Shadowing to improve patient care

Ongoing improvement to the care and experience of both patients and their families is of utmost importance to everyone involved in healthcare – but how?  Anything which helps us to answer that question must be applauded and an excellent example has arrived this week in the shape of the Patient and Family Centred Care Toolkit, courtesy of The King’s Fund.  One of the tools advocated is the practice of “shadowing”: basically the observation and recording of each step of a patient or families experience, then using this as a catalyst for change.

Having had first-hand experience of this practice – both in the role of observer and the observed – I would strongly advocate its benefit to anyone involved in an NHS leadership role.  You undoubtedly learn from the opportunity to observe colleagues in action with patients.  The detached position enables the stimulation and crystallisation of ideas regarding what needs to change.  There is also much to be gained by the colleague being observed.  Firstly, a heightened self-awareness is inevitable when you are in the spotlight, with conscious recognition of what often happens automatically.  Secondly, it provides an excellent opening for learning through feedback.

All sounds good?  Yet there is an unmentioned, essential requirement that must be considered to ensure any such exercise is a success: the need for excellent communication skills for those involved.  To begin with, any doctor who wants to initiate a shadowing exercise should expect to face a degree of resistance and is likely to need to influence others to overcome this.  Just like influencing, the ability to give genuinely useful feedback to colleagues, while avoiding or addressing any resulting conflict is another skill which must be developed and practiced.

When combined with constructive feedback and supportive challenge, the practise of shadowing is a very powerful tool to improving patient and family centred care.  To enable this, the continued advancement of communication skills for doctors with their teams has to be a priority.

Future focus


How much have you changed over the past 10 years?  How much do you expect to change in the next 10?  According to Harvard Psychologist Dan Gilbert’s new six minute talk on TED the Psychology of Your Future Self, we all vastly underestimate how different we will be in the future, but readily recognise the transformations we have already experienced.  This, he explains, has to do with our ease of remembering, versus our difficulty in imagining.  We mistakenly think that because it’s hard to imagine, it’s not likely to happen and this has significant implications for the decisions we make.

So what would we do differently if we had a greater expectation of change to our careers, our working environments, and our ways of working?  We know from experience that precise long term predictions of “the way things will be” are likely to be wide of the mark.  What we can predicted with confidence, however, is that change will happen; that we will need to be at our best to deal with the unknown obstacles as and when they appear and that the more we develop our skills today, the better our best will be.

Any candidate who presents themselves at an interview with a long track record of proactive personal development is always likely to impress.  The interview panel will be drawn to any doctor who can demonstrate that a positive learning attitude is an imbedded part of their personality.  Such a candidate is far more likely to be able to give compelling examples of situations where they have put their learning into action, dealing effectively with the hurdles which got in the way of progress.

Whatever the future holds, our medical leadership, management and communication skills will need to be at their best.  Taking Dan Gilbert’s thinking on board, the time to take action to drive our development is always now.  How much change do you expect to undergo over the next 10 years?  What will you do about that today?

Simon Stevens and your Consultant Interview


With this week’s headline grabbing news story, it would be safe to assume that every doctor will now know the name of NHS England’s new Chief Executive.  In his high profile interview in the Daily Telegraph, Simon Stevens, outlined his opinion that the NHS is at a defining moment, why he took at 10 per cent pay cut to lead the NHS and, most controversially, his belief in the importance of smaller community hospitals.

So what does this actually mean?  Is this a complete volte face for the development of services back to a previous time?  Alternatively, is it a progression and natural evolution to something new; something which could not happen without the centralisation approach of recent times?  What are the implications to the organisational and financial structures of the NHS?  What do patients’ actually want?  Does that matter?  After all, to quote Henry Ford:  “”If I had asked people what they wanted, they would have said faster horses!”

