Covid-19: a chief resident’s experience as the voice of junior doctor leadership

by Dr Laura Croucher

Chief Resident and ST5 Paediatric Registrar, Poole Hospital NHS Foundation Trust

Being a chief resident (CR) is an honour at any stage of the registrar years. However, to be a CR during the COVID-19 crisis is, by far, the proudest moment of my medical career to date.

In March, in recognition of the impact a CR can have in times of crisis, the medical director at Poole Hospital NHS Foundation Trust released me from most of my clinical duties. This allowed me the time and energy to gain valuable management experience while simultaneously providing the Trust with leadership at junior doctor level.

Despite working in a hospital less affected by COVID-19 than others, this role was needed to guide junior medical staff and provide support to consultants and the senior management team. Over the past eight weeks, my workload has focused predominantly on two areas: junior doctor workforce planning and staff wellbeing.

Having built a rapport and understanding of the experiences of many junior doctors over the preceding few months, I was able to use this information to restructure the junior doctor workforce. I redeployed staff across the Trust to meet demand and matched them to areas that best suited their previous experience and/or career aspirations. Working as part of a team of three junior doctors we reported to the medical commander. In addition, I gained experience of major incident planning and action, implemented on a timescale not previously seen within the NHS.

On weekdays I was included in a morning briefing between the Medical Director, Clinical Directors and Directorate Managers. As the junior doctor ‘voice’, I was able to provide an overview across the Trust, problem-solve and lead on new initiatives. It certainly helped that I had completed my foundation years at the same hospital and therefore knew most of the teams and departments, and the people I needed to call upon at a moment’s notice. Having spent the preceding six months getting to know many of the senior medical and management team, I was given the scope and support to try out pretty much any sensible suggestion I made – a position I never expected to be in.

What has struck me most is how quickly new initiatives can be implemented; for example a PICC line and difficult cannulation service, which needed to be offloaded from the ITU team, was agreed, set-up and running within the space of one afternoon. Fast-forward a few weeks and the Trust recognised the need for elective surgery to restart, and thus utilised the local private hospital. Our workforce team assessed the site, recognised the risks involved and countered these within a matter of days. We then tested the systems we had put in place using an in-situ simulation involving numerous hospital staff and even the ambulance service.

The teamwork, ‘can-do’ attitude and optimism of staff across the Trust has been extremely humbling. The next few weeks will be spent identifying all the positives that have come from this and working out how to ensure they remain a permanent fixture in the new way in which we work - a legacy I did not expect to leave when I began my year as CR.

Staff wellbeing has always been a special interest of mine. Having spent months trying to implement my ideas, suddenly I was given a green light (and most importantly some funding). Working alongside a fellow junior doctor, we have achieved a great deal in a very short space of time: three ‘safe space’ areas for staff (the Bubble, the Nest and the Hideout); wellbeing gifts; access to an in-house 24/7 phone line for doctors in distress with 24/7 consultant psychology for those requiring it; numerous initiatives to distract staff and remind them of the need to have fun (such as dance challenges, zoom quizzes, the #passthepager challenge etc); free refreshments; education and self-awareness training - the list goes on. Wellbeing was the focus for one of our weekly medical director updates via MS Teams, and our achievements have even made the national news.

In some respects it makes me sad that it needed a pandemic, and all the worries, harrowing experiences and added stress that that bought with it, for the wellbeing needs of staff to be recognised. But ultimately it does not matter what has made it happen, and there is no point looking back. Staff wellbeing IS now recognised, it is high on the hospital’s agenda moving out of the crisis and into the future, and I am excited to influence this in any small way I can over the coming months.

Being chief resident during the national response to a global pandemic has given me an experience like no other. To be the voice of the junior staff and to have that voice listened to, respected and actioned at all levels within the Trust has been an extremely moving experience. I have learnt a great deal, not all of which I can put down in words.

Reflecting on the last few months, I hope I have represented my colleagues well, advocated for their needs and that they too have learnt something from the way I have conducted myself. It is often the observation of others’ behaviour, our experiences over time and the actions of those around us that ultimately influences our own performance.

As for many in healthcare, this experience will remain with me for the rest of my career, but most importantly it has shaped the doctor I want to be. It is, quite simply, the best thing I have ever done.