his team received contact Professor Sauid Ishaq on (EFTR) may be an adequate approach their training in the new technique 01384 244 263 or for diagnostic or therapeutic tissue in Germany and their first patients [email protected]. removal in these cases. Full-thickness were treated in early February 2015. resection of the GI wall may also Now 20 cases have been completed

22 www.rcplondon.ac.uk | newsletter Autumn 2016 Professor Sauid Ishaq (WF-EMR) for advanced colonic mucosal Consultant gastroenterologist, Russells neoplasia is infrequent: results and risk Hall Hospital factors in 1000 cases from the Australian Mr Anthony Kawesha Colonic EMR (ACE) study. Gut 2015; Colorectal surgeon, Russells Hall Hospital 64:57–65.

References 1. Moss A, Williams SJ, Hourigan LF et al. Long-term adenoma recurrence following wide-field endoscopic mucosal resection

Fig 1. The EFTR team. From left to Scope of service right: Dr Michael Ray (anaesthetist), Professor Thomas Gottwald, Mr Referrals may be made to the Dudley Group for EFTR for any George Flahn, Professor Sauid Ishaq indication of the conditions below and Mr Anthony Kawesha. • Non-lifting neoplasias - Recurrent adenomas (scarring) - Primary non-lifting adenomas (potentially diagnostic in high-risk carcinomas) • Adenomas in difficult locations - Diverticula - Appendix (?) • Re-resection of malignant T1 carcinomas - Primary resection complete? - Determination of submucosal infiltration depth for risk stratification • (Small) submucosal tumors • Diagnostic full-thickness resection for motility disorders (e.g. Fig 2. EFTR procedure. (A) Recurrent Hirschsprung) polyp. (B,C) Polyp pulled into the cap. For first cases it is important to select patients with smaller tumours, up to (D) Polyp resected after clip applied 1cm diameter, to ensure complete (RO) resection. to hold the bowel wall. (E) Specimen. (F) Histology confirms full thickness R0 resection.

newsletter Autumn 2016 | www.rcplondon.ac.uk 23 Specialist clinics for alpha 1 antitrypsin deficiency: two pioneering centres in the West Midlands

Queen Elizabeth Hospital Birmingham and University Hospital Coventry have recently become two of a handful of centres in the UK to offer a multidisciplinary NHS clinic specifically set up to treat patients with alpha 1 antitrypsin deficiency (AATD).

Unmet clinical need in AATD AATD is an inherited condition that (Dr Parr third from right, Dr Lara first on right) affects around one in 3,000 to one in 4,000 people in the UK, normally caused by a recessive mutation in the AATD services at University physician in the UK who has employed Z-AT gene. Normal AAT protein inhibits Hospitals Coventry and augmentation therapy outside of a a range of proteases and has a role Warwickshire NHS Trust clinical trial, having previously worked in protecting tissues inflammatory In May 2015, University Hospital in Spain until joining the Coventry enzymes. AATD predisposes to the Coventry’s respiratory department’s team in 2015. Patients attending the development of chronic obstructive existing multi-disciplinary clinic Coventry service are also invited to pulmonary disease (COPD) or for patients with complex airways participate in clinical research, with emphysema, usually before the age of diseases was reorganised to meet the the expectation that therapeutic trials 40, but sometimes much later in life. clinical needs of AATD patients and will be commencing in 2017. Smoking increases the appearance provide convenient appointments of symptoms and damage to the for patients who wished to travel to Word of mouth and social media have lungs. AATD also predisposes to liver Coventry from further afield. led to a large increase in regional and cirrhosis, which affects about 10 out-of-region referrals through Choose percent of diagnosed children and All clinic appointments are with and Book and we are now running up to 15 percent of adults. Rarely, consultants from the respiratory, additional dedicated AATD clinics. AATD causes panniculitis, which is hepatology, dermatology and characterised by hardened skin with paediatric departments, as well For further details, please visit our painful lumps or patches. as a team of respiratory nurses, website (www.uhcw.nhs.uk/our- The Alpha-1 UK Support Group has physiologists and physiotherapists. services/a-z-of-services?sID=124) or carried out a survey highlighting We also provide general information, contact Dr David Parr (david.parr@ the nationwide lack of specialised clinical advice and genetic counselling uhcw.nhs.uk) or Dr Beatriz Lara NHS services and consequent for carriers of one deficiency mutation ([email protected]). unmet clinical need. Patients and and for siblings of severely deficient AATD centres across England have patients who may be contemplating Dr David Parr campaigned to establish national AATD screening. Our genetic testing Clinical director of cardio-respiratory funding for specialised services, but services include routine genetic testing services, University Hospitals Coventry & this has not yet been successful. In for S, Z and Malton alleles and full Warwickshire our two centres, we have found ways genotyping. to offer specialised services locally, Dr Beatriz Lara but a national solution is still urgently Dr Parr and Dr Lara have over 30 years Consultant in respiratory medicine, needed. of experience of caring for patients University Hospitals Coventry & with AATD and Dr Lara is the only Warwickshire

