On 28 November 2018, Leona attended the 'Supporting Refugee and Asylum Seeker Healthcare Professionals into Employment: Best Practice and Future Directions’ conference in Durham.
The event was hosted by the Resettlement Programme for Overseas Doctors (REPOD) and workshops provided an opportunity to discuss the many challenges facing refugee and asylum seeker care professionals returning to practice in the UK.
The conference examined how early identification of healthcare professionals can be improved. Across the UK there have been long running campaigns to the Home Office and DWP, also leaflets distributed to local GP practices, churches and mosques to help attract healthcare professionals and inform them of local initiatives to help them return to work.
A total of 650 refugee doctors are registered with the BMA but only one third are in programmes or employment. It is recognised that more needs to be done to reach the remaining two thirds, and others who aren’t registered, and support them back to work.
Some programmes support dentists, nurses and radiographers through requalification, although many challenges face the nursing workforce in particular. These include social issues, as often women with family responsibilities have difficulties attending classes because of childcare issues.
There are issues nationwide with refugee doctors initiatives: it is often viewed as an area of work for ‘well meaning individuals’ rather than highly successful programmes that increase the NHS workforce at a fraction of cost. Refugee doctors is an area of work has not been legitimised; there are no publications or platforms for shared learning.
The conference concluded that we need an improved unification process across the UK to take this work forward. Key messages were the necessity of promoting inter-agency relationships; the increase of local networking within NGO, academic institutions and the NHS; to report to the Department of Health to direct all nations to provide funding for refugee healthcare workforce programmes; to establish a nationally hosted website for resources; to campaign for a Minister for refugees; and to meet annually as a group.
Following attendance at conferences in Stockholm and Toronto, Leona travelled to Halifax, Canada, to attend her tenth International Medical Education Leaders’ Forum (IMELF). Leona said, "IMELF is a unique opportunity to meet leaders in medical education across the globe. The meetings provide leadership solutions to overcome resource challenges in health care, medical education, and continuing professional development, to mitigate increasing global healthcare needs."
The workshops focused on Artificial Intelligence (AI) and Dr Tanya Horsley, the presenter of the first workshop, spoke of the inevitable developments in automation. There followed a discussion about the possibility of disruption to medical practice and the conclusion that although AI will not replace doctors, doctors who use AI may replace those who don’t.
In the following session led by Dr Ingrid Philibert, delegates examined how medicine and medical education are no different from any other industry and how, like other industries, can be ‘blindsided’ by innovation. AI is moving towards the mastery of medicine and self-learning capabilities will overcome human factor errors.
Dr Kent Bottles explained in his workshop how AI will affect all involved in drug discovery, robotic surgery and personalised medicine. Teaching methods will need to change and there is a risk that those who don’t learn to work with AI will be replaced by those who embrace it. Big data, computer science and coding will be necessary to help prevent ‘unintended consequences’ of AI.
In a subsequent session, Dr Alyson Byrne explained how we are well positioned to integrate competencies of character, such as behavioural integrity, accountability and professionalism in medical education, and we need to take into account the extraordinary diversity in the medical workforce and across all the stages. Byrne believes procedures are often inhumane: they need to be followed but do not leave a lot of room for character.
Dr Miroslav Jaana examined with delegates how the environment has changed. Healthcare is the largest contributor to job growth and more providers are needed. A new generation of patients and providers have increased expectations and demand. Populations worldwide are ageing and this increases the range and prevalence of complex and chronic conditions and diseases.
Following the successful IMELF Europe meeting in Stockholm (see below), Leona will continue her autumn conference schedule when she flies from Heathrow to Toronto on 9th October to attend the International Conference on Physician Health (ICPH).
Physician health and wellness are critical to the future of healthcare and healthcare systems worldwide, and the ICPH is regarded as the World's premier conference on physician health. It is a unique event held every two years and organized by the Canadian, American, and British Medical Associations. The theme for 2018 is 'Driving Meaningful Change: Make it Happen. Make it Matter'.
