How to … be a jolly good fellow

Elinor Burn is a Department of Medicine for the Elderly (DME) and Quality Improvement (QI) fellow at the University Hospitals of Derby and Burton NHS Foundation Trust, in this blog article reflects on her year in post.

Taking a step off the conveyer belt of medical training can be a daunting move for trainees, who have become accustomed to the continued encouragement for career progression. It’s a choice that is not actively encouraged, but does allow(s) space to refocus through dedicated time doing a different kind of work.

After crawling to the end of my core medical training feeling exhausted, I took on this year as a chance to change gear, step back and remember why I enjoy and chose to do medicine. By filling this fellowship post I accepted the challenge of taking forward a service design programme. This has been in the form of a surgical liaison service, a project still in its infancy. It was a steep learning curve – service development is something that I’ve never actually been taught to do. I now recognise the importance of good people management, creating networks and connections around the hospital and beyond, and also recognising the subtlety of different viewpoints within a project to enable its progression.

There are a few key points that I’m taking away:

  • We all need time for personal rest, and to be aware of our limitations.
  • This role has enabled me to appreciate the range of priorities held by different healthcare professionals. Making time to understand these views is a worthwhile investment and can avoid conflict.
  • Taking time away from the pressured environment of on-calls has allowed me to remember why I do medicine. I am now more confident in my aspirations and feel encouraged to pursue a career in geriatric medicine.
  • Quality improvement projects take time in order to create meaningful results. Being able to follow a QI cycle to its natural conclusion has allowed me to understand the challenges that trainee doctors face in supporting service change.
  • Quality improvement has a language of its own, and it helps to understand this when working within service improvement.
  • Being a senior physician is about more than just clinical skills. This year I’ve built confidence in my decision making, in managing my own diary and have started to mentor and support junior staff.

One of the most interesting insights was how much time you can have on your hands as you transition into a new role. I was so used to being busy on the wards that felt a pressure to fill this time with available quality improvement opportunities. So, I find myself with many projects to finish off and limited time to do so. Consultant colleagues have highlighted the similarity here to the transition into a more senior post and I now feel in better equipped for these upcoming transition periods.

My fellow year has provided a great opportunity to have a break from the persistence of medicine whilst also being a positive, career developing time. Junior doctors’ enthusiasm for time out of formal training suggest that they value these periods of rest and refocusing. Maybe it is the encouragement to consider these alternative opportunities, to have a constructive break, that is what’s really missing.

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