JuniorDr Magazine - Issue 14 by JuniorDr

medicine from oxford www.oup.com/uk/medicine

OXFORD SPECIALTY TRAINING ALL YOU NEED TO PREPARE FOR SPECIALIZATION Oxford Specialty Training is a brand new series and the first to take account of the new training structure and syllabuses, as introduced by the Modernising Medical Careers initiative.

• • •

OUT NOW

• • •

TRAINING IN SURGERY

TRAINING IN OPHTHALMOLOGY

“I do not believe we want technical surgeons, but rather doctors who as surgeons can deal with uncertainty and retain the skills to assess conditions outside their normal sphere of influence. This excellent textbook goes a long way to fulfil these principles.”

This complete guide to early years specialty training in ophthalmology is the first to take account of the new ophthalmic training structure and syllabus, as defined by the Royal College of Ophthalmologists (RCOphth).

FROM THE FOREWORD BY BERNARD RIBEIRO, PAST PRESIDENT OF THE ROYAL COLLEGE OF SURGEONS OF ENGLAND This complete curriculum guide to specialty training in surgery covers the material taught during the first two years of training, as well as the topics examined as part of Royal College membership.

A practical aid for trainee ophthalmologists and foundation year doctors, it guides and aids progression through the initial years of the new postgraduate Ophthalmic Specialist Training.

978-0-19-920475-5 | January 2009 | £39.95 |

978-0-19-923759-3 | February 2009 | £49.95 |

PAPERBACK

TRAINING IN OBSTETRICS AND GYNAECOLOGY This complete evidence-based guide to specialty training for junior obstetricians and gynaecologists features all the material relevant to everyday practice and the new RCOG curriculum. 978-0-19-921847-9 | March 2009 | £39.95 |

PA P E R B A C K

TRAINING IN PAEDIATRICS Training in Paediatrics covers the broad knowledge base required by postgraduate trainees choosing to specialise in paediatrics, from their intial Foundation Year placements through to examination for Membership of the Royal College of Paediatrics and Child Health (MRCPCH examinations). 978-0-19-922773-0 | September 2009 | £49.95 |

PA PE R B AC K

• • • FORTHCOMING • • • TRAINING IN ANAESTHESIA | 978-0-19-922726-6 | November 2009 | £49.95 |

PA PE R B AC K

TRAINING IN PSYCHIATRY | 978-0-19-922758-7 | November 2009 | £49.95 |

PA P E R B A C K

TRAINING IN MEDICINE | 978-0-19-923045-7 | February 2010 | £49.95 |

PA P E R B A C K

available in all good bookshops and directly from OUP

FASTEN YOUR SEATBELTS: THE TURBULENT JOURNEY TO BECOMing A DOCTOR THE MAGAZINE FOR JUNIOR DOCTORS

Presenting History JuniorDr is a free lifestyle magazine aimed at trainee doctors from their first day at medical school, through their sleepless foundation years and tough specialist training until they become a consultant. It’s proudly produced entirely by junior doctors - right down to every last spelling mistake. Find us quarterly in hospitals throughout the UK and updated daily at JuniorDr.com. Editor Ashley McKimm, editor@juniordr.com Editorial Team Michelle Connolly, Anita Sharma, Muhunthan Thillai, Andro Monzon Newsdesk news@juniordr.com Advertising & Production Rob Peterson, ads@juniordr.com JuniorDr PO Box 36434, London, EC1M 6WA Tel - +44 (0) 20 7 684 2343 Fax - +44 (0) 87 0 130 6985 team@juniordr.com Health warning JuniorDr is not a publication of the NHS, Gordon Brown (if he is still PM by date of publication), his wife, the medical unions or any other official (or unofficial) body. The views expressed are not necessarily the views of JuniorDr or its editors, and if they are they are likely to be wrong. It is the policy of JuniorDr not to engage in discrimination or harassment against any person on the basis of race, colour, religion, intelligence, sex, lack thereof, national origin, ancestry, incestry, age, marital status, disability, sexual orientation, or unfavourable discharges. JuniorDr does not necessarily endorse or recommend the products and services mentioned in this magazine, especially if they bring you out in a rash. © JuniorDr 2009. All rights reserved. Get involved We’re always looking for keen junior doctors to join the team. Benefits include getting your name in print (handy if you ever forget how to spell it) and free sweets (extra special fizzy ones). Check out JuniorDr.com.

resh into medical school I would have been the first person to dash down the aeroplane aisle if they had asked for a doctor on board. Eager with enthusiasm no stewardess could have stood in my way to attempt a tracheotomy with little more than a drinks straw and an airline napkin. Today, despite being a qualified doctor for five years, I’m pretty confident I wouldn’t. More likely I would be cowering in my seat hoping, that by some luck, there is a trauma consultant on board who could deal with any eventuality. The bad news, as we find out on page 9 (Medical Emergencies at 30,00ft), is that the frequency of hearing that dreaded message over the flight tannoy is likely to rise. With increasing life expectancy more people are flying long-haul in later life taking with them all their co-morbid medical conditions. Costing as much as £125,000 to divert a plane, falling ill in the air is a very serious business. We look at what the airlines are doing to provide medical assistance during a flight and the most likely emergencies you might have to deal with. This all however, is far from the minds of new medical students starting their training this month. That first day at medical school is the beginning of the final chapter in the dream to get that Dr prefix to your name. We offer some advice (Medical School Survival Guide p14) from doctors and medical students who have been there before on how to survive in the land of colonoscopy clinics, cardiology vivas and neuro MCQs. Good luck to everyone starting out on that journey. Just try to hold back that enthusiasm to dash down the aeroplane aisle mid-Atlantic - especially if there is a trauma consultant just behind you.

“No stewardess could have stood in my way to attempt a tracheotomy with little more than a drinks straw and an airline napkin.”

Ashley McKimm JuniorDr Editor-in-Chief ST3 Psychiatry

What’s inside 04 09 14 15 18 20 21

LATEST NEWS Medical Emergencies at 30,000ft StarTing Medical School Guide Weekend Ward Escape SECRET DIARY OF A CARDIOLOGY SPR Dumbo gets a check-up Hospital Confidential

TRIAGE

Tell us your news. Email team@juniordr.com or call 020 7684 2343.

Working Conditions

Junior doctors “press-ganged” into HIV tests

training

Manchester chosen as new PLAB centre

unior doctors working at four NHS trusts in England have reported feeling “press-ganged” into HIV tests as part of their pre-employment occupational health checks, says a study published in the Journal of Medical Ethics. New guidance in 2007 from the Department of Health stipulated that all staff should be offered tests for the serious blood-borne viruses hepatitis B and C, HIV and TB. However, the guidance makes it clear that the tests are not mandatory for doctors whose work does not expose them to these viruses, nor are they a prerequisite for employment. “The only discussion I had with somebody about the test was to say: ‘we’re going to test you for HIV. Is that OK?”

The study of 24 junior doctors found they were not given any information about the HIV test or told why they needed to have it. Most of the doctors did not feel they had the option to refuse the test; only four did so. Few were offered any follow up counselling or discussion, which would have been provided had they been ordinary patients. Only three of the doctors were actually asked about behaviour that would have increased their risk of acquiring HIV; none felt they had been at high risk. One doctor said: “The only discussion I had with somebody about the test was to say: ‘we’re going to test you for HIV. Is that OK?’ and then being stabbed.” Another said: “I wonder if they’d have sacked me if it was positive. No one really explained what would happen if it were positive either. Would my bosses have been told about it?” Only two documented HIV patients in the world have been infected by a doctor. Neither was in the UK. jme.bmj.com

NEWS PULSE

anchester has been selected as the new location for national assessment of international medical graduates from 2010. All international medical graduates have to demonstrate their clinical skills and knowledge before they are registered with the GMC and allowed to seek work in the UK. From March 2010 doctors who want to work in the UK but graduated outside the European Economic Area will be assessed at the centre. It is expected that 1,800 will be examined each year which will form the second part of the Professional Linguistics and Assessment Board (PLAB) test. “The move of these facilities to Manchester will ensure that we can continue to provide, and improve upon, a high quality of service. We expect to assess around 1,800 candidates every year,” said Anthony Egerton, Assistant Director of Registration at the GMC. The PLAB test assesses doctors’ skills and knowledge through a variety of exercises across four areas – clinical examination, practical skills, communication skills and history taking. Tested skills include taking blood, examining a mocked-up ‘pregnant’ abdomen and performing simulated examinations of the eye, ears and nervous system. The GMC is moving the Clinical Assessment facilities because it is expanding its remit to take full responsibility for the whole spectrum of medical education, following a merger with the Postgraduate Medical Education and Training Board (PMETB). The centre will also be used by doctors undergoing a performance assessment as part of an investigation into their fitness to practise.

www.gmc-uk.org

training

Consultants failing to use portfolios properly in appraisals

onsultants who assess the performance of junior doctors and medical students are failing to use the portfolio-based appraisal systems properly, says new research presented at the British Sociological Association’s Conference. The study found that almost half of consultants simply ignored the trainees’ own portfolios when assessing them and completed the tick-box exercise based on their own assessment. “All [of the appraisers] reported trainees’ portfolios played a highly superficial role in helping them decide what work tasks an appraisee should undertake and be assessed in and form an opinion about the level of technical proficiency possessed by an appraisee,” said Dr Chamberlain and his research team from the University of Chester. Those questionned believed the new portfolio-based performance appraisal systems were ‘box-ticking exercises’ and continued to use the traditional method of day-to-day performance for the assessment The study which looked at 46 UK consultants, surgeons and GP assessors found none fully complied with the appraisal system’s requirements.

“You fill in the forms in a workmanlike ‘dotting the Is and cross the Ts’ fashion. But it’s all for the look of the thing.” Assessor

Portfolio-based performance appraisal systems have been brought into medical training over the last decade as a way of formally logging the progress of junior doctors as a record during their training. They are also used during the annual appraisal of all doctors as part of their NHS contract. www.britsoc.co.uk

New report ignores ‘crippling cost’ of medical education

Romanian Society for Medical Mycology & Mycotoxicology

One doctor questionned described the process as purely a bureaucratic exercise: “You fill in the forms in a workmanlike ‘dotting the Is and cross the Ts’ fashion. But it’s all for the look of the thing. It doesn’t mean that you actually have done what you are meant to have done, or for that matter believe in what you have written past a very superficial level,” he said.

training

new report aimed at increasing the number of doctors from lower income groups has been branded a missed opportunity by doctor and medical student leaders after it failed to address the full extent of the soaring financial cost of studying medicine in the UK. Unleashing Aspiration, a report by the Panel on Fair Access to the Professions and chaired by former health sec Alan Milburn MP, examined the barriers and pathways to reaching the professions. The BMA is critical of the UK government for restricting the Panel’s remit to allow it to examine fully two of the main barriers blocking wider access to medicine - debt and tuition fees. “Just 4% of medical students currently come from the lowest two socio-economic groups. Ministers have no hope of addressing this poor level of participation without examining the

“I strongly recommend this book to all medical students, clinical microbiology and ŝŶĨĞĐƟ ŽƵƐ ĚŝƐĞĂƐĞ ƌĞƐŝĚĞŶƚƐ as a useful guide for their training.”

crippling and increasing costs of medical education,” said Tim Crocker-Buque, chairman of the BMA’s Medical Student Committee. “The Panel has been undermined from its inception by the government’s refusal to allow it to examine fully two of the main barriers blocking wider access to medicine - debt and tuition fees.” The BMA estimates a graduation debt of £37,000 for those who began their medical degree in 2006. They rejected the idea that tuition fee waivers for those staying at home would have a substantial impact on increasing social mobility in medicine - particularly as most medical students do not live within travelling distance of the 32 medical schools in the UK. www.bma.org.uk

ĂƐĞ ^ƚƵĚŝĞƐ ŝŶ /ŶĨĞĐƟ ŽƵƐ ŝƐĞĂƐĞ is an undergraduate textbook ĐŽŶƐŝƐƟ ŶŐ ŽĨ ĨŽƌƚǇ ĐĂƐĞ ƐƚƵĚŝĞƐ ŽĨ ƚŚĞ ŵŽƐƚ ŝŵƉŽƌƚĂŶƚ ŚƵŵĂŶ ŝŶĨĞĐƟ ŽƵƐ ĚŝƐĞĂƐĞƐ ĞŶĐŽƵŶƚĞƌĞĚ ŐůŽďĂůůǇ͘

COMING SOON: INDIVIDUAL CASES FOR PURCHASE AT OUR EBOOKSTORE: www.ebookstore.tandf.co.uk

Cases ϭ͘ Aspergillus fumigates Ϯ͘ Borellia burgdorferi Θ ƌĞůĂƚĞĚ ƐƉĞĐŝĞƐ ϯ͘ Campylobacter jejuni ϰ͘ ŚůĂŵǇĚŝĂ ƚƌĂĐŚŽŵĂƟ Ɛ ϱ͘ ůŽƐƚƌŝĚŝƵŵ Ěŝĸ ĐŝůĞ ϲ͘ ŽǆŝĞůůĂ ďƵƌŶĞƫ ϳ͘ ŽǆƐĂĐŬŝĞ ǀŝƌƵƐ ϴ͘ Echinococcus ƐƉƉ͘ ϵ͘ Epstein-Barr virus ϭϬ͘ Escherichia coli ϭϭ͘ Giardia lamblia ϭϮ͘ Helicobacter pylori ϭϯ͘ ,ĞƉĂƟ Ɵ Ɛ ǀŝƌƵƐ ϭϰ͘ ,ĞƌƉĞƐ ƐŝŵƉůĞǆ ǀŝƌƵƐ ϭ ϭϱ͘ ,ĞƌƉĞƐ ƐŝŵƉůĞǆ ǀŝƌƵƐ Ϯ ϭϲ͘ Histoplasma capsulatum ϭϳ͘ ,ƵŵĂŶ ŝŵŵƵŶŽĚĞĮ ĐŝĞŶĐǇ ǀŝƌƵƐ ϭϴ͘ /ŶŇ ƵĞŶǌĂ ǀŝƌƵƐ ϭϵ͘ Leishmania ƐƉƉ͘ ϮϬ͘ Leptospira ƐƉƉ͘ Ϯϭ͘ Listeria monocytogenes ϮϮ͘ Mycobacterium leprae Ϯϯ͘ Mycobacterium tuburculosis Ϯϰ͘ Neisseria gonorrhoea Ϯϱ͘ EĞŝƐƐĞƌŝĂ ŵĞŶŝŶŐŝƟ ĚĞƐ Ϯϲ͘ EŽƌŽǀŝƌƵƐ Ϯϳ͘ WĂƌǀŽǀŝƌƵƐ Ϯϴ͘ Plasmodium ƐƉƉ͘ Ϯϵ͘ ZĞƐƉŝƌĂƚŽƌǇ ƐǇŶĐǇƟ Ăů ǀŝƌƵƐ ϯϬ͘ ZŝĐŬĞƩ ƐŝĂ ƐƉƉ͘ ϯϭ͘ Salmonella typhi ϯϮ͘ Schistosoma ƐƉƉ͘ ϯϯ͘ Staphlococcus aureus ϯϰ͘ ^ƚƌĞƉƚŽĐŽĐĐƵƐ ŵŝƟ Ɛ ϯϱ͘ Streptococcus pneumoniae ϯϲ͘ Streptococcus pyogenes ϯϳ͘ Toxoplasma gondii ϯϴ͘ Trypanosoma ƐƉƉ͘ ϯϵ͘ sĂƌŝĐĞůůĂ ŽƐƚĞƌ ǀŝƌƵƐ ϰϬ͘ tƵĐŚĞƌĞƌŝĂ ďĂŶĐƌŽŌ ŝ April 2009 z 608 pp z 270 full color illus Paperback: 978-0-8153-4142-0: £30.00

www.garlandscience.com

garlandUK@tandf.co.uk

surgery

Most surgeons do not report needle stick injuries

hree-quarters of surgeons who experienced one or more sharps injuries in the last year did not report them, according to research by The Royal College of Surgeons. The study at three district general hospitals in the UK found that only 25.8% followed proper procedure and reported all of their sharps injuries - perforations of the skin caused by a needle, scalpel or other sharp instrument. When asked why they didn’t, more than a third of surgeons responded that they did not think it was necessary as they considered the patient to be at a low risk of carrying an infectious virus. A further third said they had no time and almost a quarter simply said they were not concerned. “While the probability of acquiring a blood

borne infection remains low, the potential consequences are severe,” warned John Black, President of the Royal College of Surgeons. “In failing to report sharps injuries, surgeons are missing this opportunity for treatment, and masking the true scale of the problem.” A report published in 2003 by the Senate of Surgery of Great Britain and Ireland – an association of all major surgical bodies – recommended that all sharps injuries should be reported at the earliest possible stage, as early treatment can significantly reduce the chance of acquiring some infections, particularly HIV.

GMC Fees frozen for 2010/11

www.rcseng.ac.uk

More chest pain for men John Black President of the Royal College of Surgeons

“In failing to report sharps injuries, surgeons are missing this opportunity for treatment, and masking the true scale of the problem.”

www.gmc-uk.org

Men with angina are twice as likely to have a cardiac arrest as women, according to a study by the National University of Ireland - the first to link primary and secondary care data with mortality records. The study of 1,785 patients also found that although angioplasty (PTCA) or coronary artery bypass surgery (CABG) was also higher in men neither procedure was associated with significantly improved survival. www.bmj.com/cgi/doi/10.1136/bmj. b3058

nhs

Steroids for sore throats

Rise In Homicides By Mentally Ill

A single dose of corticosteroid drugs alongside antibiotics to adults with severe sore throat can relieve pain more quickly and effectively, suggests research published in the BMJ. Metaanalysis showed the average time to pain relief for patients given corticosteroids in addition to antibiotics was reduced by about six hours. The study found no evidence of significant benefit in children.

he number of people killed by individuals with mental health problems has increased between 1997 and 2005, figures from the National Confidential Inquiry into Suicide and Homicide by People with Mental Illness show. The research by the University of Manchester and funded by the National Patient Safety Agency found that there had been an increase in the number of homicides committed by people with mental illness at the time of the offence from 54 in 1997 to over 70 in 2004 and 2005. The rise occurred in people who were not under mental health care and was not found in mental health patients. “It is important to emphasise that the increase has not occurred in mental health patients,” said Professor Louis Appleby, Director of the National Confidential Inquiry into Suicide and Homicide by People with Mental Illness. “It is also important to keep these findings in perspective. The risk of being a victim of homicide in England and Wales is around 1 in 1,000 and the risk of being killed by

The GMC and PMETB have announced that fees for trainee doctors completing specialty training will be frozen at the current levels for 2010/11. It comes as PMETB is merged with the GMC meaning that for the first time, all stages of medical education and training are the responsibility of a single organisation. The merger is due to be completed by 1 April 2010.

NEWS PULSE

www.bmj.com/cgi/doi/10.1136/bmj. b2476

someone with schizophrenia is around 1 in 20,000.” There study found a rise in the number of homicides by people with schizophrenia from 25 in 1997 to 46 in 2004 and an estimated 40 in 2005. The data also shows that the number of patient deaths by suicide has gone down to its lowest level since data collection began in 1997. In 2006, there were 185 fewer deaths than in 2005. The number of in-patient suicides has continued to fall from a high of 219 deaths in 1997 to 141 in 2006. www.npsa.nhs.uk

Not quite an emergency? Call 111 Consultation on a new three-digit number - 111 - to offer advice and information on non-emergency care has been launched by the government. In the long-term, 111 could become the single number to access non-emergency care services in England, including NHS Direct. 999 will remain the number to call in an emergency situation. www.nhsdirect.nhs.uk

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training

Training affected by service reorganisation

ew ways of assessing and reviewing patients can negatively impact junior doctor training, according to a study of acute care at the Royal Liverpool University Hospital. The results, published in the journal Clinical Medicine, show that while waiting times in A&E until assessment by a consultant have improved, restriction of hours prevented junior doctors from being present when the patients they admitted to the wards were reviewed by a consultant. It noted that around half of all diagnoses are changed after assessment by the junior doctor and that the current system has no mechanism “The restriction of junior doctors’ hours means there is less time for consultants to discuss their decisions with the doctors in training.” Dr Solomon Almond Royal Liverpool University Hospital

BMA

New BMA Junior Doctor Chair Elected

hree Datta, a Specialist Registrar in obstetrics and gynaecology at Royal Sussex County Hospital, has been elected as the new chair of the BMA’s Junior Doctors Committee. Shree takes over from Andy Thornley when he steps down after a year in the post on 19th September. She says the impact of the EWTD is one of the key challenges for the year ahead. “The introduction of the 48 hour week has left many junior doctors concerned about getting

training

Student Assistanceships

uture medical students will undertake ‘assistantships’ before entering FY1 as a trainee doctor, according to new guidance issued by the GMC this month. During ‘student assistantship’ blocks they will assist a junior doctor to become familiar with the workplace and undertake supervised procedures. The aim is to help students understand practical

for feedback to the initial assessing team. “The results of our audit highlight the benefits for patients of being seen by consultants soon after admission. However, the restriction of junior doctors’ hours means there is less time for consultants to discuss their decisions with the doctors in training,” said Dr Solomon Almond, one of the study team. “Ideally all emergency admissions would be seen straight away by consultants accompanied by the junior doctors. This would re-establish the link between hands-on clinical medicine, training and experience that was for many years the foundation of post graduate medical education in this country.” The authors noted that hospitals are struggling to balance government targets for waiting times with the new target for reducing junior doctors’ working hours whilst maintaining training. www.rcplondon.ac.uk/pubs/clinicalmedicine/

the training opportunities they need to be the consultants of tomorrow,” says Datta. “It is essential that hospitals, especially those under financial pressures, do not cut back on their obligations to train new doctors in an attempt to deliver services on the cheap. This attitude is short-sighted and threatens our future capacity to provide high quality services to patients.” Shree is joined by Tom Dolphin, Vice Chair of the Junior Doctors Committee, and Johann Malawana, Deputy Chairman with responsibility for education and training issues. A further election will take place on the 19th September 2009 to select a new Deputy Chairman with responsibility for negotiations. www.bma.org.uk

tasks such as filling in a prescription form or ordering a blood sample before their first formal post. The plans are part of a new version of Tomorrow’s Doctors issued by the GMC which provides the framework that UK medical schools use to design their own detailed curricula and schemes of assessment. The report also outlines ‘hard science’ subjects and a standardised list of clinical procedures that students must be competent to undertake before graduation. www.gmc-uk.org

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Royal College of Art

Smart Pods

‘S

mart Pods’ was a two-year study at the Royal College of Art that explored new mobile treatment solutions that would enable healthcare professionals to assess and treat more people in the community, instead of taking them by ambulance to hospital. In the future, urgent response vehicles will not be required to travel at high speeds. The look and feel of such vehicles will reflect a new type of service, which is geared to treating people at home, rather than taking them to hospital at speed. The Shell Concept, by Rui Guo, is a compact and efficient vehicle designed for the delivery of urgent medical capability. The removable ‘shell’ can be deployed to create an expanded treatment space, or left on-scene for extended periods of time. It is equipped with all the kit and consumables required. To accommodate a range of uses the shell is interchangeable: multiple treatment units can be prepared at base ready for immediate deployment. For more information on ‘Smart Pods’ visit: www.rca.ac.uk

Royal College of Art Masters Vehicle Design Project: Shell Concept Designer: Rui Guo Length: 4.4m (6.2m when expanded) Width: 1.7m Height: 1.9m

Medical Emergencies at 30,000ft Settling in for a flight is never the same once you’ve taken the Hippocratic Oath. In the back of your mind is always the fear of hearing the dreaded message asking if there is a doctor on board. But how likely is it that you’ll need to perform an in-flight trachestomy with only a coat hanger? And what assistance can you expect at 30,000ft? JuniorDr’s Ben Chandler finds out.

ramped in a cabin with up to 850 other anxious passengers isn’t the best place to practice medicine. Add in the effects of engine noise, cabin pressure and a limited supply of unfamiliar equipment and it can become your worst nightmare. Unfortunately with an ageing population and greater passenger numbers your chance of facing a medical emergency whilst jetting off on your summer holiday is on the rise. With between 1 and 10 incidents per 40,000 passengers1 it’s a scenario that many doctors will face at some point in their careers.

In-flight emergencies There have been numerous documented medical incidents in the air but perhaps the most famous occurred in 1995 between Hong-Kong and London. A female patient developed chest pain and dyspnoea shortly after take off and was seen by two doctors onboard. Having diagnosed a tension pneumothorax they proceeded to insert a chest drain using brandy as disinfectant, a coat hanger as a trochar and bottle of Evian water as an underwater seal. The flight continued and the patient was eventually seen in a

AVIATION MEDICINE

Commonest Medical Emergencies Inflight

• Syncope • Gastrointestinal disorders • Cardiac conditions • Nausea and Vomiting • Allergy • Accidents • Hypoglycaemia

Federal Aviation Authority, Emergency Medical Equipment Regulations4 • Sphygmomanometer • Stethoscope • Airways, oropharyngeal (3 sizes): 1 pediatric, 1 small adult, 1 large adult or equivalent • Self-inflating manual resuscitation device with 3 masks (1 pediatric, 1 small adult, 1 large adult or equivalent)

Cabin pressure

• Aspirin tablets, 325 mg

Travelling by commercial airliner exerts various effects on the body that can precipitate medical difficulties. The most immediate is the lower ambient pressure which causes a drop in oxygen saturations to around 90% even in healthy passengers. Airline cabin pressures are usually equivalent to 2000-2400 metres altitude, and passengers with underlying heart or chest disease may require additional oxygen to counter hypoxia. Most people experience the expansion of gas in air filled cavities on take-off manifesting as pain in the ears or sinuses but it also has the potential to convert a simple pneumothorax into a tension pneumothorax. Relative humidity is low in the cabin, causing dehydration, worsened by alcohol. The risks of deep vein thrombosis from limited mobility and dehydration are well recognised as the infamous ‘economy class syndrome’.

