Interview with Dr Anna Olsson-Brown - Chair of the Academy of Medical Royal Colleges Trainee Group
by Dr Hannah Baird, Chair of the FMLM Trainee Steering Group
Transcribed by Cathy Dominic
What is your background and how did you end up in the position you are in?
I am a medical oncology registrar based in the North West. I have always been interested in representation and got involved quite early in my career with roles on a local negotiating committee and as an associate college tutor while I was in Reading. I was introduced to the Royal College of Physicians Edinburgh when I was a CMT2 and worked with a rheumatologist there who was my education supervisor. He suggested getting involved in trainee representation at the College, with the Trainees and Members Committee (T&MC). I looked into it and had quite a lot of discussions with trainee members of the committee in Edinburgh at the time, trying to understand what a role would look like.
I decided to run for the election to the T&MC in 2014 and was elected to the committee, where I initially looked at the education side, creating conferences and medical updates. After that I moved into representation and started attending meetings with the GMC, Joint Royal Colleges of Physicians Training Board (JRCPTB) and others, including the Academy of Medical Royal Colleges Trainee Doctors Group (ATDG). I started having conversations about representing trainees with senior medical organisations, which was a fascinating experience; it became clear to me that trainees were being given the opportunity for a voice, to raise issues and be listened to.
I represented trainee views during the development of curricula, and generic professional capabilities, giving institutions information on trainee needs, rather than leaving them to assume knowledge of trainees’ concerns. I became Chair of the T&MC in Edinburgh and sat on the Academy ATDG as one of the junior representatives. The Academy is where all the specialities come together, the place where you can get a multi-specialty view and understand trainee issues across a much wider spectrum. I was approached to run for election last year and became Chair of the ATDG in November 2019.
What has your role required you to do this time?
Due to the pandemic, my role has expanded exponentially. To put that into perspective, normally we have two or three projects that an academy group would work on over the course of 12 to 18 months. That all changed at the end of January when it became very clear that this was going to be a very intense and fundamentally challenging period for trainees, alongside our senior medical and allied professional colleagues. With trainees forming a large proportion of frontline medical staff, they were going to be hugely affected as a group throughout the pandemic.
Training time is short and most of it crucial, but it was going to be significantly interrupted by the pandemic. We had to start working with the statutory educational bodies, the Academy and royal colleges, the GMC and the BMA to get some plans and assurances in place for trainees and medical training, so that once the pandemic became the issue taking up all of our time we could just get on with the job of looking after patients with coronavirus.
We had to think about ARCP progression, recruitment and exams very early on. That was partly influenced by the time of year the pandemic struck. If it had been in September, the focus and need would have been very different, but because it was spring there was far more going on in trainees’ lives. It was a very intense time, trying to tie down all of the routes that would be affected for trainees, including having provision in place for those training less than full time and for out-of-programme and academic trainees.
All had very different needs and we had to make sure there were plans in place for all groups, as well as understand what was going to happen with medical students and foundation doctors. It became evident we needed a clear plan and structure for both groups, which meant talking to the Medical Schools Council Foundation Programme office early on.
The number of meetings, documents and decisions required was extensive to ensure as robust provision, for as many trainees, as possible. This was an expansion of the traditional role, which normally focuses on core and higher speciality trainees. The whole of February was spent on telephone calls and discussions about the full spectrum of doctors’ training as well as support to make sure they were ready to respond clinically to the pandemic.
What are the main leadership challenges for you at this time?
One of the keys to leadership is that you need to be the person people recognise as the representative lead. As Chair of the ATDG I have to represent the views of those I have been elected to represent, as well as enable people to work as a team and have an opportunity to give their views effectively. One challenge was to make sure I broadened my experience and understood all the issues from multiple angles, that trainees from different specialties come at things from different directions and will have different takes on things.
Balance really needs to come across when representing these views; I have had to realign my focus to make sure I was getting the views of different specialities who all needed slightly different things – for example, that the surgical/anaesthetic position and ophthalmology angles are different and they needed to be appropriately represented. I think the members of the ATDG have united to meet the challenges asked of them, as a group we have been proactive and responsive.
For me, any leadership challenge is about getting the team that you represent to work together and to give them opportunities to contribute, while ensuring communication channels work so people know what’s going on and can give opinions when they need to. The biggest challenge has been moving from a relatively distant group to being a team that functions as one in a very short time, and I think everyone has done a phenomenal job.
What are the particular qualities that a leader needs to demonstrate at this time?
Collaboration is key. Leadership can only be done if you are able to understand and work with the people you are leading. Understanding that your viewpoint is important, but it is part of a bigger picture is essential. There is a degree of politics, not necessarily in swaying things, but in understanding the people that you are talking to have pressures from all directions, so the way information and people’s concerns are relayed, is critical. Communication with the groups and individuals you are feeding into and those you represent requires slightly different skills.
You have to have a clear idea about what you want to do, but know you cannot achieve the world, so you have to be able to prioritise from an early stage and then keep those priorities under review to make sure you are reacting to the most pressing issues. Output is important, but so is transparency and the fact that people need to be seen to be involved. So, you need to create tangible outputs including documents and statements. You also need to make sure you are in the right room at the right time and having the right conversations with the right people.
