After working in the NHS for a few years, I have had the pleasure of working with a lot of health care professionals - some were amazing, some inspired me, some taught me more in their ward rounds than I would have learnt in a week, some were complete ***** ( insert swear word of your choice).
This post is about what I have learnt from some amazing consultants. It is a note to myself to what to do when I get to that stage.
WHEN TAKING HANDOVER FROM THE ON CALL TEAM1. Thank them for their hard work no matter how many patients are left waiting to be seen
2. Request each one of the health care professionals to send you tickets for cases they have presented during handover
YOUR OWN TEAM
1. Cake and sweets help a lot. On a warm day , ice cream is a life saver. It does not cost a lot and it helps boost the morale of the team significantly.
2. Ask your team to address you by your first name when you're a consultant- it breaks hierarchical differences and doubts. The team will open up to you more.
3. Whenever someone discusses a case with you, ask them to send a ticket for a case based discussion. Have a 2 way conversation - but do not try to antagonize the poor junior doctor who has come to you for help. Thank them and appreciate them for what they have done.
EVERY WEEK
Present on "Clinical errors and what we can learn from " - this can be a datix , SI , any personal learning points ( with food of course- pre-COVID , drug representatives used to bring a lot of nice goodies and did a quick 5 minute talk then let the team do their teaching).
Ensure that other juniors get to present as well ( not death by PowerPoint but interesting learning experiences - maybe a reg can take the lead for this )
PROTECTING YOUR TEAM AND TAKING OWNERSHIP
When an angry registrar from another specialty tells a poor junior doctor off , protect them by saying that you take full responsibility for this and instead of bashing a poor FY1 who has just started , they should talk to you.
DEALING WITH OTHER SPECIALISTS
Respect all specialties. Help them in every way possible by seeing referrals, making plans for them.
I am an acute medical registrar and when I am a consultant, I plan to work closely with ED, GPs to ensure patient flow is maintained and patients are safely transferred directly to the specialist wards where they are seen by the specialty teams directly after I have seen the patient.
HELPING THE TEAM
See patients directly when it's busy. No matter how small the job is ( cannulation , referring a patient , doing a FP10 ) , still do it.
TAKE CARE OF THE PERSON SITTING IN THE CORNER OF THE OFFICE
A new doctor from abroad, who's just started here as their first job in the NHS will be shy , won't socialize and may even struggle to talk to the consultants/ registrars. Befriend them. Supervise them. Support them. They are vulnerable. And need a lot of hand holding initially ( they're very good clinically but just need to get the hang of the "logistical " part of the NHS and within 3 to 6 months they will really shine. The same goes for other health care professionals like nurses, physiotherapists - talk to them, break the barrier and they will open up nicely and you will see a significant difference in their confidence.
SOCIALS
Taking the whole team out for team breakfast after a set of long days. You don't have to pay for it ( or maybe pay 50% of the total bill ).
Arrange a regular get togethers and include everyone in the ward - go out to a nice pub/restaurant. Invite everyone from the ward including doctors, nurses, physiotherapists ward clerks, etc. Again - you do not have to pay and everyone can pay for whatever the eat/drink but this builds very nice relationships outside work.
TRAINING ACPs
I would want to have ACPs on every ward who can help with discharge summaries, cannulations and junior doctors can focus on unwell patients, ward rounds, teaching attending clinics and teaching ACPs who then can also do on calls ( under supervision - but help the junior doctors with ward jobs, clerking, etc thereby not overwhelming the team).They can run the acute floor with the acute medical registrar and consultant.
I would want to have ACPs on every ward who can help with discharge summaries, cannulations and junior doctors can focus on unwell patients, ward rounds, teaching attending clinics and teaching ACPs who then can also do on calls ( under supervision - but help the junior doctors with ward jobs, clerking, etc thereby not overwhelming the team).They can run the acute floor with the acute medical registrar and consultant.
The ACPs should also be allowed to do procedures like ascetic taps , lumbar punctures , attend clinics so that they feel motivated to stay in this job. They should have supervision where necessary and should not be left alone if they do not feel confident.
With time, they will become confident enough to help the ward cover and acute take doctors thus easing the load.
SIMULATION SESSIONS
Every trust has a resus office where there is a mannikin and a full system to run a mock arrest call. This should happen every month and all doctors should be able to polish their ALS skills.