• Bronchodilator, inhaled (metered dose inhaler or equivalent)

Airline defibrillators

• CPR mask (3 sizes), 1 pediatric, 1 small adult, 1 large adult, or equivalent • IV Admin Set: Tubing w/ 2 Y connectors • Alcohol sponges • Adhesive tape, 1-inch standard roll adhesive • Tape scissors • Tourniquet • Saline solution, 500 cc • Protective non permeable gloves or equivalent • Needles (2-18 ga., 2-20 ga., 2-22 ga., or sizes necessary to administer required medications) Syringes (1-5 cc, 2-10 cc, or sizes necessary to administer required medications) • Analgesic, non-narcotic, tablets, 325 mg • Antihistamine tablets, 25 mg • Antihistamine injectable, 50 mg, (single dose ampoule or equivalent) • Atropine, 0.5 mg, 5 cc (single dose ampoule or equivalent)

• Dextrose, 50%/50 cc injectable, (single dose ampoule or equivalent) • Epinephrine 1:1000, 1 cc, injectable, (single dose ampoule or equivalent) • Epinephrine 1:10,000, 2 cc, injectable, (single dose ampoule or equivalent) • Lidocaine, 5 cc, 20 mg/ml, injectable (single dose ampoule or equivalent) • Nitroglycerine tablets, 0.4 mg

hospital in the UK where she made an uncomplicated recovery2. But before you start revising chest drain insertion it is useful to know that this is one of the more rare emergencies you are likely to face. Most cases are due to exacerbation of pre-existing medical conditions, either from the aircraft effects such as cabin pressure or the stress of flying, or medication problems such as accidentally packing important medication in the hold. Syncope is by far the commonest, making up around 50% of cases. Gastro-intestinal upset and generalised pains are the next most frequent - possibly related to dehydration, alcohol consumption and disrupted sleep. Fortunately many emergencies will be dealt with by airline staff without the assistance of onboard doctors.

AVIATION MEDICINE

Over recent years the amount and type of emergency equipment carried on aeroplanes has been reviewed with many airlines now carrying automated external defibrillators (AEDs). One person who has benefited from this is MP Paul Keetch. In 2007 Mr Keetch suffered a cardiac arrest whilst on a Virgin Atlantic flight from Heathrow to New York.

He was successfully defibrillated and returned to Heathrow for hospital treatment. In a recently published study one major US airline reported 200 uses of AEDs over a 2 year period, including 13 defibrillations. They found a 40% survival rate for VF or pulseless VT arrests - remarkable when you consider the difficult cabin environment.3

Emergency Landings Many of these medical scenarios can be dealt with in the air avoiding unnecessary emergency landings, however in around 1-2% of cases an emergency diversion is necessary. This is potentially a very expensive decision with the overall cost as much as £125,000 to divert a plane.5 If other passengers are left stranded for any reason, then hotel bills and other expenses can increase dramatically. In 1996 a passenger on a Virgin Atlantic flight had a suspected heart attack, and the flight diverted to a small airport in Eastern Canada. However during the landing one of the aeroplanes’ engines was damaged. Nearly 400 passengers (including pop star Gary Barlow) were left stranded for 15 hours at the local curling rink while other aeroplanes were sent to pick them up.6

Support from the ground If called upon to help you are unlikely to be totally alone. On any flight there is approximately a 6085% chance of there being a doctor as a passenger onboard7 and most flight attendants are trained to deal with common medical emergencies. Many airlines also have access to MedLink, the largest medical support service with experienced emergency doctors on hand to offer advice. “In this scenario the medical volunteer assumes a position of being the eyes and hands, helping in assessing and administering medication” says Dr Paulo Alves, the Vice-President of MedAire, who run the service. “The MedLink Physician will have the experience and emotional detachment to help with situation onboard, and help the captain to make the best decision about landing or not.” Medlink is run from Pheonix USA, and is staffed by emergency

doctors with training in aviation medicine. They deal with nearly 100 cases per day. As well as supplying medical knowledge they also have access to a database of medical resources and details of runways around the globe, so they can advise on the most suitable diversion should it be necessary. Interest is now growing in telemedical devices which will allow vital signs, ECG and other data to be transmitted to staff on the ground. This technology has already been taken up by several airlines.

Good Samaritan Acts Many doctors have concerns that they could potentially be the subject of medico-legal action arising from their decisions during an aeroplane medical emergency. The legal position is complicated as it is different in different countries. Despite this the GMC and BMA stance is that doctors should assist if required. Indemnity against prosecution may be offered by the airline, but this may depend on whether you were asked to help. Both the MPS and MDU cover their members for actions taken while on a plane. The MPS suggest that before getting involved doctors should clearly state their competencies and skills, as well as other factors that may affect their performance, such as alcohol.8 So if you ever hear those dreaded words over the airline tannoy, keep in mind to do simple interventions, recognise your own limits, and in most cases there should be help of some kind available.

References 1. Surgical ad Medical emergencies onboard European aircraft. Sand M, Falk-Georges B, Sand D, Mann B. Critical Care, 2009. 13:1 2. Managing in flight emergencies. Wallace W. BMJ, 1995;311:374-375 3. Use of Automated External Defibrillators by a U.S. Airline. Page R, Joglar JA, Kowal R, Zagrodzky J, et al. NEJM, 2000; 343:12101216 4. Federal Aviation Authority Advisory Circular, 2006. www.rgl.faa.gov 5. How much does an airline diversion cost. Martin G. www.gadling.com 6. Unexpected Arctic stop for Brits, Yanks. Van Rassel J. Nunatsiaq News 1996. 7. Health Issues of air travel. DeHart R. Annual Review of Public Health, 2003; 24: 133-151 8. Flying doctors: is protection plain. Williams S. Casebook 2008; 16: 8-11

Is there a doctor on board? At thirty thousand feet and four thousand miles from the nearest medical support it’s the last place anyone would want to take ill. Over the loudspeakers a call goes out asking for a medical doctor on board. From that point onwards the care of one man with chest pain and the decision to divert four hundred passengers rested with junior doctor Krish Vedavanam.

t all started with a ham sandwich, Dr Vedavanam told JuniorDr. It was November and I was flying from London to Toronto for the wedding of a close friend who had been on my GP training scheme. With me were two other junior doctors - a paediatrician and a general physician. Arriving at Heathrow we found our Air Canada flight delayed by five hours. After some time complimentary food arrived in the form of a ham or egg sandwich. Sitting opposite us in the terminal were a Muslim couple. I could tell as the woman was wearing a hijab. I looked at her, then at the ham sandwich, and said, “Are you sure you ought to be eating that?” She looked back blankly clearly not understanding. “Pork!” I said in a loud voice pointing at the sandwiches. Her husband responded and thanked me with some broken English. I gave them my egg sandwich but not the cereal bar - it was full of sugar and I was sure they were both diabetic. They were really grateful for the sandwich. Later the man came up to me again and asked if he could phone his son in London, which he did. Finally at 9pm we boarded the plane. I was very tired and fell fast asleep just after take-off.

Is there a doctor on board? Three quarters of the way into the journey, still in a daze, I heard the dreaded phrase over the loudspeaker - “If there are any medical doctors on board could they please make themselves known to the cabin crew”. My friend had also heard the message and had got up. I followed her. Towards the back of the plane we found the man who I had given my egg sandwich to before the flight. He was complaining

of central chest pain and looked generally unwell. After my communication problems at Heathrow I was a little concerned about the ability to understand what was happening. Luckily there happened to be an Urdu speaking air stewardess onboard - the only one in Air Canada. The gentleman told us that he was a cardiac patient and had chest pain at rest before starting his journey to Canada. Before stopping in London he had been in Saudi Arabia where he was given low molecular weight heparin and had been told to take another dose when he got off the flight - which I’m sure you’ll agree this was already a little worring. As he was already taking beta-blockers and GTN patches we tried another patch but there was no improvement. With difficulty we laid him down flat behind one of the bulkheads in the plane and gave him highflow oxygen and treatment dose aspirin. His wife was terrified throughout. She was scared he was going to die and, because of the language barrier, there was very

AVIATION MEDICINE

little we personally could do to reassure her. Although his observations were stable the pain was still not improving. The airline medical kit, although containing items like morphine, didn’t have a BM monitor. We had to put an announcement out for any passenger with a BM kit to come forward. Luckily someone did, but rather embarrassingly we had to call them back for a second time to explain how it worked. As he was still in acute pain we decided to obtain IV access and gave him morphine. Dr Krish Vedavanam

“Diverting a jumbo jet is a pretty big decision to make when you know it will affect the other 400 people on board.”

Diverting the plane It was at that point we were asked to make the decision on whether to divert the plane. Diverting a jumbo jet is a pretty big decision to make when you know it will affect the other 400 people on board. We had a working diagnosis of acute coronary syndrome and decided that he needed medical treatment as soon as possible so informed the crew. The cabin crew had been great throughout the flight, efficiently helping in whatever way they could. The plane was diverted to Newfoundland, the most easterly point of Canada. It took a further two hours to reach there. Luckily the gentleman was stable throughout the reminder of the journey. Whilst other passengers and the cabin crew were strapped in on the landing we weren’t. As the plane came into land we were still with the gentleman trying to keep him comfortable - it was a strange experience. On touching down in Newfoundland we were met by paramedics who stretchered the gentleman off the plane. He remained stable and was quite comfortable at this point. His wife went with him. After he had been ‘unloaded’ the pilot thanked us and the passengers applauded. It was a good feeling, not just the appreciation but also the relief of getting him to safety. Although he had remained stable throughout we always had a fear in the back of our minds that he could deteriorate at any time - not something you want to happen when the nearest hospital is

AVIATION MEDICINE

three hours away and you have 400 people watching.

Back in the air Less than two hours later we were back in the air and continuing on our way to Toronto where we landed safely. Looking back the entire incident went smoothly. I do however understand how stressful it must be for doctors when someone takes more seriously ill - especially if they don’t have colleagues to help like we did. After our experience I definitely feel all planes should carry a full doctor’s bag, as the onboard medical kit lacked some key items. Although, I think most doctors wouldn’t hesitate to help in a similar situation, I feel it’s also really important to make sure you’ve got medical indemnity insurance for Good Samaritan acts. As far as I am aware the gentleman recovered. We went on to our wedding slightly late but it was still an amazing day. Fortunately our return flight to London was less eventful with no more dreaded announcements over the speakers. This time I slept soundly throughout.

Flight facts • Medical emergencies are the most common reason for diverting an aircraft. • 75 per cent of medical emergencies among passengers take place whilst still on the ground. • 1 passenger per 40,000 need emergency medical assistance in-flight. • Items falling from overhead lockers represent 6.3 per cent of incidents requiring treatment. Wallace WA. Managing in flight emergencies. BMJ 1995; 311: 1508 Cummings RO, Schubach JA. Frequency and types of medical emergencies among commercial air travelers. JAMA 1989;261:1295-9

Flying doctors Treating a patient on a plane is no easy task, says Sara Williams, MPS Writer. Should a doctor play the Good Samaritan at 30,000ft? Air travel is booming – rising at a rate of 3-5% each year, as budget airlines make it increasingly attractive to those who can live with the size of their carbon footprint. According to British Airways, one consequence of this is more sick, elderly and vulnerable people flying further and more frequently. So what does this mean for you when boarding a plane for a two-week respite? There is more chance that your skills will be called upon in a medical emergency on a plane – one in 15 flights will experience some kind of medical incident. Probably the most famous example of a doctor assisting in an in-flight emergency was consultant orthopaedic surgeon Professor Angus Wallace, who hit the headlines when he operated on a woman suffering from a tension pneumothorax with a coat hanger, a plastic bottle and a roll of sellotape on board a flight from Hong Kong to London. Although this was an extraordinary case, which roused much debate in the medicolegal world, it was a rare one. Cardiac and respiratory problems account for only 5% of the problems reported to British Airways aboard their aircraft. The most common problems are gastrointestinal and neurological (20%).

The key thing to remember is to work within your competence wherever possible; in the eyes of the law, those working outside their skill and training are harder to defend. However if the situation is critical, where the patient is at serious risk if no intervention is made and there is no one better placed to intervene, then a doctor may need to treat outside their immediate area of expertise. In these circumstances you simply need to do the best you can, not achieve the standard of an expert in the field. Help can come from a number of sources: one of the most important is Medlink – a telemedicine service attached to a trauma hospital in Phoenix, Arizona. Equipment is used to measure the baseline medical signs in an in-flight emergency, such as the ECG and blood pressure, and the information is transmitted to Medlink. BA was one of the first major airlines to subscribe to Medlink and now instructs its crew to report all medical incidents. When it did this the number of incidents recorded went from 3,000 to 20,000. Medlink takes 2,500 calls from air crews every year. This equates to one in every 14,000 passengers, or one in every 160 flights.

Should you intervene?

Waking up to the resounding call on a plane “Is there a doctor on board?” you would immediately think “Should I intervene?” The GMC would say yes, as although you have no legal duty to do so (in UK law), you have an ethical and a professional duty to help. MPS advice is to do the best you can in the circumstances with the resources available. By responding to the call you have taken on the role of a Good Samaritan. MPS will assist you with the problems arising from a Good Samaritan act anywhere in the world – whatever jurisdiction you’re flying in. Before proceeding: Consider whether any factors might be compromising your competence (alcohol, medication and tiredness). Understand that you will normally be assisting experienced flight attendants – so don’t try to immediately take charge. During the emergency: Take a full history and carry out a full examination in order to make an informed assessment. Suggest options for managing the situation (balance benefits and risks of treatment). Work within the confines of your expertise and training, except in a critical emergency. Delegate and communicate appropriately.

Officially, a Good Samaritan act is where medical assistance is given, free of charge, in a bona fide medical emergency, upon which a doctor chances in a personal as opposed to a professional capacity. Examples include: roadside attacks and in-flight medical emergencies.

MPS’s five Cs Clinical competence – taking account of the limits of your competence and safety is paramount. Clinical negligence – standard of care in the UK is set by the Bolam test (test that expects standards in accordance with a responsible body of opinion), so a doctor is not negligent if they acted reasonably. In an emergency a doctor is only expected to do what could reasonably be required in the circumstances, and not to perform to a level of expertise they do not have. Communication – inform the crew and the patient of the limits of your competence, experience and qualifications. Consent – the principles of consent must be applied. Case notes – a Good Samaritan act is a clinical intervention, so make a full clinical record before handover. Junior doctors should not be afraid of encountering an in-flight emergency, but be aware that walking on by, or staying in your seat, is not an option. Knowing what protection is provided before flying will ensure peace of mind, and lessen the opportunity of panic should your skills be required.

MPS professional support and expert advice 24-hour medicolegal emergency advice line Medicolegal publications – Casebook and New Doctor Risk Management materials including medicolegal booklets

Online resources including factsheets and case scenarios Educational support through discounts with leading publishers Largest international defence organisation

For more information call 0845 718 7187 Or visit www.mps.org.uk The Medical Protection Society Limited. A company limited by guarantee. Registered in England No. 36142 at 33 Cavendish Square, London W1G 0PS. MPS is not an insurance company. All the benefits of membership of MPS are discretionary as set out in the Memorandum and Articles of Association.

MPS0900

Get Fresh

Starting medical school guide

Medical school can be a scary place. There’s the dissection room, angry hospital consultants and the student union bar on a Wednesday night. But don’t go running for home just yet. With the help of medical students and doctors who have been there before we’ll tell you how to survive in the land of colonoscopy clinics, cardiac vivas and neuro MCQs. So put on that white coat, swing a stethoscope round your neck and step out into the big bad world of becoming a doctor. We start with the essential induction to your new life. Trust me I’m a doctor

Make friends

Ask most patients what a ‘medical student’ is and they’ll screw up their eyes in confusion. Patients see you trailing around after the real doctors in your smart white coat and often view you in the same medically qualified club. As such you’ve unwittingly become a privileged member of society’s most trusted profession. As a medical student you’ll spend more time with patients than any other person in the team. You’re in that middle-ground between being a member of the public and a medical professional. Patients won’t find you quite as scary as a proper doctor and you’ll be making an extra special effort to suck up in order to take their medical history. Because of this they’ll tell you things they’ve never told anyone and you’ll witness grown men break down in tears behind that thin, flimsy cubicle curtain. It’s all part of becoming a doctor - and a good one at that. Just don’t abuse it. Patients trust you with this information and you’re legally bound to confidentiality. So no blabbing about it down the pub, it could be the patient’s relatives at the next table. Medical students have been kicked out of medical school on a number of occasions for abusing this - and they’ve no defence.

Whether you like it or not you’re going to be stuck with that big hairy guy who picks his nose for at least the next five years. There’s also a high probability that you’ll end up marrying one of those drunken idiots who vomited over you during freshers week. You need to remember that medicine is a team sport. Refuse to play ball with your colleagues and your performance and experience will suffer. Medical school isn’t a competition, you either pass or fail - and the pass mark has already been set. It’s better to drag your buddies with you when you pass the final exams rather than fall flat on your face when you attempt to go solo.

How to spot a fresher

1 2 3

Can be spotted fighting over free tins of beans at freshers fairs.

4 5

They turn up to all lectures - even those that aren’t compulsory.

Conversation over lunch includes topics other than resection of the small bowel. Jump at the chance to sign-up for clinical trials to earn a fiver being injected with the Ebola virus.

Commonly throw up in the tube/taxi on the way back from the union.

MEDICAL STUDENTS

Work hard, play hard Unlike those other students studying embroidery or pole dancing, you’re going to have to do some hard studying during the course. You’ve made it to medical school which proves you’ve got a few brain cells - but don’t let this go to that straight-‘A’ head of yours. Medicine is one of those subjects which trumps the ‘A-levels are the hardest exams you’ll ever do’ line - in fact, it rips this theory to shreds, throws it on the ground and stomps all over it. Medicine is tough and there’s no escaping that.

A first year med student can be spotted more easily than a baby with chicken pox. Here’s what gives you away.

6 7

Borrow every book on pathology from the library so no ‘proper’ medics can use them to revise for path exams. Appear to drown when trying to do a ‘funnel’.

8 9 10

Clothes are badly stained with fat from the dissection lab. End up on the floor after watching a surgeon make the first incision. Still want to be a doctor because they ‘care deeply about mankind and want to repay their debt to society for their pitiful existence’

Fresher Translation Guide

hought a ‘fresher’ was a kind of fizzy sweet? Or that you only had one ‘mummy and daddy’? Think again. Freshers week is the maddest, most fun, least slept seven days you’ll have at uni. Let’s first start with the basics. Here’s the translation guide you’ll need to get through those first few weeks. Fresher also known as – freshman, ‘fresh’ student Similar to ‘fresh milk’ - innocent, unpolluted and doesn’t mix well with alcohol. Refers to all new first year students. See opposite for a guide on how to spot one. Although technically the nametag ‘fresher’ should only persist for those first few weeks you’ll mostly likely be branded it for the entire first year - or longer if you’re extremely incompetent and uncoordinated. Mummies and daddies also known as - student parents During freshers week you may be allocated a ‘mummy’ and/ or ‘daddy’. This doesn’t mean you’ve unwittingly put yourself up for adoption. They’re ‘student parents’ who are there to guide you through the transition into the big bad world of university life. They’re great for advice on which events to go to, which clubs to join and for borrowing lecture notes and exam papers.

But don’t get disheartened if you only scraped into medical school by the skin of your teeth and the number of zeros on daddy’s cheque to the alumni association - you don’t need to be a whizzkid to pick up a MBBS. A little common sense and good organisation is all you need. Medicine is a practical subject that requires lateral thinking and it’s the straight ‘A’ students who often struggle. The easiest way to fail is to fall behind with the curriculum. Remember that we’re learning about the human body - everything is linked. If you miss that lecture on the science behind gastric acid production then the GORD workshop will leave you with a burning pain in your chest - and you won’t understand why. Keep on top of the work and you’ll be fine. This means occasionally being prepared to ditch drinking games at the union for a night with your head in the books.

Get involved You may not be keen on chasing after a ball on the rugby pitch, or testing your tactics in the chess team but that’s no excuse for not getting involved in uni activities. It’s very unlikely that you won’t find at least one club or society that interests you, and in that rare case you can easily set up your own. Joining a club isn’t just about improving your ball passing ability or checkmating skills, it’s all about making friends and being part of university life. With the team environment of medicine and being away from home you’ll need all the friends you can get. Throughout your career you’ll realize that medicine is as much about who you know as what you know.

Unlike your real mum and dad though, it’s highly unlikely they’ll offer to do your ironing or give you pocket money. Doing a funnel Not exclusive to medical students but we’re the only ones who understand the physiology behind it. A ‘funnel’ is a plastic tube (like a hosepipe) ideally less than 5cm in diameter with a funnel attached to one end. Done properly it involves crouching down, inserting the end of the plastic tube into your mouth while your rugby club buddies pour half a crate of beer into the funnel at the other end. Thanks to the power of gravity you’ll be able to consume the same amount as the entire team in a matter of seconds. Unfortunately on most occasions it all comes pouring out again thanks to projectile vomiting or the stomach pump in your local A&E department. Freshers Fair Nope, it’s not where you get auctioned off to the highest bidder, or a chance to ride on the merry go-round. The fresher fair is your opportunity to find out about which clubs and associations are available in your university. There’ll also be loads of big firms offering you freebies and harassing you to sign-up for bank accounts and credit cards. You’ll end up leaving weighed down with free popcorn makers, CD vouchers and more bank accounts than a major international money laundering operation. Freshers week is the time when you’ll meet more potential doctors than any other. Work the crowds and get involved. Remember that students in the years above will be doctors soon. They’ll be able to bail you out of trouble, not just when you’re an incompetent student, but when you’re an incompetent doctor and they’re your boss.

A little respect While other students will be playing with PCs we medical students get to play with people’s lives. Patients are often scared, in pain and may even be terminally ill. Put yourself in their position, treat them as you would want to be treated and you won’t go wrong. Watch out for the difference between consultants who treat patients like real people and those who think they’re just a piece of meat. Learn from it. By the time you finish medical school you should have a list of doctors who get the respect of both you and the patients, and a list of those who you wouldn’t want to treat a member of your own family. When you reach consultant grade you’ll want medical students to talk about you down the pub as a ‘great doctor’. That’s when you’ll know you’ve finally made it. You’ve got around twenty years to become this fantastic individual so start moulding yourself now.

Practice makes perfect Unlike A-levels your medical exams will test your practical skills and not just your academic knowledge. Sucking up pints down the union when you should be practising sucking up blood may appear the better option at the time but could land you in trouble in a few years.

MEDICAL STUDENTS

Get Fresh

Starting medical school guide

Sure, it’s difficult trying a new practical procedure, especially when it involves sticking sharp things into little old ladies but unless you force yourself to overcome this fear now you’ll struggle even more in the future - and no-one wants to be a venflon virgin forever. Watch someone experienced first and get them to talk you through the procedure. It doesn’t need to be the head of the anaesthetics department, one of your brave buddies is often a better bet as they can point out the areas where they struggled themselves. Most medical schools and placement hospitals have a clinical skills centre where you can practice procedures. Dummies don’t care if it takes seventeen tries to get an arterial blood gas sample. Ask at the centre for training workshops or times when you can practice by yourself. Always remember that it’s not just getting the needle in the vein

that’s important, there’s going to be a terrified little old lady attached to it. You’ll need to hold a conversation about her granddaughter’s new baby whilst maneuvering that piece of metal in her arm. Just like riding a bike, practical procedures become easier the more you do. You’ll soon be able to simultaneously extract blood and recall all eight grandkids in order without any trouble.

Enjoy it The last and most important point - enjoy it! You’re one of only a few thousand students accepted into medical school each year. With electives, the best student events and an almost guaranteed job at the end, your life’s looking great already. Live it up!

Living in halls You’ve just moved into the thirteenth floor of halls. Your room is the size of a matchbox. The person next door plays music so loud that cracks are forming in the wall and someone’s stealing your milk. Don’t panic! … here’s some advice. Label your food If you have to share a kitchen then get your initials on your grub. There’s nothing more irritating than finding someone has eaten your pack of choccy biccies by mistake. Be open minded You’ll meet a greater diversity of people than ever before. You’ll have to share your living space, the kitchen and even the shower. So what, they might eat Coco Pops for breakfast but the fact that you eat Ricicles isn’t exactly normal either! Don’t hide in your room The hairy guy in room 13 may be frightening but staying in your room isn’t the answer. Get out and meet people. Your first year in halls is the easiest way to meet other medics. If you don’t push yourself to meet new people this term you’ll regret it later. Sort out any problems If you’re slowly going deaf because of the loud music played by your neighbour confront him about it. Don’t shout, yell or throw your dissection scalpel at him. Offer him a cup of coffee, explain calmly the problem and invite him to hear how loud the music is himself. Shower power If one of your floormates spends 45 minutes in the shower each morning shaving his/her legs then here’s a trick to get them out. Most of the water outlets on each floor are connected so turn off and on the hot or cold taps in the sinks or showers. The water going from stifling hot to freezing cold should speed him up.

