Intensivist Stories

Is on-call possible at 60?

It is possible that 2015 will be recognised as a seminal year for the medical 
workforce in ICM and all other specialties. At the time of writing, contract 
negotiations that may change terms and conditions of working for a 
generation of doctors (in England at least) are underway. Whether the
feasibility of being on-call during the later parts of a career will be 
addressed as part of these discussions is not certain. What is clear, 
however, is that ICM should not rely on external events and agencies to 
solve what is an increasing concern for many in the specialty. 

The changing demographic profile affects doctors as well as patients.

We’re all increasingly aware that the demographic of our patients is 
changing. We provide intensive care to older patients than we did a decade 
ago, and predictions suggest this trend will continue^1,2. These patients 
are complicated, have challenging co-morbidities, and need experienced 
clinicians to manage them effectively. The Academy of Medical Royal 
Colleges report into Seven-day Consultant Present Care³, outlines how 
‘patients expect treatment by competent clinicians and a parity of care 
irrespective of the day of the week’. The FICM / ICS Core Standards⁴
re-enforce the need for regular consultant input irrespective of the time or
day of the week. 

We need to remember, however, that as doctors we are ageing too. 
 
¹ Sean M Bagshaw et al., “Very Old Patients Admitted to Intensive Care in 
Australia and New Zealand: a Multi-Centre Cohort Analysis,” Critical Care
13, no. 2 (2009): R45, doi:10.1186/cc7768.
² C BRANDBERG, H BLOMQVIST, and M JIRWE, “What Is the Importance of Age on 
Treatment of the Elderly in the Intensive Care Unit?,” Acta Anaesthesiologica Scandinavica
57, no. 6 (February 4, 2013): 698–703, doi:10.1111/aas.12073.
³ AoMRC, “Seven Day Consultant Present Care,” Aomrc.org.Uk, accessed 
November 29, 2015, http://www.aomrc.org.uk/doc_view/9532-sevenday-consultant-present-care.
⁴ Core Standards Working Party of the Joint Professional Standards Committee, “Core 
Standards for Intensive Care Units” Ficm.Ac.Uk, n.d.

Changes to retirement age and pensions means that consultants will be 
expected to work until their late sixties. We must ensure they are able to 
do so effectively and safely. How?

Avoiding Burnout

‘Burnout’ is a big topic: a full discussion is out-with the remit of this article, 
but it merits consideration in this context. Often associated with ICM, there 
is little literature from the UK, although stress in UK intensivists has been 
described⁵: burnout is more assumed than measured. A ‘real time’ survey 
I conducted using voting pads at last year’s ‘State of the Art Meeting’ 
suggested that the audience (obviously a self-selected and highly 
unscientific sample!) were very interested in the subject, but knew little 
about it. They wrongly believed that burnout is most likely in older, male 
colleagues (it isn’t - young, female doctors are the most affected group⁶)
and failed to recognise the impact that conflicts can have⁷, feeling that 
organizational issues (such as bed shortages) were more likely to 
precipitate the problem.

Alternative Ways of Working

A central tenant of medical rotas has often been ‘equality of burden’: that 
all contribute their share of the work – often translated by rota-masters 
into a division of nights, weekends and bank holiday duties between those 
on the rota.

Is this the only way to work ‘fairly’? Increasingly units have different 
arrangements for colleagues with particular requirements. I have a 
colleague with university commitments who works ‘excess’ weekends to 
make time available for university duties during the week, a solution 
readily accepted as both necessary and ‘fair’ by others on the same rota.
Shouldn’t we accept that alternative working patterns may be necessary 
 
⁵ S Coomber, “Stress in UK Intensive Care Unit Doctors,” British Journal of Anaesthesia 89, 
no. 6 (December 1, 2002): 873–81, doi:10.1093/bja/aef273.
⁶ 1
⁷ E Azoulay et al., “Prevalence and Factors of Intensive Care Unit Conflicts: the Conflicus 
Study,” American Journal of Respiratory and Critical Care Medicine 180, no. 9 (October 20, 
2009): 853–60, doi:10.1164/rccm.200810-1614OC.

for other demands, such as an ageing workforce?