24 www.rcplondon.ac.uk | newsletter Autumn 2016 Specialist clinics for alpha 1 antitrypsin deficiency: two pioneering centres in the West Midlands

AATD services at University Hospitals Birmingham NHS Foundation Trust

For a number of years UHB has been leading research into AATD through its research arm ADAPT, established by Professor Rob Stockley in the 1990s, and which is widely recognised internationally. UHB also heads a British AATD research network with funding from the National Institute of Health Research (NIHR). The unmet need in AATD was clear to us, therefore when it became clear that national funding for AATD services (Dr Turner fifth from right) was not going to be forthcoming, our local clinical commissioning group (CCG) and managers at UHB agreed on lung disease and is therefore multidisciplinary meetings with our to step in to allow us to run an NHS headed by a respiratory physician whole team, particularly when we service too. (Dr Alice Turner), but we also have feel lung or liver transplantation may specific multidisciplinary pathways be needed. Dr Richard Thompson Our service, which also began in established. The liver service is and Prof Phil Newsome represent the 2015, was based initially in Queen headed by Prof Phil Newsome, and two transplant teams. Elizabeth Hospital Birmingham the skin service by Dr Helen Lewis. (QEHB) outpatients adjacent to lung Referrals are stratified by a consultant For more information about our function but recently relocated to the in the AATD service before booking service please visit our website Centre for Rare Diseases, part of the the appointment. This enables us (www.uhb.nhs.uk/alpha-1-antitrypsin- Institute for Translational Medicine to request lung function tests and deficiency.htm). (ITM). QEHB’s standing as a centre liver scans, if required, allied to the able to offer multidisciplinary care clinic appointment. If panniculitis Dr Alice Turner and lung and liver transplantation, is suspected a dermatologist can Senior clinical lecturer, Institute of alongside the ITM’s support system be available to assess and biopsy Inflammation and Ageing, University of for rare diseases, were key drivers for the skin. Those patients who have Birmingham CCG funding. Since the establishment more serious liver disease may be of the NHS service and information booked for a joint appointment about it being placed on the UHB with a hepatologist and respiratory website we too have seen a rise in physician simultaneously. Some referrals, and have altered clinic patients have specific worries structure to enhance capacity. In about the effect of AATD within common with Coventry we continue their family, so we also have the to offer research opportunities to ability to invite genetic counsellors patients. from the regional genetics service at Birmingham Women’s hospital Our service is primarily focussed to our clinics. Finally we can run

newsletter Autumn 2016 | www.rcplondon.ac.uk 25 The NIHR Clinical Research Network (CRN) West Midlands

