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The Royal College of Psychiatrists Improving the lives of people with mental illness

Fellowship in Leadership and Management blog

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21/02/2013 12:26:12

Welcome to my blog...

Over the next year I hope to give people an understanding of the sort of opportunities that exist in the form of Fellowship posts as Out Of Programme Experience (OOPE). Until recently, OOPE was something that I had given little consideration to as an idea, largely because I had little appreciation of the sort of opportunities that were available. As such, one of the main aims of this blog is to illustrate some of the projects that exist in Psychiatry and other aspects of Medicine, and the benefits that these can bring. Through description of the projects that I am involved in, including the successes, challenges and setbacks, I hope to demonstrate the sort of work that these Fellowships can entail (and ideally, show how these can add ‘value’ to our training).
My post has the rather inelegant title of “Clinical Leadership and Management Fellow” for the Yorkshire and the Humber School of Psychiatry. I don’t think that is going to fit on a badge. The mainstay of my work will be aspects of design and delivery of a programme helping Core Trainees in Recognition and Assessment of Medical Problems in Psychiatric Settings (RAMPPS). The project has been taking shape over the last two years, and a successful pilot day was run in Leeds in November 2012. Through a number of development days, we are aiming to put together localised mini-faculties in training hubs throughout the region, allowing the roll-out of RAMPPS training for Core Trainees in the Deanery. There is a strong emphasis on multidisciplinary learning, and one of the challenges will be finding a way to combine learning needs of Doctors, Nursing staff and other Allied Health Professionals in the constructed scenarios.
In tandem with this, I am planning to liaise with senior Psychiatrists around the Deanery about local arrangements for investigation of Serious Untoward Incidents (SUIs), in particular looking at the way that lessons are learned and their method of dissemination. Identified themes could then be used in further design of RAMPPS scenarios, with the overall aims of reducing the frequency and/or the impact of such events.
21/02/2013 12:52:41

That surreal feeling

Day 1 – 04/02/13

There is a slightly surreal feeling to starting this Fellowship post...

To start with, it has meant leaving a really good community post behind, with little prospect of being able to return to a very supportive and highly effective team once the Fellowship comes to an end. As well as leaving the team behind, it has also meant taking a step back from clinical work; one of the decisions that I have had to make early on has been how much (if any) clinical work to do. After taking advice from a number of sources, and weighing up the number of unknowns that still exist in the project, I have opted to commit to the Fellowship projects full-time, whilst maintaining my out-of-hours on-call commitments. I hope that through this, I can still demonstrate progress when the Annual Review of Competence Progression (ARCP) comes around (which I apparently remain subject to on OOPE).

 

The RAMPPS pilot day, November 2012, Leeds Clinical Practice Centre

The upshot is that the timetable over the weeks ahead is somewhat more sparsely-populated than I have been used to. This is extremely helpful when it comes to meeting with Gary Jordan, Strategic Clinical Skills Advisor for the Yorkshire and the Humber Deanery, to talk about where the project is up to; when he suggests a number of meetings, conferences and development days that it would be useful for me to attend, the answer is “yes”. Over the course of around an hour I sign myself up to presenting at a RAMPPS development day next week, speaking at an educational meeting in Hull later in the month, presenting at a ‘world café’-style meeting in March (no idea what this means) and delivery of a workshop in Rotherham in April (amongst many other things).

 

In the next entry I will write about the RAMPPS development day in Leeds, as I imagine (and sincerely hope) that this will give me a much better idea of progress made with the project so far, and a more crystallised view of what my role is likely to involve.

 

21/02/2013 13:35:40

RAMPPS faculty for the Deanery

Day 8 – 11-02-13

Today represented the first of what is likely to become a number of jaunts around the Deanery as part of the project. The RAMPPS team organised a development day in order to gather together interested parties from around the region, allow for a tour of some of the available facilities and go through some of the simulated scenarios that have already been put together. The audience was made up of Consultant Psychiatrists (with both Trust and Deanery hats on), senior Nursing staff, resuscitation trainers, simulation centre managers and several others with an interest in the project. Everyone there was invited to think of themselves as the RAMPPS ‘faculty’ for the Deanery.