Other colleges are exploring similar issues. The RCEM is acutely aware of 
the need to keep consultants engaged and working, and suggests the 
development of annualised job plans can help to ‘embed safe and 
sustainable practice’⁸ . Similarly, the RCPCH report into New ways of 
working describes how the use of resident consultant on-call and ‘twilight 
shifts’ can help to solve rota problems, and describes how consultants may 
transition through different out of hours’ commitments depending on the 
stage of their career. That the same report suggests its findings are 
applicable to other 24/7 specialties, and suggests future collaboration to 
develop future service models, should make us take notice.

Conclusions

So is on call possible at 60? I’m not sure, but its definitely not the only way 
to work. We need to explore different ways of working :changing working 
patterns and developing annualised job plans to mitigate the increasing 
demands on an ageing workforce. Improving awareness of factors 
associated with burnout may allow intensivists to better protect 
themselves and avoid this problem - either early or later in their career. 

As a specialty it is definitely something we need to think about. After all, 
these are our careers we’re talking about!

Jonathan Goodall
Careers Lead, FICM
 
8 RCEM, “Developing Annualised Rotas for Emergency Medicine Consultants,” 
September 23, 2013.

I grew up in Greece and was what many people describe as a “late bloomer”, academically. I didn’t do badly at school but certainly did not get the grades one would expect of a potential medical student. Thinking back to that time, I hadn’t really considered medicine as an option. I had decided to study biology, as I had a general interest in life sciences, and wanted to do that abroad, because it would be more fun and exciting. So at the end of high-school in Greece, I packed my bags and came to the UK for what was meant to be a 3-year stay. I studied in London and had a great time, learning, exploring, and being independent. In the final year of the biology degree, I had to do a research project and really enjoyed it. That experience (and my tutor!) convinced me that an academic career and doing research was what I should do. So, I went on to a PhD in developmental biology – a cross between genetics and embryology. One part of my project involved obtaining bone samples from patients with craniosynostosis, which brought me into an operating theatre and observing reconstructive surgery in young children. I still remember that day – and the sense that this is really the place I wanted to be: working with patients. At the same time, while I enjoyed my academic research project hugely, I also quickly realised that there were other aspects of an academic career that I would find very frustrating. What to do next? On to a post-doc or a change in tack?

During this time, medicine was very much on my mind, but I thought I was too old to pursue it. However, luck was on my side, and during my final year, the first graduate-entry medical programmes were introduced and it was as if it was meant to be! I applied, got accepted, and with a PhD under my belt, left the world of basic research behind. With hindsight, the time doing my PhD was extremely valuable. It gave me many really useful skills and having done research and published scientific papers also helped to score me many points on future application forms!

After four years of intense study, I was absolutely certain that a life in intensive care and anaesthesia was for me. I arranged house jobs and SHO jobs in both specialties and when the time came applied for a training number in anaesthesia and got stuck in with the training.

Having studied medicine as a graduate, I was a fair bit older than the “usual” specialty trainee, so waiting to complete my training before starting a family was not really an option. Our first child (in fact the first 2 children – we had twins!) came along at the beginning of my ST3 year. I thought long and hard about it, but decided that I needed to achieve some sort of work-life balance, so I went part time: 80% seemed like a good compromise at the time. My plan was to train part time for a couple of years and when the children were older, switch back to full time. But part time training worked well for me and my family, so I continued. It was hard work juggling training and a young family with (now) 3 children. Sometimes especially hard – sacrificing time with the children in order to study for exams (of which there were many!) was a particular low point. I also found it hard watching colleagues and friends who had started out training at the same time as me get consultant jobs 4-5 years ahead of me. But I got through it all and was successfully appointed as a consultant in 2019, at a busy trauma and neurosurgical centre. 

I now divide my time between critical care and anaesthesia, where my interests are in neurocritical care, organ donation, and rehab. It is busy, interesting, and truly varied, but above all very rewarding. Looking back on my time, it has been a somewhat “unconventional” path (being a foreign graduate and less-than-full time trainee), though it now no longer seems as unusual. I don’t think of myself as a role model, but I also recognise that people starting out their careers need to be able to see themselves represented. You can embark on your career later in life. You can be a woman in intensive care. You can have a family. You can train part time. You can move abroad. And you can put it all together -- It might take longer. It might not be straightforward. But it can be done!

