ICSM Awards for Teaching Excellence for NHS Teachers and Inaugural Lecture

By Laurence Suckling

“Humanity, humour and passion” – Mr Martin Lupton, Associate Dean and Head of the Undergraduate School of Medicine at Imperial College London.

The evening of Wednesday 16thNovember 2016 marked a special celebration in the ICSM calendar; the Awards for Teaching Excellence for NHS Teachers and Inaugural Lecture. The Drewe Lecture Theatre at Charing Cross Hospital was packed with members of Faulty, NHS staff and students, brought together to acknowledge and celebrate the talent and dedication of the teachers, tutors, mentors and non-clinical staff which ICSM is built on.

The evening ran smoothly in three parts, commencing with the presentation of the awards by Dr Joanne Harris and Mr Martin Lupton. Each award winner was introduced by one of their past students, giving the whole ceremony a learner-centred approach, particularly apt given that the nominations were written by students.

Comments such as “knowing the names of all the students before we knew yours”, “coming in on days off”, “teaching you without you even knowing” and “goes out of their way to look after us”, displayed the passion, sacrifice and preparation that goes in to creating a valuable learning experience. One student was a little more perplexed as to how Dr Anjan Chakrabarty’s insistence that the students cleaned up the lecture theatres added to their learning experience.

The Personal Tutor Award for Dr Clare Batten highlighted the qualities that students so often seek in a personal tutor: “immediate warmth”, “easy to talk to”, “regularly checking up” and “coming to Charing Cross”. A special shout out went to Dr Sohag Saleh, who is said to “reply faster than automatic reply”.

The Associate Dean Award, a new award this year, for an individual who has shown a career-long contribution to teaching was awarded to Professor Paul Abel. The Foundation Year 1 doctor introducing him noted his ability to “teach concepts to students at an appropriate level” and build rapport that was “so normal to him but so special to the patient”.

Dr Mark Sykes, a Foundation Year 1 doctor at Northwick Park Hospital, also returned to receive the University of London Betuel Prize for coming runner up in the Gold Medal.

The evening moved swiftly into its second part; an entertaining yet pertinent Inaugural Lecture ‘Patient Zero to PrEP: HIV past, present & future’, delivered this year by Professor Mark Nelson, consultant physician at Chelsea & Westminster Hospital and professor of HIV Medicine at Imperial College.

Prof Nelson talked through the unusual patient presentations in the 1980s before the discovery of HIV, through to the challenges still faced today in battling with stigma and in particular addressing the rising co-infection of Hepatitis C with HIV. The key to addressing this Hep C co-infection epidemic is access to healthcare.

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Prof Mark Nelson with Mr Lupton and Dr Harris

And there was never a dull moment. Prof Nelson began by introducing the audience to his family and friends, including a friend from medical school (he graduated from Westminster Hospital in 1986) and even his bridge partner. There was intermittent grilling of Mr Lupton, much to everyone else’s delight. But the stars of the show were Prof Nelson’s (very little) daughters, who bravely took to the stage to sing for the audience and ultimately overshadow Prof Nelson himself!

The final part of the evening saw a couple of students share their experiences of the Imperial College Enables (ICE) project, a new collaboration between ICSM and Community Action Nepal. This saw 42 students Year 1 students, accompanied by staff including Prof Nelson, travel to Nepal in Autumn 2016 to educate rural communities about sexual and relationship health, to trek and to carry out research.

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Imperial College Enables (ICE) Nepal Project presentation by 2nd years at the Awards evening

The students found that misinformation, inadequate teaching and taboo in talking about sexual health was rife amongst the rural communities they visited. As a result, the students lead sexual education classes for school girls, mothers and school boys to improve education and answer questions that some had held for a lifetime but had been too embarrassed to ask. This was particularly important with regards to addressing misconceptions of HIV.

Mr Lupton wrapped up the evening using the words at the start of this article “humanity, humour and passion” to thank Prof Nelson. However, these words aptly painted the atmosphere of the whole evening in celebrating our teachers and support staff. Mr Lupton highlighted the importance of taking the time to acknowledge and celebrate the staff who work so hard to deliver the excellent teaching we receive at ICSM, and that this effort can never be underestimated.

Congratulations to all the Award winners and Local Teaching Heroes, a full list of which can be found below.

Special mention to Francesca Bertolini, Executive Administrator in the FEO, for co-ordinating the nomination and award process, and organising the evening.

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Teaching Excellence Awards

The Faculty of Medicine awards for NHS staff for excellence in clinical teaching were introduced in 2003. Ten prizes, including the Teaching Fellow Excellence Award, are awarded each year to staff at any grade and in any profession to recognise their valued contribution in delivering the undergraduate medicine course. The recipients of the Teaching Excellence Awards in 2015/16 are:

Dr Jacob Addo,Consultant Emergency Medicine, Ashford and St Peter’s Hospitals NHS Foundation Trust

Dr Mahmood Wahed, Consultant Gastroenterologist, Chelsea & Westminster Hospital NHS Foundation Trust

Dr Anjan Chakrabarty, Consultant Paediatrician, Chelsea & Westminster Hospital NHS Foundation Trust, West Middlesex University Hospital

Dr Nina Salooja, Consultant Haematologist and adjunct reader in medical education, Imperial College Healthcare NHS Trust

Dr Ihab Ramzy, Specialty Doctor in Cardiology, London North West Healthcare NHS Trust

Dr Evangelos Vasileiadis, Consultant/ Lead COTE, The Hillingdon Hospitals NHS Foundation Trust

Dr Tim Bullock, Consultant – Psychiatry, West London Mental Health NHS Trust

Dr Beena Gohil, General Practitioner, General Practice – Oldfield Family Practice

Dr James Warner, Consultant Psychiatrist, Central and North West London NHS Foundation Trust

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Teaching Award winners with Mr Martin Lupton and Dr Jo Harris, as well as some of the students who spoke about the winners.