The National Institute for Health Institute for Health Research Clinical scanners and x-rays that are needed in Research (NIHR) clinical research Research Network, the clinical research the course of the study: practical help network (CRN) West Midlands is delivery arm of the NHS, and is the is also available to help in identifying one of 15 such local networks in largest CRN in England by geography and recruiting patients into high England, delivering research across and by population. It supports quality studies, so that researchers can 30 health specialties, with more clinicians to originate and deliver be confident of completing the study than 800 different studies currently clinical research throughout the entire on time, and on target. available across the region. research pathway from the idea stage, through study set up and delivery, and For more information, please visit the In the last ten years the Network has in some cases, follow up, ensuring that Network website: www.crn.nihr.ac.uk/ recruited more than half a million clinical research occupies the place it west-midlands. participants into high quality studies deserves to in the day-to-day work of across the West Midlands – 64,278 of the NHS across the region. these in the last 12 months alone, the highest number in the country. It helps to increase the opportunities Prof Satyajit Das for patients to take part in clinical Professor of sexual Participants have been recruited from research, ensures that studies are health and HIV every NHS trust in the West Midlands, carried out efficiently, and supports and medical from more than half of the region’s the Government’s Strategy for lead consultant GP practices, and in hospices, nursing UK Life Sciences by improving the physician in sexual homes, pharmacies, schools and environment for commercial clinical health and HIV, Coventry & Warwickshire prisons. research. Partnership Trust. Specialty lead for infectious disease and microbiology, CRN The enthusiastic engagement of NHS Many research support posts in the West Midlands trainees and physicians is essential NHS are funded by the Network, and to sustain and build on this success, training is provided so that researchers particularly given the many competing have access to experienced staff who demands on clinician time and can carry out the additional practical resources. activities required by their study – Claire Hall such as obtaining patient consent Communications Ultimately, clinical research means for participation, carrying out extra lead, CRN West patients get access to new treatments, tests, and collecting the clinical data Midlands interventions and medicines, and required for the research. investment in research means better, more cost-effective patient care. Funding is also provided to meet The network is part of the National the costs of using facilities such as

26 www.rcplondon.ac.uk | newsletter Autumn 2016 Alvecote Wood – a very attractive retirement!

In 2006 I had to retire from my role as senior lecturer in public health at the University of Birmingham, owing to ill health. My husband Stephen and I had always been drawn to an 11-acre patch of ancient woodland on a regular cycling route near our home and, in 2007, we were able to buy it. The land has been documented in its current shape as far back as 1650, but has been wooded since at least the 12th century. In the 20th century, it was heavily grazed by sheep, pigs, horses and goats, and wood was extracted in the 19th century for local mining work. As the land had been neglected for almost 20 years, Sarah Walters and Stephen Briggs there was a lot of work to do. summer months. A wide range of community groups have We set about creating a new entrance, removing several visited us, including groups interested in birds, amphibians, generations of barbed wire fence, creating sound paths fungi, wildflowers, butterflies and dragonflies, the Women’s through the woods, opening up rides and putting in ponds. Institute, church and youth groups, Scouts and many We planted a roadside hedge and restored the coppice. We others. We also offer school visits via the Royal Forestry also planted new coppice and thinned out an overgrown Society’s Teaching Trees scheme. plantation. In 2013 we entered a competition with the Royal Forestry As if we were not busy enough, in 2010 we bought a Society to find the best small woodland in the Midlands further 9 acres of adjacent arable field, now called Betty’s and north-west of England – mainly to get advice from the Wood. We planted 6,500 trees, including wet woodland, judges! To our surprise we won, and the following year we mixed broadleaf and a long hedge, as well as three large were even more astonished to win the award for the best- wildflower meadows and five ponds. managed small woodland in England when put up against other regional winners. From the start, we have worked in conjunction with the Forestry Commission and Warwickshire Wildlife Trust, as To say that it has been life-changing is an understatement. well as other local nature conservation organisations. We We are constantly busy, because we do all the work ourselves have a management plan with the Forestry Commission, with the help of volunteers, but we are also constantly undertaking a programme of coppicing and thinning to amazed by the wonderful wildlife, and by the joy on the encourage regeneration. Most work takes place in the faces of our visitors, particularly the children. I used to work winter, although the meadows are cropped for hay in in public health, and I still am working in that field, just in the summer with our faithful vintage tractor and lots of a very different way. If you are looking for something to voluntary help. Nothing is wasted – wood is used for crafts, do with your lump sum, a woodland is something to think for timber, for firewood and even woodchip, and hay is sold about! to local stables. We are a Local Wildlife Site and a Site of Importance for Nature Conservation, and we have quite a If anybody would like to arrange a visit, please see few rare species on our site – including a rare bladderwort www.alvecotewood.co.uk or contact in our ponds and the only lesser water plantain in the whole [email protected]. We are also on Facebook and Midlands, as well as 17 species of dragonfly. Twitter.

