Academic Training: The Foundation Programme

It’s that time of year again: we’re all thinking about moving to new rotations; graduation ceremonies are happening; e-portfolios are being filled.  Inevitably, this means that my social media feeds are full of people panicking about ARCPs, e-portfolios, and trying to get things finished before the end…  In particular, I’ve had lots of comments about the Academic Foundation Programme (AFP) pop-up.

Maybe it’s because, unlike a lot of our training, the Foundation programme does feel like a separate entity with a definite end-point.  Most people move to different LETBs at this point, so it’s harder to keep connections going.  There’s extra pressure to get audits, projects, research  finished and completed.

And alongside this panic, there’s the retrospectoscope, and the “I wish somebody had told me” and the questions to yourself:

Could I have done it better? (Define better…)

Could I have done it differently? (Always)

And the most common questions coming through are these:

Why did I take this on? 

What was the point? 

 

I’ve seen a lot of the last two questions coming from Academic Foundation trainees over the past few weeks; and I understand why.  That’s exactly how I felt at various points during my FYA (and my ACF, and my PhD…) but I get the feeling that it’s for different reasons.

One of the things that makes me really sad is the feeling that the programme has somehow been a failure if FYAs haven’t completed a piece of research in that time; if they haven’t got a paper accepted for an international conference.

Publications are nice, but focusing on that is to ignore all the other things that the AFP gives you.  I started my academic training thinking that I would have a list of publications by now, and a collection of flight miles accumulated from numerous conferences in exotic locations.  The reality is that I have one published paper which came out of my FYA programme, and was published 3 years after I finished my FYA…

Publications are not what I got out of my FYA project.

 

So, what is the point of the Foundation Programme?

I think you should come out of the AFP knowing if you want to spend more time in academia or not.

It’s that simple.  Academia isn’t for everyone; it isn’t a failure if you decide it’s not for you.

What worries me is that 1) trainees feel that they aren’t suited to academia because they haven’t “achieved anything”, and 2) they have bad experiences because they aren’t properly supported.  You can get your name on a big research paper and not have had any sense of how research in the NHS works because you’ve been a lab monkey for 4 months.  You can spend your 4 months waiting for ethics /R&D approval to come through on a proposal that you drafted in your first week.  That’s not a great experience of research (it might reflect some of the reality, but it’s not all), and it certainly doesn’t feel like enough to make a decision about whether or not you want to pursue academic training.

We do things slightly differently for our trainees locally, largely because we think this is important. It’s not a perfect system by any means, but I think it’s got potential.  And it’s been running for about a decade – we’ve had time to learn what works and what doesn’t.

So, this is what I learnt from my time on the AFP:

1) Be realistic – 4 months is not a lot of time.  My first thought on having a research block was ” I actually get given time to do all this stuff??”  Let’s face it, most of us are used to the extra-curricular aspect of academic life; trying to squeeze it in between clinical commitments, and exams, and the rest of our lives. (Remember that? the rest of our lives??).  Those things don’t suddenly go away. Yes, you will have some dedicated time for reserach that you probably haven’t had before. Yes, this is exciting.  It’s still not a lot of time to get things done

2) Choose your project carefully: find something about it that interests you.  That might not be the topic, it might be the methodology.  Not everything about it will be interesting, and you still only have 4 months to get it done.

3) More important than choosing your project, choose your supervisor carefully.  You are a junior trainee coming into a research group for a short period of time.  The international professor might have a great reputation, but are they used to supporting junior researchers who only have limited time & experience?  Talk to your colleagues, talk to the potential supervisor, have plenty of meetings before you commit.

4) Learn some management skills and appreciate what you’ve learnt.  You’re learning to manage your own time, other people, organise projects… All that is important and relevant and much more useful in the future than a particular technique to count serum rhubarb concentration.

5) Boredom happens.  That’s OK.  Find other people who are in the same position as you (use social media – sometimes it’s easier).  Link up with the people who did the post before you, the people slightly senior to you, anybody who understands the frustration of a coding tree that will not make sense no matter how much you stare at it.

6) Get some training.  FYA trainees are trainees in research.  If nothing else, learn some critical appraisal skills.

Ultimately, see this as your chance to try something different, and make the most of it.

Good Luck!

 

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Why a desk is more important than my training

Last week I bought a desk from a well known high street retailer (I’m not going to give them a plug, but let’s just say that I’m a doctor in the Midlands and it’s a national brand. There aren’t that many options really)

One small problem: this desk arrived neatly packaged up in its box without any fixtures or fittings (I have never understood what the difference is, but the things that hold it together and stop it collapsing).

I made one phone call, and explained the problem. Within 12 hours, I’d had contact from the manufacturers in Denmark to confirm what I needed, and within 48 hours a package arrived on my doormat containing the missing parts.

