Collaboration and training: life as an ACF in Geriatric Medicine

depression and syncopeJenni Harrison is a Clinical Research Fellow and Junior Doctor, who has just started a PhD at the University of Edinburgh following completion of Academic Core Medical Training. She tweets @JenniKHarrison

I still remember opening the email from Dr Conroy, which simply said:

“Would you like to write an article about frailty with Professor Young and I?”

As you’d expect like many things during my time as an Academic Clinical Fellow (ACF) in Geriatric Medicine it was met with an enthusiastically prompt reply. Only a few weeks earlier I’d had the opportunity to participate in a Frailty Workshop in Leeds run by Dr Andy Clegg and Professor Young, discussing their Frailty Index using routinely-collected GP practice data. Professor Young had challenged us on that occasion to think about frailty not simply as a descriptive term, but as a long-term condition.

It was an idea that held great appeal. Far too often during my Core Medical Training I experienced the often fragmented and variable care of older people living with frailty, often driven by the opinions of those delivering their care. I’d also frequently heard the criticisms that while there is an extensive Frailty literature its application to day-to-day practice was limited, rendering it essentially an academic topic. So the opportunity arose to collaborate and work on our Commentary article developing and forwarding the case for ‘Managing frailty as a long-term condition’.

This was my first experience of writing an opinion-based piece and it took a while to get used to the freedom of being able to follow a line of argument, rather than the usual balance required when writing-up a clinical study. That said, the writing process was dynamic and I had to learn to clarify and defend our case. Fortunately, my co-authors (and writing directors) are all pragmatic, experienced geriatricians committed to improving the care of older people through their practice and research. I’d actively encourage fellow trainees to seek-out opportunities such as this to collaborate and write critically – it challenged my ideas and provided me with a whistle-stop education in Frailty in the process.

It’s been a topical time for Frailty with the publication of the British Geriatrics Society

Fit for Frailty Guidelines, all about improving recognition and management of individuals living with frailty. This was supplemented by Part 2 published in January of this year which considered the development, commissioning and management of services.

It would also be remiss to pen anything about Frailty without acknowledging the recent publication of ‘Frailty: Language and Perceptions’ prepared for Age UK and the British Geriatrics Society.

The most stark quote from that report:

“The key barriers to identifying with the word ‘frail’ itself speak to a deep fear of losing independence, dignity and control over one’s life”

The challenge to us as clinicians and researchers is how to respond. While I can’t pretend there is a simple solution here, I don’t think it should lead to a knee-jerk reaction in relation to Frailty research. If anything, it probably reflects the therapeutic nihilism that can often exist in relation to those who are often considered to be ‘frail’.

Instead I think it supports the case for a much more proactive, pragmatic approach working out how to support people living with frailty to achieve all that they can, rather than assuming it is an irreversible, unmodifiable condition. An approach outlined in our Commentary ‘Managing frailty as a long-term condition’, which I hope you’ll enjoy reading.

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