One of our aims was to provide some public access Sarah Walters FRCP FFPH OBE where previously there was none. Alvecote Wood is not Former senior clinical lecturer in public health, University open all the time, but we have monthly public open days of Birmingham with Stephen Briggs BSc – engineer and from March to November, and open evenings during the company director, Pragmasis Ltd

newsletter Autumn 2016 | www.rcplondon.ac.uk 27 Voices of Medicine: a personal view

The Royal College of Physicians experiences and opinions. It is not has conducted, for example, reveals has from time to time recorded intended to be a definitive history what medical students did in WWII the views of its presidents in an but is the personal impression and – things not in today’s curriculum, informal way, often over lunch. reminiscences of individual involved such as learning to handle a rifle There are audio recordings of in a particular situation at a particular and other small firearms, performing Lord Moran talking about the time. A long list of dates and events surgery on D-Day casualties and fire establishment of the NHS, and are not expected, nor is a well-argued watching from the top of Birmingham Lord Platt on the RCP’s move from presentation of facts, and a judicial University’s clock tower. Other topics Trafalgar Square to Regent’s Park. recounting and explanation of events include Enoch Powell and racism, a is not required. Certainly reading brush with racism in the American Two years ago the ‘Voices of transcripts of lectures or book chapters Deep South, and management of a Medicine’ project was instituted. is not wanted. boy who lost half his face in a hyena This is an oral history initiative under attack. There are quite a number of the direction of a professional oral What is required is an exploration of firsts, including the use of cytotoxics historian. It is to run for two years and the individual’s thoughts, feelings and in acute lymphoblastic leukaemia, aims to chart the professional lives of reasons why they did this rather than increasing the five year survival from a small but hopefully representative that. The focus is the individual not 50% to 90%, and descriptions of number of fellows. the event, and the colour and depth establishing the first cardiology service, that their viewpoint can add to a the first nephrology service and the After an advertisement in situation. Of course it will be factually first rheumatology service in a hospital. Commentary, a small interviewing based but the story is told from the team of mainly retired fellows was individual’s viewpoint, taking in events, A required theme is recruited, of whom I was one. To motivations, influences, pressures and ease travelling and to make use of support. Often the ‘why’ question the role of the RCP in the local knowledge of potential is used. Why was such and such a the individual’s life. interviewees, each member of the decision taken, why did you take a For many this is no team was located in a different area particular job, why did you choose a of the country. We meet twice a year particular specialty or a research topic? more than taking the for training, to review progress and to MRCP, but others have plan the next six months. The second half of the 20th century was a time of intensive innovation in devoted a substantial The interviews normally take place in medicine and in reorganisation of the part of their career the subject’s home. Some preparatory NHS, against a framework of scientific to advancing its work is necessary and an outline medicine created by medical leaders CV usually provides a framework returning from the war determined to work, through for the recording. Though there is a make up for the lost years. A flavour of acting as examiners, list of standard questions covering this is captured in personal accounts becoming a Linacre schooling, medical school, junior jobs by the people who were there. This and consultant life, the course of the post war generation is now gone but Fellow, serving interview is flexible and can deviate practitioners who grew up in that on committees or from these themes. environment are still with us and it is their story that is recorded. occupying one of the Oral history can be defined as the RCP’s senior offices. recording of people’s memories, A trawl of the interviews that the team