Any doctor who is seeking a new consultant position and preparing themselves for interview would do well to consider such questions.  On our Consultant Interview Courses, we explore such hot topics in depth, emphasising the importance of both knowing the facts and being able to convey a considered opinion.  Consultants are expected to be leaders with influence and this ability must be demonstrated to the interview panel.  In order to express a relevant opinion on any topic, the facts must be known, the potentially conflicting views of all stakeholders understood and you must be able to clearly explain your thoughts.  This takes dedicated effort and it is best to set aside time for effective preparation.

So what do you think about Simon Stevens recent statements regarding the role of smaller community hospitals?  Why do you think that?

Trust your doctor, not Wikipedia?


“Trust your doctor, not Wikipedia” is the headline on a report on the BBC News website’s Health section.  This story focuses on the output of a paper published in The Journal of the American Osteopathic Association.  It states that there are fundamental problems with nine out of 10 of the online encyclopaedia’s health entries.  The information, all of which can be edited by anyone, made statements which contradicted latest medical research.  With Wikipedia being the sixth most popular site on the internet, this clearly poses a high risk of misinformation for any patient who prefers to do their own research than to “trouble their doctor”.
This risk to patients is the key focus of the BBC report.  However, there is one short statement which any doctor involved in the teaching, support and development of others should take time to consider:  Up to 70% of physicians and medical students use Wikipedia.
There are many potential sources of incorrect or outdated information for learners in medicine.  The ongoing, progression of discovery will always mean that knowledge and best practice must continually be updated.  As a result, the papers which were at one time considered essential reading are naturally superceded.  They do not, however, cease to exist.
Students will often go “off-piste” from any reference lists which are fed to them.  The end result of such self-directed exploration can be greatly enhanced learning.  Alternatively, it could lead to disastrous misinformation.  On our Teach the Teacher Course for Doctors we discuss the importance of the teacher understanding where the learners in their care are accessing information.  Once we establish the importance, we discuss how the teacher can achieve such understanding.
It is paramount that our developing doctors are growing their knowledge from reliable, up to date, peer reviewed materials.  Many of us diligently create an “Essential Reading List” for guidance.  How many of us create “A Don’t Read List” to steer learners away from Wikipedia; from the outdated and from the discredited?  Should we?

Doctors and healthy debate

We may well believe that the state of the nation’s health and the methods of care provision are top priorities.  This would appear to be supported by the many regular news stories in the media and even by the unexpected celebration of the NHS at the opening ceremony of the 2012 London Olympics.  Yet a recent report from The King’s Fund highlights the fact that the NHS was not a key issue in the 2010 UK election.

At a time when major change and transformation is ongoing, when public satisfaction in the NHS has fallen from 2010’s record high, and when devolution has created four distinct healthcare systems, the Faculty of Medical Leadership and Management has posed the question: “How much more divergence can we manage before the free transfer of staff between the countries starts to present issues?”  No surprise then that The King’s Fund’s assessment of opinion polls concludes that the NHS is the most important issue facing Britain today.

Health appeared to play little part in the campaigning and debate preceding the European Elections.  With the previously mentioned issues, is it likely that health will take centre stage ahead of the Scottish Independence Referendum in September, or before next year’s UK General Election?  Is it safe to leave the subject in the hands of the politicians?  As front line providers of the service, at what level should doctors actively participate in the debate: passive bystanders; providers of information; active debaters or pro-active lead influencers?

We regularly receive feedback from the doctors attending our 3 Day Leadership and Management Courses that they do not feel equipped to be able to effectively contribute to the discussion.  Many are surprised by what they discover about the history, structure and finances of the NHS which are explored in detail on the third day.  Gaining clarity of such information is particularly challenging at present because of the aforementioned transformation.  Only doctors who take proactive steps to keep up with the changes are likely to understand and be able to develop well considered opinion.

If the NHS is to be higher on the political agenda over the next year or two, it’s worth asking: How well equipped am I to understand and participate in the debate?

Top doctors need support from above, below and alongside

Top doctors need support from above, below and alongside

More support is needed for top doctors “from above, below and alongside,” according to a report from Monitor and the NHS Trust Development Authority.

