Insights
Learning from the multidisciplinary team Anna Harrison Department of Otolaryngology, Tameside General Hospital, Ashton-under-Lyne, UK
C
ontinuing professional development (CPD) aims to increase knowledge and learning outside of structured training. I believe that many opportunities are available in the hospital to develop skills and knowledge, but that most of us in training do not use all possible avenues to expand our learning.
As is the case in many professional working environments, within the field of medicine there is a recognised hierarchy of practitioners, defined by role and status, and by acquired expertise and competence. Hierarchy in medical terms, as defined by Liberatore and Nydick, ‘comprises a set of integrated levels within which team members are ranked both by their disciplines and levels of authority’.1 This hierarchy often pre-defines, but may limit, our learning opportunities as we are
taught by those more senior to us. Recognition that all members of a medical team have a contribution to make is a valid principal for maximising learning opportunities and achieving personal goals. All doctors have a duty to contribute to the training and supervision of others.2 Traditionally this is seen as senior colleagues supporting and training those more junior, but although this is important, it should be recognised that other members of the multidisciplinary team (MDT) have a part to play in sharing knowledge derived from different learning opportunities and experiences. My personal training experiences have been located within a large teaching hospital in Scotland, and this has provided me with an exposure to a particular spectrum of specialist cases.
I recognise that my junior colleagues have performed procedures that I have not performed myself, and seen clinical cases that are outside my experience as a result of differences in training localities. For example, in my experience patients admitted with a peritonsillar abscess (quinsy) were treated with aspiration using a needle and syringe before admission for antibiotics. One of the current junior trainees was taught to incise a quinsy with a scalpel under local anaesthetic, rather than aspirate. I have therefore taken the opportunity of learning this skill from a junior colleague. There is no evidence base that favours either management method,3 but having more than one method in your skill base is useful in cases that are difficult to manage. Even consultants can use knowledge from trainees to complement their own
Having more than one method in your skill base is useful in cases that are difficult to manage
© 2015 John Wiley & Sons Ltd. THE CLINICAL TEACHER 2015; 12: 1–2 1
A spirit of cooperation helps to improve performance for all concerned
experiences. For example, I had seen problems postoperatively with wound infections in patients with absorbable stitches. I suggested to my consultant that he consider using non-absorbable stitches in skin closure in pinnaplasty (the procedure used to pin ears back), as sometimes it is difficult to predict when the absorbable suture will dissolve. Delays in this can cause stitch granuloma (local inflammation and swelling). He agreed that he had also experienced this in the past, and our discussion confirmed his suspicion that not all absorbable sutures dissolve completely. He is now even more careful and selective in the use of absorbable stitches for skin closure in this group. It is imperative that team members share clinical experiences, and are willing to learn from each other in order to benefit patients and progress personal learning and skills. A spirit of cooperation helps to improve performance for all concerned. I have found this to be personally beneficial and to be a valuable way of addressing the different learning opportunities inherent within the varied training environments. The movement of trainee doctors and surgeons around various hospitals helps to address the variety in opportunities, but the attitude
and experience of the consultants and other team members is a significant factor in shaping clinical attitudes and exposure to different practical interventions. Hence, if you are taught that a peritonsillar abscess is best incised, this will form the basis of practice from an early stage unless other treatments are observed and performed. The traditional hierarchy and teamwork approach is effective for patient care, but with limited working hours, as dictated by the European Working Time Directive (EWTD),4 we can and we must seek learning experiences from a variety of sources. The introduction of simulation and online learning modules is also designed to supplement training opportunities. The MDT is an ideal vehicle for the sharing of skills and knowledge across all levels within the hierarchy. For example, prior to my first postgraduate examination I spent time with the audiology department to increase my knowledge of audiograms. Hearing tests are often difficult to interpret, and using the expertise of the audiology team increased my confidence in this area. Head and neck cancer nurse specialists are other valuable members of our MDT. They are adept at changing both tracheostomy tubes and speech valves for
patients. They often have simulation models for training, and also have a rapport with patients that fosters an environment that allows a novice to learn new techniques. Making the most of all opportunities in the workplace can lead to improved patient care, and to a better knowledge base and skill set for clinicians. We should look outside of just our consultant colleagues when searching for CPD opportunities, and make use of the knowledge of all those in the MDT. REFERENCES 1.
Liberatore MJ, Nydick RL. The analytic hierarchy process in medical and health care decision making: a literature review. Eur J Oper Res 2008;189(1):194–207.
2.