That’s all it took. One phone call to report a problem, and there was a solution within 48 hours. The shop actually offered to collect the existing desk, and replace it with a completely new one, but I said no. (I couldn’t face waiting for another delivery!)

So there you go: one problem, and a solution that was discussed with me and adapted to what I need. A brilliant example of how to do customer service. And that’s just a desk. In the grand scheme of things, it’s really not that important.

I don’t usually like comparisons between the NHS and commercial organisations (for many, many reasons) but this experience came at the same time I was trying to give some feedback on my medical training, and the two encounters could not have been more different.

Nobody suggested that I was responsible for the fixings not having been delivered; it wasn’t my fault that something wasn’t perfect. The retailer & manufacturer were just concerned with finding a solution to the problem that I had reported. They weren’t trying to investigate my behaviour; there was no discussion of an inquiry into what happened. Just a genuine interest and attempt to help.

It’s just a desk. It’s not the future of the clinicians employed by the NHS.

You would think that medical training was worth more than a desk; that those responsible would relish the chance to improve the experience of their trainees; that feedback would be welcomed.

I’ve come to realise just how naive that is.

We’ve heard a lot recently about how the NHS needs to listen more to patient & carer feedback; the friends & family test is one way of picking up on this. Rather than waiting for complaints, there’s a move to seeking the whole picture from patients, families, staff. It’s a way of pre-empting problems (hopefully); of finding systems problems before they develop into errors and spark complaints.

Why is it so hard to see that could be useful for medical training? Keogh was right: trainees are the front-line of the NHS, and have useful insights into what’s going on with patient care. Funnily enough, we also have a bit of insight into what’s happening with our training. When it isn’t working, and when it is. Feedback should be welcomed & encouraged, not repressed. Raising concerns shouldn’t be seen as a reason to blame trainees for not receiving training, but rather a reason to look into why this has happened.

Maybe it’s just time to let my idealism die a little

Doctors don’t care

The conference speaker has just finished her presentation.  There’s silence in the room.  Then, a hand goes up and the inevitable question is asked:

“Do you think it’s possible to train doctors to care about their patients? If you showed them case studies like this?”

In the audience, I’m so stunned, I can’t think of a sensible comment to make.  I don’t know what I’m more astounded by: the assumption that doctors don’t “care” as a default position; or the belief that listening to a 10-minute case study can give you any idea of what it’s like to be a person who’s a patient.

It’s not an unusual belief though.  A quick look at the headlines tells you that doctors don’t care.  We perpetuate this myth in research too: projects that look at studies of care in hospitals only look at non-medical staff; studies of interaction between nurses & patients are focused on care, those about doctors are sparse to say the least.  Especially in my field of paediatrics, the idea of a doctor as someone who develops a relationship with a child is hardly acknowledged.  Studies talk about the importance of including everyone who cares for a child in planning services, and then leave out medics (they often leave out the child too, but that’s a whole other issue.  I will talk for ever about that if I get started).  I was so shocked to read this about debrief, because it actually included doctors as people who cared.

But how much do you really want me to care?  When I started in paediatrics, I found taking blood from children really difficult.  Even with the best preparation & support, sometimes it’s just a horrible experience for the family & child.  I found myself getting upset; angry with myself that I was putting people through all this.  It’s not a helpful emotion.  If anything, it feels self-indulgent.

I felt terrible about telling parents that their new baby might have sepsis; that they needed a lumbar puncture; that I had made them cry.

Here’s the reality:

My job is to be able to suspend emotion because otherwise I can’t function.  Part of the skill set I have to develop is to separate my emotions from the patient in front of me.  How can I possibly justify getting emotional about something that doesn’t really affect me? How can I allow myself to feel something that potentially impacts on how I do my job?  I step away from one patient, and on to another, and another, and another.  It’s not fair to one child if I’m still upset about something that happened 5 minutes ago; I go from sharing bad news to telling someone else they can go home  to being shouted at for not having results back to apologising for keeping you waiting.  I smile and play and laugh.

I hide in the treatment room for 2 minutes to let myself breathe; I go out and smile & talk & apologise & take histories & examine & play.  I can’t care. Not then, not there.  How do I give everybody else my full attention if I’m so engrossed in one terrible situation?

This is the other reality:

It’s the part of your brain that won’t let you go home until the test results are back.  It’s the calling up a ward in the middle of the night to see how things are, or just wandering past on your day off to see what the scan showed.  It’s remembering the look in their eyes when you tell them, and knowing that you can’t go back and intrude, that they probably never want to see you again.

It’s hoping that if I’ve done my job properly, they won’t remember me because I should just be part of the service that smooths them through the worst parts of their lives.

It’s lying in bed telling yourself to stop thinking about it; to not go back in just to make sure they’re OK: because tomorrow morning, you have to go back and do it all over again with somebody else.

But what would I know? I’m a doctor: I don’t care