Teaching Fellow Excellence Award

The Teaching Fellow Excellence Award has been introduced in 2016 to celebrate the achievements and calibre of the Teaching Fellows at our NHS Trusts. The new category ensures that one teaching award will always go to a Teaching Fellow.

Dr Catriona Hall, Clinical Teaching Fellow, Imperial College Healthcare NHS Trust

Distinguished Teaching Award

The prestigious Distinguished Teaching Award, open only to those who have already received a Teaching Excellence Award, has been created to recognise truly excellent teachers who continue to consistently deliver outstanding teaching over and beyond expectation.

Mr Abdul-Majeed Salmasi, Consultant Cardiologist, London North West Healthcare NHS Trust

Associate Dean Award 2016

The Associate Dean’s award has been introduced in 2016 to celebrate individuals who have supported education over their long career. This award is given at the special request of the Associate Dean/Head of Undergraduate Medicine.

Professor Paul Abel,Professor of Urology, Imperial College Healthcare NHS Trust

Supporting the Student Experience Award

The Supporting the Student Experience Award was given to an individual who has demonstrated excellence in their primarily non-teaching role, providing outstanding support to Imperial students.

Ms Annette Stanley, Medical Student Co-ordinator, Ashford and St Peter’s Hospitals NHS Foundation Trust

Local Teaching Heroes

This is a scheme for non-consultant level staff that runs alongside the Teaching Awards for NHS Teachers to acknowledge the excellent teaching and commitment shown by our colleagues at our associated Trusts, which has been recognised locally. The nominee must have demonstrated a continuous, high quality, commitment to teaching Imperial undergraduate students. This award is available to all healthcare professionals, including junior doctors, nurses, midwives, physiotherapists etc

Congratulations to the 2015/16 recipients!

Ashford and St Peter’s Hospitals NHS Foundation Trust

Dr Siobhan Carver, Dr Dominique Barretto, Dr Boris Tocco, Dr Jack Hammond, Dr Rachel Kirby, Dr Felicity Poulter, Dr Christian Asher, Dr Salwa Malik, Dr Jonathan Ainsworth, Dr Ruby Chu, Dr Surabhi Varma

Central and North West London NHS Foundation Trust (CNWL)

Dr Ruby Osorio, Dr Helen Sinclair, Dr Alexis Theodorou, Dr Ayodeji Morah, Ms Pauline Ujeyah, Dr Lynsey McAlpine, Dr Laetitia Clarke

Chelsea & Westminster Hospital NHS Foundation Trust

Dr Kerry Burnett, Dr Arvind Singhal, Dr Megan Griffiths, Dr Rosalind Kings, Dr Sophie Ladbrooke, Dr Adam Mitchell, Dr Fiqry Fadhlillah, Dr Brent Bartholomew, Dr Imran Lasker, Dr Esther Tillson, Dr Majd El-Harasis, Dr Hannah Mills, Dr Rebecca Mitchell, Dr Laura Hopkins, Dr Gareth Lock, Dr Mohamed Shamshudin, Dr Julie Witter, Dr Ankur Khajuria, Dr David Jones, Dr Sarah Young, Dr Andrew Alabi, Dr Heather Reid, Mr Chang Park, Miss Dannielle Browning, Miss Beryl De Souza

Endocrinology & Diabetes team (Dr Daniel Morganstein, Dr Craig Leaper, Dr Emma Kenney-Herbert, Dr Priyesh Karia, Dr Kirsty Bromage, Dr Joe Froggatt & Dr Theo Bartholomew)

Imperial College Healthcare NHS Trust

Mr Andrew Busuttil, Mr Crispin Wiles, Dr Hanine Fourie, Dr Sarah Hogan, Mr Michael George, Dr Sammy Trinh, Dr Mohammad Mahmud, Mr Matthew Jaggard, Mr Khalid Al-Dadah, Dr Sarah Morton, Dr Harriet O’nions, Mrs Joanne Jones

Y3 & Y6 Breast Surgery Team (Mrs Katy Hogben, Dr Steph Rimmer, Dr Claudia Pisarek, Dr Georgina Keogh, Dr Michael Charalambous Dr Dan Cocker & Dr Nikoletta Petrou)

Y3 Endocinology Team (Dr Emma Hatfield, Dr Rhea Chatterjea, Dr Robert Jack, Dr Dinesh Aggarwal, Dr Thomas Charlton, Dr Rozana Ramli, Dr Monika Reddy & Dr Sufyan Hussain)

London North West Health Care NHS Trust

Dr Silvia Lovato, Dr Sivasujan Sivasubrananiyam, Dr Tiffany Su-Jin Ng, Dr Louis Peters, Dr Arun Rajendran, Dr Tumaj Hushemzchi, Dr Sarah Howlett, Dr Katherine Chatfield, Dr Fatima Nawrozzadeh, Dr Sayed Iftekhar Al-Aldarous, Dr Catherine O’Hare, Dr Benjamin Paul Goodman, Dr Fiona Bellamy, Dr Alison Lievesley, Dr Rachel Milne, Dr Samar Ahmed, Dr Shree Voralia, Miss Hannah Knowles, Mr Chukwuemeka Anele, Dr Yousaf Bhatti, Dr Jen Mae Low, Dr Bharati Bhatkal, Dr Ume Uchenna, Dr Eve Boakes, Dr Nikita Shah, Dr Kristijonas Millinis, Dr Clare Thakker, Dr Dean Malik