MEDICAL STUDENTS

The clean team Share the laundry load. Team up with a mate and do a mass of laundry at one time. It’ll save you a fortune and you’ll have someone to hang out with while the machine goes round and round and round ... just keep your red boxer shorts out of her whites. Remember to hang your CK pants up right away and you might just escape the need to iron them. Don’t shop till you drop Save yourself the torture of dragging five tons of shopping back from the supermarket by getting it to come to you. Get together with the rest of the guys on your floor and order your beer and pizzas online. Enter you shopping list at Tesco.com or Sainsburys.com and they’ll cope with all the trolley trauma. As long as you request it they’ll bring it right to your floor … so your don’t even have to change out of your PJ’s! Sort problems soon If you do have any problems about living in halls get it sorted straight away. There’s no point letting things get you down. The staff in the student accommodation office have dealt with every conceivable problem so don’t feel embarrassed.

Sucking up with style Soon you’ll be swinging your stethoscope round your neck and venturing into the big bad world of hospital life. Here’s how to look both cool and clever ... Imagine this When your consultant can’t distinguish you from an RTA victim that’s been trailed through an articulated lorry sideways, there’s a problem. “Image is everything,” says Deborra Radcliffe, a professional image consultant. “Looking smart and dressing professionally can actually make you appear more intelligent than you actually are.” Male magic “For men, wear a shirt and tie that complement each other with the same colour shades,” suggests Radcliffe. If you’ve less colour sense than a blind patient without a guide dog, high street chains such as Next and Debenhams sell pre-packaged matching combinations. “Shirts with cufflinks will improve your ranking but only if you wear a jacket or white coat on top.” Pokemon ties are only acceptable if you’re doing paeds … or if your consultant has the mental age of a five-year-old. Winning as a woman If you’re a woman, forget the skirt advises Radcliffe, “Women who power dress are taken more seriously.” For women who

have a soft voice and mild manner, wear darker colours to appear more confident. “Students who ooze confidence should choose paler shades to help you take advantage of your womanly side - it will make you appear more in touch with the patient’s perspective.” Role play Making small talk with a patient about haemorrhoids can often put you in more pain than they are. The fear of talking to someone for the first time is all about being scared of the unexpected suggests Radcliffe. “Having a practised introduction when you meet a new patient can help you through this difficult period,” she advises. “The first 30 seconds of conversion is the most stressful and yet the most important for making a positive impression.” Practise your speech and face expressions in front of a mirror, she suggests. Escaping embarrassment Examining semi-naked patients can be an uncomfortable experience even for the most confident. You need to distance yourself from the reality of the situation suggests Radcliffe. “There’s nothing unnatural about nakedness - it’s just the human emotions we’ve attached to it,” she explains. “Treating the consultation in a purely clinical way is one way to deal with this. Removing the concept of the ‘person’ from the ‘body’ often works.”

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03/08/2009 17:12

Secret Diary of a Cardiology SpR Monday If you’ve been following this column you’ll realise that I had accepted a consultant post and was on the verge of starting work. Douglas, my boss and unofficial mentor, offered me a way of delaying for six months by finding me an interventional fellowship in Australia. I pondered it for a while and then declined. Instead, I found a position myself. In California. Rounds here begin at 6.15am. And the day doesn’t get any smoother than that. After a radiology meeting with two black coffees and a skinny blueberry muffin (not my first choice but I’ve decided to copy everyone else out here) we go to CCU to see what came in over the weekend. Although I don’t have any on call commitments during these six months I’m still expected to act as a senior resident (think final year registrar) on the wards in between my interventional work. By 8.30 I’ve had a third coffee and am now ready, albeit a little shaky from the caffeine, for a day of intervention under the watchful eye of my boss James Kawani, a very slim and very bronzed Hawaiian surfer (I kid you not) with a fantastic technique when it comes to stenting the left main stem. A full day of this, followed by lengthy rounds of the cardiac wards, leaves me shattered and I get back to my apartment around nine. I fall asleep on the sofa in front of the television.

Tuesday The morning is spent teaching at the university. I give a lecture on cardiac anatomy to a hall full of second year medical students who seem to know a surprising amount and ask some proper questions. I then have a bedside teaching session with five final years. I push them hard until I realise that we’re going through it as if they were sitting their MRCP. I bring it down a notch and they visibly relax. Hopefully the rumours of the mad English doctor who cracks the whip haven’t spread too far. I spend the afternoon reviewing patients with my team and teaching a couple of juniors about echos. Again, they prove to be pretty knowledgeable. I wonder if it’s my own prejudices about American (or in fact anyone other than British) graduates that have lowered my expectations. I mention it to James who smiles. He asks me what I’m doing on Thursday afternoon and my reply of ‘doing rounds’ makes him laugh out loud. He tells me to keep it free.

Wednesday The usual start but this time I choose a full fat chocolate chip muffin. This draws a couple of looks from some of my colleagues who are no doubt counting the calories that I gulp down. More time in CCU, this time with a sick patient who needs an angioplasty so we take her straight to the lab. I spend the rest of the day learning to play with a new piece of kit which helps inject the dye into the coronaries a little bit better. Very neat but I’m not sure it’s worth the extra £30k. The afternoon goes by quickly seeing patients and I go home early. It’s a resident’s night out in a local bar so I have a long shower and get changed into something reasonably hot before heading out. I spend the evening downing shots of vodka whilst letting a neurology resident get a little close. It turns out neurologists in this part of the world aren’t as geeky as their counterparts back home. He invites me back to his but I decline and go home alone and a little more than drunk. 18

SECRET DIARY

* Names have been changed to try to keep our cardiology SpR in a job - though she’s doing a pretty good job of trying to lose it without our help!

Thursday A major hangover is compounded by the lack of full fat muffins on the trolley so I settle for two of the skinny variety. We rush through rounds and some more bedside teaching and after a few coffees and a bacon sandwich I start to feel better. After lunch James swings by and asks me if I’m ready. I can’t work out if this is a date or a teaching session but have worn something that would be appropriate for both. We head to his car and he drives ten miles downtown into an area that is as deprived as any I’ve seen. We stop outside a drab and dilapidated building and it is only after we enter that I realise that we’re in some sort of hospital. We’re here to run an inner city clinic. The attendings at the university have set this up and they take it in turns to run two daily sessions. Thursday afternoons is cardiology and it’s James’ turn to pitch in. We take a room each and begin seeing patients. After half an hour I realise that as fantastic as the care uptown is, for those without health insurance it is approaching that of a developing nation. Patient after patient needs an angiogram but can barely afford the Lasix (furosemide for me and you) let alone the procedure. We do what we can and then head out for a drink.

Friday James calls my cell on the way in and tells me not to bother with radiology and rounds. I knew that Friday had a session called ‘wave’ but I assumed this was some sort of new ECG technology. I’ve done a little surfing before and as I get to the beach James hands me an old board and a wetsuit. Much of the team are here, from the portly chief attending to the sprightly young medical students attached to the team. We spend an hour splashing about as the sun comes in over the Pacific. We head back to the beach, shower and get changed before all heading to a breakfast place overlooking the ocean. I wolf down some scrambled eggs with salmon on toasted muffins. An intern presents the patients from the night and we make tentative management decisions before going in to see them. We laugh and joke and James tells the others about our clinic yesterday. I try to defend our own antiquated health system and my stance about all patients getting an angiogram at the expense of hardly anyone getting a cardiac CT or MRI draws a few nods of approval from the older attending who have worked in their system for too long. I sip my orange juice and watch as a young couple meander down the beach towards the surf with a little dog in tow. I could get used to this place.

Weekend Ward Escape to

Ljubljana A city which few can pronounce and even fewer can locate may not sound the ideal location for a few days retreat after MRCPs. Surprisingly though, Ljubljana is the hidden gem of the EU accession states. It’s got more museums per population than anywhere else in Europe and is packed with riverside bars and restaurants – plus, where else can you return to Monday’s ward round having spent the weekend in prison and enjoyed it! Ljubljana is tiny for a capital city. It’s the size of Nottingham, the British city with which it is twinned, but with students making up a staggering fifth of the population it can feel more like a ghost town if you are wandering around in summer. Underneath this emptiness is an enthusiastic attempt to appeal to new European tourists clutching their shiny mauve passports. Ljubljana now has more museums per head than any other city in Europe. There’s also a reported 10,000 concerts per year and 12 international festivals.

Hostel Celica (www.souhostel.com) is a converted prison with each “cell” designed by a different architect. It’s chic and stylish and costs just £20 per person per night. Doubling as an art gallery you’re obliged to let visitors peer through the cell door bars during the day. Breakfast is served outside, there’s a meditation room and free internet access too. The city centre is a 5 minute walk away. If you don’t fancy a short stay behind bars the three-star City Hotel is a good option (web.cityhotel.si) right in the centre. Rooms from around £70 per night.

Key attractions Tromostovje (Triple Bridge) - Marking the centre of Ljubljana this is the feature that appears on postcards. It is literally what it’s called - a ‘triple bridge’ - and an impressive one at that. Moderna Galerija (Museum of Modern Art) - Stunning exhibits with lots of projects based around the past

To date Ljubljana hasn’t been overrun with loud, beer-swilling stag parties. Compared to the new EU cities of Prague, Riga and Bratislava it appears on the surface more upmarket and locals welcome visitors in well spoken English.

conflicts that led to the breakup of Yugoslavia in 1991. Definitely worth a visit.

Nightlife Cafe Galerija, Mestni trg 5 - Definitely the trendiest bar in Ljubljana. Candles light the path to a Middle Eastern style bar with vast couches and adorned with curtains everywhere. Levstik, Levstikov trg 9 - If you’re looking for a more original Slovene experience try Levstik. With broken walls it’s pretty grotty but has great food and beer! Find the full Ljubljana guide at JuniorDr.com.

Key facts • Population - 280,000

Where to stay?

• Language - Slovene

There are nearly a hundred lavish hotels in Ljubljana offering concierge style service with all the latest hi-tech offerings and flatscreen TVs. But don’t stay there - Ljubljana is one of the few cities where you can stay in a prison.

• Currency - Euro • Slovenia has only existed since 1991 • Slovenia has the lowest rate of marriage of all the countries in the EU

Assessed by Gil Myers

Medical Report

DUMBO

e may believe that an elephant can fly but I believe that he may be suffering from a number of different conditions.

Fragile X Syndrome The picture I get of Dumbo’s life is one of psychogenic muteness, repetitive behaviour (the same jump into the bucket of pie filling every night), social anxiety, peer teasing and difficulty with physical feats - most recently the elephant pyramid disaster resulting from poor muscle tone. This, coupled with his appearance, suggests the possibility of Fragile X syndrome - a genetic disorder caused by mutation of the FMR1 gene on the X chromosome. It would also explain why Dumbo’s mother was so secretive about his birth using a stork delivery service rather than a hospital to avoid questions which may have been raised regarding her family history.

Temporal lobe aneurysm

Across:

4 The recumbent position (9) 5 Name associated with syndrome of rheumatoid arthritis plus

necrotic lung granulomata (6) 7 Pyrexia (5) 9 Inner longer bone of the forearm (4) 10 Acute confulsional state (8) 11 French surgeon associated with ulcer that develops at the edge of a chronic skin ulcer; usually venous (8) 13 Third stage of mitosis (8) 15 Schisotosomiasis (12) 16 Blind-ended air-sac of microscopic size in lungs (8) Down:

1 Boeck’s disease; characterised by appearance of granulomata (11) 2 Long thin outer bone of the lower leg (6) 3 Commonest type of thyroid neoplasia (9) 6 Gingiva; chewy sweets in variety of flavours (3) 7 Licensed antidepressant for under-18s (10) 8 Ringworm (5) 12 Functional obstruction due to reduced bowel motility (5) 14 First cervical vertebra (5) 15 Name associated with irregularly shaped cells occurring in uraemia; hole in the head (4) 17 Disease caused by Borrelia burghdorferri (4)

You can find the crossword solution by searching for ‘crossword answers’ at www.juniordr.com.

HOSPITAL MESS

At various points in the documented life of Dumbo he begins to hear others singing rather than speaking to him. Although that could be a purely escapist fantasy to avoid confronting his own mundane dilemmas it would be remiss not to think about the possibility of these being auditory hallucinations (defined as sensory stimuli in the absence of external sensory stimuli). A CT should be requested as a matter of course although it would be a challenge to accommodate him in a scanner.

Vertigo A belief that you can fly is, more often than not, incorrect. Even given his enlarged ears it is near impossible that Dumbo can lift his own body weight off the ground. Add to this the physiological impracticality of “flapping” ones ears and the result is that we must assume that Dumbo cannot actually fly. We are therefore left with an assumption that Dumbo experiences what could be misinterpreted as “flight” - the sensation of swaying while the body is actually stationary with respect to his surroundings. Inner ear problems are often the cause of vertigo as they act to effect the balance mechanisms of the vestibular system - more likely given Dumbo’s distended auricular protuberance.

Schizophrenia All of these symptoms could be brought together in a single diagnosis: schizophrenia. Dumbo reports auditory hallucinations, visual hallucinations and delusional beliefs about flying and his famed destiny. There is a suggested family history of odd behaviour: when Dumbo’s mother assaulted those teasing Dumbo she is judged to be “mad” by the other circus performers (and locked away). There is a strong genetic component to schizophrenia making the diagnosis more likely. A trial of antipsychotics may be in order - I would suggest Seroquelephant.

Writing in the Notes Team American

still tired

hear that we’ve Dear Editor, e EU! I’m glad to th r fo rs ee ch e keep patients Thre orking hours to w ith w ss re og merican junior made pr last issue that A ur yo in d te no 80 hours per safe. I ng an average of ki or w ill st e ar s about reducdoctors w making noise no ly on e ar d hours (‘No way week an ep from 30 to 16 sle t ou ith w e ctor hours Iss 13 ing tim in US junior do n io ct of du re r fo to pay’ of the dark ages K is finally out U e t th en e tm lik ar el ep fe the D p5). I ons - hurray for iti nd t ea co gr ng a ki e or at plic poor w Obama can re ly ul ef e th op H of . e lth sid other of Hea e NHS on the th e lik e. em tim st e sy m health es at the sa prove doctor’s liv Atlantic and im

Jay Gurinder y ST1 Psychiatr

Colleges are doin

g their best

Dear Editor, I am writing in response to the anonymous lett criticising the la er ck of support fo r the EWTD by Royal Colleges the (Colleges unrepr esentative Iss 13 I feel it is impo p21). rtant for the au thor to remembe one of the roles r that of the Royal Col leges is to maint and set professio ain nal standards fo r higher training position that th . Th e Royal College e of Surgeons, am others, has taken ong supports the need for trainees to ha adequate experie ve nce to maintain safe practice. I agree that the co di sllege is not repr esenting some of members. I hope their you will realise that they are ta this stance for th king e benefit of the speciality and al members, both l their present and in th e future.

Dr Sajid ST3 Anaest

hesia, Notti ngham

Women worries l?) juxtaposiDear Editor, al (or intentiona nt de ci ac e th ths of women I note les about the pa tic ar o tw e th mmitted to tioning of t docs remain co os (M S H N e come majorthrough th d Women to be an s ar ye 25 r te e discontinuthe NHS af 13 p6). I find th s Is 17 20 r te af e to outnumity of docs women are clos lst hi w at th g one-third of ity worryin still only occupy ey th s or ct do e in the othbering mal despite, as stated is is Th s. st po similar career consultant women follow d an en m at th ress to make. er article, have some prog ill st e w s ar pe paths. It ap ghes Siobhan Hu GP Registrar

‘Writing in the notes’ is our regular letters section. Email us at letters@juniordr.com.

hen your hospital food tastes like the remnants of a liposuction procedure and the price bears more resemblance to the cost of a PICU incubator things start to take the biscuit. Here’s our regular column of the best and worse hospital essentials you’ve reported:

Ready salted crisps

Enough to make you choke at:

80p

Chase Farm Hospital, London

Just watch your arteries at this price:

40p Hot chocolate (small)

Woodend Hospital, Aberdeen

Burns your wallet as well as your mouth at:

£1.80

Royal Free Hospital

Lucky chocolate is good for you at:

95p Apple

Cirencester Hospital

Good for your health but not your pocket:

80p

St Marys’s Hospital, London

Munch-tastic at:

30p

Barnet General Hospital

Next issue we’re checking the cost of fish and chips, a cup of tea (small) and a jacket potato with cheese. Email prices to hospitalconfidential@juniordr.com.

Princess Alexandra, Harlow Sky HD on 42in High Def plasma, wireless 16Mb broadband, leather sofas, lava lamps. 3 computers in separate computer room: 2 for all access broadband. Kitchen with dishwasher, microwave, basic food bread, tea, coffee, biccies etc usually topped up. Separate chill out/quiet room (with a few old sofas!). £10/month.

JuniorDr Score: ★★★★✩

HOSPITAL MESS

Get your neural input to junior doctors. Advertise here. Call us on 020 7684 2343.

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FORTHCOMING CONFERENCES 2009

September

17 The Failing Gut Ͳ Causes and Consequences (with the British Society of Gastroenterology) 21 Optimising Care at the CardioͲRenal Interface (with the British Cardiovascular Society and The Renal Association, in association with the Cardiorenal Forum) October 26Ͳ28 Acute and General Medicine for the Physician November 9 Vasculitis Ͳ Recent Advances (with the British Society for Rheumatology and The Renal Association) 26 Anorexia, Cachexia and Fatigue (with the Association for Palliative Medicine) December 9 Integrated Care and the Management of Chronic Illness: The Patient’s Agenda for Healthy Living Further information is available on the RCP website: www.rcplondon.ac.uk/conferences Conference Dept, Royal College of Physicians, 11 St Andrews Place, Regent’s Park, London NW1 4LE Tel: 020 7935 1174 ext 252/300/436, Fax: 020 7224 0719 Email: conferences@rcplondon.ac.uk

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EMPLOYMENT

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EMPLOYMENT

September Edition

NHS Training Bulletin Register your details

WIN A LAPTOP

Safeguarding Children Extending the learning across the NHS Sue Eardley, Care Quality Commission

Patient-Centred Healthcare What should it really look like? Sir Donald Irvine, Picker Institute

EWTD for Junior Doctors New technology rides to the rescue

Leadership Development Getting the edge on the competition

Leadership Lessons What can be learned from the DH Staff Survey?

Approaching Interview Preparation Ensuring peak performance on the day More articles inside...

www.NHStraining.co.uk

NHS Training Bulletin

Wanted...

Leaders with Potential for Greatness Proactive doctors with an eye for an exceptional opportunity True leaders recognise unique opportunities. This opportunity is about providing you with the knowledge, skills, insight and support to achieve at the highest possible levels, irrespective of what you have achieved to date, and without you parting with a single penny. Imagine adding everything we know to everything you know and then us supporting you in your endeavours to achieve. We bet you could achieve amazing things.

Learning Leadership Programme Would you like to gain access to the full spectrum of renowned Medicology open programmes without having to pay a single penny? Would you like to develop exceptional levels of personal effectiveness? Would you genuinely do great things, if we showed you the very best way? Do you believe that your success in life could be taken to new levels with the right support? Do you believe in the importance of a win-win approach to life?

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Medicology is looking for a select number of committed individuals who can answer ‘yes’ to the above questions and who have significant aspirations or challenges to overcome, regardless of their chosen specialty or seniority. In return for developing your knowledge, skills and capability beyond your wildest expectations, we will ask you for some limited support on our leadership journey too. This in itself will further contribute to your overall success.

Intrigued individuals can find out more by visiting www.medicology.co.uk/LLP2

The next step www.NHStraining.co.uk

is up to you.

NHS Training Bulletin

NHS Training Bulletin Your foremost source of Courses, Conferences and Training for Healthcare Professionals Welcome to the September edition of NHS Training Bulletin and a major step forward in increasing efficiency and effectiveness in the process of finding and booking courses, conferences & training. Distributed monthly to 27,500 professionals and designed to be read by many more (so please share!), Training Bulletin brings training opportunities into a single location, negating the need to search far and wide. The journal is backed up by a comprehensive online portal of courses, conferences & training at www.NHStraining.co.uk, coupling extensive journal and online reach to a powerful and secure booking and event management system. Just a single registration allows you to book courses from any provider without having to re-enter your details again and again.

This Issue...

Inside, you’ll find relevant, up to the minute articles, as well as comprehensive listings of courses, conferences and training opportunities, neatly organised by category and by specialty. Each event listing contains a quick link reference allowing you to rapidly obtain more comprehensive information online without the grind of having to hunt for it. Should you decide to attend an event, you’ll find booking a breeze. We do hope you enjoy your new found efficiency but spend the time-saving wisely!

Safeguarding Children Patient-centered Healthcare Leadership Development Hospital-at-Night Leadership Lessons Team Effectiveness News from the ether Approaching Interview Preparation Training Tips E-Learning - opportunities, limitations & the danger of letting the geeks control it! Medical students to have more ‘hands on’ experience EWTD for Junior Doctors The Foundation Trust Trap

2 4 6 8 10 14 16 18 22 24 26 30 32

Event Listings Leadership & Management

Personal Development

Membership & Revision

Mr Andrew Vincent

Dr Sara Watkin

Clinical Courses & Conferences

Managing Director

Medical Director & Editor in Chief

Non-Clinical Courses & Conferences

How to contact us... Sian Parrott Advertising & Sales sian@NHStraining.co.uk Tel: 01332 821271

NHS Training Bulletin is supported by Medicology Ltd and is not an official publication/ service of the NHS

Andrew J Vincent Managing Director andrew@medicology.co.uk Tel: 01332 821270

Sara L Watkin Medical Director & Editor in Chief sara@medicology.co.uk Tel: 01332 821270

NHS Training Bulletin Oxford House, Stanier Way, Wyvern Business Park, Derby, DE21 6BF

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NHS Training Bulletin

Safeguarding Children Extending the learning across the NHS

Summary The extensive media coverage of events around the tragic death of “Baby Peter” have largely focussed on apparent inadequacies in social services, care, focussing far less on the many missed opportunities within healthcare which resulted in Peter’s death at the hands of members of his household in August 2007. This short article, linked to a presentation at the Safeguarding 2009 conference explains how a regulatory focus is supporting transformation of the priority of safeguarding in the NHS. Introduction The Care Quality Commission is the new regulator for health and adult social care. Formed by merger in April 2009 of three previous regulators (the Commission for Social Care Inspection, the Mental Health Act Commission and the Healthcare Commission), CQC’s principal task is to make a positive contribution to improving outcomes for people and one of the ways in which this is done is through robust monitoring and review systems with a range of powers inherited from the predecessor organisations. When news of events surrounding Baby Peter’s death came through, the then Healthcare Commission was asked by the Secretary of State to join Ofsted in a Joint Area Review of safeguarding arrangements in Haringey. In parallel with this, the nature of the events had also triggered a specific intervention by the Healthcare Commission into the four NHS organisations that had had contact with Peter and his family in the months before his death. These two pieces of work were complementary, and their findings showed worrying gaps in systems and processes within and between the organisations involved, and a failure to learn effectively from Peter’s death.

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Although child protection cases like Peter’s are relatively rare in proportion to the number of children using the health service, we wanted to understand the system where despite Peter having 60 contacts with health professionals in his life, for number of reasons none of them managed to trigger appropriate protection to prevent his death. The Healthcare Commission/CQC’s intervention was relatively short and focussed but followed a robust process. We found a number of inadequacies had occurred in the systems in terms of • Communications between health professionals and agencies • Awareness of staff around child protection procedures and adherence to them • Recruitment practices and training

• •

Shortages of staff Failings in governance in three of the Trusts involved

Compliance with Standards Particularly worrying was that the Boards of the three organisations causing concern had all self-declared compliance in 2006-7 and 2007-8 with relevant standards in the Annual Health Check of the NHS conducted by the Healthcare Commission/CQC. These standards include specific topics such as child protection (C2), employment checks (C10a) and training and professional development (C11a,b,c). We found that 97% of all organisations, like those in Haringey, declared specifically that they had met standard C2, so we wanted to explore whether the concerns we found

in Haringey were unique or were replicated to a greater or lesser extent in other health communities in England. The review We launched, in December 2008, a full and swift review of systems for child protection across all 392 organisations in the NHS. We wanted to assess, through a questionnaire and accompanying notes, how far organisations were compliant with the statutory guidance “Working Together to Safeguard Children”, and whether there were any steps that needed to be put in place on a national or local basis to ensure that systems were working effectively. Following a literature review we consulted widely, albeit over an extremely tight timetable, to get the right questions in the survey, building a picture of what was important whilst minimising the burden of completion and submission. Named and designated nurses and doctors, in particular, told us their experiences and areas to explore to ascertain if boards were knowledgeable and supportive of the risks and responsibilities carried by frontline staff in child protection work. People told us the importance of effective team working, good leadership and sensitive performance management, recognising that success was in fact the absence of a failing. We recognised that measuring the quality of interventions that keep a child safe is much harder but more effective than measuring things that have gone wrong. We worked with Government Departments, Strategic Health Authorities and Ofsted to minimise overlap with other surveys and questionnaires, keeping in mind the importance of developing clear questions that were useful for staff and that would

NHS Training Bulletin prove beneficial as Nationally collected benchmark indicators. We wanted to examine how well Boards were assured that they had sound systems in place, and how well those systems were working. We focussed on staffing, training, governance, working with LSCBs and processes around Serious Case Reviews. There were many more questions that we would have liked to ask or which staff told us would be useful, but we were constrained by the questionnaire length and the need to stick to examining only statutory requirements. The resulting questionnaire was accompanied by a detailed set of notes which explained the rationale for each question and the relevant section of statutory guidance. All Chief Executives were contacted to nominate a member of staff to lead on completion of the questionnaire and all 392 Trusts completed the 114-question survey by the deadline date in late March. Soon after this, at the end of April, Boards were again asked to make declarations against Annual Health Check Standards. This time self-declared compliance had dropped around 3% to 94% which we interpreted not as a worsening of systems but a better understanding by some Boards of what compliance required. We have followed up those Trusts that declared non compliance and cross-checked the questionnaire submissions against those Trusts that declared that they met the standard. Analysis of the findings showed worrying concerns in several areas across England, including staffing and training levels, procedures in A&E departments, Board reporting systems and the time taken to conduct Serious Case Reviews. These and wider policy developments such as the implication of Lord Laming’s report and new processes for Serious Case Review reporting will be discussed in the presentation on 21st October. Next steps By April 2010, all NHS organisations will have had to register the services they provide with the Care Quality Commission. Unless certain services (such as maternity, care and treatment, surgery, etc) are registered, it will be illegal to practise. Registration requires compliance with statutory conditions of registration, which were set out in a consultation by CQC during the summer (www.cqc.org.uk). One of those registration requirements is based on having robust safeguarding arrangements in place and the findings of this survey provide an important wake-up call to provider units about what they need to do to ensure they are compliant with the new procedures. This will be expanded upon further, along with other findings of the review at the CQC presentation on 21st October 2009 at the ‘Safeguarding Children – Getting it right across the NHS’ conference to be held in Friends House, London. Author: Sue Eardley Senior Policy Lead, Children and Safeguarding Care Quality Commission

Safeguarding Children Getting it right across the NHS Wednesday 21st October 2009, Central London

After the heartbreaking events and consequential media frenzy surrounding the catastrophic circumstances of Baby P, few healthcare organisations underestimate the imperative of putting their safeguarding house in order. Safeguarding Children 2009 is designed to serve two vital goals; drawing together insight, information & understanding around the core issues facing health professionals in this area, whilst providing a forum for debate, collaboration and networking by the very professionals implementing child protection services at the coalface.