 

Day 8 title: Members of the RAMPPS faculty providing feedback

"I need to be part of a team that turns the ideas into something tangible; and in places where the project still needs a local faculty..."


The opportunity to tour the Clinical Practice Centre at St. James’s Hospital, Leeds was incredibly useful. Here, there is a full simulated ward, together with individual skills training rooms which are coupled to observation and control rooms. The centre makes good use of video recording equipment, so that aspects of performance in a given scenario can be played back in order to inform the debrief.

 

The day gave the audience the chance to look at individual aspects of the five RAMPPS scenarios that have already been written, suggest changes that could be made, and importantly begin to think about how they could facilitate running such scenarios in their own part of the Deanery. The wealth of experience in the group was also invaluable in coming up with suggestions about other scenarios for the future. Many had first-hand experience of situations that had been challenging when they occurred in real-life, and the idea of exposure to such occurrences in a safe, controlled environment was welcomed by all.

I came away from the day with a better understanding of the work that has been done so far, and an appreciation that different parts of the Deanery are at different stages with regard to facilitating such a course. As such, my role looks to be differentiating somewhat: I need to support the well-represented localities in delivering a course in the next few months; in areas where there is already some interest, I need to be part of a team that turns the ideas into something tangible; and in places where the project still needs a local faculty, my role has to be at first more educational (with aspects of marketing?), explaining what the project is and why it is important.   In my next post, I will feed back on an idea that the day gave me about a way that we can collate resources for the course and make them accessible to facilitators, and hopefully also tie in ways to maintain communication between faculty members (unless the idea turns out to be a complete non-starter, in which case further references to this paragraph will be rather conspicuous by their absence).

 

21/02/2013 14:02:46

‘Hot-desking’ in Chesterfield

Day 18 – 21-02-13:

Replacement Bus services, Workplace-based simulation meeting the 'Webmaster' and a slightly vague sense of being in people’s way... 

Things are getting busier.

The end of last week was a bit more like being a Higher Trainee, as I remain involved in assessing the medical students for their ‘observed long cases’, and I have been putting together a teaching session for the next wide-eyed batch. But this week things are stepping up a gear. My new employers (my employment switches to the Trust which is hosting the Deanery Fellowships for the year) have sent me details about their corporate induction, which essentially means three consecutive days in Hull in March (and also confirms that I am on the payroll. I will sleep more soundly tonight). My childish side initially got quite excited about the novelty of train travel. However, this was short-lived, as the chilling words “replacement bus service” brought me down to earth with a bump, as I remembered hearing something about railway lines between here and there being obliterated by a landslide.

‘Hot-desking’ in Chesterfield

This also has implications for more imminent engagements; next week will see me travel to each side of the Humber on consecutive days. On Wednesday, as mentioned earlier, I will be in Hull with Gary Jordan and Paul Rowlands (Head of School for the Yorkshire and the Humber Deanery), talking to local Consultants, Specialty Doctors and Trainees about RAMPPS, hoping to recruit senior local clinicians to the faculty. Before that, I am going to have the chance to observe some of the simulation training that is already going on in other parts of the Deanery; there is a collaborative partnership between the Clinical Simulation Centre at Mexborough Montagu Hospital (an amazing facility provided by the legacy of local business owners Fred and Ann Green – seriously, look it up) and NAViGO, Health and Social Care Community Interest Company providing mental health services to North East Lincolnshire. The Montagu team will be delivering training at the inpatient unit in Grimsby, and this will give me the chance to better appreciate the pros and cons of workplace-based simulation, as opposed to simulation centre-based scenarios.