Understanding the array of issues in front of you and that each of those issues probably needs a slightly different answer is a balancing act; for example we developed documents on redeployment and on principles of re-establishing training, but also there have been important conversations about how PPE is being managed and the issues trainees were facing on the ground. More functional issues about how the practicalities of studying and working have been affected in the current climate do not necessarily mean documentation, they simply mean a conversation with the right person, and being able to manage multiple ongoing issues with different solutions being developed with different timescales is critical.
How have you approached your role alongside working clinically?
It has been interesting balancing my local and national activities. I have been having local conversations about what has been happening locally and then the national conversations about the bigger picture. It has been a personal learning curve in terms of switching my mind to focus on what is happening at each stage. It was important to have a conversation very early on with my training programme director regarding this role and she has been incredibly supportive, which has made the difference. Having an effective support network outside of work is also very important.
Have you turned to any particular people or resources in this time, other than your social support networks to guide you through this?
As you gain seniority you find your mentors and they are not necessarily through formal mentorship schemes. There are people I can sit down with to discuss my concerns, either to better understand a situation or work through whether I am doing the right thing. There have also been a couple of quite strong mentors in my life who have been important. I was new in post when the pandemic began, so I have developed a strong working relationship with AoMRC President, Professor Carrie MacEwen, and Chief Executive, Alastair Henderson. Their awareness of and openness to trainee issues, along with support of my role, has been fundamental in enabling me to be effective.
This is also true of the senior clinicians who have worked alongside the many committees throughout Covid-19. My ATDG executives have been phenomenally supportive and responsive. We have a WhatsApp group and a system of open, supportive communication channels which has been essential throughout. That support network and peer group has been the most important throughout this period.
As an outpatient-based physician I have benefited from the counsel of the acute physician/geriatrician, psychiatrist and ortho surgeon on my exec; that spectrum of insight has been incredibly useful. There has been lots of senior support, but my biggest mentorship would be my peer support – it has been a privilege to work with them.
How do you think trainees have stepped up in this time?
There are lots of amazing trainees out there doing great work which has become more cohesive due to the pandemic. The way the ATDG members have worked together and responded – often with short lead times – has shown the commitment they have to trainee representation. We have also worked closely with the BMA Junior Doctors Committee, which has been an important relationship. We are obviously coming at this from slightly different angles, but broad trainee representation drawing on different perspectives is essential to represent the needs and views of trainees. We have training and education as our focus, they focus more on working conditions and contractual issues, but we have an extensive overlap, particularly in education. So, working with a different trainee group with a slightly different remit, but understanding how we can work together and support each other in meetings to support as many trainee voices as possible, has been positive.
I think trainees are keen to voice the issues that are present and want to be part of the discussion. There has been some sense of ‘leadership today is not what it used to be’ but I don’t agree with that, I think trainees want to represent their peers, it is an interesting pathway and everybody gets there via a different route. When together, we are all on the same page and have similar views which we have been able to represent to more senior groups with a clear voice about what needs to happen.
What things coming out of Covid-19 would you like to see continue, whether as part of the ATDG or the NHS in general?
One of the things that the Covid-19 crisis has induced is a ‘can do’ attitude, so things that had previously taken time and a lot of discussion and decision-making have not necessarily been held up in the way they would have been before. I think there is a balance to be struck between the two, and we do need a considered process. But Covid-19 has shown you can come up with new things and think slightly outside the box and it can be successful. There are lots of positive learning points to take away from this time: joined-up thinking and the national and UK wide approach, are all things we should absolutely take forward and not go back from.
The huge focus on trainee well-being and support for trainees has been a real step forward, including feeding the healthcare professionals working over the weekend, the Nightingale’s focus on trainee well-being as part of their standard operating procedures, the focus on identification and prevention of moral injury, and thinking about processing downtime and working in teams are all positive outcomes of this new era. We had lost sight of many of these things and were struggling to get them back; now we have, to some extent.
We knew doctors were burning out, and were overwhelmed, yet one senior physician remarked how the workforce is happier than it has been for a long time. I think that is because everyone is showing that we are valued, supported and cared about. The public support for the NHS and the ethos that we are valued as an entity has been so revitalising – if we can possibly keep hold of that and reinvest it in our future activities it will mean not just trainees but doctors and health professionals as whole will feel more valued and that will be a positive result of the pandemic.
We are starting to move back to the things we put on pause to focus on the pandemic, and refocus our attention on many other areas, so it would be good to use the learning from this time to actually work out how and on what we are going to prioritise. The ATDG has created a principles document focused on the re-establishment of training to facilitate this. We talk about support, coaching and mentorship and had lots of policy in place prior to the pandemic, but turning that into reality has been challenging. The delivery, as well as de-stigmatisation, of these things has been facilitated over the past four months, so hopefully we can continue to expand on the steps made so far to maximise access to formal and informal support and development.
It is not the end of the journey, only the start, but we have started doing some things more effectively and it would be good to ensure they continue.