Case Studies

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Case Study 1 (RTP after OOPE)

Name
Katherine Gaskell

What is your current job and planned career path?
I’m currently a ST3 Infectious Diseases ACF, I’m planning towards a PhD prior to my

CCT in Infectious Diseases and General Medicine

What did you take time out of program for?
I spent six months volunteering as a Medical SPR in Blantyre, Malawi and then a year and a half running a clinical trial at the Malawi Liverpool Welcome Trust in Cryptococcal Meningitis.

What were you most apprehensive about on returning to clinical practice and how did you overcome this?
Acute medical takes. I was aware my knowledge was rusty and out of date. I read recent papers in areas I was aware had changed, for example treatment of MI, DKA etc. I then attended an acute and general medicine conference. However after a few on call shifts I realised my anxiety was worse than the reality.
What do you think are the key areas to focus on to prepare for returning to a position of seniority?

Ability to refresh areas of medicine that have changed prior to starting. A good idea of how to access medical information when on call. A good grasp of the structures you will be working in, how the department/referrals process works and perhaps figure this out prior to starting.

What was the biggest difficulty you faced when returning?
My own anxiety about stepping in to a senior position, a bit of experience taught me that I was capable and could rise to the challenge.

What one piece of advice would you give to a returning registrar knowing what you know now?
Prepare yourself with knowledge beforehand, use the experience of allied professionals working with you to understand the structures that are in place. For example the specialist nurse or experienced A+E Resus nurse.

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Case Study 2 – (RTP after two year OOPE and parental leave)

Name
Suzie Pomfret

What is your current job and planned career path?
Currently I am on an OOPR as an Education Fellow doing an MD in Medical Education/Patient Safety. I am also a Gastroenterology SPR.

What did you take time out of program for?
I have taken time out of program for maternity leave (9 months) after the arrival of my son, Max and I am due to go on maternity leave again soon in a matter of months. I have also had nearly two years out of program as an Education Fellow, completing my Masters in Medical Education and working towards an MD.

What were you most apprehensive about on returning to clinical practice and how did you overcome this?
I was most nervous about the clinical and practical work. I had just been signed off for gastroscopy but felt like I had never held an endoscope in my life on my return from maternity leave. The same is true now as I am beginning to get to grips with colonoscopy and feel like this is all a waste of time as I will be back to square one when I go back to clinical practice after my second maternity leave. I think that you need to realise your apprehension and that it is natural that you will not be at the same stage you were when you left and just be honest to supervisors etc. I wish I had used my Keep In Touch Days better in this regard but they seemed difficult to arrange. I think like everything it takes patience and perseverance and it would have been worth doing a few lists prior to my return.

The same was true for being on call. I was worried that I was not up to date and that I was deskilled – concerned again about procedures. I felt so much better after my first night shift and I was lucky that I returned to a hospital that I knew well with supportive nursing staff who knew me well! I was also very honest to the team both junior and senior. I remember asking the SHO to watch me do a chest drain! You soon remember how to look things up quickly and I think that is half of it anyway. It gives you confidence. I used the BMJ learning sections to get my head in gear a little before I returned but obviously not as much as I should have done in an ideal world – this is a running theme after children! I also went on an excellent acute medicine course at Charing Cross (run by Dr Amir Sam) as soon as I could which was brilliant for giving updates and also building confidence.

The other alien aspect of returning after having a child is that your focus is different, and I was concerned that that would affect the type of doctor I am. You can no longer just stay late in order to finish clinic letters, meet a family etc. However, the flip side is that having a child made me even more organised and time effective.

The guilt is a difficult one to discuss in this short format and I think everyone deals with it differently but what others had said about feeling like a rubbish doctor and a rubbish mother/wife was very true for me, but you find a way through because you have to. It is easy to listen to everyone around you – medics, friends and family – but ultimately it is your family and your career and your family’s decisions so very difficult for anyone else to relate to.

I found the Coaching Scheme through the Deanery incredibly useful although I was very doubtful about this at the beginning. It is probably one of the best things I have ever done and I can imagine applying again when I next go back, so would recommend anyone to give it a go no matter how cynical you are!

What do you think are the key areas to focus on to prepare for returning to a position of seniority?
For me, I am probably my own worst enemy so it was trying to get my confidence and up and my head straight. I was fine with managing the take etc although some things did not come as naturally (ie you forget what you used to record on the patient list etc) but it all returns very fast. Once you are in the position you have no time to worry, so really getting back to it is the best way through.

What was the biggest difficulty you faced when returning?
My son was ill a lot and ended up in hospital and although this gives you a beautiful perspective, you feel so bad about taking time off to look after him but yet you have no choice. My husband was away during the week for most of a year when he was really little so the main burden fell on me. Our parents all live far away. I think ultimately you realise that there are some things that you have no choice about and you try your best to make it up to those who have had to cover for you etc. I apologise a lot!