Topics & speakers include: Lessons and imperatives What the NHS should be learning from Baby P Sue Eardley, Head of Children’s Strategy and Safeguarding Children, Care Quality Commission

Child protection challenges facing healthcare professionals Professor Terence Stephenson, President of the Royal College of Paediatrics & Child Health

Expectations on safeguarding children The Strategic Health Authority Viewpoint Briony Ladbury, Lead for Safeguarding Children, NHS London

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NHS Training Bulletin

Patient-centred Healthcare What should it really look like?

As a child in the late 1940’s I spent several months in bed with rheumatic fever and pericarditis. It was a serious illness for which there was then no effective treatment. I have never forgotten my mother’s devoted nursing care or the kindly paediatrician who always made me feel as though I was the only patient who really mattered to him. For them, care was all because there was nothing else they could do. Now fastforward to 2009, and contrast their attitude to care with the outlook of a nursing team leader – also a conscientious woman – who shocked me recently when she said that she ‘didn’t need to care to do her job properly’. She sees herself as a technician, but is she really patient-centred? These two anecdotes illustrate the challenge to modern health care. In the intervening 70 years healthcare in the Western world, and societies themselves, have changed out of all recognition. We all know the story. Dominating everything, we have seen, and celebrated, the wonderful, relentless onward march of medical science and discovery which has made it possible for health professionals to diagnose, treat and cure or alleviate the clinical effects of illness as never before. Inevitably, given the relative powerlessness of patients, an all pervasive medical and health policy culture has evolved primarily around doctors’ clinical and scientific interests and priorities, which are not always exactly the same as patients’. At the same time the increasing complexity of much care, and pressures of demand, have made it more difficult for health professionals and patients to establish and sustain the relationships essential to the building of trust.

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New science and new ways of organising care, welcome in themselves, nevertheless come at a price we have only recently acknowledged. For some health professionals, their professional organisations and the institutions in which they work, the so-called ‘soft’ parts of healthcare, basically about attitudes, relationships and communications have tended to be seen as less important, less interesting and less relevant than the hard science of clinical outcomes and clinical effectiveness. One result is that patients report wide variations in their experience of care. Even in the same episode of illness such experience can range from excellent to unacceptable. Actually patients have always wanted the best of science and the best of care – for them they are not alternatives. They tolerated the dichotomy because, until recently, they have never had sufficient influence or power to do much about it. A big step forward came in the early1980’s when the late Harvey Picker, an American scientist and philanthropist, and his wife Jean who suffered from a serious, relapsing infection, decided to try to adjust the

balance. From their own experience they could see that, whilst the US healthcare system was strong on medical science, it nevertheless left much to be desired in terms of its humanity and ability to be responsive to the experience of illness as seen “through the patient’s eyes”. So, to raise the profile of what they called ‘patient-centred healthcare,’ they decided to enlist the aid of science.

New science and new ways of organising care, welcome in themselves, come at a price They endowed the Picker-Commonwealth Program for Patient-Centred Care, from which the Picker Institutes evolved. Located at Boston’s Beth Israel Hospital and Harvard Medical School, the programme’s main thrust was to devise new instruments and new scientific methods for measuring, assessing and comparing patient experience against seven carefully developed dimensions of patient-centred care in the

NHS Training Bulletin hospital setting. The results of this basic research provided ammunition for the emerging patient-centred care movement and has underpinned our understanding of and ability to measure patient experience in the NHS today. In the last ten years the policy argument for regarding patients’ expectations and experiences as fundamental elements of health care quality has been won on both sides of the Atlantic. Now the focus is on delivery, the subject of the Conference on Quality, Governance and Experience to be held on 17th December 2009 in London. What will it really be like? My expectation is that patient-centred care in the NHS and private sector will include the following: 1.

Full acceptance of the fact and the practical implications of patient autonomy by Parliament and all providers. The patient becomes the active focus of a partnership in care, not a passive recipient. That means their full involvement in decisions about their care – “no decisions about me without me” as Harvey Picker was often heard to say. A thorough understanding of what constitutes patient-centred care at any point in time which is based on solid, well – publicised evidence gained from patients and the public as well as health professionals and policy makers. Health professionals and institutions will have a clear idea of the standards of care expected of them, and the public will be equally clear about what patients are entitled to expect. That understanding will be absorbed fully into the culture of individual health care professions, their educational organisations and their regulators, and into the governance of every hospital and general practice. Since patients do not choose to be ill, and medical investigations and treatment can often be painful, frightening and distressing, it will become a given that the process of care - which is largely in the hands of providers – should be exemplary, and never of itself become a cause for worry and concern to patients or their relatives.

Measures of patient experience will therefore be accepted as valid expressions of quality in their own right, not conditional on establishing a relationship with clinical indicators or a business case.

Patients and the public will have direct access to a comprehensive range of generic and specialty- specific metrics of clinical performance at the team and where possible individual clinician level, with an emphasis on clinical outcomes and patient experience.

In terms specifically of experience data, near real-time feedback at the level of clinical teams and individual clinicians will replace point in time surveys very quickly. If used imaginatively there is huge new scope for quality improvement.

More generally, all concerned with health care will make far more extensive use of the Internet as data on the performance of individual clinicians and clinical teams becomes available, enabling them to benchmark against national and international peers.

That will give patients, potentially, much more scope for deciding whom to choose for their care in future. Equally, it will challenge providers who are bound to become more concerned to protect and enhance their reputation as their performance is laid out for all to see.

Best possible outcome in clinical terms into an approach that is truly patient-centered Marrying the imperative to constrain costs with the necessity for the best possible outcome in clinical terms into an approach that is truly patient-centred is likely to be one of the most significant but fundamentally important challenges facing healthcare organisations over the coming years but the rewards of achieving it are priceless. So there is the challenge! Author: Sir Donald Irvine Chairman, Picker Institute Europe, Former President of the General Medical Council

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NHS Training Bulletin

Leadership Development Getting the edge on the competition

With recent announcements (scares) suggesting that the NHS workforce could be in for some downsizing, coupled with increasing differentiation between ‘super’ services and ‘simple’ ones, competition for the best of new consultant posts is likely to become increasingly fierce with only the fittest CV surviving the initial cull, commonly known as short listing. The quality of your leadership & management development is likely to become a key focus and a matter that should be given priority as you progress towards consultanthood. Evolution & Competitive Advantage A few years ago, surprisingly few, most applicants to consultant posts would not have undertaken any meaningful leadership & management development with the emphasis placed instead on acquisition of clinical knowledge and skill. Furthermore, the consultants on the panel, your potential future colleagues would have been equally unlikely to be able to cite significant leadership development, despite already being in leadership roles. As recognition of the importance of leadership & management skill has grown, along with development opportunities too, it is unlikely that you would manage to survive the first CV sift if you could not cite attending a leadership course. So, a leadership course on your CV has become the ‘over 18 years’ verification card that lets you into the club. However, that’s a far cry from being invited to the top table. So, if attending a course got you to the top of the pile a few years ago and that has now eroded to simply sneaking you past the first bouncer, does this signify a loss of value of leadership development as a differentiator between candidates? Absolutely not;

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but it does mean you need to carefully consider how you go about leadership & management development, what you focus on and the quality of the programme you undertake. Competitive advantage is what you are looking for. When someone reviews your CV they need to be saying “wow, this person’s proactively developed their ability to a significant degree – this is the kind of person we need in our service”. Consequently, you need to be absolutely clear when undertaking leadership development that you are acquiring a badge of honour, not simply ticking a box. What are services looking for in their leaders? Traditionally, clinical leaders have focused their attention on delivering clinical care to the highest possible standards whilst seeking out ways to improve that care through research and innovation. Although this remains a key component of service success, much more is expected of clinical leaders today. Consequently, services are looking for leaders who they believe will help drive success for the service and wider Trust as a whole. Service success in the modern, increasingly competitive environment is built on a platform with essentially six legs:

• • • • • •

Successful clinical results Financial stability & growth Strong referrals and attraction of patients Exceptional patient experience Efficient, effective & productive teams Continual strategic evolution in response to market changes

A candidate that can demonstrate not only an understanding of these principles but who presents evidence of their journey towards excellence in each of them, is likely to prove highly attractive and gain a Fastpass ticket to the front of the queue. That candidate will be seen as the best possible bet for creating service success, as well as the sort of person who could work collaboratively with the Trust as it faces the market. Consequently, your leadership journey and any leadership programmes that you attend must be consistent with this blueprint for effective service leadership. Idealism versus real-life-ism One side effect of the late entry of leadership development into the professional pathway for clinicians is that leadership development itself is often out of kilter with the environment in which it is delivered. When investing your limited funds in leadership development it is vitally important to ensure that the programme has the leader’s context firmly embedded into it. Sadly, too much leadership falls into a category of idealistic (we call it 4G leadership - Gandhi and Greater Good Generalism), which can be interesting and engaging but falls short of developing the hard-nosed, gritty reality type of leadership demanded of clinical leaders today. The environment today is tough. Services can be eroded or lost due to insufficient attention to adaptation or improvement. Frontline clinical staff are as vulnerable as anybody else from redundancy. We’re entering a period of extreme financial famine at a time when disease burden and population demand are both increasing. Services are expected to do more for less, with increasing capacity and efficiency,

NHS Training Bulletin better patient experience and minimal (if not zero) mistakes. That’s a tough challenge for even the toughest leader and so leadership development needs to reflect that too. Effective Leadership Development So what does effective leadership development really look like and how is that delivered on a programme? Firstly, leadership is not a ‘course’ it’s a way of operating that needs nurturing and discovering over time. A good leadership programme recognises its own place as being the stimulator for the journey, not the journey itself. Sure it provides skills and techniques but these need applying, practising and honing into long term leadership effectiveness. Consequently, someone taking leadership development seriously will have a CV that includes the following:

• • •

•

An exceptional leadership programme (we’ll come back to this) A series of experiences with the leadership learning clearly identified Increasing achievements that demonstrate the embedding of leadership and the benefit being realised from it Ongoing activities or learning tied to addressing each area of creating service success

If these have also been achieved through interesting or innovative means, this too will help you stand out from the crowd. Consider the difference between the following three people:

• •

•

Bob went on a good leadership course Victoria went on a good leadership course and then acted up as a consultant, also taking a month out to participate in building a Reindeer Farm in Siberia Rupert went on a good leadership course and then acted up as a consultant. Additionally, he also instigating and led a project to build a profitable and successful Reindeer Farm in Siberia to test out where he had successfully gained leadership abilities and where the holes still remained

Obviously we can’t all build Reindeer farms but the key point is that Rupert stands out because he has gained learning and then clearly demonstrated application of that learning, as well as ongoing learning – he’s the safer bet and seems like an interesting person too. The leadership programme itself We’re now in a position to determine the key components of the ideal programme. Without going into the individual topics that need to be covered, a high quality, badge of honour programme is at the very least going to include:

• •

Environment insight and the leadership imperatives arising from that environment The classic skills of leaders including setting direction, vision, people, motivation and influencing built around a robust leadership model

If you don’t exit the programme thinking “wow, how can people lead properly without that stuff” then the programme has fallen short and the CV might too. •

•

Application of the skills in the six key areas of service success (which we call the Six Core Components of Clinical Business Excellence) Stimulation of the ongoing journey, with guidance, self awareness and a good dose of passion

If you don’t exit the programme thinking “wow, how can people lead properly without that stuff” then the programme has fallen short and the CV might too. Investment in the right leadership development is an investment in your future success in life as a whole. Invest with passion and make a solid choice of programme.

Author: Andrew Vincent Managing Director, Medicology Ltd

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Choose The Right Course Each course is unique to a specialty, or group of specialties, so make sure you choose the right one for you. See which sub- or alliedspecialties are included by going online. Anaesthetics & Intensive Care www.medicology.co.uk/CML1 Emergency Medicine www.medicology.co.uk/CML2 Medicine (Physicians) www.medicology.co.uk/CML3 Mental Health www.medicology.co.uk/CML4 Obstetrics & Gynaecology www.medicology.co.uk/CML5 Oncology www.medicology.co.uk/CML6 Paediatrics & Neonatal Medicine www.medicology.co.uk/CML7 Pathology & Laboratory Specialties www.medicology.co.uk/CML8 Radiology www.medicology.co.uk/CML9 Surgical Specialties www.medicology.co.uk/CML10

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Hospital-at-Night

NHS Training Bulletin - Hospital-at-Night

Hospital-at-Night What’s its true place in a competitive service?

Hospital-at-night predates much of the move towards a competitive healthcare market economy but is an essential component of the overall care a person receives. Whereas clinical excellence will always be the true mark of a successful service, there is growing recognition that there is more to a successful service that the outcome alone. Is it time to re-visit hospitalat-night to re-evaluate its true purpose and how it contributes to overall service success in our increasingly unforgiving environment. Understanding service success & how H@N applies to it If we are to re-visit the role or structure of hospital-at-night, we need to consider what service success needs to be built on and how this relates to the night time environment. Besides clinical excellence, services need to consider their financial stability, their strategic evolution as the market evolves, how patients are attracted to the service, patient experience and how well the team works together, which arguably enables all of the others. The original purpose of H@N was two-fold; coping with service delivery requirements on reduced junior-doctor hours whilst providing a better training environment to compensate for the degradation of training by hours & rest time restrictions. However, if we are all honest, we know that the former has taken much greater priority over the latter and most H@N teams find little time to specifically focus on learning, other than the experiential component that comes Clinical excellence

from working across specialties and even then, most doctors working during the night as part of the H@N team find the work stretching from a load perspective but not from a learning one. What we want to consider is the potential impact of incorrectly focused H@N on the factors influencing service success as a whole. Let’s look at just some of the potential issues (Table .1) This brief set of questions only touches on the range of issues that come to bear but already we can see that the H@N team has the potential to seriously impact success, either positively or negatively and yet we are constantly surprised by just how much H@N teams are ‘forced’ to work in isolation of the day-time services, with the predominant interaction being one of clinical handover, not strategic collaboration. In all too many instances, we also find that it is not for want of trying to engage but more the subject of how people perceive the role of the hospitalat-night service. Evolving the vision for H@N Firstly, H@N has the unenviable premise of being both a service in its own right, with a distinct team, its own structure and processes etc, as well as effectively being a part of every service they support. This differential view is important in two respects, one internal to the team and one a real wake up call for the services they support. Taking the internal perspective first, the true purpose of the H@N service is to enable

Financial performance

• •

How can we better support the surgeons to compete in the market? How can we contribute to a positive patient experience for night-time admissions?

The key here comes from understanding the game you are a component of and in many respects developing that understanding is the role and responsibility of senior leaders, as well as service leads. Failure to do so is a bit like employing an expert without a job description or never telling Granny that you’ve outgrown cardigans and then moaning when you get another one for Christmas! Services expecting proactive and supportive assistance from H@N teams need to take on board just how important it is to positively engage with them to define what that support really looks like and how it contributes to your own service success. In many respects that is an ongoing, two-way process or even the start of a partnership in which both teams needs should carry similar weight in order to work towards ever greater success for both. It involves those enabling questions running both ways:

Patient experience

Strategic Evolution

Does the H@N team support or lead clinical effectiveness in the night time environment?

Are the H@N team active participants in CIP?

How does the patient experience differ at night?

Does the H@N team understand the longer term vision for a service?

Do they understand what clinical excellence looks like for patients in specialty X,Y or Z?

Do they disproportionately consume some resources e.g. a specific drug?

Is it adding or subtracting from the overall service perception?

Are they complimentary to it or inadvertently detracting from that vision?

Are they truly assisted in getting it right e.g. through effective handover?

Do they make it easy for the coders to identify what’s happened to someone?

What is the overall level of experience necessary?

Table .1 8

success for each and every other service in the hospital. Contrast this to something more akin to ‘get through the night safely’ and we can already see a likely change from reactivity towards proactivity. Longer term, this allows H@N teams themselves to ask a series of enabling questions such as:

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Do they have partial ownership of that vision or are they disengaged from it?

NHS Training Bulletin

To the service: How can we, the H@N team, best support your vision for service excellence? From the service: How can we, the service, assist you, the H@N team to get it right for us? Failure to actively address these two questions misses a massive opportunity to develop excellence across a hospital and possibly even leaves one third of the patient experience entirely up to an often over-worked, under-supported group of individuals whose most frequent marker of success is â&#x20AC;&#x153;we got through the night without a serious incidentâ&#x20AC;?. Fully integrated H@N Fully integrated H@N involves bringing the H@N team fully into the working environment of each service, not as â&#x20AC;&#x2DC;servantsâ&#x20AC;&#x2122;

but as equal owners of the vision that service has established for itself. Service leaders, whose whole stability and existence relies on attainment of that strategic vision, need to firmly recognise the role and contribution of H@N to that vision, as well as how they as a service impact on how easy it is for H@N teams to successfully conduct their role, for instance with handover practices. That goes well beyond simply â&#x20AC;&#x2DC;tiding us over until the day team takes control againâ&#x20AC;&#x2122;. Over time, service and H@N teams need to consider what they both really want out of the night time environment. How does training fit into this? How can clinical effectiveness be developed further across the night? How is the H@N team kept abreast of service developments, stresses and priorities? What shared goals do they collectively own? What resources does the night team need to successfully operate? And so many more questions too...

Hospitals that fail to address this preexisting issue place themselves at a competitive disadvantage to those that do and potentially give themselves an uphill struggle to compete on even the basics such as clinical results. Our fear, or the challenge to be resolved, is that the further drop in junior doctor hours that we have just adopted is likely to place H@N teams under even more pressure to achieve on even less resource, leaving precious little opportunity to resolve the bigger picture as it gets swallowed by the immediate stress of the night time load. Or we could just do it!

Author: Andrew Vincent Managing Director, Medicology Ltd

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Leadership Lessons

NHS Training Bulletin - Leadership Lessons

Leadership Lessons What can be learned from the DH Staff Survey?

Annually, over quarter of a million staff (289,000 in 2008) are invited to participate in the NHS staff Survey, resulting in some 160,000 respondents and eliciting a wealth of data on the experiences of staff working across all manner of NHS organisations. Used intelligently, the insight contained within could hold the key to resolving some of our greatest human-related challenges, as well as providing a stark wake-up call in some topic areas. We’d like to focus on what leadership lessons can be drawn from the survey results. Strengths and limitations Besides the insight gained, it needs to be appreciated that all surveys have limitations too and the staff survey is no exception. It asks an intelligent set of questions, comprehensive even, but then suffers from the manner in which the data is interpreted, resulting in sometimes misleading perceptions. For instance, to establish the key findings (e.g. KF1 % staff feeling satisfied with the quality of work and patient care they are able to deliver) the interpretation consists of the amalgamation of results from 3 different questions, rather than a straight forward, singular question. This runs the risk of potentially important findings being masked by better results in concurrently analysed questions. As soon as you pool data to obtain an aggregate result, you need to consider weighting. Consider the question “the quality of leadership in my organisation is excellent ” with a 5 point scale running from strongly disagree to strongly agree with a neutral midpoint. On its own, the question elicits comparatively little information because leadership is a broad area with many components. So, to improve the quality of insight gained, leadership is explored by its components, breaking this into say three questions such as:

• • •

I received clear, unambiguous direction Communication is active and focused Shared ownership & accountability is encouraged

Let’s say that the results return as 24%, 51% and 74% strongly agreeing with the statements respectively. The aggregate result of ‘leadership’ is an acceptable 50% but it masks the underlying and serious problem that direction is poor. That’s serious enough but clear, unambiguous direction is known to be one of the most significant influencers of performance there is and therefore carries more weight than the other statements.

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If you married the strongest result and the weakest result into a statement, you could almost say that “almost everybody is committed to the organisation but almost nobody really knows what to do” – which doesn’t sound like a high performance environment or even a well led one. This highlights both the danger of aggregates and the absence of weighting, both of which are inherent in the results of the staff survey. That said, the data obtained focuses on key areas know to contribute to performance and affect morale and therefore gives rise to a range of interesting findings only some of which we will focus on, from the leadership perspective. Teams & teamworking Over 90% of respondents indicated they worked in teams but only a worryingly low 39% felt that they worked in wellstructured teams in which staff have clear objectives, work closely together to meet these objectives, and regularly review and reflect on performance. In effect, the results suggest that although staff are gathered and expected to work together, this is not coordinated, organised or led in an effective manner. This is a poor finding for leadership across the NHS and if the staff survey is truly representative, then the tax payer is funding 90% of 1.3 million people to work together to deliver a high quality, efficient ‘result’ and yet only 0.5 million receive the sort of leadership that is likely to deliver the expected performance.

