key: cord-0709768-yqcl3adp
authors: Newton, Lucy E Homer; Bedford, James D
title: Continuing professional development whilst shielding
date: 2021-10-07
journal: J Plast Reconstr Aesthet Surg
DOI: 10.1016/j.bjps.2021.09.025
sha: b7b5f3d8ec185f05ac8d4d8a6027eb7853e041f6
doc_id: 709768
cord_uid: yqcl3adp

nan

Dear Sir, On 23 March 2020, at the start of the first UK COVID-19 lockdown, clinically vulnerable individuals were instructed by the government to shield (1) . This applied to vulnerable doctors including 1343 doctors in training (2) and has resulted in 216 days of shielding away from clinical duties, patients and supervisors.

The impact on staffing and patient care from those suddenly required to shield was substantial.

The UK government body, Health Education England (HEE), who are responsible for training, noted trainees were not "sick" and recommended they continue to engage in clinical work. Despite this unprecedented situation, there was no uniform formula for such a large proportion of the workforce to suddenly start to work from home (WFH).

Trainees shielding reported feelings of guilt, frustration, anxiety and loneliness (3), along with concerns about delays to training and career progression. There are a number of opportunities to ensure training continues. We present our experience from a large UK plastic surgery department with personal perspective from a shielding trainee and a local lead for training. We offer recommendations that we hope may be useful for trainees faced with situations where they are unable to undertake face-to-face clinical work, but where there is the opportunity for remote working.

The key to successful WFH is summarised in table one. This revolves around the IT infrastructure, remote access passes to hospital systems and help from non-clinical and clinical staff.

Supervisors should ensure they have access to and are familiar with the latest trust software for remote consultations to allow participation of WFH trainees. There are a number of activities that those shielding can be involved with depending on local provision. These are summarised in table two. Opportunities for professional development may seem difficult to achieve, but each allows the individual to guide their learning to personal development objectives. Cumulatively this allows for greater self-directed learning, but does not compensate for face-to-face clinics or time in theatre. Most clinical opportunities are through outpatient clinics and these form the basis for workplacebased assessments. Before clinic, the role of the trainee should be discussed. In fully remote video clinics, the trainee may be better as an observer to avoid more than one clinician speaking.

In consultant face to face clinic a multiscreen set up can allow the trainee to be more involved, for example by guiding examination. It is important that the consultant is familiar with the video systems available and complies with the trust"s IT policy. Recommendations for online clinical engagement should be adhered to. Our patients have viewed the remote attendance of the trainee as positive, interesting and have had no concerns.

UK guidance from HEE advises that an appropriate professional development plan should be devised reflecting the opportunities available (1, 5). A diary of opportunities missed and gained should be kept up to date whilst WFH and uploaded to the surgical portfolio for progression review as well as any learning events attended including the certificate of attendance.

HEE also recommends that supervisors need to be proactive whilst engaging with shielding trainees to stop the feeling of "out of sight, out of mind". This is achieved by agreeing a set of goals early with regular check-ins, appraisal of progress and review of goals, and attention to the pastoral and emotional elements of shielding. These meetings should be documented on the surgical portfolio. Before return to work any outstanding training and personal issues should be addressed and whether any enhanced supervision should be implemented on return.

Across the UK, clinical supervision for trainees has been reported to be variable. Ideally for each clinical opportunity an appropriate supervisor should be sought, whether this is the trainees own clinic or attending a consultant"s clinic virtually, this allows for contemporaneous discussion about cases and opportunity for assessment.

Through the e-learning for health care portal in the UK there is an e-learning programme for supervisors and shielding trainees as well as a module for when this cohort returns to work (5).

WFH creates a number of challenges psychologically as well as clinically. The lack of face-to-face contact with colleagues and patients resulted in feelings of unequal distribution of tasks, namely that while WFH I was not completing my equal share of the work. Through perseverance attending clinic remotely I found there were ways that I could contribute such as requesting scans and imaging ahead of time, chasing letters from other health care professionals and booking tests during the consultation through my remote log on. Maintaining motivation for self study and solo clinics was also difficult. Through open and frank discussions with trainers about patients, arranging "de-brief" sessions for case-based discussions helped reduced feelings of isolation and gave drive to read around topics.

Shielding provides a number of unique challenges for trainees and supervisors. It requires the trainee to be organised and motivated to actively seek out a diverse range of learning opportunities. It also enables trainees to direct their own learning to areas they have a personal interest in or require development. With the increasing face to face component in clinics, this can reduce the role of the shielding trainee and adding to feelings of frustration and isolation. However, engagement of trainers and supervisors in the commitment to continued professional development can help improve this. Support is also crucial from the managerial team in the department to help prepare opportunities (such as clinics), identify supervisors and provide contacts to enable remote access to the hospital systems.

Currently there is no guidance from the UK Royal Colleges nor speciality groups about supporting this cohort of trainees. While there can feel like a plethora of challenges for all involved it is essential to remember that this cohort are still members of the team and must not be forgotten.

The pandemic has created a number of challenges but WFH has also allowed trainees to develop skills, contribute to the team and continue to provide good patient care. 

Department of Health and Social Care, Public Health England. Guidance on shielding and protecting people who are clinically extremely vulnerable from COVID-19

Guidance for managing postgraduate medical trainees who are shielded due to COVID-19

The authors thank Mr Adam Reid for his advice and support with the manuscript.

None Ethical Approval 6 Not required