 

I have also had the chance to meet with Sean Smith, who has the ‘90s sci-fi job title of ‘webmaster’ for the Deanery. I wanted to know how feasible it would be for the resources for RAMPPS courses to be hosted on a specific part of the School of Psychiatry website. I have been working on a ‘scenario handbook’ for the project, but given the number of training centres in the region, and the frequent changes, refinements and additions to the scenarios, the ‘handbook’ may be better suited to being web-based. This would indeed seem to be a possibility (and in fact, a couple of the Fellows in other disciplines are already working along similar lines) and we were able to discuss several other features that could potentially be built-in to such a site that could really aid the faculty and the project as a whole (such as pre and post-course evaluation, streaming of video clips, discussion forum for faculty members etc.). The next step is to establish what is available in terms of a) administrative support and b) budget. I get the feeling that this may not be the last time that these particular ideas emerge as potential limiting factors.
14/03/2013 15:54:50

Two ends of the spectrum

Day 24: 27 February 2013

This week has given me the chance to see two very different stages of the RAMPPS project...This week has given me the chance to see two very different stages of the RAMPPS project...

On Tuesday, I spent the day at Harrison House, an inpatient unit operated by the NAViGO social enterprise.

The video camera: your best friend
They had arranged for facilitators from the Montagu Clinical Simulation Centre at Mexborough to come over and provide a RAMPPS course on their own Enhanced Care ward, for Nursing, Healthcare Assistant and Medical staff. I was told on a number of occasions that “we do things differently in Grimsby”. This was quite elegantly illustrated just before the course started, when a number of participants were temporarily distracted by a wild horse that had entered the hospital grounds. Impressively, they were able to quickly de-escalate the situation, and bring the horse under control (I’m sure there’s a cheap punch line here about the lunch that was provided, but I think I’m above that. Of course, there will always be naysayers).

"My idea of being an impartial observer was somewhat shattered early on, as the medical staff were unavailable until the afternoon. As such, I was cast in the role of “on-call Doctor”..."


The course itself was very well run; small multidisciplinary groups took part in four simulated scenarios over the course of the day, whilst those not directly participating watched a live video stream of the events. My idea of being an impartial observer was somewhat shattered early on, as the medical staff were unavailable until the afternoon. As such, I was cast in the role of “on-call Doctor” for the first two scenarios. (In case you’re wondering, I did OK. I probably should have done a little better, given that I have read and helped to develop the scenario handbook).

 

Afterwards, things were brought back to a shared debrief session, where everyone could provide feedback about how things went. Participants initially found the artificial nature of the SimMan a little difficult to manage, but there was the opportunity to explore these issues amongst many others. I look forward to seeing the feedback that the participants provided.

 

By contrast, today provided the opportunity to take the RAMPPS to a location where the idea is still in its infancy. Gary Jordan and I spoke to the East Riding Training Scheme’s educational meeting about the background to the RAMPPS project. We were very grateful to Dr. Paul Rowlands for warming up the crowd before we started, and we were able to have a good interactive discussion about the project so far, and ways that it could be taken forward in the future, in the immediate locality and across the Deanery as a whole. There was always going to be an element of ‘sales pitch’ to our talk, and we were able to recruit some senior Consultants to the ever-growing RAMPPS faculty. This will be crucial in rolling out delivery of the course in Hull.

 

We finished the morning with a tour of the very impressive Clinical Skills Centre at Hull, and we were able to put the wheels in motion for arranging a RAMPPS Development Day for the area.

15/03/2013 09:10:49

Corporate induction? HEY, why not?

Day 31:

6 March 2013

The week started pretty well...

We’ve all been there…

I met with Hayley Darn, Nurse Consultant and Sarah Butt, Manager of the Acute Care Service for the North of Derbyshire Healthcare Foundation Trust, to discuss a pilot RAMPPS course to take place in Derby. It gave me the chance to feed back about the course that I had seen in Grimsby, and suggest ways in which we could use elements of that approach: i.e. to have one scenario running at a time, rather than four or five scenarios running concurrently.

Naturally, this brings its own challenges, and relies on a certain amount of AV technology being in place. Hayley and I agree to meet up ahead of any pilot to have a proper look at the set-up.