While issues related to physician health are being increasingly recognised, and emerging trends demonstrating the need to address these at not only the individual but also the system-level, now is the time to take steps toward meaningful and sustainable change. Given the complexities of health systems and professional culture, it is important for the physician health community and other leaders to come together, share ideas and learn from each other at this critical juncture. To complement the high-quality research being shared through the conference program, this year’s meeting is showcasing ‘innovations’ — new ways of doing things, tools/resources, and ideas — that are, or could help to, promote physician health and wellness. This is regarded a unique opportunity to share innovative work with others from around the world.
Having arrived safely in Toronto, Leona attended the first day of the ICPH 2018 and found it posed some challenging questions and offered interesting ideas. There is certainly an international agreement that there must be a culture change in how wellness is viewed and approached, and this is supported by a strong body of evidence.
Leona said, "I was encouraged to hear that the AMA, BMA and CMA actively support the wellness agenda. For example the CMA have a ‘Statement of Wellness’ and the BMA launched a survey of mental health wellbeing of all doctors in the UK which will provide valuable insight.
"The keynote lecture by Dr Anthony L. Suchman on ‘Three paradoxical secrets for leading organisational change' was inspiring. He invited us to look at organisations as conversations and provided examples of positive and negative pattern forming which is often formed by serendipity of events or conversations. He challenged us to be the agents of change by trying new behaviours in order to foster new patterns."
Dr Clare Pain asked ‘How do we hurt?’, and through examples from her award winning work in psychiatry and in the Canadian Center for Victims of Torture and the New Beginning Clinic for Refugee Mental Health, she painted a picture of well-being connectedness to language, clarity, healing and the attunement to values and purpose.
In other workshops Leona attended, delegates looked at examples of good practice including training the trainer programs for recognition of early distress; bridging the gap of ‘knowing’ and ‘doing’; believing that change is possible; that burnout isn’t a ‘me’ issue but a ‘we’ issue and, finally, how the quality of relationships in the workplace directly affect employees' work.
At the end of a busy first day, Leona networked with colleagues from across Canada who are working in the field of supporting healthcare workforce.
The second day of the conference began with a plenary panel on Wellness as a competency in Medical Training. Dr Lotte Dyrbye spoke about the influencers of wellbeing* and emphasised that wellness is a shared responsibility that needs to be nurtured by all. Dr Kim Lomis reminded delegates that wellness is not easy and requires a lot of skill and hard work throughout your career.
Dr Debbie Cohen challenged the audience with the question, ‘How do we measure the competency of wellbeing?’ and stressed that competency may increase isolation and anxiety instead. Dr Cohen advocated for a synergy with permaculture: small changes make a big difference. The edge is the most productive place to be but it must be a supportive environment. She went on to say that when people are well, what they think they would do should they ever become unwell, is not what they actually do if they become ill. Cardiff University School of Medicine has introduced 'One Act of Kindness' (OAK) which has been shown to have a positive impact on both the giver and the receiver.
Leona found the workshop on building a personal resilience by Dr Brazeau to be a good opportunity to review strategies for resilience, including building ´quick fixes’ into the working day, positive reflections and establishing ground rules around non negotiables whilst remembering that what is meaningful to you now may change throughout your career.
During a workshop on using the 'coach approach' to promote physician wellbeing with Dr Simon and Dr Rehm, attendees reviewed the principles of coaching and reflected that doctors are trained to focus on the problem and provide a solution. The challenge is the change in focussing on the opportunity, as focusing on opportunities empowers individuals to find their own strategies and solutions. If we focus on problems, we narrow our thinking. A proactive approach is to consider ‘what do you want it to be like?’. Most successful people start with asking ‘why?’ when thinking about their work. More can be learned in Simon Sinek's TED talks 'Why good leaders make you feel safe' and 'How great leaders inspre action'.
