The President Writes - September 2016
College President Michael Lavelle-Jones provides his regular update
"While the term 'junior doctor' and 'trainee' might be factually accurate, they are somewhat pejorative and probably don't instil a huge amount of confidence in patients"
Last November, when I took up office, I noted in my first President’s column what a difference a day makes. Again, I have a deep sense of déjà vu as I reflect on the outcome of the historic EU referendum vote on 23 June 2016. The impact of this decision on the NHS and on education, assessment, training and research is hard to gauge and may be clearer by the time this column goes to press.
Inevitably, the law of unintended consequences will apply and there will be major implications to our healthcare system, many as yet unseen. Irrespective of your position on the referendum and its outcome, I do hope the coming months will see us all pulling together for the benefit of our health service.
You can be assured that the College will do all in its power to help steer a course through the unknown waters that lie ahead.
WHAT’S IN A NAME?
In recent weeks, too, the junior doctors voted to reject the new contract, which now looks set to be imposed by government.
Stepping aside from the result, this long running and bitter dispute has awakened a long-held view of mine about the appropriateness of the terms ‘junior doctor’ and ‘trainee’, when you consider they encompass all those in training from the moment they leave medical school to a point in time some 10 years later when they embark on their first positions in independent practice. While both terms might be factually accurate, they are somewhat pejorative and probably don’t instil a huge amount of confidence in our patients.
I am quite comfortable being flown across the Atlantic by a First Officer – who is, after all, a pilot in training – but I wonder how I might feel if they were referred to as a trainee in the pre-flight preamble. Matters can have been made only worse by the widespread use of the terms in the media during the dispute and I wonder if the time has come to reconsider their designation, taking into account levels in training and professional responsibilities. By no means do I suggest that we return to the SHO/Registrar/Senior Registrar descriptors that accompanied my progress up the training ladder, but now would be a good time to consider other options. At the ASiT session at the ASGBI meeting in Belfast, there was a groundswell of approval in the audience for such a proposal. Perhaps we should ask our trainees to take the lead on this.
BULLYING AND HARASSMENT
It was my privilege to represent our College at the Royal Australasian College of Surgeons’ (RACS) Annual Scientific Conference held in Brisbane in May. The event coincided with the launch of the Australasian College’s Let’s Operate with Respect initiative, a three-year campaign designed to put an end to bullying, discrimination and sexual harassment in the workplace. This has been launched on the shoulders of the output of a RACS commissioned Expert Advisory Group, whose findings of widespread abusive behaviours in the workplace thrust the issue on to centre stage. The Australasian College is to be commended on showing strong leadership in this area and adopting a policy of zero tolerance, however hard that might be to achieve.
Closer to home, a report from our sister College, the Royal College of Obstetricians and Gynaecologists (RCOG), has looked at the incidence of bullying and undermining among consultants in the UK in that specialty. The report, published this June by the BMJ, makes for a sobering read. Of those who responded, 44% reported being a victim, with up to half experiencing these behaviours in the long term. It would appear that UK-qualified females and non-UK-trained males and females predominate as recipients. Key perpetrators among other grades are their consultant colleagues. I am quite sure that obstetrics and gynaecology are not alone in this practice and I shall be interested to see the outcome of a similar survey in surgery that our College is due to undertake. I commend the report from RCOG and the RACS’s Let’s Operate with Respect. We know that the GMC’s annual survey of surgeons in training regularly shows that surgeons, obstetricians and gynaecologists hold the unenviable position at the top of the league table of dissatisfaction with their training. Feedback from our own trainee membership has highlighted the negative impact of such damaging behaviours on their performance, ability to deliver safe patient care and the perception of their training. Perhaps this is the right time for us to lead by example.