Based on a survey collating the views of NHS medical directors, it’s worth considering the report’s messages from the viewpoint of all doctors, regardless of level, speciality or sector.  Many of the respondents reported they are new to their role – a quarter having served a year or less in their current position.  They would value improved mentoring and induction, particularly in relation to the less familiar aspects of their new responsibilities.  Improved organisational and peer support is identified as a requirement to nurture the growth of personal resilience.  Finally, the climate of significant cultural change has accelerated the urgency to perform now, with little time for orientation.

These comments are likely to resonate with many doctors, experiencing similar situations and feelings as they progress through their career.  In an ideal world, everyone would experience “organisational and peer support from above, below and alongside.”  However, such a culture must be carefully and deliberately nurtured to become a reality.  It requires the commitment of each individual involved.  For each person in an organisation to receive this multi-level support, the implication is that each must in turn be actively engaged in providing the same in return.  It’s therefore essential for doctors to equip themselves with the skills required to meet the challenge.

Such team interaction – how to both gain and provide such support – is a key topic of discussion on our Advanced Communication Skills Course for Doctors. At these events we explore team interactions in depth and support doctors to create action plans for improvement.

So when we consider the support you receive and how it could be improved, pause to consider: How well equipped am I and how effectively am I supporting above, below and alongside?

The Consultant interview process

Have you ever wondered how the application process works for Consultant Interviews?

After submitting your application the short-listing process occurs. Each candidate is assessed according to the person specification that was published with the job advert. Essential and desired criteria are awarded points with varying degrees of importance. Each candidate’s application is scored and the score allocated by each member of the appointments advisory committee is averaged to rank the candidates.

This process normally takes in the region of 3 to 4 weeks. You will be informed by the Human Resources department either by telephone, email or post, of your invitation to attend interview. Invitations for interview are often sent with no more than 10 days’ notice.

If you have never worked in the hospital or department before it makes sense to find out more about both and therefore you should arrange to have a look around the department during a “pre-short listing visit”.

You will need to arrange this appointment before you plan your journey. It is common to have many applicants for an advertised job and the department will make a decision about whether to allow candidates to visit before the shortlisting process.

The interview itself doesn’t formally start at this point but impressions made by you during your visit will stay with you if you decide to apply.

The pre-interview visit is a formal part of the job application process. It gives you an opportunity to meet departmental team members and gives them an opportunity to assess how you might fit in. The interview process formally starts during the pre-interview visit.

You should prepare for this visit with the same degree of effort as you would for your AAC panel interview. Details of how to prepare, dress, communicate, and more are discussed in detail in the Oxford Medical Consultant Interview Guide.

You should make appointments to see the Clinical Director, Medical Director and Chief Executive and whilst you are there it will do you no harm to say hello to as many prospective consultant colleagues as you can. Once you receive your invitation to interview it is not a bad idea to get straight on the phone and arrange your appointments to hopefully be accommodated within one day, thereby saving you having to make multiple journeys.

Dress as you would for the interview itself and take several copies of your CV on good quality paper, as it is common that these managers will see you between meetings or clinical commitments and may not have your CV to hand. Do not attempt to contact the Chairman, the Royal College representative or the University representative before the interview as this is considered canvassing and is not allowed by the AAC panel. Whilst visiting try to investigate what the strategic, topical and management issues are in the department and trust, possible future direction of the trust and the department’s clinical interests. These can then be brought into discussion during interview demonstrating informed knowledge and enthusiasm for the Trust.

Find out more about the Consultant Interview itself on our Consultant Interview Course page or downloading our Consultant Interview Guide.

Support for Foreign Doctors

The chief executive of the General Medical Council (GMC) has said that more needs to be done to support foreign doctors coming to the UK and to help them adjust to different social and cultural attitudes, the BBC reports.

Mr Niall Dickson said, “They need to be supported and helped, and I don’t think that the NHS or indeed we as a country have done enough to support them when they are coming into this country”.

He went on to praise foreign doctors who provide a “fantastic service” for the UK’s national health system.