General Practice and Primary Care

Dr Julita Salijevska, Dr Ravi Parekh, Dr Ruth Henniker-Major

The Hillingdon Hospitals NHS Foundation Trust

Dr Felicity De Vere, Dr Suraj Dabhi, Dr Sara Mills, Dr Cathy Pye, Dr Katherine Gardner, Dr Viral Thakerar, Dr Ben Blackman, Mr Etienne Cassar Delia, Mr Jonathon Aboshiha, Dr Shreena Shah, Dr Ted Reakes, Dr Lawrence Ame, Dr Daren Hanumathadu, Dr Basel Chimali, Dr Rachel Aldersley, Dr Catherine Longley, Dr Naomi Garnder, Dr Claire Edmondson, Dr Chris Kyriacou, Dr Natasha Piddock

West London Mental Health NHS Trust

Inspector Michael Partridge, Dr Fiorenza Shepherd, Dr Jose Maret, Mr Steve Buglass

With thanks for Francesca Bertolini for her help in providing this information

Obituary: Dr David Tunbridge

Ronald David Gregg Tunbridge was born on the 4thDecember 1941 and died on the 17thFebruary 2016 at the age of 74. He came to St Mary’s in 1962 after a short period as a Laboratory Technician in the Almroth Wright Institute. He joined an intake of thirty students from very diverse backgrounds entering their 1stMB year.  Some had come from an Arts or Classics background, some still needed to complete pre-medical science subjects and some mature students were changing career. From the outset it was evident he would question the perceived wisdom of his teachers, a quality that would lead him to make a major contribution to Medical Education later in his career. Following his 2ndMB he was offered a scholarship to study for a BSc in Physiology. However, he chose to head straight for the wards and clinical medicine. Even as a student he was ahead of his time in seeing the need for readily accessible, peer reviewed, evidence based medical information that could be used for the benefit of patents. The genesis of these aspirations can in part be found in the volume ‘St Mary’s – The History of a London Teaching Hospital’.

 In 1965 the pathologists introduced the ‘research project’ as a compulsory part of the course. The students gathered in the Almroth Wright lecture theatre, greeted the announcement with an ‘angry silence’. But soon the anger changed to enthusiasm. The students were encouraged to present their projects to the class and were thus exposed to the atmosphere of a research society. One student, David Tunbridge, described his experiences in the Gazette in 1967. He had been outraged on hearing that so ‘unglamorous’ a group as the pathologists were permitted to encroach so profoundly on his clinical years. He and his fellow students found it impossible to think up suitable topics. Then he clerked a series of renal patients but failed to notice the patients suffered from peripheral neuropathy. Humiliated by his chief, Tunbridge wondered why he hadn’t picked it up. He found that very little had been published, which only whetted his appetite further and led him to write up the experience as a research project. He observed that with the introduction of the research project, the library changed from a reading to a reference room and original papers became less authoritative in his eyes: “The amount of double checked rubbish that is published was brought home, along with the warning that we were probably in the process of contributing to it.”

Following qualifying, he was destined to be a physician and it was no surprise that he was appointed to the Professorial Medical Unit at St Mary’s. He undertook many research studies, largely in the field of hypertension, completed his MD and published several important studies on factors affecting blood pressure such as levels of various hormones and identified a number of significant ethnic differences – perhaps a first foray into the now topical ‘personalized medicine’.

He was appointed Senior Lecturer in the Academic Medical Unit at the University of Manchester and Physician at the Manchester Royal Infirmary. There he continued his research interest in hypertension. He worked with many other colleagues from different specialties to ensure his patients had the best advice – again ahead of his time since Multidisciplinary Team decisions are the norm these days. His last publication was a scholarly review on the Management of Hypertension in Pregnancy published in 1994 in the Postgraduate Medical Journal.

He had a passionate interest in medical education, particularly for undergraduates, since he believed if you could instil the right attitudes at an early stage these would persist throughout their careers. Soon after arriving in Manchester he brought together a stellar cast of the medical hierarchy from Manchester to contribute to a book for medical students; Notes on Clinical Method, the second edition of which he part wrote and edited in 1982. He became Hospital Dean for Undergraduate Medical Education and led the implementation of a new medical curriculum in the late 1990s.

As an exceptionally gifted photographer even in the pre-digital era his camera was always close to hand to record the milestones of student life, both social and educational. Self-effacing and modest by nature, it was a typical of him that when congratulated on his father’s Knighthood for services to medicine he replied: ‘Don’t worry – it’s not hereditary.’ Those of us who had the privilege of knowing him over our student years, which for many was followed by the separation that our post qualification dispersal inevitably caused, have lost a true friend

 

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Photo by Richard Strittmatter

 

 

By Dr Ian McNamara,

Former GP Inverness and director of postgraduate GP education, North Scotland

With thanks to Mrs Eileen Tunbridge and Ms Laura Tunbridge

Football Inter-year tournament 2016

By Toby Pepperrell

After a mixed season for medics’ football, with an astounding 2’s promotion and varsity win alongside a 3’s double demotion, the inter-year event provided a clean slate for club members past and present. The first sunny day of the year lit the carpet of Heston as the boys arrived in dribs and drabs and every team backed itself in the pre-tournament chat. Tensions were high as three and a half teams warmed up, waiting for the final few übers and buses to roll in so that the four-way tournament could begin.

The doctors’ team kicked off the day against the 5thyears. From the start, it was evident that the doctors should have had the upper hand, the vast pool of alumni maybe producing the better footballing side. Unfortunately, it became apparent in the intense game of two ten-minute halves that the docs maybe weren’t as lean as they once were, with the 5thyears accumulating chance after chance. Adam Green, heroically mid-light opera 24, eventually lobbed an onrushing keeper to set the scene for the day: some great play amidst some more questionable football. The 5thyears came away 2-0 to the good, asserting themselves as favourites over the 3rdyear team and the freshers, yet to play.