Dr V Jagannathan – Consultant in Intensive care medicine and Anaesthesia with special interest in Obstetric critical care

I have been very lucky as a young consultant to not only pursue my choice of career in medicine but also my chosen specialty. For this, I am deeply indebted to my trainers who took the time to support and lead me.

I joined medicine through a competitive process in India when I was 16 years old and never looked back. Critical care was what I always wanted to do – it amalgamates a multitude of skills, cutting across various medical specialties and challenges oneself to perform and serve.

I came to the United Kingdom to train in Intensive care in early 2002 – at a point when such training was not formally available in India and in early developmental stages in England. I joined as a clinical observer in ICM in London and then went to Aberdeen as a SHO in ICM and then anaesthetics. My training journey was complicated (due to both personal and professional reasons). I trained in London and the North east of England, completing my training in 2012 with dedicated time in intensive care (advanced training) and obstetric anaesthesia (higher module).

Working in a challenging specialty such as intensive care helps one develop personal resilience, and the long duration of training, such as mine, mirrors the training pathways of many others. Long working hours, dysfunctional work-life balance, exams, rotas and working with staff shortages are all synonymous with the training.

However, for all aspiring intensivist out there, all this toil is repaid in kind from all the happiness and expressions of gratitude from the sick patients and their family we serve. It reminds us ultimately why we are in this profession.

I am now a consultant in intensive care at a big district general hospital in the North of England. I balance my day to day life as an intensivist with a lovely family with two children. My work life is busy, I have an interest in dealing with sick parturient, contribute as an ICM assessor for MBBRACE, have management interests (I have been the Lead for a 16 bedded unit for last 3 years) and have been part of a Faculty committee for the last 2 years.

Intensive care skills give you the choice to train others, gain management skills and be at the fore of change in such a critical time for the NHS – being the only common denominator specialty amongst all intra-hospital care of patients.

After a dual-CCT in anaesthesia and intensive care medicine, I took up a consultant post in a medium-sized DGH in the midlands in 2009. My initial clinical working pattern was a mixture of around 60% time spent as an anaesthetist and 40% as an intensivist. My initial anaesthetic practice included regular urology and breast lists, emergency theatre cover and an exodontia list including children and special needs adults. My non-clinical activity included chairing the resuscitation committee, attending the drugs and therapeutics committee, educationally supervising up to 2 trainees and being the ICM Faculty Tutor. Within a couple of years of starting as a consultant, I also took on the role of Anaesthetic College Tutor and really enjoyed the interaction with the trainees and other educational leaders across the region. 

After nearly 6 years in the role of College Tutor, the opportunity to be clinical lead for critical care in my trust came up – I was fortunate at the time to have a deputy College Tutor who was well motivated and ready to take over, so I stepped down from being College Tutor and became the clinical lead for critical care instead. As we also had a willing volunteer to step into the ICM Faculty Tutor role, I stepped down from this at the same time. The lead role was more of a clinical than managerial one, so I had the opportunity to help develop the service and gain leadership experience without the downside of managing my colleagues! At around this time, having attended the ICM recruitment interviews as an interviewer several times over the years, I began to take on a more prominent role in co-ordinating and developing the national recruitment process. The covid pandemic came around 4 years into my tenure as the clinical lead. This proved to be both a demanding as well as a rewarding time, as I played my part in helping my organisation respond to the unique and huge challenge which the pandemic posed for us all. 