His comments follow the results of a study conducted by University College London, which concluded that pass marks for entry exams sat by international doctors should be set ‘considerably higher’ as a ‘performance gap’ between international and UK-based medical graduates was found.

The research, commissioned by the GMC, suggested that the pass mark be raised from 63% to 76% after it found that 1,300 foreign doctors passed competency exams each year, but their performance following this showed that half of them should not have qualified.

“Overseas doctors have contributed tremendously to the National Health Service,” said Umesh Prabhu, national vice-chairman of the British International Doctors Association (BIDA) “The NHS wouldn’t survive without their contribution, but it’s important that we protect patients”.

Dr Chandra Kanneganti of BIDA said that the higher referral figures of foreign doctors to the GMC could also be a result of issues such as communication differences and racism.

The UK is home to over 95,000 foreign-trained doctors, amounting to a quarter of the total number of doctors.

Mr Dickson explained that foreign doctors need guidance; he said, “Doctors are a bit like flowers. We can’t just take them up from one garden and plonk them down in another and expect them to thrive.”

Oxford Medical currently works to support overseas and UK doctors, on a non-clinical and personal level, and in their career development. “In order to help overseas doctors develop in the UK, communication training, and essentials in leadership and management are the most appropriate skills to develop” said Stephen McGuire, Training Manager at Oxford Medical.

Immigration: The political hot topic and the relevance to doctors

Internaltional community of doctors Immigration is without doubt one of the most contentious subjects in the news over the past couple of months.  Earlier this week Home Secretary Theresa May stated thathigh levels of immigration make it impossible to have a cohesive society.

Whatever your views on the matter, immigration undoubtedly has direct implications to practising as a doctor.

At present some 13% of the UK population were born abroad.  At one level this ethnic diversity and demographic change means that today’s doctors are required to address different medical challenges than their predecessors – higher prevalence of diabetes in some localities or sickle cell anaemia are a couple of examples. On another level language barriers and cultural differences can lead to the challenges of effective communication with both patients and their families.  I know some clinicians working in areas where there are significant communities who have taken the practical step of learning the relevant language to address the challenge.

According to the General Medical Council’s statistics 36.4% gained their Primary Medical Qualification outside of the UK.  This figure rises to 41.5% for those on the specialist registers.  By implication the diversity of nationality is considerably higher within the community of doctors in the UK than in the general population and this has been the case for some time.  Such diversity brings both great benefits and great challenges.

The subject of cultural differences and language barriers – both between doctor and patients and between doctors communicating with each other – is a regular topic of discussion on ourAdvanced Communication Skills courses.  These events successfully focus on the principles of good communication, the factors affecting communication/ behaviour and the application of communication models to healthcare.  What often becomes clear, however, is that it can be a doctor’s confidence and skill with English language or understanding of UK culture which is having the greatest impact upon their interactions with both patients and colleagues.  This can lead to frustrations between colleagues and can inhibit the doctor’s career progression.  Most importantly patient care can be both impacted both directly and indirectly.

In 2013 the GMC amendments to Good Medical Practice includes the following statement: 14.1 ‘You must have the necessary knowledge of the English language to provide a good standard of practice and care in the UK.’  In addition their new powers under the fitness to practice procedures include ‘to make sure all doctors are able to communicate in English well enough to treat patients safely’.

Doctors must now achieve level 7.5 in the ILETS examination to be accepted on the GMC register.  Though ILETS level 7.5 sets a basic standard it does not necessarily equate to confidence and fluency.  Continued Professional Development should cover all aspects of a doctor’s practise and it would not be considered acceptable to settle for ‘basic level’ on any regulary employed skill without refresher or effort to advance.  Good application of the English language is a fundamental skill which underpins all aspects of practise.  For this reason we have now introduced our new Improving English Language Skills Course for Doctors.

What steps are you taking to improve your communication skills and cultural awareness?

Oxford Medical Training is the UK’s leading provider of high quality career development for doctors of all levels.  We specialise in advancing leadership, management, communication ,interview and teaching skills in the medical environment.  Our new Improving English Language Skills Course for Doctors is now available for bookings.