The 3rdyear team suffered managerial issues and so the 5thyears, proceeding their dispatch of the docs, retook centre-stage against the freshers. 1styear captain Sam Acors cracked a long-range free-kick under the crossbar and the slightly worse-for-wear older side was victim to a surprising fresher victory, which they claimed fervently was the result of back-to-back fixtures.

It was then the turn of the buoyed up freshers to go straight back in against the docs. It was hard-fought, with the quick play of the freshers countered by the docs’ physicality and experience. The freshers scored early on and suffered some close calls at the hands of heavy-hitting alumni, but squeezed out another goal for a 2-0 win. The two teams rested on their aching and bruised laurels, awaiting the showdown between 5thand 3rd year. However, the 3rdyears’ managerial qualms presented as a shambolic performance and the floodgates opened for the 5thyears to ease to a 4-0 win.

The 3rdyears immediately faced the unbeaten fresher side. They got their act together and held the freshers for much of the game, who eventually took a 1-0 lead and held against the brunt of last-minute attacks with solid defence, securing their wildcard place in the final and ensuring the 5thyears the opposing corner.

The teams with a place in the final settled down to rest up before their game on London’s biggest stage, while the docs and 3rdyears scrapped it out for bronze. The 3rdyears’ heads were down from the off, suffering another 4-0 insult and achieving a strong last place with a goal difference of -9.

As hype for the final built up, the players waddled back onto the pitch with seizing limbs for their fourth and longest game of the day. The rested 5thyears showed their experience with 70% possession and territory for much of the first half. Eventually it took a world-class curling free-kick from Acors to alleviate the pressure, bettering his first strike to hammer into the top corner of the goal. The freshers regained their confidence into the second-half and a brilliant exchange through a befuddled 5thyear defence led to an easy tap-in second. A quick rebuff led to a dangerous 2-1 score-line, with the older team again piling on the pressure. The fresher team were eventually saved by the simultaneous final-whistle and fantastic breakaway solo effort from Toby Burn: 3-1, meaning the first fresher inter-year victory in over ten years at the club.

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ICSM Staff and Students petition London’s Mayoral Candidates on Affordable Housing

ICSM is mobilising to help Citizens UK petition the London mayoral candidates to commit to making promises on Affordable Housing.  Martin Lupton, the Head of the Undergraduate School, and Med Harris, the SU President, are part of a large team which is keen to involve as many students as possible.

5th Year student Sarah Sturrockhas written more about this for the Gazette:

We Want You – to tackle the London housing crisis with ICSM & Citizens UK!

When you come to study or work in London, rent is one of the first things your friends from elsewhere will ask you about.  How do we afford it?  For ICSM students and staff, it seems we manage by accepting poor quality housing, long commutes, and part-time work balanced perilously alongside our demanding studies.  This has been the case for so many years that it almost seems as though we have ceased to consider it unreasonable to spend our entire student loan, and then some, on the rent for a damp and dilapidated room in an over-occupied flat.

This year, ICSM is refusing to accept the status quo.  Joining together with the nationwide community organising group Citizens UK, ICSM is taking part in a campaign for affordable housing that we hope will deliver a tangible benefit to our students, our staff, and our community.

A small group of students, led by staff members Martin Lupton, Kevin Murphy, Sohag Saleh and our ICSM Presidents past and present (Maredudd Harris, Steve Tran and Dariush Hassanzadeh-Baboli), have been feeding back to West London Citizens the issues that hit our community the hardest when it comes to housing. Last year, a survey of 5th and 6th year ICSM students found that 87% of students have financial concerns, and with average rents at that time as high as £141 per week, this is hardly surprising.  During our period of listening, students spoke of being left with nowhere to stay last-minute when landlords decided to sell up, unsafe conditions in their homes, and their studies and attendance being damaged by exhausting shifts in bars and clubs to try and make ends meet.

Citizens UK have taken the concerns of London member institutions to develop a radical Housing Manifesto for the upcoming London Mayoral Elections.  Viewable in full at citizensuk.org, this Manifesto asks candidates to commit to four proposals to improve the housing situation in our city:

  1. London Living Rent – Londoners should have to pay no more than a third of their salary on rent, and the Mayor should deliver 10,000 London Living Rent homes by the end of the Mayoralty
  2. Rogue Landlord Taskforce – a permanent staffed service to increase prosecutions and support tenants and communities to campaign for better landlord practice
  3. Good Development Standard – all developments on public land should provide 50% genuinely affordable housing and prioritise local people
  4. Community Land Trusts – a way of providing genuinely and permanently affordable home ownership

The most exciting part of this campaign is yet to come.  To persuade frontrunner mayoral candidates Zac Goldsmith and Sadiq Khan to commit to the proposals, all ICSM community members (staff and students) are invited to attend the London Citizens’ Mayoral Accountability Assembly on the 28th April at the Copper Box.  At this poignant and powerful event, 6000 organised voters will gather and ask the candidates to publicly respond to this manifesto.  We need 250 ICSM members to come with us, and we predict that those who do not attend will greatly regret missing the opportunity to speak out for their community.  It is critically important that we, and our neighbours, set the agenda for this election – for our own futures in London, and for the future of our beloved medical school.

For more information please contact ss6210@ic.ac.uk, join the Facebook group (ICSM@ Citizens Mayoral Candidates Housing Event) or see the full manifesto, available here – http://www.citizensuk.org/housing_manifesto_2016.

To attend the Copper Box event with free transport there and back, please contact ss6210@ic.ac.uk or sign up directly at

https://docs.google.com/forms/d/1oE7eKk_vmm5XyOMmkiueEcGr7aksiHnOnOE-XvS73X8/viewform

Please do sign up asap, so we know how many people to organise transport for! 