In some trusts, there are simulation rooms to run busy ward scenarios and have equipment to practice procedures like LPs, ascetic drains, cardioversion, chest drains, etc.
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IMG REPRESENTATIVE SYSTEM
This is how it started in the trust I previously worked at:
One of the educational supervisors who was also the college tutor called all the IMG'S and asked what issues they have had. They all said that they had problems settling in and did not understand how the system worked. Then we decided it is best we have IMG representatives.
I was part of the team- as a non trainee SHO. There was one ST7 trainee IMG reg and an IMG who had just passed his PACES and had applied for a ST3 post- so we have representatives from each level.
This is how it worked:
Whenever a new IMG came , we were given their contact details and we sat with them and went through everything.
In case no one is interested in your trust:
You could also do a short survey and ask all of IMG's what problems they had when they joined and they will say the same. Collect the data and you could even present it in your educational half day. Or at least inform the educational supervisors in your trust.
This is a typical survey form I had thought about-This should be restricted to IMG’s who have just started in your trust or were not working in the NHS before starting.
Name of Doctor:
Country of origin:
Date of start of job:
Did you have trouble settling into your new job:
Do you think it would have been helpful if there was an International Medical Graduate Guide whom you could have contacted when you started work :
You will have a certain idea of how many people there are who would have found it useful after circulating this survey.
This is how it started in the trust I previously worked at:
One of the educational supervisors who was also the college tutor called all the IMG'S and asked what issues they have had. They all said that they had problems settling in and did not understand how the system worked. Then we decided it is best we have IMG representatives.
I was part of the team- as a non trainee SHO. There was one ST7 trainee IMG reg and an IMG who had just passed his PACES and had applied for a ST3 post- so we have representatives from each level.
This is how it worked:
Whenever a new IMG came , we were given their contact details and we sat with them and went through everything.
In case no one is interested in your trust:
You could also do a short survey and ask all of IMG's what problems they had when they joined and they will say the same. Collect the data and you could even present it in your educational half day. Or at least inform the educational supervisors in your trust.
This is a typical survey form I had thought about-This should be restricted to IMG’s who have just started in your trust or were not working in the NHS before starting.
Name of Doctor:
Country of origin:
Date of start of job:
Did you have trouble settling into your new job:
Do you think it would have been helpful if there was an International Medical Graduate Guide whom you could have contacted when you started work :
You will have a certain idea of how many people there are who would have found it useful after circulating this survey.
How to maintain the continuity:
These IMG’s whom I guided became the IMG representatives when my colleagues and I left this trust. So there was continuity.
How I did this:
My educational supervisor emailed the contact details of the new IMG’s when they met her on the first day. We then contacted them and arranged a convenient time to meet. I made a checklist of what I wanted to tell them about.
Here is a typical example:
General stuff:
1. Blogs and facebook groups you know of.
2. If they have collected their BRP’s
3. If they have opened a bank account
4. If their accommodation has been sorted out – ask if they need any help. Advise them where to shop from and transportation, etc
5. Explain the different travel routes and what places there are to visit.
Hospital related:
1. First, get to know their qualifications – so that you have an idea of what competencies they have.
2. Show and explain to them how a patient is admitted to a ward in your trust – starting from the front door of the A and E
3. Tell them about how the ward work by just talking about what you do.
4. Tell them about the computer systems of your trust – If they do not have access to the IT systems, contact the IT team on their behalf and arrange access. Give their email addresses to the IT team who can contact them and ask the relevant questions.
5. Show them how the computer systems work too – it’s hard to explain unless you demonstrate it
6. Ask them to get their ID badges and get access to medical wards.
7. Ask them to download your trust based apps: like antibiotics guide, how to get trust emails on their phones
8. Tell them about documentation, information governance, the importance of patients privacy and maintaining hand hygiene
9. Show them how the intranet works and how they can access their rotas and apply for leaves
10. Show them when your regular physicians meetings are.
11. Give them your contact number and ask them to message you if they have any trouble.
12. Message them regularly asking how they are if they need any help with anything.
13. Explain the importance of a PDP ( personal development plan)
General stuff:
1. Blogs and facebook groups you know of.
2. If they have collected their BRP’s
3. If they have opened a bank account
4. If their accommodation has been sorted out – ask if they need any help. Advise them where to shop from and transportation, etc
5. Explain the different travel routes and what places there are to visit.
Hospital related:
1. First, get to know their qualifications – so that you have an idea of what competencies they have.
2. Show and explain to them how a patient is admitted to a ward in your trust – starting from the front door of the A and E
3. Tell them about how the ward work by just talking about what you do.
4. Tell them about the computer systems of your trust – If they do not have access to the IT systems, contact the IT team on their behalf and arrange access. Give their email addresses to the IT team who can contact them and ask the relevant questions.
