Modernised Medical Careers: Time to Listen

1. Modernised Medical Careers: Time to Listen Professor Jacky Hayden

2. The role of the doctor • Leadership • Dealing with complexity and managing uncertainty • Effective and efficient problem solving • Working with patients to take legitimate risks and effectively managing risk by providing information alongside professional judgement to maximise patient independence and choice • Grasping clinical situations intuitively based on a deep, tacit understanding of their area of practice

3. We live in a world of constant change • Major NHS Reorganisation • HEE • LETBs • Revalidation • Standards for trainers • Better Training Better Care • Patient partnerships • The Shape of Training

4. Where and when do trainees have an opportunity to discuss the wider aspects of providing high quality clinical care?

5. If it be the purpose of medicine to give explanation and advice in consultation, how are we to train our students? How are we to maintain in doctors the sympathetic understanding of so many individuals, without which their work becomes a weariness of spirit and flesh? Sir James Spence 1892 – 1954

6. What I have heard since MMC • Trainees who are aware that they need to learn how to manage more complex patients/situations independently • Trainers who are frustrated that a ‘tick box’ approach to assessment does not allow them to express their true opinion about a trainee

7. Trainees report that the only time they are able to take decisions is when they are working out of hours

8. Some also report that when they handover patient care to the incoming team that there is frequently no consultant present……

9. …..and that no one checks their clinical findings with them…….

10. Have we allowed a drift in our aspiration of high quality care and high quality learning?

11. Are we basking in warm water waiting to boil? Charles Handy – the Age of Unreason

12. GMC and AoMRC Supervised Learning Events ‘The intention is to ensure a striving for competence whilst fostering aspiration towards excellence: the accumulation of experience to encourage expertise over and above the achievement of competence’

13. Supervised Learning Events The important feature of SLE is the reflection and learning from discussing a clinical (or non-clinical) activity

14. SLEs do not need to be limited to clinical activity

15. Trainee involvement in quality improvement

16. Are our trainees so busy doing the simple tasks (especially during the day) that they have little time to learn to manage more complex issues?

17. By changing one demographic of a patient we can alter the context and management. How often do we use this?

18. Some questions to think about • Is it time to review the nature of our trainees’ day time work – are we stretching them enough? • Should every trainer (named supervisor) spend an hour a week with their designated trainee to discuss the wider issues that the trainee has been facing? • What might we learn from general practice? • Should senior trainees regularly catch up with junior trainees during a shift period - perhaps for a meal break?