As the pandemic receded and I was 6 years into my clinical lead role, I began to look for a new direction in my non-clinical career. Having been in post as one of the first cohort of Medical Examiners in my organisation for just over a year, I took the opportunity to become the Lead Medical Examiner. This came at an interesting time, with the service set to become statutory in 2023 and a lot of preparatory work that will be needed to be ready for this. To enable me to dedicate the time and energy to this, I have stepped down from the clinical lead role. My clinical working pattern has gradually evolved over the years, such that I now spend around 40% of my clinical time as an intensivist, around 40% in the medical examiner role and 20% as an anaesthetist. To maintain my interest and commitment to ICM training, I have recently been appointed as a FFICM examiner and really enjoy the academic side of this, as well as the opportunity to meet new colleagues and renew old acquaintances. I still chair the resuscitation committee and have a trainee who I am the named clinical supervisor for, I have also taken on a governance role in the department to help guide our clinical governance programme. 

As I approach what I anticipate being the last 10 years of my career, I really enjoy the balance of clinical and non-clinical work I have achieved. The clinical work keeps me grounded and enables me to still get all the satisfaction from working as a frontline clinician, whilst the non-clinical aspects of my work enable me to develop my leadership and teamworking skills as well as meet inspiring colleagues and individuals from other professional walks of life. There will still be time for me to explore new roles in the future; as always it will be a case of seeing what comes along and what I might be interested in, after all, this has always seemed to serve me well in the past.

A Day in the Life of an Intensivist Intensivists are part of a large specialist team that provide care for the sickest patients in the hospital in a complex, dynamic environment. The successful intensive care physician requires a sound understanding of basic sciences and medicine, diagnostic acumen, proficiency in a number of invasive procedures and a broad range of non-technical skills.

Referrals to critical care may come from anywhere in the hospital. As an intensivist, you may be called to review a deteriorating patient with sepsis on the medical ward who needs respiratory and circulatory support, to resuscitate a polytrauma patient in the emergency department, or to assess a shocked patient following surgery. The diverse nature of critically ill patients means that one of the rewarding aspects of being an intensivist is delivering patient care in collaboration with colleagues from across the entire spectrum of medical specialities - often with several at the same time. Although our patients are the sickest in the hospital and may present with a myriad of diagnostic and management challenges, it is focusing on providing safe and high quality basic care that is the bedrock of a successful ITU.

The day of the intensivist often has a familiar structure - but there are few places in the hospital where the adage every day is different is more apt. The morning multidisciplinary handover is a forum to review all recent imaging, blood results and investigations, and allows for a detailed update and discussion of each patients progress. A safety briefing helps determine any potential hazards and the relevant activity expected both on the unit and in the wider hospital for the day, as well as highlighting if there are patients suitable for trial inclusion, or any complex or long term patients requiring discharge plans. A thorough clinical ward round forms the foundation of decision-making and planning of daily goals for each patient as well as a good opportunity for teaching.

The ITU is an ideal place to develop and use innovative monitoring and therapeutic technologies, and provides an environment to develop skills with echocardiography and ultrasound, as these modalities increasingly change the management of critically ill patients. Common procedures that require proficiency on ITU include invasive line insertion (including catheters for renal replacement therapy or cardiac output monitoring to guide inotropic, vasopressor and fluid therapy), bronchoscopy, chest drain insertion and percutaneous tracheostomy.

Intensive care medicine has a range of sub-specialties, and offers the opportunity to develop specialist skills in areas such as neurointensive care, burns, paediatric and cardiothoracic intensive care. Important areas outside the ITU where the intensive care team are also integral to patient care include outreach and critical illness rehabilitation.

Discussing and delivering end of life care are some of the most challenging and rewarding skills for the intensive care doctor to develop, and these skills are continually developed throughout one’s career. Other non-technical skills such as ethically sound, non-biased decision-making, and communicating clearly and empathically with patients and relatives are of paramount importance.

Intensive care medicine is constantly expanding and evolving as a specialty. It offers the specialist doctor a chance to develop a unique set of skills in an exciting and dynamic setting - in which it is difficult to be bored!

Whilst my current ICM consultant role appears conventional, the same cannot be said for my ICM training and subsequent ICM consultant career. 

At present I am a full time consultant intensivist in a large teaching hospital intensive care department. My consultant job plan has not included anaesthesia for 20 years. The critical care service has around 1300 mixed medical and surgical admissions per year. The hospital is a major trauma and neurological/neurosurgical centre and our critical care admissions reflect this. 