In the poster session, Leona thorougly enjoyed listening to the presentation from Dr J Egan on the strategies used for building a positive working environment at the EM department at Waitemata District Health Board, Auckland. Among these is the introduction of 'A & A' meetings ('Amazing & Awesome') alongside 'M & M' meetings (Morbidly & Mortality).
Dr Margaret O’Rourke gave a presentation on SAFEMED SMART, a stress management and resilience training programme. Dr O'Rourke reminded delegates that people are not always aware of their own stress, particularly those in busy careers such as medicine. Dr O'Rourke believes that stress is inevitable but burnout can be avoided. The group was tasked with identifying their three biggest expected and unexpected stresses before discussing how they equip themselves appropriately in order to cope with busy work.
Leona concluded day two of the conference by attending a workshop entitled ‘From meaning to mission: Speaking up for change’. which began with the message ‘You are the change that you are waiting for. We are the change we are waiting for.’ It was noted that the biggest barrier to change is often one's own low expectations and beliefs that one can’t make a difference. If you want change to happen, pick projects big enough to matter and small enough to win.
*Dyrbye et al. JAMA 2018:320: Acad Med Sept 2018 ePub: Med Educ 2018
Day three's opening plenary panel 'System-Level Change: International Perspectives' offered insight into the culture of the medical working environment. Dr M.Kay, MD QDPH, Australia, explained that the knowledge about higher stress, depression and even suicide rates among doctors is not a recent issue. In1889 Sir William Ogle presented his epidemiological study to the Royal Colleges in the UK which reported on higher rates of physician suicides among the population. Dr Gigi Osler encouraged us to teach doctors better leadership skills so that they can speak the same language as the leaders in healthcare. It is recognised that we need leaders and doctors to stand up and speak.
In the ICPH 2018 closing plenary, Dr Steven Strongwater spoke on ‘Joy in Medicine’ and stressed, as did many other speakers in this conference, the importance of practical strategies for reducing stress. Following the session, Leona said, "I particularly liked the idea of allowing employees and trainees to use their CPD or study leave budget for wellness as well as academic activities." Leona added, "I look forward to taking some of the learnings from the ICPH 2018 and making a change to report at the next ICPH in 2020 in London."
Having recently returned from Stockholm where she attended the first ever IMELF Europe meeting at the Karolinska Institute, Leona reported back on her experiences of the conference:
"The conference was especially important in the current political landscape. Discussions revolved around issues global to all such as workforce retention, faculty development, delivery of training in a changing system and promoting the importance of non technical skills in medical training.
"We heard excellent examples of positive changes in medical education; for example from France where they are breaking barriers in inclusiveness and diversity. There was a sense of urgency around some of the issues raised and we hope that this forum will stimulate collaboration on projects, reports and publications across the nations. The next IMELF Europe will be held next year in Dublin and I hope that Wales will be able to contribute."
The blog will be updated mid October when Leona attends the International Conference on Physician Health in Toronto, Canada.
Earlier this year, we featured a week in the life of Leona Walsh, Manager of the Wales Deanery Professional Support Unit. The PSU offers advice, guidance and support to trainees in their professional context and provides a network of support for educators throughout Wales.
This autumn Leona is attending three overseas conferences, beginning with the International Medical Education Leadership Forum Europe (IMELF) on 20th - 21st September at the Karolinska University Hospital in Stockholm. This is the first time the conference has been held, the theme of which is 'A changed healthscape in Europe: Implications for residency training and CME/CPD'.
Many European countries have health systems undergoing significant changes. Although the changes vary, there seems to be one recurrent factor: the implications for education and training for the next generation of physicians. In the opening session of the conference, one person from each country will be invited to give a brief update on changes and the current status of the health system and implications for the training of future physicians. During the afternoon session, a 'BBC Dateline London' panel will be led by former BBC news anchor Maxine Mawhinney.
Check back to the blog to find out Leona's experience of the conference.