Quality time: The value of consultants - BMA

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QUALITY TIME Two years ago she became Director for Medical Education at her Trust, a role which involves ensuring that the 280 junior doctors at the Trust get the training, experience, and support they need. And various changes in the NHS mean that her clinical role is becoming more challenging and time-consuming: ‘I qualified 20 years ago but it’s become a lot more complex. The expectations of patients, staff and relatives are much higher, and there are more directives about how things should be done. In orthopaedics, a lot of the easy cases have gone to Independent Sector Treatment Centres so I’m left with a lot of complex cases without much time for working out the best way forward. With surgery you can’t afford to get it wrong – you have one go at it. But it does take a surprising amount of time, reading the journals, going to conferences, and keeping up to date and ahead of the game.’ She describes as ‘a very sad move,’ the national trend for SPA time to be cut: ‘There are a lot of consultants doing a huge amount of very good work. Medicine does keep changing so consultants are developing new initiatives, and that can take a huge amount of time.’ BMA – Quality time 19
Dr Stephen Mather Consultant Anaesthetist University Hospitals Bristol NHS Foundation Trust 20 ‘We have to let some of them die,’ says Dr Stephen Mather sadly. Fortunately the patients he’s talking about are made of latex and plastic, but it’s easy to see why the trainees at his Medical Simulation Centre soon forget that. Dylan can be pre-programmed with a variety of conditions – so for example he can suffer an asthma attack while he’s being treated, and will become seriously ill if trainees do not respond BMA – Quality time Using a combination of technology, acting and make-up, staff at the centre are able to recreate almost any clinical situation trainees could face in real life. Some of the courses use very simple techniques – ‘They can depend on a raincoat and umbrella,’ says Dr Mather – but at the other end of the scale are ‘high-fidelity’ interactive simulators, such as Dylan – a manikin of a young boy connected to a computer, which carefully controls his physiology. His breathing changes, he blinks, his pupils react to light, he has a basic circulatory system, and he can talk via a microphone in the trainers’ control room. Trainees can treat him with a range of drugs – a barcode reader on his arm detects what he’s being injected with, allowing him to react accordingly. Dylan can be pre-programmed with a variety of conditions – so for example he can suffer an asthma attack while he’s being treated, and will become seriously ill if trainees do not respond quickly enough. Meanwhile, trainers behind a one-way mirror are not only observing the trainees, but filming them, and can play back clips during debriefing to show the exact moment a different strategy might have been considered. Dr Mather says that simulation provides a level of interactivity and immediacy that ‘you just don’t get in a lecture theatre’. One of the most popular courses at the centre allows trainees to test their life-saving skills on an interactive manikin while being driven round Bristol in a fast-moving ambulance, complete with siren and flashing lights. ‘It’s very realistic,’ he says. ‘When you’re in that ambulance, the suspension of disbelief is very powerful. It’s very immersive – some people get quite emotional.’ quickly enough. The project was born in 1996, when Dr Mather and colleagues set up a group to build the UK’s first Simulation Centre based on a computer-interfaced manikin developed at the University of Florida. The centre, which opened the following year initially consisted of a mock operating theatre housed in a derelict drill hall by the old Bristol General Hospital, and although it received a loan from the hospital’s Charitable trustees, it had to pay its own way by selling courses commercially, which it did with considerable success – in less than 10 years it was generating around a quarter of a million pounds a year.
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Page 5 and 6: Dr Idris Baker Consultant in Pallia
Page 7 and 8: Mr Stephen Blair Consultant Vascula
Page 9 and 10: Mr Hamish Brown Consultant Breast C
Page 11 and 12: Mr Michael Davidson Consultant Oral
Page 13 and 14: Dr Carol Emerson Consultant in Geni
Page 15 and 16: Dr David Flynn Consultant in Emerge
Page 17 and 18: Dr Sara Hedderwick Consultant in In
Page 19: Mrs Scarlett McNally Consultant in
Page 23 and 24: Mr Alastair Murray Consultant Ortho
Page 25 and 26: Dr Alexandra Murray Consultant in C
Page 27 and 28: Dr Cliona Ni Bhrolchain Consultant
Page 29 and 30: Dr John Painter Consultant Gastroen
Page 31 and 32: Dr Fawzia Rahman Consultant Communi
Page 33 and 34: Dr Catherine Ralph Consultant Anaes
Page 35 and 36: Dr Cait Searl Consultant Cardiothor
Page 37 and 38: Dr Bill Stephens Consultant Physici
Page 39 and 40: Dr Paul Tesha Consultant Ophthalmol
Page 41 and 42: Dr Rani Thind Consultant Radiologis
Page 43 and 44: Dr Julia Thomson Consultant Paediat
Page 45 and 46: Mr Atef El-Kholy Consultant ENT Sur

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