Tiago Villanueva: How can doctors avoid becoming deskilled whilst working in non-clinical roles?

Tiago_VillanuevaMy main concern about working in a fulltime non-clinical position is becoming a less competent doctor by the time I start to see patients again (whenever and wherever that is). Doctors need to continually see patients and to regularly study and manage their own needs of Continuous Medical Education (CME) to avoid becoming deskilled, particularly in surgical specialties, where deskilling is even more of a problem.

Working as an editor in a medical journal probably helps to some extent to make up for the loss of patient contact and certainly to a greater extent than other non-clinical roles for doctors like research jobs or working for pharma. Part of the nature of a medical editing job is to be up to date with the latest developments in clinical medicine, and inevitably I thus spend a lot of my time at work reading education articles and research papers and indirectly becoming updated. I wish I had as much time as I do now to keep up to date when I was working full time and long hours as a clinician. Most of the time I have dedicated over the past few years reading and attending CME events came at the cost of my own downtime, evenings, and weekends. Trying to remain up to date, competent, and fit to practise is extremely challenging.

Nevertheless, I feel I have to come to terms with the fact that I will become deskilled, regardless of whether I resume seeing patients again in one year’s time or in five year’s time. Seeing patients is not only a matter of knowledge. It also requires reasoning skills, communication, and interpersonal skills, hands-on clinical skills, time management, but, most importantly, the ability to integrate all those skills during patient encounters. If an elite athlete stops training and competing for a while, he/she will not forget how to perform, but his or her performance will be much worse by the time he or she resumes training and competitive sport again. The same goes for doctors.

Having said this, I have realised that there may be some available strategies to mitigate the consequences of spending time out of clinical medicine, and being in London is a huge advantage. For instance, there’s no shortage of opportunities in central London to attend free or paid lectures and workshops aimed at updating GP’s that are free of pharmaceutical sponsorship. I’ve already attended a few at University College London and the Royal College of General Practitioners, and I’ve been encouraged at the BMJ, where some part time GPs work, to book a GP Update course. I am considering whether to shadow a local London based GP for a few hours not only because I miss clinical medicine, but also because it could help to remind me of the complex and messy world of patient needs and to maintain some sort of connection to a clinical environment.

I wrote an article some years ago about deskilling in medical students, after feeling so uncomfortable seeing patients following a year away from medical school (ironically, I also worked at the BMJ for part of that year). I don’t think I will feel so uncomfortable as before when I see patients again as my knowledge base and clinical skills are much stronger and more consolidated now. Moreover, I am likely to bring in added value in terms of new skills the next time I see patients again. Clinical work can be enhanced and benefit substantially more directly or indirectly from a doctor’s exposure to non-clinical settings. Fear of deskilling aside, I prefer to see the glass half full rather than the glass half empty!

Tiago Villanueva is the current editorial registrar, BMJ, and a former BMJ Clegg Scholar and editor, studentBMJ.