Sarah Sturrock

5th Year Medical Student

 

Circle Line 2016: Over 1000 Medical and Biomedical Sciences Students Will Take to the Streets of London to Give Back to the Community!

By Mala Mawkin, ICSM SU Entertainments Chair 2015/16

This Friday 5thFebruary 2016, the Imperial College School of Medicine’s (ICSM) students will take to the streets of London for their annual Circle Line organised by the ICSM RAG Committee (Raising and Giving). The day will involve students from all six year groups participating in voluntary activities such as: street collects, volunteering with the elderly, musical performances in hospitals and train stations, helping with Amnesty International campaigns and volunteering in shelters. The students will then all celebrate their charitable achievements in the evening with everyone who signs up to a charity act getting free entry at a local club.

Traditionally, this day can make up to tens of thousands of pounds for charity from collections, ticket sales and T-shirt sales. This year the charity the union are supporting is the Royal Hospital for Neuro-disability in Putney, near to the Charing Cross Hospital Imperial College campus.

The event has moved away from what it was traditionally built as back in 1999. The union maintain the tradition of using the circle line, but use the stations on the circle line as different points for volunteering opportunities- to which there is an abundance! Circle line 2016 is expected to be a day where everyone in the School of Medicine that wants to take part will be able to make a real impact in the local community, and celebrate a massive amount of hard work! The RAG Chair, Sammy Sundar, said “ICSM RAG Circle Line is an annual event that has been at the heart of the medical school for over a decade. It feeds the life and soul of our ICSM RAG and allows us to continue to raise tremendous amounts of money, for a truly worthy cause and contribute to what makes the medical school so special”.

The day comes at the end of RAG week, with events running through the week such as a sponsored Head Shave and a charity auction! The President of the ICSM Student Union, Maredudd Harris, said in his email to all students “I hope you will all rise to the challenge and embrace the change. This day is already looking to be highly enjoyable and I invite you all to join in. I hope everyone has a fantastic time throughout RAG week and to see you all at the events.”

About Imperial College School of Medicine RAG (Raising and Giving)

RAG events run throughout the year to raise money and give community opportunities to the Imperial College School of Medicine students. For more information on the Circle Line event or on other RAG events please contact one of the members of our ICSM Student Union below.

Trial of new Integrated Clinical Apprenticeship to run alongside 5th Year teaching

A group of senior clinicians and teaching staff for the 5thyear have put together a plan for a new course, the Integrated Clinical Apprenticeship, designed to be trialled next year for 24 students who will spend 1 day a week in the new course and the rest of the time on their Year 5 firms.

Read more about the new course in this interview with Dr Arabella Simpkin, a SpR in Paediatrics who is currently doing her Masters in Medical Education at Harvard, and who will be leading the course next year.

Please could you give us a broad overview of the course?

The Integrated Clinical Apprenticeship is really a re-design of 5thyear. As one of the 24 students taking part next year you will still have your rotational firms but within that you will have your own cohort of about 12 patients who span the different disciplines in 5thyear.  These patients will be drawn out of primary care, and you will have the opportunity to follow their progress across the year, for example in going to their appointments with them.  Every Thursday you and another student would spend the morning with a dedicated GP mentor and the afternoon in tutorials with the rest of the course group.  These tutorials will be facilitated by experienced, enthusiastic clinicians and will involve debriefing on your experiences with presentations on clinical tutorials that you will give to your fellow students. This is very much driven by and for you, and we hope that having these Thursday sessions will create continuity with your fellow students and clinician tutors.

Where did the idea for a change come from?

There has been a lot of interest in medical education and whether we’re preparing doctors for tomorrow.  In particular shorter hospital stays have meant that students are often only seeing a snapshot of the disease process.  Additionally in medical education there’s often been a loss of the relational continuity that existed in the past, and we’ve been thinking about how to bring in some of the apprenticeship model that has been lost. Internationally there has been a huge amount of interest in this, we’ve taken lessons from America, Australia and South Africa and designed a course which is tailored to ICSM students.  By following your own patients and sticking with your GP mentor we hope you will get back some of that continuity and in a sense you would have some responsibility and become an advocate for your patients, perhaps acting as a translator of medical jargon after their appointments, and bridging primary and secondary care for them.

What do you think are the main benefits of the course for students?

This is a unique opportunity for students to part of an inaugural class, to really learn through experience and develop relational continuity not only with patients but also with clinician mentors and also with each other.

A key theme is to help prepare you for life as a doctor as much as possible, and so we hope you would develop many skills from the apprenticeship.  For example through this Thursday tutorial we hope that students will develop self-directed learning and teaching skills, and think about professional identity formation through reflection and discussion of patient journeys and clinical experiences they’ve had, as well as nurturing patient-centredness, empathy, resilience and other key attributes needed to thrive in the medical environment.

How much extra work would be involved?

There shouldn’t be much extra work involved at all.  You will be asked to give tutorials to the rest of your group 3-4 times during the year, and the rest of the tutorials will be based around debriefing and reflection on your experiences with teaching from experienced clinician teachers.  We are hoping that you can develop your sense of the cross-disciplinary nature of medicine. You would also have to keep track of your patients within your pair of students on the course. We hope this will enable you to see the whole spectrum of disease process, gaining a rich understanding of your patients’ journey through the healthcare system.

Is there a set curriculum for the tutorials?