28 www.rcplondon.ac.uk | newsletter Autumn 2016 In identifying subjects for the he would give a third interview, lasting passed on one of the grand old men interviews the obvious names an hour, covering his time in the House of British medicine. appear, those at the top of the tree of Lords. – presidents and registrars of the The recordings go into the RCP’s RCP, medical knights, those regarded The 94 year old entered the interview archive and can be accessed through as the leaders of the profession. But room right on time, sat down and the library catalogue. To listen to one, more importantly and truer to the spoke for two hours. We only stopped find the catalogue on the RCP website experiences of the average doctor because the next users of the room (rcp.soutron.net/Library/Catalogues/ and hence the true state of medical were hovering at the door. He was as Search.aspx) and type ‘Oral History’ practice are those who did good sharp as a tack, correcting me twice into the search box and the interviews work, but did not rise to the supreme on factual items, mentioning that completed so far will appear. There heights, as is the case for most of he still plays nine holes of golf. His are many more to come and I am sure us. We had our successes and we contributions over nearly 20 years in they will provide a rich resource for had our failures, our triumphs and the House of Lords were too numerous future historians and interest for the our frustrations. It is this group we to summarise. So a small number of occasional browser alike. are trying to cover as well as the big topics were selected: those connected beasts. with the various bills concerning the For more information about the NHS. project please contact David Young Was there an outstanding subject? For on [email protected] or Sarah me, this was Lord Walton of Detchant, As he left a high-stepping gait was Lowry, project leader, on sarah. Sir John Walton, giant of world noted. Well, at 94 he was entitled [email protected]. neurology, giant of British medicine. to a little proprioception loss. Lord Walton had already given two Unfortunately within a few days of Dr David Young interviews for a previous project, the interview he was taken seriously Retired consultant physician bringing his life story up to a year after ill, a terminal condition was found and his ennoblement. It was arranged that he died after about three weeks; so

newsletter Autumn 2016 | www.rcplondon.ac.uk 29 Job descriptions

In the context of approval of job descriptions advertising the post. the role of the Royal College of Physicians (RCP) is to provide objective comments on The RCP aims to speed up the approval job descriptions for consultant, specialty process by giving you a checklist to ensure you doctor and honorary consultant posts. The have all of the essential elements included RCP regards such work as being for the wider prior to sending to your regional office for benefit of the NHS, in achieving our common approval. goal of high quality patient care, as referred to in national documentation such as the Please contact the regional office for all new consultant contract and job planning enquiries regarding job descriptions for RCP guidance published by NHS Employers and approval within the region: the BMA. Wherever possible, RCP approval of [email protected] job descriptions should be obtained prior to

Midlands Gastroenterological Society – New Members The committee of the Midlands Gastroenterological Society (MGS) are keen to try and recruit all gastroenterology consultants and trainees as members and invitations are welcome to join this Society. Membership subscription is only £10 per year which offers: - MGS meetings twice yearly for CPD - endoscopy travel fellowship to Japan awarded annually to an MGS member in addition to BSG fellowship - research grants - travel grant. These benefits are only available to members of the Society. Please email [email protected] for further information on membership and details regarding the next conference on 11 November 2016.

30 www.rcplondon.ac.uk | newsletter Autumn 2016 West Midlands New Consultants Forum

The RCP has a national New Consultant We would like to welcome all new consultants Committee which has regional representatives to the region and encourage you to participate from across England and Wales. The Chair in this group. of the West Midlands new consultants forum is currently Dr Gordon Wood, consultant in For further information please contact respiratory medicine at Shrewsbury & Telford [email protected] Hospitals NHS Trust.

