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ss triple helix - summer 2014,  Looking after your juniors

Looking after your juniors

KEY POINTS
  • A good induction sets a clear keynote.
  • Taking supervision seriously is important.
  • Give priority to teaching and learning.
  • Imitate Christ.
Sarah Maidment recounts why her first hospital post proved so satisfying.

Reaching the end of the first hospital post of my GP training, I realised this had been the most enjoyable six months of my career.

Reflecting on what had been so different about this post, I realised that the senior doctors in the department had gone out of their way to look after their juniors. Because we were happy in our jobs, we worked well as a team and supported each other. We enjoyed work and I am certain this led to better patient care.

Here are some thoughts, written during these months, reflecting on practical ways in which senior doctors can look after their juniors.

1. Recognise that things are different for juniors 'these days'

'I don't cope well with change. Having moved house five times in the three years since leaving medical school, I was not looking forward to upping sticks and moving yet again. This was going to be another big change: moving to a new area, a new house with a new housemate, starting a new job in a different specialty in a big hospital. Having spent a year trying to make friends, establish relationships and settle into church, I would have to start afresh, yet again. In addition, having done a year of Paediatrics, I faced the transition back to working in adult medicine. The pink cannulas looked monstrous, compared with the tiny yellow "neoflons" I had used all year. I was nervous.'

Since the restructuring of medical careers, juniors have had to move around far more frequently: between hospitals, deaneries, cities and different specialties; moving miles from family and friends to pursue their chosen specialties. This often means leaving behind a solid support network. It takes time to set down roots in a new place, make friends and settle into a new church family, especially whilst working unsocial hours.

Senior doctors frequently comment that juniors 'have it easy' these days. Whilst the European Working Time Directive has put an end to 72 hours on-call, juniors face different pressures: busier hospitals, more intense working, cross-covering other specialties, caring for many unfamiliar patients on a number of different wards, the fatigue of shift work and more defensive practice (to name but a few).

2. Ensure your team has had a proper induction

'It was an early start but thankfully I'd managed to arrange a couple of days off prior to starting this new job. (This is not always possible, with juniors sometimes being expected to work a late shift or night shift in one hospital trust and turn up for induction at 7:30am the following morning at a different hospital in a completely different region.)

'Some Trust inductions run over several days. This was an example of a well-organised induction process: run over one morning with short, sharp, focused sessions on a wide range of topics. We spent the afternoon orientating ourselves on the ward, meeting key members of the team and receiving teaching in some of the basics of the specialty. Above all, we were made to feel welcome and we felt ready and well-equipped to start work the following day.'

Trust and departmental inductions have a reputation for being dull and long-winded. This model induction process helped to lay the ground rules, gave us confidence in our new roles and set us up for the weeks and months ahead.

3. Take clinical/educational supervisor roles seriously

'On our first day in the department, each junior doctor received a welcome letter, giving us details of our clinical supervisors and inviting us to arrange a "start of placement" meeting.

'My clinical supervisor was genuinely interested in finding out about me. He clearly knew how to navigate the ePortfolio system. Consequently, instead of sitting in front of a computer screen and ticking boxes, we discussed my CV and came up with realistic, manageable learning objectives for the six months I would spend in the department. Importantly, he appreciated that my learning needs as a GP trainee were different to those of the Core Medical Trainees, which allowed us to consider how I could make the most of my time in the department.

'At the end of the placement, we reviewed an audit project I had completed, discussing how change could be implemented in the department. He completed my assessments and provided constructive feedback.'

Seniors can stand out by taking supervision roles seriously, being proactive in arranging meetings, completing assessments in a timely fashion, showing enthusiasm, and providing encouragement, support and feedback.

4. Promote teaching and learning

'At the end of the first ward round, in which a learning point had been drawn from every patient we had seen, the consultant gave us a short tutorial on a core topic. His enthusiasm was infectious. Teaching was a priority in this department and attendance at formal teaching sessions was encouraged, with middle grades and consultants covering the workload when necessary.'

Could you look out for opportunities to teach, or share some wisdom, whilst on the ward or in clinics? We're really keen to learn...

5. Imitate Christ

'Therefore, as God's chosen people, holy and dearly loved, clothe yourselves with compassion, kindness, humility, gentleness and patience.' (1)

As Christians, we are called to imitate Christ in our lives, glorifying him in everything we do. This is challenging in an environment where stress levels run high, morale is low and cynicism is rife. But living out our faith, counter-culturally in the workplace, remaining positive, seeking to be salt and light – even in the smallest of ways – does not go unnoticed.

I have found it hugely encouraging to discover that another member of the team is a Christian, so do 'flag up' your faith.

Compassion

'Recognising I was not well one Monday morning, I was sent home from work. On my return, the consultant made a point of asking how I was doing and checking I was feeling better.'

Doctors are well known for their 'I'll be fine' attitude, but the reality is that we all become unwell from time to time. It is not uncommon for juniors to feel overlooked, overworked and anonymous. Learning the names of the junior doctors and looking out for their pastoral needs will pay off in the long-run and make for a healthy, happy team.

Kindness

'At the end of the ward round, the consultant would treat the juniors to coffee and buns in the cafe.'

Remember to thank your team. It may not be possible to sit down together for coffee on a regular basis but a simple, 'Thank you' at the end of a ward round – an acknowledgement for the hard work that so often goes unseen – will go a long way.

Humility

'Having been called away to a cardiac arrest, I returned to the ward to find my registrar rewriting a drug chart. Rather embarrassed (this shouldn't have been his job), I thanked him and set about the next task. "Lunch?" he asked. I explained I was too busy and would get some jobs out of the way first. "No. Come on. Those things can wait. We're off to the canteen and lunch is on me!"'

Gentleness and patience

Despite the changes that came with the European Working Time Directive, it is still possible to work in excess of 120 hours in one stretch without a day off.

'After the busy weekend of long days on-call, I would dread Monday morning: turning up on the ward exhausted and bleary-eyed, surrounded by fresh, rested chattering colleagues… Inevitably something would go wrong on the ward round. As much as I tried to be organised and have everything under control, I would forget a crucial blood result, drop the notes on the floor, or search for a missing drug chart.'

If your juniors are not quite so on the ball as usual, could it be that they have just finished a set of night shifts, worked the whole weekend on-call, or come to the end of a twelve day stretch at work? Please be patient and go gently with us!

And finally...

'Do everything without grumbling or arguing, so that you may become blameless and pure, "children of God without fault in a warped and crooked generation". Then you will shine among them like stars in the sky.' (2)

Sarah Maidment is GP trainee in Oxford and a member of the CMF Junior Doctors' Committee.

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