The leadership lesson is simple – the leadership of teams needs attention. Fortunately, around 60% of staff reported meeting to discuss how to improve teamwork, although the survey doesn’t address just what kind of team building or development teams undertake. Our personal experience is that comparatively few teams undergo formal team development, which is often seen as an overly soft ‘skill’ to invest in. However, the issue here is more of a leadership one than a team one and highlights the urgent need to address leadership development in those leading teams. Line management More worrying results appear when considering the leadership skills of line managers in general. The survey highlights that line managers are clearly committed to their staff, with 67% of participants reporting that their manager helped them with difficult tasks and 70% reported feeling supported in a personal crisis. However, only just over half (53%) felt that their manager gave them feedback or asked for their opinion (51%) before making decisions that affected their work. This highlights more failings from a leadership perspective. Healthcare staff, particularly on the front line, have a strong motivation to be helpful and supportive and this shows through strongly in the results. However, good leadership practice involves staff having regular feedback on performance and this

NHS Training Bulletin is known to impact morale, not to mention being an important part of a performance management feedback loop – it is difficult for staff to improve if they don’t actually know how they are doing! Furthermore, transformational leadership involves developing ownership and accountability in team members and this is highly unlikely to occur if managers simply take decisions without consulting or sharing the process with the team members those decisions affect. It is dangerous to over-interpret the results but we can probably conclude one of two things, or both:

•

Those in leadership positions have not had sufficient leadership development

•

That transformational leadership is not commonplace in the NHS, which could be due to the first point or possibly a more transactional approach is preferred

We refrain from concluding that those in leadership posts are just not up to the job because our experience is that with proper development, good leadership practice can be encouraged, developed and embedded in most. Appraisal In 2008, 64% of respondents had undertaken an appraisal (or a knowledge and skills development review). Given a historical disdain for appraisals in the public sector this is a welcome finding that suggests a stronger commitment by organisations to actively performance manage their staff. However, only 27% of all staff felt that their review was ‘well structured’ in that it improved how they worked, set clear objectives and left them feeling that their work was valued. Consistent with previously

highlighted findings, only a third (34%) said that they received clear feedback on how they were doing. At a practical level, the findings could simply be down to a lack of experience or training in delivering appraisals but the trends towards no clear direction, poor feedback, lack of recognition etc are frighteningly consistent throughout the survey results as a whole, suggesting a more likely issue with the leadership development process rather than the skills training. Feeling valued One of the strongest predictors of morale in staff is whether or not they feel valued for the contribution they make. Ensuring that contribution is recognised is not only consistent with delivering against the fundamental human needs but also falls into a category of leadership 101. It is sad to find that less than a third are satisfied with the extent to which their Trust values their work. The survey report strives to highlight the positives by identifying that in some trusts, over half (56%) of staff are satisfied with the extent to which the Trust values their work but in the interests of balance, which we applaud, lets on that in some Trusts is only 11%. If 56% is the highpoint in a caring profession where staff have traditionally given their all and more, this finding should encourage shame in the leadership ranks. From our perspective, it is one more notch on the post of conclusion that leadership needs addressing and addressing fast. So what can we conclude? Our first conclusion is somewhat frightening. Although we spend over £100 billion annually on health, employing 1.3 million people and expecting those 1.3 billion to perform well, deliver value and improve

continuously, the survey highlights a stark lack of proven leadership behaviours. Our long experience of front line clinical staff and managers alike is that they are committed, hard working and with positive intention in almost everything they do. They are also capable people that manage sometimes to achieve amazing things with comparative little resource. However, they are enormously disadvantaged by not adopting good quality leadership practice. Our experience is that healthcare staff are highly motivated to adopt good practice in all that they do and so our second conclusion is that the lack of leadership behaviour is a corporate failure to develop leadership that has persisted for a very long time. As we enter and era where much is going to be expected of our healthcare workers, some of it very uncomfortable too, organisations need to take on board the absolute imperative of ensuring they have the right calibre of leader in place by identifying them, training them and nurturing their leadership journey. When dealing with this dearth of existing leadership expertise, it would be easy to adopt an almost frenetic approach to instilling leadership skill. We urge caution. A competitive market, coping with a demanding environment in an era of financial famine and massive reconfiguration requires something a bit different – the imperative of context-specific leadership. Imagine increasing your leaders’ ability to achieve and muster the support of people whilst they still disagree with the direction to travel. Now that’s an interesting challenge! Author: Andrew Vincent Managing Director, Medicology Ltd

Leadership Training & Development Top leadership courses that could help you

Why not bring it in-house?

r Clinical Management & Leadership for Year 4/5

Tailor training to your specific issues

r Foundation Course in Leadership & Management for FY Doctors

Improve transfer of knowledge into practice

r Management Skills for Junior & Middle Grade Doctors r Advanced Communication & Influencing Skills

Work on live challenges

r Communication Skills for Junior & Middle Grade Doctors

Highly cost-effective

r Leadership Masterclass for Healthcare Professionals r Effective Clinical Leadership r Essential Leadership for SpR-level Doctors r Time Management & Personal Effectiveness for Junior & Middle Grade Doctors

To take this forward and to find out more contact Dean Kellogg on 01332 821261 or email him at dean@medicology.co.uk

Medicology: Passionate about People, Performance & Health View the full programme for all these courses at www.medicology.co.uk/leadership www.NHStraining.co.uk

NHS Training Bulletin

Medicology Local Bringing our outstanding Leadership, Management & Personal Development courses to you Norwich

What would you like to see on your doorstep? Medicology Local is a programme of local courses based on an assessed demand in a specific location. The challenge has always been getting people to â&#x20AC;&#x2DC;co-ordinateâ&#x20AC;&#x2122; which is a bit like organising cats at a mouse fest. Medicology takes the stress out of this by leading the assessment of demand, and then creating a local programme based around the specific needs of the doctors in question. This allows you to bring training to your doorstep without any more work than simply suggesting what might be needed in your locality.

Cardiff

Exeter

Poole

Plymouth

To take the first step by finding out more, visit www.medicology.co.uk/local

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Cambridge

Southampton

Portsmouth

NHS Training Bulletin

Barts and The London Queen Mary’s School of Medicine and Dentistry was ranked 4th in the UK for quality of research in 2008 (RAE) We offer graduate study with the following modes of delivery: • Structured distance learning • Part time study • Block teaching days • Full time study • Clinical days Campuses in Whitechapel, West Smithfield, Mile End and Charterhouse Square Open Evening 25 November 2009 5pm to 7pm at our Mile End Campus To order a prospectus or book a place on the Open Evening, please visit: www.qmul.ac.uk

Taught Course Subject areas • • • • • • • • • • • • •

Aesthetic Surgery Analytical Toxicology Burn Care Cancer Therapeutics Clinical Dermatology Clinical Drug Development Clinical Microbiology Dental Clinical Sciences Dental Implantology Dental Public Health Dental Technology Endontic Practice Experimental Oral Pathology

• • • • • • • • • •

Forensic Medical Sciences Gastroenterology Genomic Biotechnology Healthcare Research Methods Implant Dentistry Medical Terminology and Health Care Administration Mental Health: Psychological Therapies Mental Health: Transcultural Mental Healthcare Molecular Pathology and Genomics Oral Biology

• • • • • • • • • • •

Oral Surgery Orthodontics Paediatric Dentistry Primary Care Primary Health Care Management Public Health Prosthodontics Sport and Exercise Medicine Surgical Skills and Sciences Translational Neuroscience Vascular and Cellular Inflammation

www.smd.qmul.ac.uk

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Team Effectiveness

NHS Training Bulletin - Team Effectiveness

Team Effectiveness The role of psychological tools

Encouraging effective team working sometimes seems a bit like riding a roller coaster. Just as you think you have got it nailed it races downhill again. And you’ve probably noticed, it positively hurtles downhill but chugs slowly back up hill. This is in part due to the multifactorial nature of team performance with a myriad of factors involved in the final result. We’d like to explore one aspect of team development – that of the role and use of psychological tools. Perspectives on team performance Team dynamics are complex. When performance ebbs, it is often possible to identify distinct causes, such as Jim doesn’t really like Bob and so they avoid each other and work ineffectively together, also leading to the ‘Jim crowd’ and the ‘Bob crowd’ or unwanted separation/ factions within a singular team. This factor identification is paramount to resolving team issues but sadly is not helpful in establishing a baseline of high quality teamwork. It is a bit like the patient with a problem but no outward symptoms. You don’t even know you need to go and fix something.

You could be forgiven for pointing out that team performance would start to suffer if all wasn’t right. True enough. But most teams perform well below their true potential; it’s just that we don’t know it! It’s not until you get a team into a high performance state do you really realise how ‘ordinary’ performance actually was. The answer is to systematically improve performance by addressing factors known to contribute and for that we need a model.

What do we mean by ‘psychological tools’? The type of psychological tool that we refer to is one that helps an individual make sense of or interpret behaviour, behaviour being the outward ‘symptom’ of the fuzzy inner wiring. Many healthcare professionals will come across a plethora of these tools during their career but the more common ones are:

• • •

10 facets of team effectiveness As part of developing an effective approach to improving team performance, an examination of the literature, coupled to experience, elicited 10 key areas that high performance teams focus on to ensure they remain high performance. This framework is known as Medicology’s 10 Facets of Team Effectiveness (see figure 1). Although overlapping and interacting, each stands alone in its influence or impact on performance. The framework can be used to develop more effective team development programmes and forms the basis of the Medicology approach to team development. What we’d like to discuss is the use of psychological tools in this process, including both the benefits and pitfalls, as well as the limitations.

Conflict Management & Resolution

Common Purpose & Direction

MBTI® - Myers Briggs Type Indicator SDI® - Strength Deployment Inventory FIRO-B® - Fundamental Interpersonal Relations Orientation

In healthcare, the commonest one is MBTI, which examines a series of dimensions, for instance ‘introvert-extrovert’, known as preferences and which give rise to behavioural trends. The tool helps someone with a preference for extroversion understand and interpret the behaviour of someone with introversion as their preference. FIRO-B looks at certain types of behaviour and how much a person desires or gives off under certain distinct circumstances. SDI attempts to examine the underlying motivation for patterns of behaviour, enabling people to adapt their approaches and predict responses. All of these tools have inherent weaknesses, not least of which is that only a proportion of participants like being ‘analysed’.

Shared Values & Beliefs Appropriate Structure, Power & Control

Respect & Trust

TEAM EFFECTIVENESS Morale & Motivation

Understanding People

Effective Interactions

Self Awareness Managing & Harnessing Difference

10 Facets of Team Effectiveness Figure .1 14

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NHS Training Bulletin

Where do they play a role? Using the 10 facets model, we can examine the sorts of scenarios where use of a psychological tool may be useful. That doesn’t mean it should be used and the decision to use is not something that should be taken lightly. We approached the examination by considering what use a tool might be and consequently, whether it would be valuable, assessed simply as vital, valuable, neutral and low. What becomes clear is that psychological tools play an important or even vital role in team development, even allowing for our earlier words of caution. The cause for caution Psychological tools can have a number of detrimental effects when not used appropriately. The commonest ones are:

•

Frustration – if they are too difficult to use practically, then they hold little value

•

Isolation – outliers can start to feel like outsiders if not handled appropriately

•

Generalisation – people get assigned to a box that they may or may not be happy with, resulting in disengagement

We find that some tools that are robust at a research/ validity level are less practical in everyday reality. Without sufficient attention paid to embedding the understanding and application, they become ‘interesting’ but not useful. In our book that is also called ‘wasteful’. Conversely, sometimes the more simple tools can provide immense benefit despite their simplistic approach. We have to remember that without the benefit of these insights our approach to our teams is somewhat unobjective. In actual fact we tend to approach all team members in a manner that works well for us, which is a direct expression of our own underlying wiring, and so even subtle changes in the direction of others can produce measurable improvements in team effectiveness. Overall we like them, we just urge organisations to make an intelligent choice based upon what they are trying to achieve and then devote sufficient attention to making them work.

Facet Common purpose & direction

Shared values & beliefs

Appropriate structure, power & control

Understanding people

Self awareness

Managing & harnessing difference

Effective interactions

Morale & motivation

Respect & trust Author: Andrew Vincent Managing Director, Medicology Ltd

Conflict management & resolution

Value Low

Use Differing psychology plays some role in the acceptability of a chosen direction

Valuable

Our underlying wiring gives rise to many values and beliefs, so tools can help develop a picture that is useful in both managing differences and reaching consensus

Valuable

Approaches to leadership e.g. transformational versus transactional, are fundamentally influenced by our wiring. Understanding this helps develop a team structure consistent with the team members

Vital

People are far more similar on the outside than within. Without an appropriate framework, it is almost impossible to truly understand people and what makes them tick. Even with it’s difficult!

Vital

One of the most valuable aspects of these tools is how they help an individual understand their own behaviour, which is a precursor to developing behavioural flexibility, essential in teams.

Valuable

Difference occurs at many levels, from our underlying wiring to the skills we hold. Whereas tools provide little insight into skills, they elicit useful information around structuring the work by helping you identify who might get the most out of it and what’s important to them.

Vital

An interaction between two people results in an emotional response and psychological tools help us not only understand that but also to predict it and adapt so as to create positive, unambiguous interactions.

Valuable

Our morale and motivation is linked to our underlying psychology interacting with external stimuli. BY understanding that, we can ensure team members remain motivated, with good morale.

Vital

Whereas most can subscribe to the need for respect, few realise just how much it is influenced by our behavioural drivers. It is differences in wiring which often cause degradation in respect between individuals.

Vital

When team members fight, actively or passively, the cause and the solution is most often found in their wiring. The tools also provide a neutral basis on which to explore and resolve differences.

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News

NHS Training Bulletin - News

News from the Ether

Tortilla Chips Lower Cholesterol

Regulator Signals Funding Over-Optimism by Foundation Trusts

Not usually associated with healthy eating but researchers may have found a way to make tortilla chips help lower your cholesterol, by frying the chips in oil containing a plant extract called phytosterol, part of a group of steroid alcohols that naturally occur in plants. The research was conducted within the US and as such most of the discussion and opinion currently available is on whether the tortilla chips taste as good as normal ones and not on whether there are genuine health benefits from the new snack.

Monitor, the regulatory body for Foundation Trusts, has responded to Trust 3-year forecasts saying they are concerned that growth forecasts may well be optimistic, given the tighter funding constraints likely to face the NHS beyond 2011. The 115 foundation trusts authorised as at 31 March 2009 are forecasting a combined income of £26.2 billion in 2009-10, representing growth of 4.2% on incomes in 2008-09. Future growth forecasts suggest continued growth in revenues after 200910 (2.1% in 2010-11 and 1.6% in 2011-12), with similar growth in costs (1.6% and 1.1%).

forecasting and submissions to Monitor but that these represented an over optimistic view given the funding famine the NHS is expected to face over coming years. Consequently, Trusts have been asked to submitted revised ‘downside’ forecasts by the end of September to provide a more pessimistic view. It will be interesting to see if Foundation Trusts plan internally based on the optimistic or pessimistic view and even more interesting to see how they will approach unexpected shortfalls in revenue if the famine turns out to be at the dryer end of predictions.

Stephen Hay, Monitor’s Chief Operating Officer, commented that Trusts were continually improving the quality of their

The Readers Voice

Let’s get talking! If you have a thought, don’t just keep it to yourself. Tell the world!

Do you want to voice your ideas, opinions & experiences of the healthcare system across the board? Well now you can!

We are always excited to hear of research projects, important topics and current issues to proudly display in the latest edition of NHS Training Bulletin. So, to share what you have to say contact Sian on 01332 821271 or email her on sian@NHStraining.co.uk

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Quality Nursing revealed by New Tool Under a new Strategic Health Authority Initiative funded by The Department of Health, nurses will be able to compare the quality of patient care against other trusts in England. The new initiative ‘Energise for Excellence in Care’, lead by senior nurses is designed to improve fundamental nursing care through a new tool, and once adapted, is hoped to be available on the NHS Institute for Innovation and Improvement website.

summer 2008. In May 2009 the Government published a list of over 200 indicators that could be used to improve services across the NHS.

The new tool is based on the ‘acuity/ dependency’ tool which was developed by the Association of UK University Hospitals. It helps categorise patients depending on their conditions (for example ‘stable’ or ‘unstable’) which can then be used to help inform staffing levels, skill mix and workforce development needs. It is hoped to enable nurses to deliver evidence-based care and will include the development of new services where appropriate.

Although it is hoped that the ‘Energise for Excellence in Care’ initiative will help the QIPP initiative, it is important to stress it also has wider goals, such as getting nurses to focus on the things that really matter to patients. It is designed to give nurses permission to say what needs to be done and encourage them to reflect on the quality of the care that they are providing.

In order to improve quality patient care, indicators are key according to Lord Darzi’s Next Stage Review of the NHS, published

The Chief Executive David Nicholson will take personal responsibility for the ‘quality, innovation, productivity and prevention’ (or QIPP), also the focus of the DH management board.

If nurses are consistently providing high quality care, costs may reduce for the NHS with fewer mistakes and improved morale, particularly as low morale is detrimental to productivity and in this case patients.

NHS Training Bulletin

£20 to see the Doctor The Social Market Foundation claims that forcing patients to pay for appointments would help the NHS cope in times of financial hardship. They state the only way to survive would be to raise taxes, limit demand or work more effectively. Whilst funding is guaranteed until 2011, many are expecting the budget to be frozen or cut after that. Both the government and doctors are against such a move, one doctor saying: “All patients have a right to free healthcare that is based on their clinical needs, not the size of their bank balance.” Those who support the idea believe it would make patients think twice about their visit and a small charge could help reduce appointments by about 5%. They also say that children and those receiving tax credits should not be charged and the think-tank was opposed to fees being levied on any form of emergency care.

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Would we not be simply privatising healthcare? In many other countries there is no free healthcare but help for those on low wages, so it could work, but what about those with existing conditions like diabetes?

Missed the last NHS Training edition?

Those who oppose the scheme claim charging for appointments would undermine the doctor patient relationship, stopping some needing care from coming to the surgery and is against the founding principles of the NHS - free healthcare for all.

View & download all our previous copies of NHS Training Bulletin online at www.NHStraining.co.uk

Millions wasted on “No Shows” Statistics show that patients failing to keep hospital appointments are costing the NHS at minimum, a staggering £600 million. That’s enough to run two medium-size hospitals! The figures show that between 2007 and 2008, 6.5 million patients missed appointments costing hospitals £100 per patient in revenue. To compensate anticipated non-attendance, some hospitals are overbooking appointments, with obvious repercussions if 100% attendance occurs. Young males appear to make up the biggest proportion of those that don’t show up and people aged between 70 and 74 were the most reliable in terms of attending appointments. However it isn’t all doom and gloom, over the past few years the attendance figures have improved slightly in England, Northern Ireland and Wales. In Scotland however, figures have actually increased. To combat missed appointments, schemes such as text message reminders are being rolled out by the Department of Health. Other initiatives such as the ‘choose and book’ scheme have also been introduced. Whilst some say that missing appointments is unforgivable, Unison back patients in saying they are not to blame when appointments are arranged months in advance.

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Got a suggestion for the next edition? If you’ve got an idea for articles or features you would like us to include, or want to let us know what you think of this edition email Sian at sian@NHStraining.co.uk with your comments

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NHS Training Bulletin

Approaching Interview Preparation Ensuring peak performance on the day So, the job you set your heart on has finally come up. You’ve submitted a CV and if you’re shortlisted the interview will be in just a few weeks time. The big question is – have you started preparing for interview success or are you just going to wing it? Starting early... very early In truth, the best time to really address interview success is way before there’s any chance of an interview. A good interview skills course isn’t just about the interview. It needs to help you develop a job hunting strategy, ensure your CV gets you shortlisted, identify any career-limiting holes in development whilst you have time to do something about them and point you in the direction of the sorts of things that will truly ensure you stand the best possible chance of gaining just the position you require and that’s all before you even apply for the job! Ideally, the best time to start is a few months before you are likely to even commencing applying for posts. It’s not until you

undertake a robust interview programme that you start to realise just what’s missing from your CV and just how much there is to do if you really, really, really do want your first choice job. Core components of effective interview preparation These we’ll split into two distinct categories, although they are firmly related and overlapping; a.) the strategic stuff and b.) the interview itself (See table below) Consistently successful people realise that the true interview skill is to ensure you’ve got the job before you walk into the room and then not lose it through your performance on the day. Those that rely on the interview itself as the key component for getting the job place themselves at an enormous disadvantage to their more savvy colleagues. A good interview programme should help ensure that this is not the case.

Strategic Category

Interview Category

Your CV is in optimal shape both from a contents and a presentation perspective

You know how to make all the right impressions with the right people

Your career experience, courses, leadership development etc is sufficient to both get you shortlisted and make you attractive as a candidate

You are ready for any hard questions on your CV

You have undertaken any necessary evaluations, feedback, psychological profiling etc so as to enter the process with solid self awareness and any inherent weak points dealt with

You are knowledgeable about key topics and aware of the sorts of questions you’ll face (and how to answer them)

You know how to approach maximising your chances of success well ahead of the ideal job appearing

You know how to handle troublesome panel members

You know how to get the best out of the process, pre-interview visits and more

Any presentation you need to make is powerful, addresses the right issues and is well delivered

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So what does a good programme look like? A gold standard programme balances job strategy with interview technique i.e. it covers the full spectrum of issues that contribute to you achieving the job you want. Furthermore, it must add to your understanding of self and where your own unnoticed psychological pitfalls may lie. Although a good course will also steer you towards key topics that you need to be mindful of or maybe asked questions about, a great programme will also provide you with resources, information and links to help you save time when there is just so much preparation to do. Consequently, when assessing Interview Skills courses or programmes, you want to ask the following questions: Is the programme comprehensive and balanced between strategic and interview issues? • Does it deal with tips, tricks & strategies for improving your chances of being selected? • Will it provide CV guidance to help ensure I get short listed? • Are the participant numbers low enough for me to get sufficient attention & feedback? • Do I get to practice interview questions and receive personal feedback? • Do I get access to further resources to help my preparation? • Does it include psychological profiling and feedback to increase myself awareness? A good programme will answer ‘yes’ to all of these and thoroughly prepare you for what is akin to revising for a membership exam. The difference is that you get to re-sit your membership exam whereas you never get a second chance at your first choice of job. Author: Andrew Vincent Managing Director, Medicology Ltd

NHS Training Bulletin

Consultant Interview Coaching Do you have a looming interview? Prefer one to one interview practice and feedback? Want to absolutely ensure you get the edge against fellow interviewees at interview? Then one to one interview coaching may be the answer for you!

Coaching costs ÂŁ400 + VAT for a 2 hour 1 to 1 session

If you would like to speak further about coaching or to book coaching please contact Sara Watkin directly on 07855 312529 or email her at sara@medicology.co.uk

Consultant Interview Skills

medicology

Comprehensive courses with comprehensive support r Specialty-specific r Psychological profiling and feedback r Insightful and comprehensive resource centre r Back up coaching if you are struggling to get appointed

The GOLD Standard ors course for doct wanting to get the edge

View full information, including which specialties are covered online at:

www.consultantinterviews.co.uk www.NHStraining.co.uk

UCL Institute of Child Health and Great Ormond Street Hospital for Children NHS Trust

Autumn/ Winter 2009 Courses at the Institute of Gastroenterology for General Paediatrics 8th – 9th October 2009 A practical course focusing on the investigation and management of common gastroenterological problems met in secondary paediatric practice. Lectures & group workshops. For full information: www.NHStraining.co.uk/281 Or simply put 281 in the reference box on the homepage

Post traumatic Stress in Pre-school Children: Assessment & Evidence-Based Treatment 21st – 22nd November 2009 The course will give participants a working knowledge of assessment and treatment for practical everyday clinical work. This will be conducted through lectures and supported by video examples from Dr Michael Scheeringa’s research studies. For full information: www.NHStraining.co.uk/273 Or simply put 273 in the reference box on the homepage

Update in Paediatric Respiratory Medicine

MRCPCH Part 2 Pre-Written Revision Course

4th November 2009

23rd – 27th November 2009

An annual course which provides an update on current practice in paediatric respiratory medicine on an everyday basis. The programme and range of issues covered will be suitable for everyone concerned with paediatric respiratory medicine.

A comprehensive and detailed revision course designed to prepare participants for the MRCPCH Part 2 written examination. Tuition is provided in all aspects of paediatric medicine covered by the examination syllabus equipping participants with skills and understanding needed to approach the MRCPCH Part 2 examination with confidence.

For full information: www.NHStraining.co.uk/272 Or simply put 272 in the reference box on the homepage

For full information: www.NHStraining.co.uk/274 Or simply put 274 in the reference box on the homepage

For more information and to book online use the course reference number at: www.NHStraining.co.uk Book over the phone by calling 01332 821270 or email customer.service@NHStraining.co.uk

Child Health, London Nephrology Day for General Paediatricians

Neonatal and Paediatric Ventilation

27th November 2009

3rd – 4th December 2009

This annual course aims to give a full overview of paediatric nephrology by selecting different themes each year and presenting them in a way which will be useful for general paediatricians. This year’s themes are: The Neonate, Hypertension and Systemic diseases and the kidney.

This popular course combines lectures with practical workshop sessions. The programme includes a wide range of topics including Initiation, Maintenance, Weaning of Assisted Ventilation & Special Ventilatory Techniques. For full information: www.NHStraining.co.uk/277

For full information: www.NHStraining.co.uk/275 Or simply put 275 in the reference box on the homepage

Eating Disorders in Children and Adolescents 30th November – 2nd December 2009 A course for CAMHS Clinicians, Adult Eating Disorders Clinicians, those working in paediatric services and others who are involved in the management of young people with eating disorders on an inpatient or outpatient basis. The course provides a comprehensive overview of eating disorders in children and adolescents, from recognition and diagnosis to management. For full information: www.NHStraining.co.uk/276

Or simply put 277 in the reference box on the homepage

Diploma in Child Health (DCH) Revision Course - preparation for the written RCPCH examination 8th – 11th December 2009 An in-depth and practical revision course aimed at preparing candidates for the Diploma in Child Health written exam (MRCPCH Part 1 Written Paper 1A) and giving insight into the clinical exam that follows. For full information: www.NHStraining.co.uk/278 Or simply put 278 in the reference box on the homepage

Or simply put 276 in the reference box on the homepage

For more information and to book online use the course reference number at:

wwww.NHStraining.co.uk

Training Tips

NHS Training Bulletin

Training Tips Improving training & education delivery skills

Training Tips is a punchy, bite-sized column aimed at improving training and education delivery skills and standards by focusing on those seemingly insignificant areas that can make a significant difference. If you have your own handy hints that youâ&#x20AC;&#x2122;d like to migrate into practice then donâ&#x20AC;&#x2122;t be a stranger, submit them to the Editor at editor@nhstraining.co.uk

Tip 1 The Learner, the Holiday Maker and the Prisoner People who attend training courses

During the training session you have spent hours researching, writing and practicing, you will notice differing delegate behaviour. Some may zone in and out during the presentation, others hang on -and then question- your every word; whilst others never engage at all. This isnâ&#x20AC;&#x2122;t necessarily because of you or your material (although feedback here could be helpful). Each delegate is there for a reason and you are unlikely to predict their personal motivation for attending, although to actively find this out is good practice! Here are some thoughts on classifying delegates: 1. The Learner- has heard about your presentation and is pleased to be there. This is the easiest of our three types. 2. The Holiday Maker- times are tough in the department, so a training course provides the perfect opportunity for a break! They have little or no interest in the subject matter and is unlikely to pay much attention to your training. 3. The Prisoner- this delegate has been forced into attendance by somebody in authority. Much like the holiday maker they will take little interest and may even be disruptive just to make the point (perhaps they should have been sent anyway!) Each of these types can provide problems for a trainer. The Prisoner can refuse to engage, the Holiday Maker can be seen by other group members to not be taking it seriously or be having too much fun. The Learner can overpower with their questions and desire for information. In the past when I have spotted a Prisoner (and I have had some extreme cases) I have given them the opportunity to leave. If they choose to stay, the least I expect from them is not to disrupt the learning of others. For the Holiday Makers I hope to offer an entertaining and informative day, where they have the ability to learn something useful with little or no effort. For the Learners I attempt to ensure I am well researched in all areas of my subject and can answer their questions accurately and concisely (thus allowing us to move on!).