West Midlands As you may know, we hold twice yearly lunchtime meetings for our retired physicians, where we invite a retired physicians guest speaker on any given topic. As you will see from gatherings the previous topics, the subject matter is broad:

- life after the NHS - life as an independent MP and afterwards - the great detective and medicine: insights from the Sherlock Holmes Society - dishonesty in medicine and research - Dean Mahomet, 1759-–1851, shampooing surgeon to George IV - Frederick Henry Horatio Akhbar Mahomed, 1849-1884, pioneer of hypertension research - the young Turner, his alternative families and the women in his life. - Alvecote Wood - a very alternative retirement!

We are now planning our next schedule of events and would like to invite you to consider topics/speakers for these meetings. If you have any suggestions, or indeed have a hobby or interest that you would like to share with your colleagues, please contact: [email protected]

We hope to hear from you, and see you at one of our meetings.

newsletter Autumn 2016 | www.rcplondon.ac.uk 31 w

2016 Remaining events – West Midlands 17 October 2016 RCP Regional Update in Medicine Conference 11 November 2016 Midland Gastroenterology Society Meeting Conference 2 & 3 November 2016 RCP Effective Teaching Skills Doctors as educators workshop 15 & 16 November 2016 RCP Educational Supervisors accreditation Doctors as educators workshop 6 December 2016 GIM training day SpR GIM training day 13 December 2016 National training scheme for the use of radioiodine Workshop in benign thyroid disease 15 December 2016 Retired physicians gathering Lunch meeting 2017 Dates to your diary – West Midlands 25 January 2017 GIM training day @ University Hospitals Coventry SpR GIM training day & Warwickshire

9 March 2017 RCP Regional CME Day – Managing acute medical Conference problems

27 April 2017 GIM training day @ City Hospital SpR GIM training day

12 May 2017 Midland Gastroenterology Society Meeting Conference

17 May 2017 National training scheme for the use of radioiodine Workshop in benign thyroid disease

25 May 2017 West Midlands Physicians Association Conference

1 June 2017 RCP Regional Update in Medicine Conference (Oxford & Thames Valley)

15 June 2017 Retired physicians Lunch meeting

22 June 2017 GIM training day @ City Hospital SpR GIM training day

19 September 2017 GIM training day @ Shrewsbury & Telford SpR GIM training day

26 September 2017 National training scheme for the use of radioiodine Workshop in benign thyroid disease

20 October 2017 RCP Regional Update in Medicine (West Midlands) Conference

10 November 2017 Midland Gastroenterology Society Meeting Conference

23 November 2017 West Midlands Physicians Association Conference

5 December 2017 GIM training day @ UHB SpR GIM training day

14 December 2017 Retired physicians gathering Lunch meeting

For further details on any of the above events please contact: [email protected]

32 www.rcplondon.ac.uk | newsletter Autumn 2016 Conference Programme – 2017

26 January Respiratory update 30 January Heart failure 13–16 February Advanced medicine 16 –17 March Medicine 2017: RCP annual conference 27 March Update in management of stroke 6 April Acute medicine 16 May Hypertension: state of the art in 2017 22–23 May Acute and general medicine 19 June How to succeed as a new consultant 26 June Frailty for physicians 5 July Liver disease for the general physician 22 July Fast bleep the doctor-how to survive your first on-call shift 28 September Update in Endocrinology 5 October Cardiology update 14 October How to succeed in medicine 23–25 October Acute and general medicine 2 November Kidney for general physician 13 November The neurology of systemic disease 21 November Rheumatology update 11 December Gastroenterogical problems in pregnancy www.rcplondon.ac.uk/events or contact the Conference Team: Tel: +44(0) 20 3075 2389 Email: [email protected]

newsletter Autumn 2016 | www.rcplondon.ac.uk 33 MRCP MRCP Part 1 MRCP Part 2 Tuesday 10 January 2017 Wednesday/Thursday 29/30 March 2017 Examination Tuesday 09 May 2017 Wednesday/Thursday 28/29 June 2017 Dates 2017 Tuesday 05 September 2017 Wednesday/Thursday 28/29 November 2017