We have a co-located Long term Ventilation with long stay complex weaning service. Six consultant Intensivists, out of a total of 28 ICM consultants provide the continuity of service to this patient cohort. Around one third of my clinical sessions goes to provide the consultant sessional in-put. I find this very rewarding. The work is very multi-disciplinary team (MDT) focused with a weekly goal planning MDT meeting. The relationship between patients, their families and the MDT is very different from the acute ICM service. 

I am also one of three consultants who provide the medical in-put into our Follow Up and rehabilitation clinic which aims to see those patients who have been through our critical care service with a length of ventilated stay of more than 72 hours. We see patients every other week. Each clinic sees 6 patients and is a 2 session (PA) day. I find this provides a good link with other specialties and I really enjoy medical clinics - appreciating that this is not every Intensivists idea of enjoyment. 

My current job plan is around 50% acute ICM and 50% lower acuity ICM which still requires a good working knowledge of critical care medicine in a broader sense. I will be coming off the consultant resident night shift from aged 55 years. This means picking up more day time sessions (PAs) at weekends and weekdays. Our sessions (PAs) are all annualised. This allows periods away from clinical work provided the total annual sessions are worked. 

The career timeline to my current job included undergraduate medical training in London, a medical rotation in Bristol through to registrar level, anaesthetic core training in West London and then ICM and anaesthetic training in north central London. During this period I did a year as a cardiothoracic ICM/Anaesthetic fellow and also did training and an examination in TOE. 

The expectation at that time was to be a consultant in London covering ICM and anaesthesia for cardio-thoracic surgery. I did this for a year as a locum consultant in UCLH. However with young children came the realisation that we did not want to live and work in London. I had also come to the conclusion that I only wanted to do Intensive care medicine. The opportunity arose to move to Cardiff as an Intensivist and I took this up. 

After 6 years in this consultant post I decided to move to a neighbouring Health Board where I worked in a large DGH as one of three full time Intensivists. In time I was the Lead clinician for the large DGH and following a merging process also the cross site lead clinician for a small DGH unit. I was also the lead clinician for the south east Wales critical care network. 
I was offered the chance to return in a split ICM consultant job in Cardiff which I took. After several years working in two Health Boards I decided to consolidate my sessions in Cardiff. 

I am not sure if ‘variety is the spice of life’ but refreshing career changes have been very important to me. The ICM consultant post we are appointed into does not need to be the same as the one we retire from. Flexible job planning which takes into account changes in our interests and lifestyle have been very important as is the support of our consultant colleagues. 

Role Summary
Direct Clinical Time (PAs) = 7.5
DCC divided into 50% acute and 50% lower acuity + Follow Up
SPAs 2.5 including FICM role
All PAs are annualised 
 

A Day in the Life of an Intensivist-Working in the South West

Where I work

I work in a progressive 600 bedded District General Hospital in Somerset, where I am one of a team of 8 intensivists that look after a 12 bedded critical care unit.

Why I work here

District General Hospitals offer a unique blend of quality of life and long term professional satisfaction for intensivists. ICM job plans in my trust are focussed on ensuring continuity of care and providing a sustainable work life balance. One consultant is nominally in charge of the unit from Monday - Thursday, and another covers Friday - Sunday, handing over Monday morning. A second consultant also covers the unit weekday mornings, to help with rounding, decision-making and referrals. Tuesday, Wednesday, and Friday nights are covered by other consultants not on for the week.

The patient case mix is fairly equally split between surgical and medical admissions which offers a broad spectrum of clinical presentations. For the majority of the consultant group, clinical time is split approximately 60:40 between ICM and other clinical commitments (such as anaesthesia) on a 10 PA job plan. This balance is adjustable as long as the ITU rota is covered, so people drop anaesthetic sessions if they wish to reduce their PAs. The intensivists are a cohesive group. We try to be flexible and accommodating to each other as this will of course work reciprocally in our favour.

One of the obvious attractions of working in a DGH is that it encourages close professional relationships with colleagues from other specialties. It is hard to walk down the main hospital corridor or grab a coffee without stopping to talk to someone, and I believe this degree of close and easy communication with both medical and nursing staff makes a significant difference to patient outcomes, as well as maintaining personal wellbeing.