My son is in nursery and I wonder whether it is easier if you have a nanny, but I have no experience of this. Juggling childcare and work is so difficult and very exhausting. You feel like you are battling the clock the whole time but there are sometimes small ways of making it easier. Some of the nursery staff have babysat Max after nursery a few times and I think they really like doing this. There are more solutions than you realise, you just have to explore. I just keep reminding myself that nothing is impossible! If you can share the burden with your other half then you are very lucky and make the most of it! Also get a cleaner as house stuff takes a very back seat!

What one piece of advice would you give to a returning registrar knowing what you know now?
Everyone else has managed fine so I will be too! Prepare as much as you can within what is possible for you and your family, taking some time out for research has been a good bridging gap as I was only clinical for 4 months before I started my research after Max was born, as it gives you some flexibility that a clinical job does not afford, give coaching a try and use your Keep In Touch Days if you feel you need them. Good luck!

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Case Study 3 – (RTP after 3 years to LTFT training)

Name
Anna Moore

What is your current job and planned career path?
I’m currently ST5 in respiratory medicine and hoping to construct a career that somehow combines respiratory medicine with palliative care.

Why did you take time out of program?
I wasn’t really out of program as such - my first maternity leave starting in 2012 was followed by six months in ITU, which is part of my respiratory training. I had a month back on the general wards after that but off the on call rota as I was pregnant again, and then went back on maternity leave for a further 11 months. I finally came back to acute medicine and a normal rota in April 2015.

What were you most apprehensive about on returning to clinical practice and how did you overcome this?
I’d been away from the acute take for nearly 3 years and was really worried about finding myself back in the role of medical registrar on call, where it often feels as though out of hours you are looked to for all the answers. I was concerned about not knowing about the latest updates in clinical medicine, and worried that the SHOs and F1s wouldn’t trust my judgement! But my first on call was fine – it almost felt as though I hadn’t been away...

I deal with worries by talking about them (with everyone!) and so was very open with all my colleagues about my own apprehension about med regnoting after so many years away. I was lucky that on my first take I had very good, supportive SHOs, whose knowledge of local policies (and idiosyncrasies of the system) I was very grateful for.

What do you think are the key areas to focus on to prepare for returning to a position of seniority?
Try and get some experience of the trust and department you’ll be working in, for example the way the acute take works, who supervises the take and how, where the secretaries are based etc. I visited my current trust and shadowed one of the medical registrars for a morning then went to the ward and found the offices for our department. It meant that I could orientate myself when I started and could focus on the clinical side of things more easily.

What was the biggest difficulty you faced when returning?
I’ve found the change in working pattern the hardest, as I’m now part time.

Previously I could leave some things (like signing clinic letters) for the next day or come back and discuss things further with patients or colleagues on another day.

Although I have a wonderful job-share partner and we have a detailed hand over process, I still find it difficult and sometimes end up feeling as though I’m doing less than full time colleagues. Also forming relationships with colleagues, especially ward staff, is harder because I’m there a lot less.

What one piece of advice would you give to a returning registrar knowing what you know now?
Don’t worry too much, it will all come back very quickly! But be open with colleagues about any worries – in my experience it makes coming back after a break much easier to handle!

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Case Study 4 –(RTP after Parental leave then OOPE in Education)

Name
Charlotte Ford

What is your current job and planned career path?
ST6 Gastroenterology S Thames, luminal gastroenterologist with interest in medical education.

What did you take time out of program for?
Maternity leave (July 2011 – August 2012 and May 2013 – Feb 2014) and OOPE

Fellowship in Education Leadership and Management, London School of Medicine (Feb 2014 – April 2015).

What were you most apprehensive about on returning to clinical practice and how did you overcome this?

Clinical developments within my specialty and in general internal medicine
Changes to clinical competency frameworks and required assessments for ARCP
Supervising junior colleagues when lacking in confidence myself
Changes to my working arrangements (move to LTFT training) and logistics involved
Recognising opportunities to develop skills in clinical management, leadership and service development

Overcame by:

Before my return:

Keeping in contact with fellow specialty trainees while OOP to maintain awareness of specialty developments and regional/national educational events
Became involved in organisation of relevant events while OOP such as helping organise UCLP Nutrition course and establishing educational events in general medical specialties within role as Education Fellow in London School of Medicine.
I took on the role of BSG trainees section rep for my region to keep up to speed with training developments and educational opportunities
I continued teaching on an MRCP PACES course during OOP fellowship and did a Diploma in Postgraduate medical education

Following my return

Meeting with educational supervisor before returning to work to make learning needs/expectations clear on both sides clear
I was honest with my registrar and senior colleagues about perceived gaps in knowledge and training
What do you think are the key areas to focus on to prepare for returning to a position of seniority?
Identifying training needs with an informed and engaged educational Supervisor. Recognising the need for support and enhanced supervision while building confidence in clinical abilities and re-establishing your role
Mentoring arrangements where possible within training programme and at local trust level
Identifying additional training opportunities relevant for specialty interests and stage of training

What was the biggest difficulty you faced when returning?
Prioritising learning needs

What one piece of advice would you give to a returning registrar knowing what you know now?
Set clear and achievable short term training goals, be clear and realistic in the expectations you place upon yourself. Seek advice from those within your specialty who have navigated a successful return to clinical practice and don’t be afraid to ask for support from your peers and seniors.