Tip 2 Training Tips

Making the trainers life easier

Reducing the Pressure Imagine asking a class to construct a list that you will record on a flip chart. What pressures does this put you under? What would happen if you already had the list (written in fine pencil) on your flip-chart. Would you appear to know the answers, whilst having relieved yourself of the pressure of trying to remember the list? Encouraging Questions Have you ever tried to ask a large group of delegates if they have any questions and been greeted with silence? They probably all have questions but someone needs to break the ice and be the first. What would be the effect of you asking one delegate to pose a pre-determined question? Probably a very good conclusion to a fine training session. Last- minute Hiccups Imagine you are waiting to deliver a presentation. To your horror you realise the speaker you are following is delivering almost the same presentation! So, when you get up to speak, you tell them what has happened and explain that they are very very lucky, as you are now going to test their knowledge and look for gaps. By posing half a dozen questions you can decide whether to give the presentation as prepared (if they got more than 2 wrong) or praise the audience and last speaker before taking your presentation content to a more advanced level.

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NHS Training Bulletin

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NHS Training Bulletin

E-learning – opportunities, limitations & the danger of letting the geeks control it! With the ubiquitous nature of personal computers and the internet, reducing costs whilst expanding development possibilities through e-learning appears to be an attractive proposition.

Today’s modern healthcare, office and home environment means that almost everyone has access to a PC with broadband internet access and this opens a world of opportunities for training and development of staff. Missed opportunities? There isn’t a corner of a healthcare organisation that cannot benefit from continuous training and development and this is far from limited to the clinical space, where there are obvious implications of insufficient continuous professional development. However, with so much pressure to manage costs and balance budgets, many Trusts find the ever increasing requirements for statutory training, coupled to a growing need to develop leadership & management capability, whilst keeping up with job-related skills across all areas an almost insurmountable challenge. It is perhaps surprising therefore that e-learning has not been utilised more, with its obvious cost advantages. So, why hasn’t e-learning taken off in the public sector, or any sector for that matter, to a greater degree, given the huge time and cost advantage associated with no trainers, no venue, no catering, flexible access, simultaneous delivery to hundreds or more? Perhaps it looks like an opportunity missed,

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or maybe it is an opportunity examined and then discarded because of the fundamental issue that most e-learning fails to deliver the learning impact that organisations desire. Perhaps then, if e-learning can be constructed in a manner that restores the training impact, then more organisations can benefit from the potential it holds. To examine this, we need to consider the what, how, why set of questions that could herald the solution to the e-learning enigma. Keep the geeks at bay! The root of the problem is actually easily identified when you start to assess the current and burgeoning array of e-learning possibilities. The developmental pathway appears to look like this. Someone has had a good idea for important training that could be delivered as e-learning but then, conscious of their own technical limitations, has passed it on to their IT people (the Geeks) to implement it. On the face of it this appears sensible because after all it will rely on technology for construction, migration and delivery. However, the reality is often an end result that consists of a series of text-based pages amounting to a paragraph or two explaining the topic and a few questions with limited, quantifiable answers designed to test whether the

participant has understood the topic. If they get the right answers, they’ve obviously understood the topic, if not they just need to go back and read about the topic again. Simple... The problem is that this is so simple that it is also not effective. You could be forgiven for asking the question “why didn’t I just buy a book?” which you also know would have sat on the shelf because it too often fails to deliver the intended learning benefit. To be fair, this approach may work for the science and maths-based training that Geeks have undertaken – I know, I am a geek – but it falls way short for many other subjects – especially the “softer sciences” such as management training. Another problem with letting the technical people run the project is that although it will work perfectly, just as it was intended to run, it will usually miss out some key element that Geeks feel isn’t worth the space or programming time. Take for instance the human element. We ‘technical’ people tend to feel that human interaction is overrated – why risk the robustness and integrity of the project on something as spontaneous and unpredictable as a person, when all the information you could possible need can easily by conveyed through a

NHS Training Bulletin few paragraphs, a simple table or chart or possibly, at a stretch, maybe an image or two? The human element In reality, few e-learning products deal meaningfully with the human element, whether it is the need to engage or how to encourage new learning into practical behaviour. The most obvious limitation of a purely electronic system is that it is difficult to build in true human to human interaction and yet most trainers will know that this element is fundamental. In truth, it is not so much the human interaction as the engagement with the training, proven by the impact of an engaging book that you can’t put down. The trainer is purely the conduit for the information in a manner that promotes engagement, as well as the monitor who can bring things back when engagement ebbs. Well constructed e-learning includes the human element. Whether it is video narration, a method of asking questions or even practical case examples involving real life application of principles, it is vital that the engagement issue is addressed. Furthermore, at a simple level, it takes a human to say “out of the last 5 pages of generally useful information, paragraph 4 on page 2 is the most important thing you need to know”. If we can get that right then we are winning! So, if that helps at an individual, what about group learning? As technology has progressed we’ve gained the ability to communicate in a more personal way through the internet and with much greater ease, access and speed. Gone are the days of needing dedicated video conferencing suites to communicate effectively over great distances – we now have video messaging that can allow groups to see and talk with each with setup costs which are less than the taxi fare to get across London to a training course. The predominant issue remaining is that use of these facilities is second nature to the Geeks, who sadly don’t need or want to interact anyway, but frightening to real human beings who actually do. Geeks 1: Humans 0... Join the slideshow Let’s consider the products themselves. Probably the second biggest problem with current online training courses is that, for the most part, they appear to fall into one of two highly unsatisfactory categories: An existing training course which has been turned into an online version, without careful design for the environment and which just doesn’t work in that format A new e-learning course created for a specific purpose, but done so without the right mix of elements for the material to be covered e.g. a purely technical description of leadership The first I have seen too many times on the internet. A training company decides they have an opportunity to expand their training product (delivered courses) into a new market (millions of training hungry online punters) but achieves this by simply saving

Element

The solution

The subject matter

Needs an intelligent decision about whether it is suitable for the e-learning format. Goal for the humans.

Include the trainer

By using video embedded in the programme, engagement is improved and the viewer has someone to direct them to the most important content. Goal for the humans, again.

Function

It must work well. By working with competent IT staff, you can ensure that any interactive elements and tests work exactly as they would in a classroom environment. It may be more technically complicated and take longer to setup, but the benefits will be clear. Goal for the Geeks.

Embedding & transferring learning

The programme needs to build in appropriate reinforcement, as well as ways to transfer often complex learning to daily practice. This really requires an intelligent construction of exercises, self-directed processes and careful guidance. Drat, another goal to the humans.

Presentation is everything

By ensuring that the finished product looks good, presents the information well and is intuitive to the user, the overall result is a smooth experience with maximum learning. Actually, we’ll claim that goal because most of that’s in the construction.

Reliability

It would be amiss not to mention access, availability, system up time, bandwidth, redundancy, security and more and that’s definitely techy territory. Another late goal for the Geeks! Table 1

their current PowerPoint presentation as web pages and loading this onto their website. If you’re really lucky there will be some extra annotations to explain the slides but that is usually it. You come away feeling cheated – simply sold a product because someone can, rather than a commitment to your development, which is what you really need. The second is a tougher challenge to overcome. It is possible that there are some subjects that just don’t lend themselves to e-learning. Take ‘leadership’ for instance. It’s not that elements of leadership can’t be covered in an e-learning approach but leadership is part acquisition of skills and part journey of self-discovery. The former can be covered in part by e-learning but the latter really needs careful facilitation that just can’t be provided without one of those human-being things. Geeks 1: Humans 1, drat. Resolving the challenge So, with the score at 1:1, let’s examine how we can improve the e-learning experience. (See Table .1)

The final score Well, we’ve added up the goals and the final score looks like this: Geeks 4: Humans 4 It appears that the sort of e-learning that delivers the sorts of results demanded by forward thinking, performance-orientated Trusts is actually a combination of intelligent application of learning science by experience human beings, married to rock solid technical structure and reliability. Ultimately, the humans can’t deliver it without the Geeks and the Geeks can’t construct it without the humans. The really good news is that combine the two and maybe, just maybe, we can fully harness the power of technology to increase reach, reduce costs and improve results. That’s not so much a draw as a win-win.

Author: Andy Wells BEng Head of IT & Technical Support, Medicology Ltd

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NHS Training Bulletin

Medical students to have more ‘hands on’ experience GMC launches new guidance Tomorrow’s Doctors Today’s undergraduates – tomorrow’s doctors – will see huge changes in medical practice. Becoming a doctor today is about so much more than understanding how the body works and developing technical skills . The demands of a doctor mean they must be excellent communicators, leaders and negotiators. They need to understand a condition in relation to a patient’s environment, beliefs and outlook and communicate with them in a way that the patient understands. To help doctors with this daunting prospect the GMC has just launched an updated version of Tomorrow’s Doctors which sets out the outcomes medical students should achieve at medical school and what they need to know for their first posts as a trainee doctor. The guidance will ensure medical students have the right mix of medical knowledge and clinical ability as well as important communication skills. In the new Tomorrow’s Doctors there are standardised lists of practical diagnostic and therapeutic procedures that students will learn with lay descriptions of what the procedures involve. Students were, of course, often taught these procedures before, however in this new version of Tomorrow’s Doctors the GMC is being more explicit about which procedures (including some new additions) need to be taught. The new list of specific clinical procedures ensures students are able to take advantage of advances in medical technology that allows increasingly lifelike training mannequins to be used for clinical procedures, as well as developing skills on real patients with consent and under supervision.

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When drafting the guidance the GMC also responded specifically to concerns about education of medical undergraduates in the scientific basis of medicine, partnership with patients and colleagues, and commitment to improving healthcare and providing leadership. The guidance sets down new requirements to prepare ‘The doctor as a scholar and a scientist’ covering sciences such as anatomy, genetics and molecular biology. New standards have also been set out for the delivery of medical education, with indications of the respective responsibilities of students, Medical Schools and healthcare providers. There is an emphasis on equality and diversity, involving employers and patients, the professional development of teaching staff, and ensuring that students derive maximum benefit from their clinical placements. Examples of these include supporting students with disabilities by making appropriate adjustments, collecting feedback from patients and employers about the preparedness of graduates and staff development programmes which promote teaching and assessment skills which all staff must attend. Tomorrow’s Doctors introduces the concept of student assistantships which are new placements undertaken before a student enters ‘Foundation 1’ as a trainee doctor. They will help students to become more effective in using their knowledge and skills in clinical environments such as a hospital or community setting and to understand practical tasks such as filling in a prescription form or ordering a blood sample. Student assistants will assist a junior doctor, become familiar with the workplace and undertake supervised procedures.

Graduation is an early threshold in doctor’s careers. We do not expect new graduates to have the clinical experience, specialist expertise or leadership skills of a consultant or GP. But they must be able to demonstrate all the outcomes in Tomorrow’s Doctors in order to be properly prepared for clinical practice and the Foundation Programme. The Foundation Programme builds on undergraduate education, allowing new doctors to demonstrate performance in the workplace. The outcomes set out what the GMC expects medical schools to deliver and what the employers of new graduates can expect to receive although medical schools are free to require their graduates to demonstrate additional competences. These outcomes mark the end of the first stage of a continuum of medical learning that runs from the first day at medical school and continues until the doctor’s retirement from clinical practice. It is clear that meeting these outcomes and standards will be challenging and there are implications for resources and priorities both for medical schools and for the health service. But the benefit will be a further enhancement of the knowledge, skills and behaviour which new graduates will bring to their practice. Tomorrow’s Doctors will be implemented over the next two years and will apply from 2011-2012. For further information please visit www.gmc-uk.org Author: Professor Jim McKillop, Chair of GMC Undergraduate Board

NHS Training Bulletin

Insights - Understanding the Evolving NHS Environment An insightful programme designed to help doctors, nurses and other healthcare professionals truly understand the competitive, evolving healthcare economy in which they operate, including the risks and opportunities arising.

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For more information on how to take this forward contact Andrew Vincent by emailing him at andrew@medicology.co.uk

eMedicus Online Learning

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NHS Training Bulletin

Clinical Management & Leadership for Year 4/5 Simply the Finest Preparatory Course Available

Specialty Specific Welcome to the finest course available for specialist registrars approaching completion of training, designed to enable you to make a step change in your ability to be effective as a new consultant in your specialty, whilst demonstrating your clear commitment to effective leadership. This course is designed to create exceptional clinical leaders ready for the challenges facing them as consultants in the modern healthcare environment. It is packed with the knowledge and skills that you’ll need to competently achieve, as well as specialty-specific insight into the challenges you’ll be facing as new consultant in the evolving health service.

Choose The Right Course Each course is unique to a specialty, or group of specialties, so make sure you choose the right one for you. See which sub- or alliedspecialties are included by going online. Anaesthetics & Intensive Care www.medicology.co.uk/CML1

Powerful Combination This course is developed and delivered by Medicology, market leader in leadership & management development, in conjunction with specialty-specific consultants, offering the highest possible learning experience coupled with deep, specialty-specific insight. The result is a series of exceptional programmes, each unique to its specialty.

Emergency Medicine www.medicology.co.uk/CML2 Medicine (Physicians) www.medicology.co.uk/CML3 Mental Health www.medicology.co.uk/CML4 Obstetrics & Gynaecology www.medicology.co.uk/CML5 Oncology www.medicology.co.uk/CML6 Paediatrics & Neonatal Medicine www.medicology.co.uk/CML7 Pathology & Laboratory Specialties www.medicology.co.uk/CML8 Radiology www.medicology.co.uk/CML9 Surgical Specialties www.medicology.co.uk/CML10

Practical Details Duration: 3 Days Registration Time: 09:15 Start Time: 09:45 Finish Time: 16:15 - 16:30

CPD Points: 15 Maximum Delegates: 20 Accommodation is not included

Full details, dates & locations for this course at www.consultantfundamentals.co.uk

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NHS Training Bulletin

Specialist Registrars (Specialty-specific) Programme Elements 1. The NHS Today and the Evolving Role of the Consultant r Our NHS – past, present & evolving future r Understanding the changing landscape and who leads it r Different providers types – opportunities and threats r The changing balance of power and how this affects you r Core principles underpinning the modern NHS r Developing strategic insight & visioning r Issues arising out of the current environment r The role of the consultant in the modern health service r Defining the key challenges facing a consultant today r Key transitions necessary for success as a consultant r Engaging in the business of health r Understanding Trust priorities, their drivers and impacts r Balancing clinical, service and fiscal priorities

5. Risk, Governance & Complaints

r Understanding the consultant’s balance of responsibilities r Engaging the whole team in clinical governance r Core principles in risk analysis & management r Common risks & errors in your specialty r Managing identified risk - protection of self, team & Trust r Management of complaints – core principles r Common complaints in your specialty and strategies for management r Avoiding complaint escalation r Trust complaint policies versus national standards

2. Your Leadership Journey r Between now and consultanthood r Prioritising the immediate learning journey r The 5 core roles of the consultant r Defining critical success factors for the core roles r Qualities & skills for success in each role r Understanding yourself – the impact of your wiring r Self diagnostics – developing insight and self awareness r Personal challenges and key insights arising r Developing presence as a new leader r Principles of trust and probity - ensuring you are beyond reproach r Defining your personal journey

6. Leadership, Ambassadorship & Service to Others r The responsibilities of effective leadership r Setting effective direction – core tools & strategies r Creating the right environment to maintain morale and motivation r Understanding & demonstrating ambassadorship towards your team, your Trust and specialty r Defining the stakeholders in modern health – stakeholder mapping r Understanding and rationalising differing priorities r Working effectively with Primary Care r Principles of the patient as stakeholder

3. Priorities & Insights in your Specialty r The impact of the current & evolving environment on your specialty r Understanding the evolving role of your service r Developing insight and vision aligned with healthcare agenda r Clinical priorities in your specialty r Service frameworks and knowledge that you need to know r Opportunities & threats r Current challenges and evolving solutions r The changing nature of being a consultant in your specialty r The 5 most important insights you need

7. Management of Others, Inc. Performance Management r Core principles in management r Management planning – the art of getting things done r Creating and deploying a strong team r Core principles in team effectiveness r Management communication skills & influencing r Essential delegation skills r Creating compelling business cases for equipment & service evolution r Core principles in performance management r Giving feedback constructively r Escalating performance issues

4. Self Management & Personal Effectiveness r Time management essentials for the newer consultant r Achieving balance between clinical and non-clinical priorities r Job planning for consultants in your specialty r The importance of work-life balance and the impact of responsibility r Key pitfalls facing new consultants and how to avoid them r Self support mechanisms - balancing self-reliance with support r Taking responsibility for development of self

Highly Comprehensive Specialty-Specifc Programme

Full information at www.consultantfundamentals.co.uk

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NHS Training Bulletin

EWTD for Junior Doctors New technology rides to the rescue

From 1st August 2009 almost all junior doctors in the NHS are supposed to be working an average week of less than 48 hours, with perhaps 10% allowed to work up to a 52-hour week because of a transient derogation from the regulations. It will have been a difficult month for all concerned – the EWTD, a change-over of staff, summer holidays, unfilled posts, few locums or international medical graduates available, and swine influenza – though swine flu is the only problem that failed to turn-up in August. But there is some new technology – software as a service from RotaGeek.com – that does bring some new solutions that are ready to be applied, now that the 48-hour implementation phase is over.

There are two parts to the EWTD It is important to realise that there are two distinct parts to the EWTD, which are only slightly connected. The first is the strict, inflexible regulations that enforce every worker having at least 11 hours of rest in every 24 hours, and 24 hours once a week or 48 hours in a fortnight. There is no way around this rule, and it is this regular rest in the EWTD that provides almost all the benefit in terms of safety. Rested doctors make less mistakes. The second part of the EWTD limits the average working hours per week – and the new limit is 48 hours. This has essentially nothing to do with Health and Safety, and is all about manipulation of the labour market in Europe – essentially making more jobs for the workers. That is perhaps a good idea when there is a surplus of workers – but the NHS is still very short of doctors… so I have no guilt about devising ways of allowing junior doctors to volunteer to work longer hours. The opt-out solution All British workers are eligible to opt-out of the working hours regulations [that is the 48-hour week], and this now includes all junior doctors. They’ve only needed to opt-out since 1st August, and their average hours remain a maximum of 56 per week, limited by the New Deal. The rest provisions of the EWTD remain absolutely intact. So how does it work? The decision to optout must be made without coercion, and the junior needs to sign a simple statement, requesting to opt-out and giving reasonable notice if they later wish to opt-in. The junior is then available to work up to an extra 8 hours per week, on average – how could

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this be used? The most obvious benefit for the employer is to have each opt-out doctor eligible to work as an internal locum – still rigorously enforcing the rules about rest. But the junior could be scheduled to provide extra sessions regularly during the day or evening – perhaps for service work, perhaps for training.

What’s the catch, and why does technology help? What’s the catch, and why does technology help? Well, it does make designing a rota a bit more difficult – that’s where the software comes in. The basic 48-hour rota is devised for a group of juniors, and agreed by all involved. Then those who have volunteered to opt-out can – with their manager and senior doctors – decide whether to allocate some extra ‘personal’ sessions during the normal working week, or to remain available for occasional locum sessions, or a mixture of the two. The rule of the opt-out demand that a full record is maintained of the hours worked by these employees – and this is made extremely easy by the software. Finally, these extra hours may trigger a change in banding and increased pay for the junior – this is not inevitable, but it is usually far cheaper than hiring external locums. The management of internal locums can be transformed by RotaGeek’s ability to identify in real-time those doctors who are rested and available for locum work – and contacting them via text message and email.

NHS Training Bulletin Shiftwork, and covering 168 hours per week Medicine is a 24/7 business and some jobs work flat-out – for example, in Accident & Emergency or on-take for acute medicine in a busy hospital – such posts demand a fresh doctor who works continuously covering full-shift working - that is, the night. But there are other posts where there is only a need for a skilled doctor to be available at very short notice in the evening and over night, but not actually present on-site in the hospital. Examples of such posts would be most surgical or orthopaedic SpRs, or junior physicians on-call for emergency procedures – for example, cardiac catheter or endoscopy. These less intense posts are often suitable for the non-resident on-call solution. The non-resident on-call solution This solution exploits the very real difference between being on duty (that is, ready for work) and actually working – whilst strictly obeying the EWTD rest regulations, and the two court judgments SiMAP and Jaeger, and the New Deal. Despite all this red tape, junior doctors can be on duty up to 72 hours / week and within those hours they may work for 48 hours (or 56 hours, if they have opted-out). Hence, the apparently impossible demands of the junior surgeons and their English Royal College are essentially met.

What’s the catch, and how does technology help? Designing such rotas, recording work performed and, most importantly, automatically sending a doctor home early if there has been an unusually heavy night of work –can all be performed by the RotaGeek technology, for example, logging overnight work via the junior’s mobile phone and/ or email plus maintaining records not only for Ministerial returns but also the Health & Safety Executive.

We founded RotaGeek because we are both committed to the NHS Where does RotaGeek.com come from? Dr Chris McCullough and I founded RotaGeek in early 2009, and we have funded the project after failing to get an NHS grant. Chris was recently an SpR in Renal Medicine in North London, having qualified in medicine and completed a PhD in Edinburgh. He was seconded to coordinate implementation of the New Deal in Scotland, was on the BMA’s junior doctor committee, and later was the first CEO of Remedy – the juniors’ pressure group. My first job was as a house officer at Guy’s Hospital in the 1969 influenza pandemic;

I trained in Gastroenterology and endedup as a Professor of Medicine at the Royal Free Hospital, UCL. I was elected Clinical Vice-President of the Royal College of Physicians in 2002, and was its lead for the EWTD until I founded RotaGeek. I have been a member of most of the Government’s central committees planning the EWTD implementation. We founded RotaGeek because we are both committed to the NHS. We want to consolidate the safety improvements that are provided by the EWTD, but want to preserve the joy of doing the good, fulfilling job of being a junior doctor – and that includes being properly trained. We believe our solutions provide a lifeline to assist the safe implementation of the EWTD. RotaGeek is ‘Software as a Service’ – that is, users login via the Internet to a central server, and this provides an economic and efficient platform to plan and implement rotas. From free trial rotas, to rotas of increasing complexity and ‘intelligence’ – all are available via RotaGeek.com.

Author: Roy Pounder Chairman RotaGeek Ltd.

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NHS Training Bulletin

The Foundation Trust Trap The Carrot, the catch and the crucial imperative

Perhaps trap is too strong a word but it does imply something you fall into because you didn’t notice it and at that level the word carries the meaning suitably well. Furthermore, the trap itself, whether by design or inadvertently, is particularly well crafted. So, what are we speaking of? You could call it a funding trap but we’d prefer to describe it as the trap of self-determination and it gives rise to some vital imperatives if organisations wish to avoid being impaled on the spikes at the bottom. Self-determination – the meaning Self-determination is defined as free choice of one’s own acts without external compulsion; and especially as the freedom of the people of a given territory to determine their own political status or independence from their current state. In our context, it can be defined as Foundation Trusts effectively cutting ties with the NHS ‘mother ship’, albeit constrained by a regulatory, Monitor, and with strict contracting requirements, in favour of going it alone or managing their own lot with much greater levels of freedom. However, with freedom comes responsibility and although 90% of Foundation Trusts are declaring a ‘green’ governance rating to Monitor, we’d like to explore some of the less obvious issues arising out of self management. The carrot Foundation Trusts are described by Monitor as not-for-profit, public benefit corporations. Although they remain part of the NHS and provide over half of all NHS hospital and mental health services, they are free to decide their own strategy and the way services are run. They remain constrained by the NHS core principles - free care, based on need and not ability to pay – but are

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not directed by Government, instead being accountable more to their local populations. With Foundation Trusts status comes the ability to be master of your own destiny, for instance they can retain their surpluses and borrow to invest in new and improved services for patients and service users. This is not an insignificant benefit and ask almost any coal face clinician whether they would prefer to be lead by Government or more self-determining and you’ll find a strong vote in favour of the latter. For instance, should a Foundation Trusts wish to focus on oncology, it can extend its cancer services by perhaps opening a new treatment centre, for which it must seek, raise or identify funding in much the same way that a business would seek funds to expand into a new market or for a major capital investment. Organisations must assess the likely ROI (return on investment) to ensure that they are utilising their financial resources wisely and in much the same way so must Foundation Trusts. Perhaps the clue is in how Monitor describes them “not-for-profit, public benefit corporations” and, other than having to reinvest surpluses for the greater benefit of patients, they do operate in essentially the same manner. The ability to determine a strategy, bring it to reality, generate surplus revenue as a result of it and then see that reinvested to improve the health of the population and the success of the Trust is enormously gratifying and arguably an intelligent way to organise the delivery of secondary and tertiary health services. But what if there isn’t a surplus...