5. Show them how the computer systems work too – it’s hard to explain unless you demonstrate it
6. Ask them to get their ID badges and get access to medical wards.
7. Ask them to download your trust based apps: like antibiotics guide, how to get trust emails on their phones
8. Tell them about documentation, information governance, the importance of patients privacy and maintaining hand hygiene
9. Show them how the intranet works and how they can access their rotas and apply for leaves
10. Show them when your regular physicians meetings are.
11. Give them your contact number and ask them to message you if they have any trouble.
12. Message them regularly asking how they are if they need any help with anything.
13. Explain the importance of a PDP ( personal development plan)
WORKING WITH HR AND IMPROVING IMG INDUCTION AND RETENTION OF DOCTORS.
Work with HR and management to improve staffing levels by making the job more attractive.
This which help are:
THE JOB DESRIPTION
The job description should be attractive and have points like:
1. Contract for 1 years, extendable to 3 years. You will get a COS which states you have been employed for 3 years.
The job description should be attractive and have points like:
1. Contract for 1 years, extendable to 3 years. You will get a COS which states you have been employed for 3 years.
2. You will rotate in different specialties
3. You will have a dedicated supervisor who will help with making a personal development plan and help with progressing in your career
4. Study budget
5. Bleep free time to attend teaching sessions like trainees
6. Portfolio access
7. Access to local simulation days where you can manage acutely unwell patients under supervision and do procedures
8. 1 week of hands off shadowing
9. No on calls till you have settled/ 3 months into your job if this is your first job in the NHS
10. Access to the IMG representative team
JOB CONTRACT
At least 1 year or 2 years ( if the trainees plan to start training this/next August).
At least 1 year or 2 years ( if the trainees plan to start training this/next August).
This way they will not be worried about applying elsewhere for jobs as soon as they start and can focus on settling in the NHS and once they are settled and confident( which takes a few weeks), they can start on calls, do QIPs, build their portfolios , give a UK based post graduate exam like MRCP 1 ( and even 2) then apply for training posts
NHS JOBS/TRAC JOBS ADVERTISEMENTS
Instead of having questions like 'have your foundation competencies been signed off', there should be more useful questions to judge if the doctor is interested in the job or not. Make the application short and simple and instead of a HR team member going through the application, an IMG doctor who has worked here for a few years ( like a registrar or consultant) sifts through the applications and short lists candidates for an interview. Shortlisting should be done within a week of applying
THE INTERVIEW
The interviews should be conducted in a weeks time from the date the shortlisting is complete.
It should be based just like training interviews:
https://www.imtrecruitment.org.uk/recruitment-process/interview/interview-structure-and-content
https://www.imtrecruitment.org.uk/recruitment-process/interview/interview-structure-and-content
Like for 5 minutes, find out about the candidate and bring out their strengths
For the next 10 minutes, ask basic clinical questions relevant to day to day practice
Allow them 5 minutes to ask any questions.
At the end of the session, let them know that they have performed really well and you will get in touch. Give them your email address and the HRs email address in case they have any queries
SELECTION
This should be based on the interview and their NHS jobs application. You would know by the end of the interview session who has stood out and who has not.
This should be based on the interview and their NHS jobs application. You would know by the end of the interview session who has stood out and who has not.
Contact both successful and unsuccessful candidates. Feedback in a constructive manner to those who were not selected.
TIME FOR THE CANDIDATE TO ACCEPT THE OFFER
Some doctors apply for multiple jobs and have a few interviews lined up. Allow them a week to decide and ask any questions.
Once they have formally accepted the post, ask HR to apply for COS ASAP and make a job plan for the doctors
A TYPICAL JOB PLAN/TIMELINE
The start date should be 2 months form the day the trust applies for a COS.