The impact on family and professional life

Another significant reason I chose to work in a DGH was the opportunity to live and bring up my children in the countryside. I live on a farm and despite year round hard work this has a hugely positive impact on my work/life balance. Like a good number of intensivists physical exercise is important to me, and whenever I am able I cycle to work through an Area of Outstanding Natural Beauty.

Regardless of where one works there is always the opportunity to pursue other challenges outside the clinical sphere; amongst my other commitments I sit on a national FICM committee, examine for the FICM Final and contribute to patient care and the strategic direction of my Trust as a Clinical Director.

Richard Gibbs

A Day in the Life of an Intensivist at Raigmore Hospital, NHS Highland: a remote and rural hospital.

Mike Duffy

Where I work

Raigmore Hospital, Inverness, is the main Hospital for the NHS Highland Health Board area and has 460 in-patient beds. The region covers an area of 15,000 square miles, which represents approximately 41% of the Scottish and 11% of the UK land surface (an area the size of Belgium). The area is highlighted in blue on the map and it also provides certain services to the Western Isles Health Board (Outer Hebrides) – the total population covered being 320,000. The catchment area comprises the largest and most sparsely populated part of the UK with all the attendant issues of a difficult terrain, rugged coastline, populated islands and a limited internal transport and communications infrastructure. The area is recognised for its outstanding natural beauty and access to all sorts of recreational activities such as road and mountain biking, sailing, hiking, climbing, fishing, snow sports and all kinds of water sports. The famous North Coast 500, 'Scotland's Route 66' has been named one of the top coastal road trips in the world is a major tourist attraction. The Scottish Highlands are fantastic place to live and bring up a family and provides a great work-life balance.

Critical Care Services

The current intensive care unit is equipped to take 7 Level-3 critically ill patients and has around 450 admissions each year. There is a separate 6-bedded surgical HDU and an 8-bedded Medical HDU. All the critical care units have nearly completed a major refurbishment and upgrade and, in May 2018, the ICU and Surgical HDU co-located to a completely new unit that is adjacent to the main theatre complex. This exciting development provides fully updated facilities and equipment. The combined unit has 16 beds – nominally 8 level-3 ICU beds and 8 surgical HDU beds, but works flexibly. The case mix of admissions is very variable – there are frequent polytrauma cases ranging from climbing accidents in the Cairngorms to motorcycle accidents on the rural single track roads. Patients that require cardiac or Map of NHS Highland INVERNESS neurosurgical intervention are transferred to Aberdeen which is about 2.5 hrs away by road ambulance. There are about 12-15 paediatric admissions/ year and the majority of these are retrieved from PICU teams (ScotSTAR), but due to the distance that has to be travelled, and also the challenging weather conditions, this can sometimes take longer than would be the case in other parts of the UK. The elective surgical workload that is on-site covers predominantly vascular, lower and upper general surgery, including liver resections and oesophageal/gastric resections, and major urology. The emergency surgical and medical admissions are varied as well and are probably similar to hospitals of a similar size.

How we work

There are 8 consultants who have daytime sessions on the ICU and the on-call is dedicated to intensive care and shared between us. We are a happy and cohesive team and frequently meet to discuss various issues. We have formal time set aside for consultant, clinical governance and audit, and general MDT/departmental meetings. Key departmental roles have been allocated within the group and we have been encouraged to develop various trust, regional, and national roles. Our working patterns have been specifically designed to give a sustainable and healthy working pattern for members of staff whilst at the same time aiming for the best quality and continuity in patient care. A ‘consultant of the week’ covers the days on the ICU from 0800 -1800 hrs Monday to Friday and is then on-call for 24 hrs on the Saturday. The weekends are ‘split’ – another consultant will cover the Friday night and the 24 hrs on the Sunday. The week following an ICU week is a ‘Zero-hours’ week when we are not expected to be in the hospital at all - this is a great way to catch up with some family time and means that we can actually enjoy the beautiful area that we live in. The remaining 6 weeks of the rota cycle are spent delivering anaesthesia in theatre (but could equally be another speciality), the share of the ICU midweek night-time on-calls, and other supporting professional activities.