Live streaming

The latest talks from our June Teach-in are You can also watch our live streamed evening now available on our video archive. The Teach-ins in your hospital and in doing so archive also includes selected sessions from gain CPD points. If you think your hospital conferences and regional updates that you could benefit from this great opportunity, can watch in your own time. You can access do not hesitate to contact us to set this up: the video archive under the Catchup Events [email protected]. section of our website. Access our live streaming page here: www.rcplondon.ac.uk/streaming

FRCP

You should be receiving a census form annually from the medical workforce department at the RCP. Completion of this form tracks your work history and ultimately your eligibility for FRCP, so please take the time to complete this! Email [email protected] if you aren’t receiving an annual census form.

If you would like to nominate a colleague for FRCP the annual closing date is 1 September. The fellowship proposal form can now be filled in online once you have logged in www.rcplondon.ac.uk/myrcp.

Assessing trainees in the workplace: an online training package for doctors of all specialties

Assessing Trainees in the Workplace is a flexible and practical e-learning package aimed at secondary doctors who are in charge of assessing trainees. Consisting of three hours of CPD-approved online training, this module helps doctors to fully understand the methods used for assessing trainees and gives insight into what makes for good practice in assessing and providing feedback to trainees in the workplace. The module covers feedback, supervised learning events (SLEs), workplace-based assessments (WPBAs) and the role of the annual review of competence progression (ARCP).

Please visit www.rcplondon.ac.uk/elearning to find out more about the modules the RCP provides and the benefits of e-learning.

34 www.rcplondon.ac.uk | newsletter Autumn 2016 Useful information

RCP Tutors are local representatives of the Royal College of Physicians. The duration of this appointment will normally be from three to five years. The role of the RCP Tutor is to ensure that adequate postgraduate information is in place and that the standard of education and training for core medical trainees is both maintained and protected. This responsibility extends to all hospitals within the Trust, including those hospitals separate from the main hospital where the RCP Tutor is based.

College Tutors (CT) within the West Midlands

Dr Andrew MacLeod Dr Kanwaljit Sandhu Regional adviser Regional adviser

University Hospital of Coventry & Warwickshire University Hospitals Birmingham NHS Trust NHS Foundation Trust Dr N Murthy Dr S Ghosh Dr R Rao Dr D Nicholl Col D Wilson, Military Medicine Dudley Group of Hospitals Dr M Pagaria Burton Hospitals NHS Trust Dr H Siddique Dr D Watmough

University Hospitals of North Midlands Heart of England NHS Foundation Trust Dr D de Takats (Royal Stoke) (Heartlands, Solihull, Good Hope) Dr T Lo (County Hospital) Dr R Yadava Dr N Dufty Sandwell & West Birmingham NHS Trust (Sandwell and City) Royal Shrewsbury & Telford Hospitals NHS Trust Dr H Abusriwil (Sandwell) Dr G Wood (Royal Shrewsbury) Dr A Rajasekaran (City) Dr M Srinivasan (Princess Royal, Telford)

Royal Wolverhampton Hospitals NHS Trust South Warwickshire General Hospitals Dr K Sandhu (Warwick Hospital) Dr J Mukherjee Walsall Healthcare NHS Trust Dr J Gupta Wye Valley NHS Trust (Hereford County) George Eliot Hospital NHS Trust Dr J Govindan Dr D Natin Worcestershire Acute Hospitals (Alexandra, Kidderminster, Worcester) Dr M Roberts (Worcester) Dr D Abban (Alexandra)

newsletter Autumn 2016 | www.rcplondon.ac.uk 35 Contact information

We would welcome contributions in the form of articles and letters for publication, and suggestions for future features.

Royal College of Physicians Regional Office Birmingham Research Park Institute of Research & Development Vincent Drive Birmingham B15 2SQ Telephone: 0121 414 7020

Email: Helen [email protected] [email protected]

How to find us: Go to: www.multimap.com type in the post code B15 2SQ and a map will appear

36 www.rcplondon.ac.uk | newsletter Autumn 2015