During these 8 weeks
1. The doctor is to contact occupational health and arrange an appointment, let them know about their vaccination status and if they can accept any blood tests done in their home country
2. Apply for a visa as soon as they get their COS
3. Come to the UK when they get their work visa
4. Get in touch with the IMG representative team
Upon landing:
1. Quarantine depending on the current guidance:
https://www.gov.uk/guidance/travel-to-england-from-another-country-during-coronavirus-covid-19
1. Quarantine depending on the current guidance:
https://www.gov.uk/guidance/travel-to-england-from-another-country-during-coronavirus-covid-19
2. Collect BRP
3. Sort out accommodation
4. Open a bank account
5. Start in a weeks time
6. Meet occupational health
Induction
1. The IMG representative team meets the new doctors
2. The trusts IT team, clinical governance team, resus team do a formal induction
3. ID badges, etc are sorted out.
4. Ensure they get medical indemnity cover:
http://omarsguidelines.blogspot.com/2017/08/indemnity-insurance-for-imgs.html
http://omarsguidelines.blogspot.com/2017/08/indemnity-insurance-for-imgs.html
Shadowing
One week of hands off paid shadowing
The doctor shadows other doctors who are working at their level. They are not expected to do anything and should be allowed to ask questions. The whole team should be aware that they are new and that they will need to explain more in detail.
After shadowing
Introductory meeting with supervisors
The new doctor has a meeting with their supervisor who brings them into confidence, supports them and explains what their role is. And that they will catch up in 2 weeks
The new doctor is to then start work only from 0900 to 1700 under supervision of the doctors whom they have been shadowing. The settled doctors should be aware that it will take time for the new doctors to settle and hence should be supportive.
The settled doctors should get certificates showing their leadership qualities which they can attach in their portfolios.
After a few weeks
The new doctor who is now settling in nicely should meet up with their supervisor to discuss their personal development plan in which things like
The new doctor who is now settling in nicely should meet up with their supervisor to discuss their personal development plan in which things like
1. CREST form
2. ALS
3. Giving a UK based post graduate exam like MRCP 1/2
4. QIP
5. Teaching sessions
6. E portfolio
should be discussed.
They should bring a print out of the CREST form and circle the points they have already achieved and what they need to work on - the personal development plan shoule be aimed at achieving all of that.
The resus teams details should be given so that the doctor can arrange ALS training and get certified within the next few weeks.
Month 3
The doctor should have passed/booked ALS and feels confident enough to do on calls. They are then added to the on call rota
From thereon -
You have a perfect SHO, who has been well supported from day 1 , is willing to learn and is encouraged. They will truly shine and then become an IMG representative and continue this way of providing personal guidance and assistance.
Word will get out how supportive this trust is and whenever there is a vacancy, you will have loads of applicants. Continue doing the same process.
SUPPORT WITH CESR
With this sort of support, some doctors may just want to continue in the same trust. They complete their MRCP/MRCS exams, step up as a registrar after getting their core competencies signed off and cover middle grade rotas.
They continue working and professionally developing themselves, they have a portfolio just like trainees and once they meet the requirements, they get signed off for CESR and become a consultant.
As you can see, this way you will have a well staffed hospital and the overall morale will be very high as everyone is well supported and looked after.
SUPPORT WITH TRAINING APPLICATIONS
If a doctor does decide to leave the trust by applying for a training post, support them as much as you can. Request them to put you as a referee and practice interviews with them. Do not be disheartened or try to ruin it for them and be proud of what you have achieved. They will always remember this kind supportive attitude and do the same whenever they get the chance.
If a doctor does decide to leave the trust by applying for a training post, support them as much as you can. Request them to put you as a referee and practice interviews with them. Do not be disheartened or try to ruin it for them and be proud of what you have achieved. They will always remember this kind supportive attitude and do the same whenever they get the chance.
BULLYING COLLEAGUES
As a consultant, it might be difficult when you hear about another colleague working in the trust bully a new doctor. Hence it is very important to help them escalate this:
https://omarsguidelines.blogspot.com/2020/01/bullying-and-stress-in-nhs.html
https://omarsguidelines.blogspot.com/2020/01/bullying-and-stress-in-nhs.html
The NHS is my home and I want to make this home for everyone else by ensuring that they feel settled. When staff morale is high, the patient care is better. And remember - the FY1 of today is the SHO of tomorrow, the SHO of today is the registrar of tomorrow and soon they will be consultants. I am going to be a consultant soon and I know how quickly time flies. With proper support and guidance, we can make the NHS an amazing place to work.
Dedicated to all my amazing colleagues who have taught me how to support and guide others and the **** ( insert swear word of choice) who have shown me what not to do when I get to that stage.
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