Why might someone work in this environment

A number of the consultants working on the ICU have moved from other regions of the UK, and we are all very happy with the move. There are great colleagues, both medical and in the whole multidisciplinary team, we have an interesting and varied job with great potential for development, and we live in a fantastic part of the UK with outdoor opportunities second to none! Finally, I have written this article as I am a member of the FICMCRW committee – this is made possible as Inverness has excellent transport links – there are daily flights to London, amongst other destinations, and the flights get in early enough to make all the meetings in London.

http://www.highlandcriticalcare.com/

My name is Chian Chyn KHOO, I am a full time Consultant in Intensive Care and Emergency Medicine working at the Royal site of LUHFT. I have been appointed into this substantive post since October 2018. With 19 other esteemed consultant colleagues, I look after our large critical care unit which consists of 18 Level-3 and 14 Level-2 beds. We are the regional specialist centres for Infectious Disease, Acute Pancreatitis, Hepatobiliary Surgery, Upper gastrointestinal Surgery and Thrombotic Thrombocytopaenic Purpura (TTP). We also provide critical care support to our neighbouring hospitals such as the Liverpool Women’s Hospital and The Clatterbridge Cancer Centre.

Besides critical care, I also work one day a week as an EM consultant in a very busy Emergency Department. I spent most of my EM shift in the Resuscitation area where I could utilise my critical care skills to provide comprehensive care to critically ill patients. My intensive care background has enabled me to initiate critical care management and to discuss appropriate level of care with patients and their family members early, as well as expediting ICU admissions wherever necessary.

Additional roles outside of clinical work

Since embarking on the consultant career, I developed great interest in Quality Improvement and Change Management in Health Care; with an aim to provide excellent quality care to patients. Locally, I have assumed the role of Quality Improvement (QI) and Audit Lead of my Critical Care Directorate since October 2020. In this role, I have gained invaluable experience in planning and leading several QI projects. This has also given me a great opportunity to work collaboratively with other health care professionals e.g., Nurses, Physiotherapists, Speech and Language Therapists, Dieticians and Pharmacists, and to engage their involvement in QI projects. With my multi-disciplinary team approach, we have successfully completed numerous projects, some of which have revolutionised our current practice. Recently, I have also taken up the regional role of being the Chair of Quality Improvement Group of Cheshire and Mersey Critical Care Network (CMCCN). I feel that my strong inter-personal skills would drive any regional agenda forwards.

Despite the heavy clinical commitments, I have maintained my strong passion in Medical Education. I hold the role of Careers and Clinical Fellows Lead of the Trust since 2021. I lead a team to provide career advice and support to junior doctors, develop career hub websites, whilst providing pastoral care and enhanced induction to the International Medical Graduates who are working within the hospital.

I also hold the position of the Undergraduate Year 2 Lead of the hospital. I organise and coordinate Second Year Medical Students schedule to ensure that they have a supportive learning environment during their hospital rotations. I work collaboratively with a team of sub-dean, educational supervisors, and staff at the University of Liverpool; and found it very rewarding when positive training feedback were received.

In addition to the above roles, I have been a Medical Examiner since 2022. My role as a Medical Examiner gives me the opportunity to gain a better understanding of registration of death as well as the investigative procedure by a coroner. I am also a trained Medical Appraiser which enables me to conduct appraisals for our locally employed doctors.

Work-life balance

With some time-management skills, I have managed to pick up some hobbies which helps to release pressures from work. I have started learning to play acoustic guitars which I very much enjoy and look forward to branching into electric guitars. I also enjoy gardening (weather permitting!) and reading a wide variety of books. With the benefit of annualization rota, my wife and I go on holidays abroad annually.

All in all, it is an absolutely privilege for me to work in these two established departments in the hospital. This invaluable ‘hybrid’ job plan has allowed me to establish good relationship and build networks with a wide range of specialties within the hospital and have made my job far more interesting. I would therefore encourage my EM trainees to consider applying for a dual-CCT with ICM.