The catch 122 Trusts now hold Foundation status (as of August 2009) and the above carrots will have grown and sprouted in many of the minds involved both prior to the decision to acquire FT status and subsequently. Furthermore, when most applied, 105 of these 122 gained their status a year or more ago with well over half more than 2 years ago, the NHS remained firmly in the midst of mandated funding increases, which meant that if you could get your financial house in order to gain FT status then the future looked rosy indeed. The harsher reality is that we are entering a more famine-like period and this will have implications for the all Trusts, let alone those with FT status. However, that isn’t really the trap. If the exciting world of how to spend your surplus is the carrot then the catch is undoubtedly that you also have the same responsibility for managing your shortfalls. A Foundation Trust with tight fiscal control, which arguably they all needed to gain FT status in the first place, can operate relatively easily whilst balancing its books. In times of increasing funding, successful Trusts generate healthy surpluses and can develop proactively to address need, demand, new technology and more. When funding is effectively flat, the status quo remains still and although you probably can’t invest in all the things you’d like, balancing is still possible. However, when the cost of delivery outstrips any funding increase, the Trust must make efficiency savings or constrain activity in order to maintain balance. But that’s not the trap either. The trap actually stems from the wider strategy for health. Concurrently with the promotion of Foundation Trust status, the

NHS Training Bulletin Our NHS, Our Future, Darzi-led movement has gained momentum. As part of that quality-cost-demand driven agenda, a differential funding system has been implemented, whereby hospital-based episodes are remunerated on a tariff-based system and community care is directly funded. Consequently, activity conducted in the community setting is almost always ‘cheaper’ than the same activity under the tariff-based system. Consequently, with increased financial pressure and growing demand there is not only an appetite to make greater use of the community setting but growing recognition that if you strip services of more simple procedures, diagnostics and care in general, then there is too much provision at the secondary care level. Now that is a problem... To be clear, across England, elements of services will move to the community, a movement that is already under way through PCT commissioning, practice-based commissioning and even the Any Willing Provider route too. For the ill-prepared or even ‘sluggish’ Foundation Trust, that could represent the undermining of financial stability at a service level and the need to ask some very difficult questions about post (redundancies) or even whole service viability going forward. Hang on, nobody mentioned that when we signed up... The crucial imperative The community movement is not one that a Foundation Trust can readily influence and therefore, rather than futile resistance,

developing alternative strategies becomes an imperative. To effect this, we also need to drop the traditional focus on tight geographical boundaries and think of the NHS as an open market. For instance, if I lose injections for rheumatoid arthritis to a GP with a special interest, could I attract more referrals for diagnosis? Typically, a hospital service serves the majority of its local population and so those extra cases may have to come from outside its traditional catchment area and maybe run through an outlying treatment centre – a competitive strategy designed to ‘take business’ from potentially a neighbouring Foundation Trust. See what we mean? Now, if you are a Senior Manager in a Foundation Trust, you are probably thinking “yes, we know this...” and far be it for us to suggest otherwise. However, we strongly suspect that the challenge to be resolved arises not from knowing it but from aligning and coordinating the behaviour of your clinical services, who may well have seen their role traditionally as including ‘protecting the patients from the evil, money-saving managers’, resulting in often competitive relationships, not collaborative ones. If an FT is to survive and thrive, there are some conditions which need to be in place in relation to the services themselves:

•

They must act collaboratively with managers and senior managers – there is no room for internally competitive behaviour

•

They must understand the market in which they operate – the majority have been so tied up with the day-to-day job of delivering medicine that it has been difficult to keep up

•

They must understand and address the fuller picture of what constitutes service success in the modern environment – the 6 core components of service success (ask!)

•

They must apply as much attention to service excellence in that wider form as they naturally do to clinical excellence

The hard truth is that let alone understanding the environment, most clinical teams have had little training in the sort of strategic service leadership that is necessary to drive services forward under the current constraints, trends and wider health strategy. Furthermore, this runs much deeper than the Clinical Director. To truly excel in a truly demanding environment requires a coordinated, consistent and effective approach by the whole service i.e. everyone in it. The crucial imperative is that this needs creating within a timescale sufficiently short to allow the Foundation Trust to adapt and proactively manage its business, rather than fall on the spikes of the trap and be slave to reactionary cuts to balance books, resulting from this community-led funding erosion. Exciting times ahead. Author: Andrew Vincent Managing Director, Medicology Ltd

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Online Learning

www.NHStraining.co.uk

NHS Training Bulletin

Getting the best from NHS Training Bulletin For busy professionals, NHS Training Bulletin represents a step change in efficiency when it comes to finding and booking courses, conferences and training. Rather than letting you guess our thinking, we thought we’d just come right out with it, consistent with Training Bulletin’s underlying ethos of getting straight to the point without the time-wasting.

Replacing searching with finding Course, conference & training information is spread far and wide across the physical & digital net from Royal College sites, to leaflets on notice boards, to weekly, monthly & quarterly journals, home and abroad, public & commercial and more. Searching for it represents an industry in itself and so Training Bulletin is designed to short cut the process by bringing as much information into a single location as is humanly possible. Whether you look in the hardcopy journal or online at NHStraining.co.uk you’ll find an array of event information neatly organised by event type and by specialty. As NHS Training Bulletin develops, you’ll find more and more opportunities brought into the convenience of a single point of access.

Comprehensive options NHS Training Bulletin consists of a number of key elements, all designed to make access as simple and personal as possible:

Benefits of NHS Training Bulletin Journal Listings

A robust journal with related articles and neatly organised event

r 4JOHMF QPJOU PG BDDFTT UP TJHOJñDBOU array of event information

Online

NHStraining.co.uk is the engine behind the events, searchable, fast and well organised

E-Bulletin

A monthly bulletin tailored to you e.g. Consultants in Paediatrics, with quick links to event details

r $PVSTFT DPOGFSFODFT USBJOJOH intelligently organised to help you filter swiftly

Notifications

For registered users, be the first to hear about the event types you specify

The system as a whole is designed to be immensely usable without being at all intrusive i.e. on hand when you need it without being in your face.

Make bookings in confidence Our turbulent economic times rightly give rise to caution when booking event places. Will the provider be there when the time comes? Will I lose my limited study leave budget? Is the event really going to happen and indeed is it a real event, not a fraudulent one? NHS Training Bulletin is the solution. All payments taken through Training Bulletin are held in our secure client account on your behalf, until the event has taken place, and then released to the event organiser. This means that should the provider be unfortunate enough to stumble, then your funds are protected and you can simply reclaim them. Equally, this simple but practical solution reduces concerns over fraud by making it impossible for fraudsters to generate bogus events and then run with the money.

Booking with ease When you are ready to book, there is a simple registration process that you only go through once. Once registered, you can book onto any course from any provider simply by logging on to your account. Furthermore, you can track all of your event bookings from a single, convenient location and should your details change then updating all providers is achieved with minimum pain from your control panel. Once registered, you can set up notifications allowing you to be first to learn about new events in your chosen areas, improving time management and ensuring you get a place where places are limited. What’s not to love?

www.NHStraining.co.uk

r 4JNQMF CPPLJOH QSPDFTT TBWJOH UJNF and improving efficiency r 1BZNFOUT IFME TFDVSFMZ VOUJM UIF FWFOU really happens, protecting your hard fought budget and reducing financial risks r 5SBDL BMM PG ZPVS USBJOJOH JO POF QMBDF meaning no more lost details r 6QEBUF BMM FWFOU QSPWJEFST simultaneously from your control panel r 4FU TQFDJñD OPUJñDBUJPOT UP CF UIF ñSTU to receive information about new events

NHS Training Bulletin

Training Courses & Conference Listings Contents Leadership & Management

Clinical Courses & Conferences

Personal Development

Non-Clinical Courses & Conferences

Membership & Revision

View Full Course Programme & Booking Details Online At www.NHStraining.co.uk

Enter the course reference number found on all course listings within the journal into the web reference box at www.NHStraining.co.uk to bring up the full course programme and booking details.

This Month’s Featured Course... Core Skills in Strategic Business Excellence for Service Leaders Cost: From £430 + VAT

Event Type: Course

CPD Points: 10

Provider: Medicology Ltd

Quite naturally, clinical & service leaders tend to focus on clinical quality, evolution and innovation. However, an increasingly competitive market place demands attention to all components of clinical business excellence if services are to survive and thrive. This two-day programme comprehensively covers strategic service leadership, enabling leaders to balance priorities effectively, whilst fostering a total team approach to creating service success. It’s practical, hard hitting and designed to enable clinical teams to excel. Event Dates & Locations Location: Date: 27th & 28th October 2009 London London 4th & 5th February 2010 View more dates online using ref #: 254

Target Audience Doctors Nurses Junior Middle Senior

Junior Middle Senior

Web Reference Number Bus & Admin Junior Middle Senior

Allied Pro’s Junior Middle Senior

Enter Reference: 254 Online at www.NHStraining.co.uk to view more event details and make a booking

www.NHStraining.co.uk

NHS Training Bulletin - Leadership & Management Events

Non-Specific

General

Leadership & Management Foundation Course for SAS Doctors Transitioning to Consultant Cost: From £430 + VAT

Event Type: Course

CPD Points: 10

Provider: Medicology Ltd

Designed specifically for Specialty Doctors (Staff Grade and Associate Specialist) progressing towards consultanthood through Article 14 of PMETB, this course takes you through the transmission from largely working in health to taking a leadership responsibility for it. The course is structured to assist you in developing the knowledge, insight and skills necessary to thrive in the very different role of consultant. Please note there is considerable overlap between this course and Core Skills for the Newer Consultant. Event Dates & Locations Location: Date: 12th & 13th November 2009 Birmingham London 26th & 27th January 2010 View more dates online using ref #: 130

Target Audience Doctors Nurses Junior Middle Senior

Junior Middle Senior

Web Reference Number Bus & Admin Junior Middle Senior

Allied Pro’s Junior Middle Senior

Enter Reference: 130 Online at www.NHStraining.co.uk to view more event details and make a booking

Core Skills for the Newer Consultant Non-Specific

Cost: From £430 + VAT

Event Type: Course

CPD Points: 10

Provider: Medicology Ltd

A raft of practical strategies built into an easy to manage framework that ensures you excel as a consultant, gain the best from your staff and carry yourself with utmost professionalism. This course is designed as an intensive submersion into the key areas necessary to succeed in being an exceptional consultant. Covering everything from new found managerial responsibility to fiscal probity, risk, governance and even the business of health, it acts as a comprehensive framework packed with the practical application of core skills. Event Dates & Locations Location: Date: 2nd & 3rd November 2009 London Birmingham 11th & 12th January 2010 View more dates online using ref #: 75

Target Audience Doctors Nurses Junior Middle Senior

Junior Middle Senior

Web Reference Number Bus & Admin Junior Middle Senior

Allied Pro’s Junior Middle Senior

Enter Reference: 75 Online at www.NHStraining.co.uk to view more event details and make a booking

Management Skills for Junior & Middle Grade Doctors Non-Specific

Cost: From £215 + VAT

Event Type: Course

CPD Points: 5

Provider: Medicology Ltd

Suddenly in a responsible clinical role you find that all the technical & medical knowledge you’ve worked hard to gain is only part of the story when managing people. To progress effectively as a doctor it is essential that you develop competency as a manager and this is a key CV requirement for gaining a consultant post. This one-day comprehensive seminar covers all the essential topics in a practical way, to enable you to really develop your management skills in the clinical context. Event Dates & Locations Location: Date: 24th September 2009 Manchester London 26th October 2009 View more dates online using ref #: 16

Target Audience Doctors Nurses Junior Middle Senior

Junior Middle Senior

Web Reference Number Bus & Admin Junior Middle Senior

Allied Pro’s Junior Middle Senior

Enter Reference: 16 Online at www.NHStraining.co.uk to view more event details and make a booking

Insights Day - Understanding the Evolving Healthcare Landscape Non-Specific

Cost: From £125 + VAT

Event Type: Seminar

Provider: Medicology Ltd

The healthcare landscape is evolving at a pace that few can keep up with, or even appreciate. The raft of changes creeping in represent both tremendous risks and opportunities for the frontline teams taking the trouble to understand their current and evolving environment. This one day programme strips the rhetoric away from the harsh reality of modern healthcare and provides an insight into the drivers of change, likely political manoeuvres and what this really means for secondary/tertiary Trusts and the clinical teams within. Event Dates & Locations Location: Date: 16th October 2009 Sheffield London 24th November 2009 View more dates online using ref #: 105

CPD Points: 5

www.NHStraining.co.uk

Target Audience Doctors Nurses Junior Middle Senior

Junior Middle Senior

Web Reference Number Bus & Admin Junior Middle Senior

Allied Pro’s Junior Middle Senior

Enter Reference: 105 Online at www.NHStraining.co.uk to view more event details and make a booking

Cost: From £215 + VAT

Event Type: Course

CPD Points: 5

Provider: Medicology Ltd

Effective direction is probably the single most important factor in driving performance and improvement, clinical or otherwise. Whereas it is often viewed as an art, we believe it is more akin to science, with a sound evidence base and known principles. This comprehensive course examines all facets of effective direction, providing you with all the knowledge, skills and practical approaches to ensure you gain the greatest possible performance and achievement from your clinical team. Event Dates & Locations Location: Date: 27th November 2009 Birmingham Manchester 1st February 2010 View more dates online using ref #: 103

Target Audience Doctors Nurses Junior Middle Senior

Web Reference Number Bus & Admin

Junior Middle Senior

Allied Pro’s Junior Middle Senior

Non-Specific

Core Skills in Setting Effective Direction for Clinical Teams

General

Leadership & Management Events - NHS Training Bulletin

Enter Reference: 103 Online at www.NHStraining.co.uk to view more event details and make a booking

Medical Management & Leadership for Year 4/5 StRs & Senior Specialty Doctors Event Type: Course

CPD Points: 15

Provider: Medicology Ltd

Comprehensive, in-depth focus on the core principles of effective management and leadership designed to create exceptional clinical leaders. This course is designed to deliver exceptional leaders with highly effective managerial ability, without ever losing sight of the fact that you are first and foremost doctors. Aligned closely with the Medical Leadership Competency Framework, jointly developed by The Academy of Medical Royal Colleges and the NHS Institute for Innovation and Improvement. Event Dates & Locations Location: Date: 12th - 14th October 2009 London Manchester 14th - 16th December 2009 View more dates online using ref #: 98

Target Audience Doctors Nurses Junior Middle Senior

Web Reference Number Bus & Admin

Junior Middle Senior

Allied Pro’s Junior Middle Senior

Non-Specific

Cost: From £645 + VAT

Enter Reference: 98 Online at www.NHStraining.co.uk to view more event details and make a booking

Leadership Masterclass for Healthcare Professionals Event Type: Course

CPD Points: 10

Provider: Medicology Ltd

One of the cornerstones of effective healthcare performance is the quality of leadership. Leadership Masterclass represents the latest thinking in how to drive groups of people to achieve great things. Focusing on both the leadership of self and others, it provides a deep level of insight into current theory and how it can be deployed in the leadership, motivation and influencing of people. At a practical level, it will help you provide strong guidance to people in a wide variety of scenarios from every day working to a sudden crisis. Event Dates & Locations Location: Date: 16th & 17th November 2009 London London 15th & 16th December 2009 View more dates online using ref #: 12

Target Audience Doctors Nurses Junior Middle Senior

Junior Middle Senior

Web Reference Number Bus & Admin Junior Middle Senior

Allied Pro’s Junior Middle Senior

Non-Specific

Cost: From £430 + VAT

Enter Reference: 12 Online at www.NHStraining.co.uk to view more event details and make a booking

Essential Leadership for SpR-level Doctors Event Type: Course

CPD Points: 5

Provider: Medicology Ltd

All SpR-level staff are expected to demonstrate a commitment to developing their potential as healthcare leaders. Effective leadership is an essential factor in the successful delivery of healthcare and also a key differentiator for those seeking consultant posts. This course investigates the key leadership issues in both a practical and theoretical sense. Designed to deliver measurable benefits in leading and motivating the staff around you, as well as providing the building blocks to develop as an exceptional healthcare leader. Event Dates & Locations Location: Date: 25th September 2009 Manchester London 27th October 2009 View more dates online using ref #: 10

Target Audience Doctors Nurses Junior Middle Senior

Junior Middle Senior

Web Reference Number Bus & Admin Junior Middle Senior

Allied Pro’s Junior Middle Senior

Non-Specific

Cost: From £215 + VAT

Enter Reference: 10 Online at www.NHStraining.co.uk to view more event details and make a booking

Foundation Course in Leadership & Management for FY Doctors Event Type: Course

CPD Points: 5

Provider: Medicology Ltd

Gain knowlegde, skills and insight into effective leadership and management, allowing you to become an effective clinical leader. This powerful course is designed to provide a significant foundation whilst recognising your career stage. Giving insight into the Medical Leadership Competency Framework, jointly developed by The Academy of Medical Royal Colleges and the NHS Institute for Innovation and Improvement, it also provides you with clear guidance on how to go about developing those comptencies throughout your progression. Event Dates & Locations Location: Date: 15th October 2009 London Birmingham 15th February 2010 View more dates online using ref #: 99

Target Audience Doctors Nurses Junior Middle Senior

Junior Middle Senior

Web Reference Number Bus & Admin Junior Middle Senior

Allied Pro’s Junior Middle Senior

Non-Specific

Cost: From £215 + VAT

Enter Reference: 99 Online at www.NHStraining.co.uk to view more event details and make a booking

www.NHStraining.co.uk

Non-Specific

General

NHS Training Bulletin - Leadership & Management Events

Effective Clinical Leadership Cost: From £430 + VAT

Event Type: Course

CPD Points: 10

Provider: Medicology Ltd

In this intensive 2-day course we marry modern management science in leadership theory with the unique demands of the clinical environment. The demands of a complex team-orientated, patient driven service require clinicians to develop skills in motivating staff clinically, fostering a sense of personal responsibility, performance management and supporting staff, at all levels of performance. Event Dates & Locations Location: Date: 28th & 29th September 2009 London Edinburgh 29th & 30th October 2009 View more dates online using ref #: 8

Target Audience Doctors Nurses Junior Middle Senior

Junior Middle Senior

Web Reference Number Bus & Admin Junior Middle Senior

Allied Pro’s Junior Middle Senior

Enter Reference: 8 Online at www.NHStraining.co.uk to view more event details and make a booking

Change Management Masterclass for Health Professionals Non-Specific

Cost: From £430 + VAT

Event Type: Course

CPD Points: 10

Provider: Medicology Ltd

Plan and implement change effectively, to reduce resistance and disruption, whilst increasing positive support. Leading people through change is probably the toughest job facing any leader, even with formal training. Covering everything from planning an effective change process to ensuring full engagement of the staff, we help you achieve your change goals with minimal disruption to performance and the fastest possible return to normal. It is designed to give you substantial expertise in getting change right. Event Dates & Locations Date: 23rd & 24th February 2010

Location: London

Target Audience Doctors Nurses Junior Middle Senior

Junior Middle Senior

Web Reference Number Bus & Admin Junior Middle Senior

Allied Pro’s Junior Middle Senior

Enter Reference: 82 Online at www.NHStraining.co.uk to view more event details and make a booking

Effective Meeting Management Non-Specific

Cost: From £215 + VAT

Event Type: Course

CPD Points: 5

Provider: Medicology Ltd

Given the sheer number of operational meetings each person engages in, we cannot afford the current level of meeting ineffectiveness. We spend more and more of our time in meetings and yet people often voice that meetings are a complete waste of time. We can change this. With the right set of skills, processes and strategies an effective meeting is possible everytime. This powerful course will have you running meetings that people look forward to because they achieve. Event Dates & Locations Date: 14th October 2009 15th March 2010

Location: London London

Target Audience Doctors Nurses Junior Middle Senior

Junior Middle Senior

Web Reference Number Bus & Admin Junior Middle Senior

Allied Pro’s Junior Middle Senior

Enter Reference: 83 Online at www.NHStraining.co.uk to view more event details and make a booking

Core Skills in Appraisal Effectiveness Non-Specific

Cost: From £215 + VAT

Event Type: Course

Accident and Emergency

Accident & Emergency

Provider: Medicology Ltd

Despite the vital nature of getting appraisals right, few have ever received training in how to set up and conduct appraisals effectively. Appraisals form an essential component of revalidation, recertification and relicensing and remain the core methodology for tying organisational priorities to individual goals, activities and competency. The appraisal itself can be a stressful experience for both appraise and appraiser, where effective communication skills are essential. Event Dates & Locations Location: Date: 20th November 2009 London Manchester 13th January 2010 View more dates online using ref #: 13

CPD Points: 5

Target Audience Doctors Nurses Junior Middle Senior

Junior Middle Senior

Web Reference Number Bus & Admin Junior Middle Senior

Allied Pro’s Junior Middle Senior

Enter Reference: 13 Online at www.NHStraining.co.uk to view more event details and make a booking

Clinical Management & Leadership for Year 4/5: Emergency Medicine Cost: From £599 + VAT

Event Type: Course

CPD Points: 15

Provider: Medicology Ltd

Welcome to the finest preparatory course available for specialist registrars approaching completion of training. This course is designed to enable you to make a step change in your ability to be effective as a new consultant in your specialty, whilst demonstrating your clear commitment to effective leadership. It is packed with the knowledge and skills that you’ll need to competently achieve, as well as specialtyspecific insight into the challenges you’ll be facing as a new consultant in the evolving health service. Event Dates & Locations Date: 4th - 6th November 2009

Location: London

www.NHStraining.co.uk

Target Audience Doctors Nurses Junior Middle Senior

Junior Middle Senior

Web Reference Number Bus & Admin Junior Middle Senior

Allied Pro’s Junior Middle Senior

Enter Reference: 109 Online at www.NHStraining.co.uk to view more event details and make a booking

Provider: Medicology Ltd

Welcome to the finest preparatory course available for specialist registrars approaching completion of training. The course is designed to enable you to make a step change in your ability to be effective as a new consultant in your specialty, whilst demonstrating your clear commitment to effective leadership. It is packed with the knowledge and skills that you’ll need to competently achieve, as well as specialtyspecific insight into the challenges you’ll be facing as a new consultant in the evolving health service. Event Dates & Locations Date: 24th - 26th February 2010

Location: London

Target Audience Doctors Nurses Junior Middle Senior

Junior Middle Senior

Web Reference Number Bus & Admin Junior Middle Senior

Allied Pro’s Junior Middle Senior

Enter Reference: 108 Online at www.NHStraining.co.uk to view more event details and make a booking

Clinical Management & Leadership for Year 4/5: Medicine (Physicians) Cost: From £599 + VAT

Event Type: Course

CPD Points: 15

Provider: Medicology Ltd

Welcome to the finest preparatory course available for specialist registrars approaching completion of training. this course is designed to enable you to make a step change in your ability to be effective as a new consultant in your specialty, whilst demonstrating your clear commitment to effective leadership. It is packed with the knowledge and skills that you’ll need to competently achieve, as well as specialtyspecific insight into the challenges you’ll be facing as a new consultant in the evolving health service. Event Dates & Locations Location: Date: 18th - 20th November 2009 Birmingham London 6th - 8th January 2010 View more dates online using ref #: 110

Target Audience Doctors Nurses Junior Middle Senior

Junior Middle Senior

Web Reference Number Bus & Admin Junior Middle Senior

Allied Pro’s Junior Middle Senior

Enter Reference: 110 Online at www.NHStraining.co.uk to view more event details and make a booking

Consultant Interview Skills: Obstetrics & Gynaecology Cost: From £299 + VAT

Event Type: Course

CPD Points: 6

Provider: Medicology Ltd

Most people would not even consider taking an exam without acquiring the requisite knowledge, skills and insight in preparation for it and therefore why would you approach perhaps one of the most important events in your life, getting the right consultant job, with any greater uncertainty than there needs to be? You wouldn’t. In fact, we know that you’d want to absolutely ensure you stood the best possible chance of success. That is why we have developed The Medicology Gold Standard Approach to consultant interview success. Event Dates & Locations Location: Date: 2nd October 2009 London Manchester 14th January 2010 View more dates online using ref #: 122

Target Audience Doctors Nurses Junior Middle Senior

Junior Middle Senior

Web Reference Number Bus & Admin Junior Middle Senior

Allied Pro’s Junior Middle Senior

General Medicine

CPD Points: 15

General Medicine

Event Type: Course

Enter Reference: 122 Online at www.NHStraining.co.uk to view more event details and make a booking

Obstetrics and Gynaecology Obstetrics & Gynaecology

Cost: From £599 + VAT

Anaesthesia

Clinical Management & Leadership for Year 4/5: Anaesthetics & Intensive Care

Anaesthesia

Leadership & Management Events - NHS Training Bulletin

CPD Points: 15

Provider: Medicology Ltd

Location: Manchester London

Target Audience Doctors Nurses Junior Middle Senior

Junior Middle Senior

Web Reference Number Bus & Admin Junior Middle Senior

Allied Pro’s Junior Middle Senior

Enter Reference: 112 Online at www.NHStraining.co.uk to view more event details and make a booking

Clinical Management & Leadership for Year 4/5: Oncology Cost: From £599 + VAT

Event Type: Course

CPD Points: 15

Provider: Medicology Ltd

Location: London

Target Audience Doctors Nurses Junior Middle Senior

Junior Middle Senior

Oncology

Event Type: Course

Oncology

Cost: From £599 + VAT

Obstetrics and Gynaecology

Clinical Management & Leadership for Year 4/5: Obstetrics & Gynaecology

Web Reference Number Bus & Admin Junior Middle Senior

Allied Pro’s Junior Middle Senior

Enter Reference: 113 Online at www.NHStraining.co.uk to view more event details and make a booking

www.NHStraining.co.uk

Oncology

NHS Training Bulletin - Leadership & Management Events

Consultant Interview Skills: Oncology Cost: From £299 + VAT

Event Type: Course

Paediatrics

Date: 8th October 2009 19th April 2010

Pathology Pathology

Location: London London

Cost: From £599 + VAT

Event Type: Course

Event Dates & Locations Location: Manchester London

Psychiatry

Junior Middle Senior

Bus & Admin

Allied Pro’s

Junior Middle Senior

Enter Reference: 123 Online at www.NHStraining.co.uk to view more event details and make a booking