It was followed by the necessary evil of corporate induction for the Hull and East Yorkshire (HEY) NHS Trust. On the plus side, this meant a day out to Cottingham, which seemed perfectly pleasant. However, most of the day was (understandably) geared towards people who will be working in a variety of roles across the Trust sites. I will not be one of those people, and so most of the sessions were… probably wasted on me. One unexpected bonus was that a very helpful lady in Human Resources managed to get me out of days 2 and 3 of the programme. Another was the chance to meet with one of the other Fellows who is due to start his project within the next couple of weeks.

He will be working on a simulation project for Acute Medicine, and a chat over lunch yielded a couple of areas where our work could be of mutual benefit. We should be meeting up again at next week’s quarterly meeting of all the Leadership and Management Fellows in the region to take this forward.

Being freed from day 3 of the induction also allowed me to attend the Formative Assessment of Communication Skills (FACS) meeting for the Yorkshire and Humber School of Psychiatry, which took place in Leeds. It gave me the chance to better understand the way in which RAMPPS could fit into an overall Core Psychiatry Training programme, where the principles that make RAMPPS (as far as I am concerned) a good idea are extended into other aspects of training: i.e. earlier use of simulated patient encounters as a way of teaching and practising communication skills.

 

Next on my agenda is preparation for a trip to Bradford next Monday, to take part in a development day for their local faculty (and more importantly, have a nosey at their simulation facilities).

21/03/2013 11:56:06

SimMen and Human Factors

Day 39 

14 March 2013

Despite the overhead skies repeatedly attempting to snow, I managed to make it to Bradford first thing on Monday morning to a development day for the local RAMPPS faculty.

The Clinical Skills Centre itself is very impressive, with several rooms that can be used, and a number of static and mobile cameras. Dr. Jill Horn, Consultant Anaesthetist and Simulation Lead for the Trust gave us a tour of the facilities and the capabilities of the 3G SimMan manikin (ably voiced by Tim Credland, Simulation Centre Technician).


"Again, we had the chance to look at the impressive facilities that exist at the Hull Royal Infirmary site, and to take part in some of the acute medical simulation scenarios (this also provided me with the opportunity to provide the voice of SimMan for the first time)."

Dr. Anilkumar Pillai demonstrates his listening skills

Everyone was invited to have a feel for the manikin’s pulse, and to listen to his chest as Dr. Horn demonstrated how the associated software could be easily used to manipulate his physical observations. We were also given a demonstration of how to use the video recording and playback software, with a system that is used in a number of simulation centres. The day served as an opportunity to talk about different ways that a RAMPPS course could be run, as well as providing an introduction to the idea to a number of newly-recruited faculty members.

Probably most importantly, we also agreed upon a pilot RAMPPS course date for later in the year…

 

Only Human; John Anderson and some of the other Fellows

On Thursday I attended one of the Deanery Leadership Fellows’ quarterly meetings, in Hull. This is a bit of a mission at the best of times, but was further complicated by a MHA assessment the night before (I say ‘night’. I mean daft o’clock in the morning. My fault for not having swapped my on call duty I suppose…). The meeting itself was really helpful, for a number of reasons; for a start, it was really good to meet lots of the other Fellows in acute medicine, surgery, anaesthetics etc., to hear about the other leadership and management projects that are going on throughout the Yorkshire and the Humber region.

Over and above this, one major focus for the day was the simulation work that has been going on over the last 7 months in acute and respiratory medicine. Again, we had the chance to look at the impressive facilities that exist at the Hull Royal Infirmary site, and to take part in some of the acute medical simulation scenarios (this also provided me with the opportunity to provide the voice of SimMan for the first time).

This was extremely helpful for me, as there were lots of aspects of the work that I think we could borrow for RAMPPS, not least their way of structuring their debriefing. There was also a large emphasis on 'human factors', and the part that these can play in things that go wrong, well-illustrated by an interactive exercise looking at a real-life serious untoward event.