These sessions will have a structure that ensures disciplines covered in the 5thyear are continuously re-visited, and that learning across specialities is brought together to emphasise the complex, cross-disciplinary nature of medicine. These sessions are not designed to be didactic, and we hope you will be able to reflect on the patient experience, with the opportunity for you to be able to lead those sessions in a meaningful way.  We have designed these tutorials to meet the demands of the students in a flexible way, building the course around that. Different students will be on different firms at different times so we hope to have rich discussions, overseen and facilitated by experienced teachers with expertise in the fields. We hope this structure will ensure students gain knowledge of, and are introduced to, the firms they won’t have until late in the year.

What if you need to be in firms one Thursday?

All of your firms will be with consultants who are aware and happy about the apprenticeship, and so although the Thursday sessions will all be compulsory we don’t envisage that this will cause a problem.

What happens if you can’t attend one of your patient’s appointments?

We hope that this will help to build your prioritisation skills, a key skill in being a doctor.  You would have the option to decide what will be most meaningful for you and to discuss with your current firm lead.

How will you select students for the programme?

We will ask students who are interested in taking part to write short answers to the two questions: what do you hope to gain from the apprenticeship; and what you think you could contribute to the apprenticeship.  This is to really ensure you have thought the opportunity through.  From those who apply we’ll then run a random lottery to select the students to be part of the inaugural class.

The deadline for applications will be on 12thFebruary at 5pm.

Watch out for an email with more information and the link to apply.

We will be evaluating the course to check we’re meeting the key goals, so we hope that those students who apply but who aren’t successful may also help us by answering some questions at the beginning and end of the year.

How do you hope the integrated clinical apprenticeship will develop?

Moving forwards we may scale the apprenticeship up to a degree. I don’t think it would ever be for the whole year group.  Whilst I think this is an incredible opportunity for some students, everyone learns in different ways and it probably isn’t how every student would want to learn.

What can students do to find out more?

For more information on the course and to meet the Faculty involved please come to the Q&A session on Tue 26thJanuary in the Reynolds building, from 5-7pm – pizza will be served, and there’ll be a chance to meet with Course Directors and Senior Faculty.  

If you’re not able to make that or can and would still have questions then please contact myself, Dr Arabella Simpkin at a.simpkin@imperial.ac.uk;  or Dr Andy McKeown, the GP lead at andrew.mckeown@imperial.ac.uk

Next Steps RevisedApprenticeship

The 11th Hour

Late in the evening of 30th November 2015, just hours before industrial action was due to start, word came from the negotiating rooms: the strikes were off. The first doctors’ walk-out in over 40 years – and the first junior-only strike in history – was to be pushed back until at least early next year; productive talks between the BMA and NHS Employers had, at the last possible moment, finally begun. The cause of this extraordinary brinkmanship: a controversial new employment contract which the Government had threatened to impose on all junior doctors in England from August 2016.

Before we address the contract, it is worthwhile reviewing the story so far. Negotiations between the BMA and NHS Employers (NHSE) began in October 2013 but stalled a year later. The Government subsequently asked the Review Body on Doctor’s and Dentist’s Remuneration (DDRB) to provide recommendations, 23 of which were presented by Jeremy Hunt in July 2015 with an ultimatum that if the BMA did not return to negotiations they would be implemented anyway. The BMA Junior Doctors’ Committee decided in August not to re-enter talks, arguing that “the threat of imposition” made negotiation impossible (2). In the following weeks, the attitudes of doctors towards the contract were made abundantly clear – that it is not safe for patients, not fair for doctors and risks the future of the NHS. The rebellion quickly gathered pace and sparked several public protests, the largest of which, in London, was estimated to be 20,000 strong (3). A ballot on industrial action was announced and ran November 5-18. The results were unequivocal: on a turnout of 76%, 98% had voted to strike (1). Junior doctors were united in opposition the new contract. Industrial action seemed inevitable.

The recent decision to postpone strikes has, unsurprisingly, proven highly controversial, and the implications will only be fully realised in time. Putting this aside for the time being, there is perhaps no better time to reflect on this bitter conflict. In this article I shall review the factors which have brought doctors so close to strike – both intrinsic to the contract and in the extrinsic barriers to settlement – and consider, as negotiations commence, the prognosis for the future.

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Reduced Pay

Much of the media circus has – rightly or wrongly – revolved around the question of pay. Indeed, it is an area of enduring controversy – whilst NHSE insist that the size of the overall pay packet is unchanged, many junior doctors fear that their salary could be cut by 30% or more (4). As each doctor’s pay is calculated individually, the precise impact will not be known until it is implemented, but it is now clear that a significant proportion, particularly those who frequently work evenings and nights, will lose out, with further scope for cuts in the future.

Concerns about the financial wellbeing of doctors are not new. Though there remains a widespread public perception that doctors are generously compensated for their work, it is difficult to argue that this is still the case. A recent study found that medical students graduate with debts of £64000-£80000 and that many will never earn enough to repay their student loan, sums which are higher still for international students and cohorts paying £9000 fees (5). Despite this, the basic salary for F1 doctors sits at £22636 (to be raised to £25500), well below the national average salary of £27600 (6). Finances have also been squeezed in other ways: free accommodation for F1 doctors have been removed and pensions cut as professional fees for exams and registration grow (5). Any further adjustments, then, will be imposed on a population already under significant strain.

Under the new junior doctors’ contract, the government will attempt a roughly cost-neutral redistribution of pay. The current method of pay calculation, known as “banding”, consists of basic income plus a pay supplement – up to 50% of basic pay – based on the working pattern, intensity of work and number of “unsocial” hours worked. The DDRB have proposed that this system be replaced by several smaller enhancements. This includes an 11% increase in the basic salary, the ability to work additional hours up to 56 per week, increased pay during “unsocial hours” and other small bonuses (7).