CPD Points: 15

Provider: Medicology Ltd

Target Audience Doctors Nurses Junior Middle Senior

Junior Middle Senior

Web Reference Number Bus & Admin

Allied Pro’s

Junior Middle Senior

Enter Reference: 114 Online at www.NHStraining.co.uk to view more event details and make a booking

Clinical Management & Leadership for Year 4/5: Pathology & Labs Specialties Cost: From £599 + VAT

Event Type: Course

CPD Points: 15

Provider: Medicology Ltd

Psychiatry

Junior Middle Senior

Web Reference Number

Date: 5th - 7th October 2009 26th - 28th April 2010

Location: London London

Target Audience Doctors Nurses Junior Middle Senior

Junior Middle Senior

Web Reference Number Bus & Admin

Allied Pro’s

Junior Middle Senior

Enter Reference: 115 Online at www.NHStraining.co.uk to view more event details and make a booking

Clinical Management & Leadership for Year 4/5: Mental Health Cost: From £599 + VAT

Event Type: Course

CPD Points: 15

Provider: Medicology Ltd

Radiology

Target Audience Doctors Nurses

Clinical Management & Leadership for Year 4/5: Paediatrics & Neonatal Medicine

Date: 26th - 28th October 2009 5th - 7th May 2010

Radiology

Provider: Medicology Ltd

Location: Manchester London

Target Audience Doctors Nurses Junior Middle Senior

Junior Middle Senior

Web Reference Number Bus & Admin Junior Middle Senior

Allied Pro’s Junior Middle Senior

Enter Reference: 111 Online at www.NHStraining.co.uk to view more event details and make a booking

Clinical Management & Leadership for Year 4/5: Radiology Cost: From £599 + VAT

Event Type: Course

CPD Points: 15

Provider: Medicology Ltd

CPD Points: 6

Location: Manchester London

www.NHStraining.co.uk

Target Audience Doctors Nurses Junior Middle Senior

Junior Middle Senior

Web Reference Number Bus & Admin Junior Middle Senior

Allied Pro’s Junior Middle Senior

Enter Reference: 116 Online at www.NHStraining.co.uk to view more event details and make a booking

CPD Points: 6

Provider: Medicology Ltd

Location: London London

Target Audience Doctors Nurses Junior Middle Senior

Junior Middle Senior

Web Reference Number Bus & Admin Junior Middle Senior

Allied Pro’s Junior Middle Senior

Enter Reference: 126 Online at www.NHStraining.co.uk to view more event details and make a booking

Clinical Management & Leadership for Year 4/5: Surgery Cost: From £599 + VAT

Event Type: Course

CPD Points: 15

Provider: Medicology Ltd

Target Audience Doctors Nurses Junior Middle Senior

Junior Middle Senior

Surgery

Event Type: Course

Surgery

Cost: From £299 + VAT

Radiology

Consultant Interview Skills: Radiology

Radiology

Leadership & Management Events - NHS Training Bulletin

Web Reference Number Bus & Admin Junior Middle Senior

Allied Pro’s Junior Middle Senior

Enter Reference: 117 Online at www.NHStraining.co.uk to view more event details and make a booking

View Full Course Programme & Booking Details Online At www.NHStraining.co.uk

Enter the course reference number found on all course listings within the journal into the web reference box at www.NHStraining.co.uk to bring up the full course programme and booking details. You can also book over the phone by calling:

01332 821270

Want people to know about your courses? Add as many courses as you like absolutely free, you only pay for bookings made. Find out more by downloading our media pack and start adding your courses at www.NHStraining.co.uk/advertise

www.NHStraining.co.uk

NHS Training Bulletin - Personal Development Events

Non-Specific

General

Personal Development People, Relationships & Conflict - Improving Interpersonal Effectiveness Cost: From £215 + VAT

Event Type: Course

CPD Points: 5

Provider: Medicology Ltd

Do you want to understand people more in order to be more interpersonally effective, as well as developing specific strategies for managing conflict situations? Our ability to get on with our peers and behave in a productive, respectful fashion is one of the key determinants of organisational performance. Self awareness is a key goal to increase effectiveness. This course delivers an advanced understanding of how people are wired, what motivates their behaviour both normally and under situations of conflict and how to deal with this. Event Dates & Locations Location: Date: 8th October 2009 Manchester London 30th November 2009 View more dates online using ref #: 27

Target Audience Doctors Nurses Junior Middle Senior

Junior Middle Senior

Web Reference Number Bus & Admin Junior Middle Senior

Allied Pro’s Junior Middle Senior

Enter Reference: 27 Online at www.NHStraining.co.uk to view more event details and make a booking

Advanced Communication & Influencing Skills Non-Specific

Cost: From £430 + VAT

Event Type: Course

CPD Points: 10

Provider: Medicology Ltd

Starting with developing a greater understanding of people, this course then translates this into a range of advanced interpersonal skills such as advanced communications, negotiation skills, building rapport, developing effective teamwork & relationships, choosing appropriate language, fostering an environment of respect, as well as developing self-awareness. A busy and invaluable course designed to make you more effective in all of your dealings with people. Event Dates & Locations Location: Date: 21st & 22nd September 2009 London Manchester 12th & 13th November 2009 View more dates online using ref #: 22

Target Audience Doctors Nurses Junior Middle Senior

Junior Middle Senior

Web Reference Number Bus & Admin Junior Middle Senior

Allied Pro’s Junior Middle Senior

Enter Reference: 22 Online at www.NHStraining.co.uk to view more event details and make a booking

Assertiveness without Aggression Non-Specific

Cost: From £215 + VAT

Event Type: Course

CPD Points: 5

Provider: Medicology Ltd

Helping consultants & juniors successfully assert themselves is an area we approach very supportively, developing capability without ever changing the person inside. It’s so easy for those to whom assertiveness doesn’t come naturally to feel manipulated, bullied and sometimes not quite in control. Despite your exceptional level of knowledge you may suffer low self esteem and a lack of confidence when it comes to being assertive. On the flip side, you probably wouldn’t want to be thought of as rude or forceful. Event Dates & Locations Location: Date: 4th November 2009 Manchester London 21st January 2010 View more dates online using ref #: 23

Target Audience Doctors Nurses Junior Middle Senior

Junior Middle Senior

Web Reference Number Bus & Admin Junior Middle Senior

Allied Pro’s Junior Middle Senior

Enter Reference: 23 Online at www.NHStraining.co.uk to view more event details and make a booking

Presentation & Teaching Skills Non-Specific

Cost: From £215 + VAT

Event Type: Course

Provider: Medicology Ltd

Gain the confidence and skills to articulate, excel and inspire in presentations & teaching. Presentations and teaching skills form one of the core backbone elements of a successful medical career. Faced with a diverse range of scenarios, from teaching staff to interview presentations right through to a presentation of an international multicentre trial, it is surprising that few have ever received any formal training in this vital area. Presentation and Teaching Skills deals with the core elements of effectiveness in this area. Event Dates & Locations Location: Date: 2nd October 2009 London Manchester 20th November 2009 View more dates online using ref #: 30

CPD Points: 5

www.NHStraining.co.uk

Target Audience Doctors Nurses Junior Middle Senior

Junior Middle Senior

Web Reference Number Bus & Admin Junior Middle Senior

Allied Pro’s Junior Middle Senior

Enter Reference: 30 Online at www.NHStraining.co.uk to view more event details and make a booking

Cost: From £215 + VAT

Event Type: Course

CPD Points: 5

Provider: Medicology Ltd

Skills in Customer Service Excellence is designed to encourage exceptional skills in and continuous attention to creating a superb patient, public and service user experience irrespective of your service type. This comprehensive programme covers the importance of an excellent experience, through skills development, right to embedding it as an enduring culture. What’s more, all team members exit the programme with an unambiguous picture of how a superior experience translates into security and success for them. Event Dates & Locations Location: Date: 24th November 2009 London Manchester 25th January 2010 View more dates online using ref #: 258

Target Audience Doctors Nurses Junior Middle Senior

Junior Middle Senior

Web Reference Number Bus & Admin Junior Middle Senior

Allied Pro’s Junior Middle Senior

Non-Specific

Core Skills in Customer Service Excellence

General

Personal Development Events - NHS Training Bulletin

Enter Reference: 258 Online at www.NHStraining.co.uk to view more event details and make a booking

Time Management & Personal Effectiveness for Junior & Middle Grade Doctors Event Type: Course

CPD Points: 5

Provider: Medicology Ltd

Aimed specifically at doctors in training, this is probably the most powerful course in personal effectiveness you will find. The successful junior or middle grade doctor needs a unique combination of skills combining a high team orientation with strong time management and organisational skills coupled with a delicate balancing act between learning and delivering. Packed full of practical strategies to plan and prioritise effectively, manage the never ending influx of work and regain effective work-life balance. Event Dates & Locations Location: Date: 5th October 2009 Birmingham Birmingham 14th December 2009 View more dates online using ref #: 85

Target Audience Doctors Nurses Junior Middle Senior

Junior Middle Senior

Web Reference Number Bus & Admin Junior Middle Senior

Allied Pro’s Junior Middle Senior

Non-Specific

Cost: From £215 + VAT

Enter Reference: 85 Online at www.NHStraining.co.uk to view more event details and make a booking

Core Skills in Marketing, PR & Referral Management for Clinical Services Event Type: Course

CPD Points: 5

Provider: Medicology Ltd

The modern healthcare marketplace demands that attention is paid to successfully attracting patients into a service, so that funding follows under Payment by Results. Clinical teams themselves are best placed to develop effective attraction strategies, just so long as they understand the principles of engagement. This course develops the necessary core skills and principles around ensuring a consistent flow of patients and successful long term growth. You’ll find it practical, fast-paced and very productive. Event Dates & Locations Date: 21st January 2010 18th March 2010

Location: London London

Target Audience Doctors Nurses Junior Middle Senior

Junior Middle Senior

Web Reference Number Bus & Admin Junior Middle Senior

Allied Pro’s Junior Middle Senior

Non-Specific

Cost: From £215 + VAT

Enter Reference: 255 Online at www.NHStraining.co.uk to view more event details and make a booking

Time Management & Personal Effectiveness for Healthcare Professionals Event Type: Course

CPD Points: 5

Provider: Medicology Ltd

Creating high achievers with more energy and better work-life balance. You’re probably successful already but I bet it could feel easier! There are many compelling reasons to access strategies and support and very few are about being poor at time management. Packed full of practical strategies to plan and prioritise effectively, manage the never ending influx of work and regain effective work-life balance. Achieve more this year. You deserve it for all your hard work. Event Dates & Locations Location: Date: 12th October 2009 London Birmingham 18th January 2010 View more dates online using ref #: 2

Target Audience Doctors Nurses Junior Middle Senior

Junior Middle Senior

Web Reference Number Bus & Admin Junior Middle Senior

Allied Pro’s Junior Middle Senior

Non-Specific

Cost: From £215 + VAT

Enter Reference: 2 Online at www.NHStraining.co.uk to view more event details and make a booking

Communication Skills for Junior & Middle Grade Doctors Event Type: Course

CPD Points: 5

Provider: Medicology Ltd

It is well known that most complaints and litigation come from poor communication process. Equally, clinical mistakes stem from a lack of communication strategy and poor communication style contributes to most interpersonal conflict in the workplace. This fast-paced course is highly effective on improving communication skills essential to junior doctors, handling patients, parents & relatives and dealing with situations where improved communication clarity is likely to lead to improve results and outcomes. A very powerful course. Event Dates & Locations Location: Date: 11th November 2009 Birmingham London 22nd January 2010 View more dates online using ref #: 24

Target Audience Doctors Nurses Junior Middle Senior

Junior Middle Senior

Web Reference Number Bus & Admin Junior Middle Senior

Allied Pro’s Junior Middle Senior

Non-Specific

Cost: From £215 + VAT

Enter Reference: 24 Online at www.NHStraining.co.uk to view more event details and make a booking

www.NHStraining.co.uk

Non-Specific

General

NHS Training Bulletin - Personal Development Events

Core Skills in Mentoring Medical Professionals Cost: From £215 + VAT

Event Type: Course

CPD Points: 5

Provider: Medicology Ltd

Mentoring is perhaps one of the most powerful and effective strategies for realising potential in individuals. Mentoring medical professionals can be an enormously rewarding experience for both mentee and mentor. Adoption of effective mentoring practises can help individuals develop self-reliance in their learning whilst over-coming unfamiliar challenges with support where needed. This course provides an effective mentoring framework from initiation to closure, including all of the practical strategies necessary to make it successful. Event Dates & Locations Date: 10th November 2009

Location: London

Target Audience Doctors Nurses Junior Middle Senior

Junior Middle Senior

Web Reference Number Bus & Admin Junior Middle Senior

Allied Pro’s Junior Middle Senior

Enter Reference: 95 Online at www.NHStraining.co.uk to view more event details and make a booking

Paediatrics

Membership & Revision MRCPCH Part 2 Pre-Written Revision Course Cost: £825

Event Type: Course

CPD Points: 0

Provider: UCL Institute of Child Health

A comprehensive and detailed revision course designed to prepare participants for the MRCPCH Part 2 examination. Tution is provided in all aspects of paediatric medicine covered by the examintaion syllabus equipping participants with skills and understanding needed to approach the MRCPCH Part 2 examination with confidence.This five day course is predominantly taught by specialists from Great Ormond Street Hospital and the Institute of Child Health; the international centre of excellence in paediatric medicine and medical teaching Event Dates & Locations Date: 23rd - 27th November 2009

Location: London

Target Audience Doctors Nurses Junior Middle Senior

Junior Middle Senior

Web Reference Number Bus & Admin Junior Middle Senior

Allied Pro’s Junior Middle Senior

Enter Reference: 274 Online at www.NHStraining.co.uk to view more event details and make a booking

Diploma in Child Health (DCH) Revision Course Cost: £725

Event Type: Course

CPD Points: 0

Provider: UCL Institute of Child Health

In depth and practical revision course aimed at preparing the DCH candidate for the DCH written exam (MRCPCH Part 1 Written Paper 1A ) and giving insight into the clinical exam that follows. Additionally this course would be of value to GPs desiring a refresher in commonly encountered paediatric problems and developmental assessment. Event Dates & Locations Date: 8th - 11th December 2009

Location: London

Target Audience Doctors Nurses Junior Middle Senior

Junior Middle Senior

Web Reference Number Bus & Admin Junior Middle Senior

Allied Pro’s Junior Middle Senior

Enter Reference: 278 Online at www.NHStraining.co.uk to view more event details and make a booking

www.NHStraining.co.uk

Personal Development Events - NHS Training Bulletin

Delivering World Class Cardiac Services CPD Points: 0

Provider: HSJ

NHS cardiac services are undoubtedly leading the way in successful service improvement. But many remaining challenges must be overcome and sustainable improvement demonstrated before cardiac services can truly be considered world class. It is essential that national priorities for service improvement - specifically those around prevention, rehabilitation and heart failure care - are promptly and effectively implemented at a local level. This important event by HSJ will help you drive improvement in your cardiac services. Event Dates & Locations Date: 30th September 2009

Location: London

Target Audience Doctors Nurses Junior Middle Senior

Junior Middle Senior

Web Reference Number Bus & Admin Junior Middle Senior

Allied Pro’s Junior Middle Senior

Enter Reference: 269 Online at www.NHStraining.co.uk to view more event details and make a booking

Update in Paediatric Respiratory Medicine Chest Medicine

Cost: £185

Event Type: Course

CPD Points: 6

Provider: UCL Institute of Child Health

The purpose of this course is to provide an update on current practice in paediatric respiratory medicine on an everyday basis. The programme and range of issues covered will be suitable for everyone concerned with paediatric respiratory medicine. The course consists of a series of presentations on paediatric respiratory problems with an emphasis on a clinical approach and plenty of time for discussion. Event Dates & Locations Date: 4th November 2009

Location: London

Target Audience Doctors Nurses Junior Middle Senior

Junior Middle Senior

Web Reference Number Bus & Admin Junior Middle Senior

Allied Pro’s Junior Middle Senior

Enter Reference: 272 Online at www.NHStraining.co.uk to view more event details and make a booking

Neonatal and Paediatric Ventilation

Paediatrics

Cost: From £329

Event Type: Course

CPD Points: 0

Provider: UCL Institute of Child Health

Event Dates & Locations Date: 3rd & 4th December 2009

Location: London

Target Audience Doctors Nurses Junior Middle Senior

Junior Middle Senior

Chest Medicine

Event Type: Conference

Paediatrics

Cardiology

Cost: From £299 + VAT

Cardiology

Clinical Courses & Conferences

Web Reference Number Bus & Admin Junior Middle Senior

Allied Pro’s Junior Middle Senior

Enter Reference: 277 Online at www.NHStraining.co.uk to view more event details and make a booking

Nephrology Day for General Paediatricians 2009

Paediatrics

Cost: £199

Event Type: Course

CPD Points: 0

Provider: UCL Institute of Child Health

This annual one day course aims to give a full overview of paediatric nephrology by selecting different themes each year and presenting them in a way which will be useful for general paediatricians. This year’s theme’s are: The Neonate, Hypertension, Systemic diseases and the kidney Event Dates & Locations Date: 27th November 2009

Location: London

Target Audience Doctors Nurses Junior Middle Senior

Junior Middle Senior

Web Reference Number Bus & Admin Junior Middle Senior

Allied Pro’s Junior Middle Senior

Enter Reference: 275 Online at www.NHStraining.co.uk to view more event details and make a booking

www.NHStraining.co.uk

Eating Disorders in Children and Adolescents Cost: £350

Event Type: Course

CPD Points: 0

Provider: UCL Institute of Child Health

A course for CAMHS Clinicians, Adult Eating Disorders Clinicians, those working in paediatric services and others who are involved in the management of young people with eating disorders on an inpatient or outpatient basis. The course provides a comprehensive overview of eating disorders in children and adolescents, from recognition and diagnosis to management. Event Dates & Locations Date: 30th November 2nd December 2009

Location: London

Target Audience Doctors Nurses Junior Middle Senior

Junior Middle Senior

Web Reference Number Bus & Admin Junior Middle Senior

Allied Pro’s Junior Middle Senior

Paediatrics

NHS Training Bulletin - Clinical Events

Enter Reference: 276 Online at www.NHStraining.co.uk to view more event details and make a booking

Post traumatic Stress in Pre-school Children Event Type: Course

CPD Points: 0

Provider: UCL Institute of Child Health

The course will enable participants to leave with a working knowledge of the nuts and bolts for practical everyday clinical work. This will be conducted through lectures and supported by video examples from Dr Scheeringa’s research studies. The course will demonstrate how to use the CBT techniques and how to identify feelings with preschool children, use a stress thermometer, build a stimulus hierarchy and use relaxation techniques. Event Dates & Locations Date: 21st & 22nd November 2009

Location: London

Target Audience Doctors Nurses Junior Middle Senior

Junior Middle Senior

Web Reference Number Bus & Admin Junior Middle Senior

Allied Pro’s Junior Middle Senior

Enter Reference: 273 Online at www.NHStraining.co.uk to view more event details and make a booking

View Full Course Programme & Booking Details Online At www.NHStraining.co.uk

01332 821270

www.NHStraining.co.uk

Psychiatry

Cost: £225

Clinical Events - NHS Training Bulletin

Quality, Governance & Experience Non-Specific

Cost: From £125 + VAT

Event Type: Conference

CPD Points: 5

Provider: Medicology Ltd

Clinical teams have a natural orientation towards quality and appreciate the significant role clinical governance plays in ensuring safe services. This important conference has quality at its heart but seeks to broaden the definition and attributes of quality from a delivery perspective. Acknowledging that you cannot claim quality without the highest standards and outcome, Quality, Governance & Experience brings the patient perception to the fore, to find a balance between hard, measurable outcomes and the softer, human experience. Event Dates & Locations Date: 17th December 2009

Location: London

Target Audience Doctors Nurses Junior Middle Senior

General

Non-Clinical Courses & Conferences

Web Reference Number Bus & Admin

Junior Middle Senior

Allied Pro’s Junior Middle Senior

Enter Reference: 252 Online at www.NHStraining.co.uk to view more event details and make a booking

Engaging Clinical Teams in the Business of Health Non-Specific

Cost: From £125 + VAT

Event Type: Conference

CPD Points: 5

Provider: Medicology Ltd

The modern healthcare economy is without doubt challenging with ever greater financial pressures, increased scrutiny, heightened expectations and ever increasing demand. However, perhaps one of the greatest challenges facing healthcare is that of engaging its clinical workforce meaningfully and collaboratively to address the issues of the day. To survive and thrive in this demanding environment requires the utmost clinical-managerial collaboration, a solid strategic plan and top notch performance. Event Dates & Locations Date: 30th October 2009

Location: London

Target Audience Doctors Nurses Junior Middle Senior

Junior Middle Senior

Web Reference Number Bus & Admin Junior Middle Senior

Allied Pro’s Junior Middle Senior

Enter Reference: 226 Online at www.NHStraining.co.uk to view more event details and make a booking

NHS Business Management Non-Specific

Cost: From £299 + VAT

Event Type: Conference

CPD Points: 0

Provider: HSJ

The NHS is entering a new era and with that comes unprecedented challenges. Delivering Darzi’s vision of high quality care for all and managing the effects of a global recession are no easy tasks, especially when coupled together. There are now, more than ever before, demands on all NHS managers and clinicians to develop their commercial acumen and business skills. HSJ is proud to bring you this essential learning event designed to provide you with the commercial skills and know-how now imperative in the new NHS environment. Event Dates & Locations Date: 29th September 2009

Location: Birmingham

Target Audience Doctors Nurses Junior Middle Senior

Junior Middle Senior

Web Reference Number Bus & Admin Junior Middle Senior

Allied Pro’s Junior Middle Senior

Enter Reference: 267 Online at www.NHStraining.co.uk to view more event details and make a booking

Safeguarding Children

Paediatrics

Cost: From £125 + VAT

Event Type: Conference

CPD Points: 5

Provider: Medicology Ltd

Safeguarding Children 2009 is designed to serve two vital goals; drawing together insight, information & understanding around the core issues facing health professionals in this area, whilst providing a forum for debate, collaboration and networking by the very professionals implementing child protection services at the coalface. Event Dates & Locations Date: 21st October 2009

Location: London

Target Audience Doctors Nurses Junior Middle Senior

Junior Middle Senior

Web Reference Number Bus & Admin Junior Middle Senior

Allied Pro’s Junior Middle Senior

Enter Reference: 223 Online at www.NHStraining.co.uk to view more event details and make a booking

www.NHStraining.co.uk

NHS Training Bulletin

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Passionate about People, Performance & Health 48

www.NHStraining.co.uk

medicology

NHS Training Bulletin

NHS Training Bulletin As well as booking online you can also book over the phone by calling 01332 821270 or by post, please fill this form in and send it back to the address below, or fax to 01332 821262

Event Details Event Reference Number (Found in the bottom right of each course listing): First Choice of Date: Second Choice of Date:

Personal Details Title: (please circle the correct one)

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First Name: Surname (Family Name): Job Title: Clinical Speciality: Any special diet and/or access requirements?

Location / Contact Details Hospital / Clinic / Trust: Home Address:

Main Telephone: Mobile Number: Email Address: (Compulsory for all registrations)

Payment Details NHS Training will contact you regarding payment options for this course. We will issue an invoice & receipt for all payment methods so that you may reclaim your costs from your employer. N.B. Invoices declined by an employer incur a further fee of ÂŁ45 + VAT, so please ensure that your employer agrees.

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Please send this completed form back to: NHS Training Bulletin, Oxford House, Stanier Way, Wyvern Business Park, Derby, DE21 6BF Tel: 01332 821270

Fax: 01332 821262

Email: customer.services@nhstraining.co.uk Web: www.NHStraining.co.uk

NHS Training Bulletin is supported by Medicology Ltd and is not an official publication/ servicewww.NHStraining.co.uk of the NHS

41850 Wesleyan Jnr Dr A4 HD-AD-12 03-09:Layout 1 05/03/2009 16:01 Page 1

You look after your patients We’ll look after your finances Tailored financial advice for doctors

• Savings and investments • Retirement planning • Life and income protection • Mortgages and insurance • Banking services Wesleyan Medical Sickness specialises in providing tailored financial advice to the medical profession. Our Financial Consultants are trained to understand the specific needs of hospital doctors and are dedicated to helping you plan for a more secure financial future. What’s more, Wesleyan Assurance Society, our parent company, is one of the financially strongest and longest serving mutuals in the UK. Choose Wesleyan Medical Sickness and you choose a Financial Consultant who is as dedicated to your profession as you are.

To find out more call:

0800 107 5352 Wesleyan Medical Sickness is a trading name of Wesleyan Financial Services Ltd, which is authorised and regulated by the Financial Services Authority. Wesleyan Financial Services Ltd is wholly owned by Wesleyan Assurance Society. Registered No. 1651212. Head Office: Colmore Circus, Birmingham, B4 6AR. Fax: 0121 200 2971. Website: www.wesleyanmedicalsickness.co.uk Telephone calls may be recorded for monitoring and training purposes. HD-AD-12 03/09