In March 2020 things changed, seismically, both at home and at work. As my 11 year old twins prepared for their first day of home school, I prepared to set off to a new kind of workplace.
“What will you be doing at work today Mummy?’
‘Well – it’s mostly about my ‘Director of Medical Education (DME) ’ stuff at the moment.’
‘But what does that job actually mean, Mummy?’ Kids always get to the nub of it so effortlessly, don’t they?
A moment of reflection. What DOES that job mean? And more specifically, what does it mean right now?
‘Well, think of your school headmistress. Its like that. I make sure that our pupils have the best possible environment to learn, and that our teachers have the best possible environment to teach. So…..’
‘OK Mummy. I get it now.’ I was summarily shut down. Move on. But I didn’t move on.
I’ve been cycling to work since COVID-19 arrived – tantalisingly delightful weather, empty roads, no kids to drop at school, and no regard for what I look like when I get there. I change from jeans, into scrubs, and back again – living in a liberated world of permanent pyjamas. That morning, as I pedalled up through historic Greenwich Park, I reflected on the conversation I’d just had.
In my mind the job of DME has always boiled down to welfare – educational, psychological, emotional and physical. It means creating a training environment which optimises all these aspects of working life. Trainee welfare directly correlates with patient welfare so, if we get the former right, the latter will be the corollary. During COVID-19 these welfare principles have not fundamentally changed, but the context of their provision certainly has done.
I remember a conversation a couple of years ago with a close mentor and colleague; ’the thing is, Cathy, as DME people will expect you to know the answer to the bigger questions. They will look to you to set the educational direction for the Trust.’ For me, COVID-19 has shone a light on the central tenets of education and training. I can now see it through a different lens, with an image of much improved focus, clarity and resolution.
Firstly, take good quality supervision; a cornerstone of training. As a huge wave of trainee redeployment crashed in, along with COVID-19, there was a relentless surge of activity. Rules came down from on high. Endless permissions were sought as GPs, Surgeons and even Psychiatrists were moved back into acute medicine, the Emergency Department and Critical Care. As trainees moved into new, and often unfamiliar, clinical areas the need for excellent supervision was put under the microscope. We had never to lose sight of it.
Amongst the necessarily generic rules, however, were important exceptions which illustrated compelling personal narratives that ran the risk of getting lost in the deluge. The GP trainee, who was a fully trained Microbiologist in her home country of Italy, felt mandated to use her experience in South London. The Foundation Trainee, who had spent 3 years working in Africa on the epidemiology of infectious disease, felt compelled to use his experience in our COVID Command centre. It was vital to accommodate these individual stories of expertise – both for the welfare of the individual and for the welfare of the organisation. I was reminded that a ‘school’ is made up of individual pupils. Rules have to be made but one of the great satisfactions of the DME job is the tangible personal support that can be offered to individuals.
Some of the most challenging narratives came from the trainees that were particularly vulnerable – pregnant trainees, trainees with underlying health conditions, trainees with relatives dying of COVID-19, trainees moribund with COVID-19 themselves. Add to that the final year medical students qualifying 3 months early and starting work on the wards as part of the COVID-19 response. The need for maintaining their welfare was paramount. Imagine jettisoning your plans to take a well-earned post-qualification break and, instead, pitching up on a critical care unit in South London in the midst of a global pandemic. These trainees were potentially rabbits in the headlights, but they were desperate to help and it was our job to ensure their adequate supervision.
Secondly, take a look at teaching. As the pandemic took hold a dedicated cohort of our trainees set up a Trust medical education group. Swiftly they innovated and collaborated, finding a niche that needed to be filled. Before long, Zoom was up and running, webinars were recorded and WhatsApp groups formed. ‘Sounding circles’, akin to a virtual doctors’ mess, provided peer-to-peer support – not to mention ‘Gratitude Corner’ and ‘Quote of the Day.’
Now my role is to encourage these trainees to publish and disseminate their innovations. Perhaps it’s about reframing ‘learning’. It may not be the learning you were expecting, but things will be learnt that wouldn’t otherwise have been learnt. Indeed, some education genies that have escaped from the bottle during COVID-19 may not have to be stuffed back in again.
So what have I learnt from directing medical education through a pandemic? A crisis really can bring colleagues together into a hive of connectivity, positivity, innovation, flexibility, camaraderie and energy. In a position of leadership one could wonder ‘How will I manage this? How will I cope?’. Then one finds oneself sitting at a metaphorical table alongside amazing people who really can get things done. It’s not about knowing the answers; it’s about knowing someone else that does. So that’s Imposter Syndrome knocked on the head.
I have also had reinforced to me what really matters in medical education. It’s about setting an organisational framework that robustly promotes every aspect of trainee wellbeing. But it is also, resolutely, about maintaining an empathic relationship with the individuals. Every trainee has their own narrative, and if you really listen you might be able to make a difference. So, its ‘back to school’ for me, and I very much hope that soon it will be back to school for my kids too.