The DDRB argues that this provides a fairer, more granular calculation of payment. However, the extent to which the new bonuses will compensate for the loss of banding is hotly contested. First, number of hours considered “unsocial” and which thus attract a premium rate have been significantly reduced: “plain time” will be extended from 7am-7pm Monday-Friday to 7am-10pm Monday-Friday and 7am-7pm on Saturday (8). As a consequence, junior doctors who have duties that frequently encompass evenings and weekends will receive bonuses for a far smaller proportion of their shift. This change particularly hits acute specialties such as A&E and intensive care, which, as we shall explore later, may exacerbate serious crises of recruitment. Other sources of income have similarly seen cuts. A new allowance for on-call availability, which involves long hours of continued vigilance, provides only a 2-6% bonus (2). Non-resident on-call pay is being similarly degraded; doctors will receive a simple allowance for being available and not pay for each hour they work. The DDRB also recommends that “fees earned during private professional work during NHS time should be remitted to the [employer]” (7). Though largely reasonable, many trainees routinely perform this kind of work for clinical benefit, such as psychiatry trainees who complete Fitness to Plead reports.

Arrangements for mitigation of income loss from the junior contract, known as Transitional Pay Protection (TPP), are temporary and not comprehensive. This scheme applies a basic calculation to ensure that no junior doctor receives a pay cut until 31st July 2019, though, as we shall see, doctors whose shifts overrun may lose out in practice due to reduced checks. Furthermore, medical students today will see no such protection. Though TPP will soften the blow in the short-term, the door remains open for further cost savings in future and it is unclear whether these savings would be re-invested into junior pay; short-term assurances may disguise a negative long-term impact.

No doctor goes into medicine purely for the money, but changes in the proposed contract represents for many a further squeeze on the finances of those who can ill-afford it. By the end of training, at least, juniors can still expect to receive a reasonable income, but given the huge amount of training involved and the responsibility of the daily job, they remain shamefully undervalued. 

Excessive Unsocial Working Hours

Another key concern is that junior doctors may be forced to work increasing numbers of weekends and evenings – often for routine work – leading to more irregular working patterns which could contribute rising levels of fatigue and stress and ultimately endanger patient safety. NHS Employers are at pains to highlight some positive changes – for example, a reduction in the legal limit of weekly hours from 91 to 72 and reductions in the number of consecutive days and nights that can be worked. However, the vast extension in the number of “plain time” working hours means that juniors doctors can be be asked to perform routine work throughout these times with no financial penalty to the trust and often without senior supervision. The work-life balance of doctors, already precarious, will be further compromised by these changes.

Removing the “banding” system takes with it the built-in safeguarding system against doctors doing unpaid overtime, offering junior doctors decreased protection against the abuse and overwork the system was initially implemented to prevent. Employers currently have a financial interest in planning rotas and staffing wards appropriately and regularly monitors juniors’ working hours, offering supplementary payments for working beyond scheduled hours. In lieu of these systems, the DDRB recommend that employers simply follow the law on Working Time Regulations, overseen by the Care Quality Commission. However, this offers shorter and fewer breaks as standard, down to 20 minutes every 6 hours, with no financial penalties for employers, less regular monitoring and no enforcement mechanism of immediate impact. The net impact of reducing safeguards whilst spreading shifts throughout all times of the day and week is a threat of returning to a time in which junior doctors were overworked to breaking point, a state which will only further compromise patient care.

Slower Pay Progression 

Changes to the system of pay progression mean that those who work less than full time will lose money over the course of their career compared to the current deal. Today, doctors receive a pay rise each year after graduation; the Government proposes that instead, pay would be tied directly to the level of training – for example CT3 or ST5. In total, there will be 6 pay increments which span the 11 stages, fewer than exist today (7). It is not difficult to see the appeal of this plan – it seemingly reframes pay as a recognition of achievement rather than an automatic process and encourages people to advance through training as quickly as possible. Critics, however, question the assumption that one’s value to the health service can be directly correlated with rank and that experience cannot be gained in other ways. In addition, the inclusion of only six tiers means that trainees could stay at the same level for three years or more depending on their rate of progress.

As a consequence, doctors who take time out for any reason, such as for sickness, maternity leave or as part of Less Than Full Time (LTFT) schemes will all see slower pay progression. Worryingly, this will affect women, who comprise 80% of doctors working part-time, more severely than men (9). In addition, people who take time out for academic training, such as a PhD, will re-enter clinical practice at a lower salary. Similarly, those who retrain in a different specialty will drop down to the base salary rather than continuing to progress annually. The DDRB suggests that thesis would be mitigated by a “flexible pay premium” which would recognise “when work benefits the wider NHS” or “additional experience” gained, respectively (7). While this is a welcome concession, it is unclear who would determine whether a break from training is ‘worthy’ of reward or whether this would adequately compensate for lost income. The BMA estimates that, ultimately, 54% of doctors will be disadvantaged by these changes (2). The new method of pay progression, then, will make it even more difficult for doctors to raise a family, pursue research or retrain than under the current system.

Worsening Recruitment Crises

We have heard thus far that the removal of banding supplements, reclassification of “unsocial hours” and erosion of safeguards particularly undermine specialties which regularly work long hours in the evenings and on weekends, such as A&E; this threatens to exacerbate a crisis of recruitment in acute medicine and in the NHS more broadly. Today, more than 50% of A&E vacancies at ST4 level and above are unfilled; fears that the junior contract could exacerbate this problem were expressed in a letter by eleven Royal Colleges to Jeremy Hunt (10). This exodus is not merely internal, with many new graduates choosing to move abroad or leave medicine entirely. In the ten days after Hunt’s contract details were confirmed 3468 doctors applied for a Certificate of Current Professional Status from the GMC, a document used as evidence when applying abroad (11). Australia is a particularly popular destination, offering higher pay and lower hours (12). At a time when resources are already severely stretched, a significant exodus could endanger patient safety and necessitate the costly hire of locum doctors.