 

The Fellows in the South (i.e. us) and the West of the Deanery have got a lot to live up to…

27/03/2013 09:49:33

Conference calling

Day 46

March 21 2013

This week was centred around two conferences looking at similar issues from different angles.

The first was Progress Towards Sustainability, an event put on (essentially by Gary Jordan) for all Trusts in the Yorkshire and the Humber Deanery. This was a joint venture between the Deanery and Leeds Metropolitan University. Representatives from different Trusts were invited to showcase any work that they were involved in to drive improvements in the quality of patient care (this was the aforementioned ‘world café’ idea – present a short piece for several small audiences rather than once to one large audience). There were also presentations from Dr. Alasdair Strachan, Chair of the Yorkshire and the Humber Clinical Skills Executive, and Steve Hemingway, senior lecturer at the University of Huddersfield.

So, after just 72 monthly instalments..."It was both impressive and disheartening in equal measure to see the eventual victim, a Paramedic, handle this occasion with aplomb, completely unfazed by the task or the audience."

My RAMPPS spiel is becoming relatively familiar now, and delivering the slides four times in rapid succession only helps to reinforce this. However, much more important than the presentation is the feedback that follows it (perhaps an allegory for the relationship between a simulated scenario and the subsequent debrief?) – over the last few days I have had contact from a number of people who saw the presentation with very important observations, feedback and suggestions (and most importantly of all, offers of help).


Still, it made it for quite a hectic morning, and I was relieved to finally take my place in the queue for lunch. This relief lasted all of 15 seconds, shattered by the invitation to take part in a simulated scenario for the enlightenment of other delegates. I am most grateful to Paul Rowlands and Sharon Nightingale for excusing me from the big post-lunch, centre-stage simulation demonstration that followed. It was both impressive and disheartening in equal measure to see the eventual victim, a Paramedic, handle this occasion with aplomb, completely unfazed by the task or the audience.

Gary and I followed this up by taking a poster about RAMPPS to the Primary Care Mental Health Conference in Manchester. This was great, not least because there was no pressure on us at all at this event, but also because there were a number of people who took an interest in the poster. It gave us the chance to talk about how simulation is used in Psychiatry and General Practice training, and indeed of the presentations focused on other innovative technologies that can be used in patient care, including “serious gaming” as a way of delivering guided self-help, and medication boxes that talk to your smart phone. I spy another couple of potential leadership and management projects.

11/04/2013 10:14:57

Sharing ideas (and lightening workloads)

Day 60

4 April 2013

The two weeks around Easter have been a little more patchwork. Lots of people are away, escaping the intermittently crippling snow attacks, and so a greater proportion of my time has been devoted to the tasks that have sat on the ‘To do’ list for the last two months: in particular, going through the core curriculum to identify exactly which elements the RAMPPS course relates to. The idea is that this will give me a set of concrete learning objectives that will be the basis of the debriefing process. Whilst this is something that is quite familiar from the perspective of a trainee in psychiatry (I do have some familiarity with the curriculum – this blog isn’t being read by anyone on the ARCP panel, right?), I am at something of a loss when it comes to Nursing curricula. As such, it was doubly welcome when Becky Burgess-Dawson, Practice Learning Facilitator at South West Yorkshire Partnership NHS Foundation Trust got in touch.


Becky and her colleague Mandy Sutton, had been involved in the pilot RAMPPS course at Leeds in November, and they expressed an interest in helping us to make the course more explicitly multidisciplinary. This is also likely to help the RAMPPS team to forge stronger links with this part of the region, helping with the recruitment of faculty members and the eventual roll-out of a RAMPPS course here.

I also had a very useful discussion with Dr Nick Brown, Senior Assessment Adviser at the National Clinical Assessment Service. NCAS use simulation in helping Doctors, and it was interesting to hear the challenges that they had faced when using this learning approach. There is very likely to be work that is mutually beneficial (adj. something that makes my life easier).

It looks like we have a date booked now for a pilot RAMPPS course in Derby, to add to those already arranged in Sheffield, Bradford and Mexborough, and I also spoke to the Training Programme Director for Older Adult Trainees in Sheffield about the possibility of running an in-house RAMPPS course at one of the inpatient units (I am starting to think of this idea as ‘RAMPPS-to-go’. It may not catch on).

17/05/2013 15:32:36

The RAMPPS Roadshow-

Day 74:

4 April 2013

We now have the basis of a strong faculty for this Trust...

The focus has been on South Yorkshire for the last week or so. Things started with a meeting with senior nursing management at RDaSH, to finalise arrangements for a RAMPPS course to take place at the Montagu Clinical Simulation Centre. We now have the basis of a strong faculty for this Trust, and it was particularly pleasing to hear that the Trust were interested in booking further RAMPPS dates, even before the first one had taken place. Wednesday 17th saw the official opening of the Research and Development Department at Kingsway, Derby. This took place at the education centre where the pilot RAMPPS course for Derbyshire will be taking place, and there was a real buzz about the place.
Magna poster

Always on duty, we were able to display two posters relating to the RAMPPS work so far, hoping to raise awareness about the project wherever possible (particularly amongst the assembled movers and shakers). The next day was one that had raised my anxieties since February. The Clinical Simulation Conference for Health Education Yorkshire and the Humber took place on Thursday 18th April. This was a really good opportunity to meet with people trying to move the simulation in medical education agenda forwards in every area of medical training, and also a chance for us to demonstrate what we are doing in psychiatry. To do this, a team of us (Dr Paul Rowlands, Gary Jordan, Andi Fox-Hiley, Dr Paul McCormick and Dr Stuart Laverack, not to mention the ever-reliable SimMan and superb actor Kazia Gamble) delivered a workshop about the RAMPPS project.Hell hath no fury - Kazia plays an “extremely agitated and verbally abusive lady" We spoke about the physical health agenda in mental health, the genesis of the RAMPPS idea and the Leeds pilot, before demonstrating a scenario based around respiratory depression. This was really brought to life by Kazia, who plays an “extremely agitated and verbally abusive lady” with considerable aplomb (to the point where people came across from other workshops to check that all was well with us). If anything, the workshop went perhaps too well, as we were subsequently invited to deliver something similar at the Tees, Esk and Wear Valleys NHS Foundation Trust's Medical Education Conference in June. And so the anxieties continue… P.s. perhaps my greatest achievement to date: as a direct result of the blog that you see before your eyes, dear reader, typing “RAMPPS” into Google (other search engines are available…) no longer yields the response “showing results for ramps”, but instead takes you here. It is of course no coincidence that RAMPPS has made its way into the title once again…
Hell hath no fury - Kazia plays an “extremely agitated and verbally abusive lady"
Multidisciplinary plotting
Kazia attends one RAMPPS presentation too many
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Fellowship in Leadership & Management Blog

 
     
  Dr. Mike Akroyd  
 
 
 

Mike Akroyd is an ST6 in General Adult Psychiatry, with particular interests in philosophy of mental health and medical education. He was born and raised in Knaresborough, North Yorkshire, before studying Medicine in Sheffield. He entered Psychiatry specialty training in 2007, initially at Bootham Park Hospital in York, transferring back to South Yorkshire the following year. He is currently based in Chesterfield, North Derbyshire. His clinical interests lie in psychosis, in particular around acute care and Early Intervention. Outside Psychiatry, his time is divided more or less equally between football, guitar and eating.

He is currently on OOPE, having taken up a one year Clinical Leadership and Management Fellowship with the School of Psychiatry in the Yorkshire and the Humber Deanery. The main focus of this will be helping to drive forward the use of simulation in postgraduate psychiatric training.

 

Mike can be contacted at: mike.akroyd@derbyshcft.nhs.uk

 


If you would like to contribute to this series, please email an outline of your blog to: webteam@rcpsych.ac.uk