Incentives offered to mitigate this with “Recruitment and Retention Premiums” demonstrate an awareness of the problem but fail to adequately address the underlying issues. Three specialties, GP, EM and psychiatry are currently earmarked to receive these bonuses, down from seven identified in the DDRB report (7). As with other “premiums”, the means by which eligibility would assessed and quantified is unclear. Notwithstanding, this olive branch ignores problems not sensitive to pay such as the stressful work environment, short breaks, unpaid overtime and increasingly erratic shift patterns.  It is worth mentioning, too, that the pay supplement for GPs replaces the significantly more reliable training supplement which exists today. Ultimately, much remains unknown about the impact of the new system on final salaries, but the threat of a pay cut risks driving away more doctors that the NHS cannot to lose.

Stretched Resources

Underlying almost all the proposed changes is Jeremy Hunt’s oft-repeated ambition to create a 7-day NHS, a plan which holds little credibility due to the poor evidence base, deep NHS budget shortfall and the widespread requirements for its implementation. The new contract, then, risks stretching resources even further for no added utility. The case for a 7-day NHS was made most memorably in July by David Cameron, citing a 15% increase in mortality during the weekend (13). The applicability of this finding is limited, however, by the fact that patients admitted during the weekend were more unwell, almost twice as likely to be emergency admissions and were no more likely overall to die during their hospital stay (14). In addition, there is no clear evidence that this effect is due to poorer quality care or whether revised working patterns would bring any benefit (15); it is extremely doubtful that non-provision of non-urgent, elective appointments and procedures is having a significant effect on mortality.

Meaningful improvements to the provision of elective weekend care can only be credibly be achieved by similarly bolstering the provision of supportive services – for instance for medical imaging – to parity with weekdays, plans which would require huge, sustained investment at a time of unprecedented funding shortfall. Today, the NHS faces an estimated £30bn funding shortfall (16), with only £8bn additional funding pledged by the Government until 2020; health managers are thus expected to make £22bn of savings. Furthermore, Monitor recently reported that the NHS currently faces a £1.6bn deficit which is projected to rise to £2.2bn by the end of the financial year (17). In this context of efficiency drives and debt, meaningful steps towards a 7-day service are impossible. Though the ambition is noble, junior contract changes will have no impact; that it is being wielded as a justification for the threat of imposition is, at best, deeply misguided.

Poor Communication

It is not unprecedented that a new contract contains limitations and oversights; however, these problems have been exacerbated by obfuscation, media manipulation and political posturing from the Government. For instance, Jeremy Hunt suggested that doctors refer to their long hours as “danger money”, but a subsequent poll found that 99.7% had never heard of this term (18). Whilst broadly praising doctors, he has alternately suggested that concerns about the contract have been expressed by a core of “militant” individuals, a claim which has little basis in fact but which is calculated to shift public opinion. Similarly, he had previously suggested that doctors lacked a “sense of vocation” for not routinely working weekends. As the strike drew nearer, hesuggested that participants will be risking lives, further alienating the medical profession in the hope of souring their image. This pattern of “megaphone diplomacy” was further evidenced by Hunt’s decision to announce an 11% increase in basic pay to the media, not the BMA; this is, of course, a lie by omission, but succeeded in grabbing headlines. Such a hostile stance has made accommodation far less likely.

The threat of imposition of the contract and an unwillingness to negotiate on most of its key components have also been barriers to meaningful negotiation. Though Hunt has claimed in interviews that there are “no preconditions” to negotiation, he has made it clear that the DDRB recommendations will form the “basis” for discussion and that he reserves the right to implement the contract anyway if an agreement cannot be reached. Though he recently decided to permit negotiations through an independent mediator, ACAS, these threats remain a barrier to conciliation. Though it is within his power to do this, it has left doctors feeling utterly disenfranchised and is thus a key motivator for industrial action.

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Looking Forward

Nobody wants a strike. Given the deep commitment doctors feel to their patients, any decision which may, even temporarily, compromise the quality of care that they receive is not one taken lightly. The near-unanimous vote, then, was an extremely powerful declaration against the new contract and the harm they feared it would cause. These concerns are justified. By cutting pay for those who work the most unsocial hours, stretching routine work throughout the evenings and weekends, weakening safeguards against abuse, punishing those who take time out of full-time clinical work and risking further exodus from the most understaffed specialties, this contract compromises the safety of doctors and patients alike and threatens the long-term health of the NHS.

Despite the clear mandate for strikes, the recent decision to postpone them, perhaps in perpetuity, should be cautiously welcomed. While a vital right and clearly justified in the circumstances, the utility of a strike is greatly reduced now that a negotiated settlement is possible. While no details of agreements have yet been announced, the potential for substantive change to the contract is greater today than it has been in months. This ought to be supported so long as there is productive discussion and even as the spectre of “imposition” looms. Indeed, it is an inconvenient truth that the medical profession needs these negotiations more than Hunt does; regardless of the vociferous opposition to the contract in the doctors’ mess and on the streets, he retains a legal right to impose the contract unchanged and could cite apparently “uncooperative” doctors and his “unbreakable” manifesto promises. His continually hostile rhetoric is particularly concerning as it demonstrates that he is unmoved by the views of the medical profession and is willing to push forward his agenda at any cost to his reputation. That the BMA has now brokered a ceasefire should not be seen as capitulation; we have a far greater chance of resolution through diplomacy than in a perpetual battle of attrition.

Words by Thomas Elliott (@talexe on Twitter). Photos by Billy Liu.

Information current as of 2/12/15. To read the new contract in full, visit http://bit.ly/ddrb2015; revisions made on 4/11/15 can be found at: http://bit.ly/ddrb4nov.

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