General Medical Council. The doctor as a teacher. London: General Medical Council; 2009. Available at http://www.gmc-uk.org/ Developing_teachers_and_ trainers_in_undergraduate_ medical_education_1114. pdf_56440721.pdf. Accessed on 10 October 2014.
3.
Johnson RF, Stewart MG, Wright CC. An evidence-based review of the treatment of peritonsillar abscess. Otolaryngol Head Neck Surg 2003;128(3):332–343.
4.
British Medical Association. EWTD for junior doctors. Available at http://bma.org.uk/practicalsupport-at-work/ewtd/ewtd-juniors. Accessed on 10 October 2014.
Corresponding author’s contact details: Anna Harrison, Clinical Research Fellow, Tameside Hospital NHS Foundation Trust, Fountain Street, Ashton-under-Lyne, OL6 9RW. UK. E-mail: [email protected]
Funding: None. Conflict of Interest: None. Acknowledgements: None. Ethical approval: Not required. doi: 10.1111/tct.12427
2 © 2015 John Wiley & Sons Ltd. THE CLINICAL TEACHER 2015; 12: 1–2
Learning from the multidisciplinary team Anna Harrison Department of Otolaryngology, Tameside General Hospital, Ashton-under-Lyne, UK
C
ontinuing professional development (CPD) aims to increase knowledge and learning outside of structured training. I believe that many opportunities are available in the hospital to develop skills and knowledge, but that most of us in training do not use all possible avenues to expand our learning.
As is the case in many professional working environments, within the field of medicine there is a recognised hierarchy of practitioners, defined by role and status, and by acquired expertise and competence. Hierarchy in medical terms, as defined by Liberatore and Nydick, ‘comprises a set of integrated levels within which team members are ranked both by their disciplines and levels of authority’.1 This hierarchy often pre-defines, but may limit, our learning opportunities as we are
taught by those more senior to us. Recognition that all members of a medical team have a contribution to make is a valid principal for maximising learning opportunities and achieving personal goals. All doctors have a duty to contribute to the training and supervision of others.2 Traditionally this is seen as senior colleagues supporting and training those more junior, but although this is important, it should be recognised that other members of the multidisciplinary team (MDT) have a part to play in sharing knowledge derived from different learning opportunities and experiences. My personal training experiences have been located within a large teaching hospital in Scotland, and this has provided me with an exposure to a particular spectrum of specialist cases.
I recognise that my junior colleagues have performed procedures that I have not performed myself, and seen clinical cases that are outside my experience as a result of differences in training localities. For example, in my experience patients admitted with a peritonsillar abscess (quinsy) were treated with aspiration using a needle and syringe before admission for antibiotics. One of the current junior trainees was taught to incise a quinsy with a scalpel under local anaesthetic, rather than aspirate. I have therefore taken the opportunity of learning this skill from a junior colleague. There is no evidence base that favours either management method,3 but having more than one method in your skill base is useful in cases that are difficult to manage. Even consultants can use knowledge from trainees to complement their own
Having more than one method in your skill base is useful in cases that are difficult to manage
© 2015 John Wiley & Sons Ltd. THE CLINICAL TEACHER 2015; 12: 1–2 1
A spirit of cooperation helps to improve performance for all concerned
experiences. For example, I had seen problems postoperatively with wound infections in patients with absorbable stitches. I suggested to my consultant that he consider using non-absorbable stitches in skin closure in pinnaplasty (the procedure used to pin ears back), as sometimes it is difficult to predict when the absorbable suture will dissolve. Delays in this can cause stitch granuloma (local inflammation and swelling). He agreed that he had also experienced this in the past, and our discussion confirmed his suspicion that not all absorbable sutures dissolve completely. He is now even more careful and selective in the use of absorbable stitches for skin closure in this group. It is imperative that team members share clinical experiences, and are willing to learn from each other in order to benefit patients and progress personal learning and skills. A spirit of cooperation helps to improve performance for all concerned. I have found this to be personally beneficial and to be a valuable way of addressing the different learning opportunities inherent within the varied training environments. The movement of trainee doctors and surgeons around various hospitals helps to address the variety in opportunities, but the attitude
and experience of the consultants and other team members is a significant factor in shaping clinical attitudes and exposure to different practical interventions. Hence, if you are taught that a peritonsillar abscess is best incised, this will form the basis of practice from an early stage unless other treatments are observed and performed. The traditional hierarchy and teamwork approach is effective for patient care, but with limited working hours, as dictated by the European Working Time Directive (EWTD),4 we can and we must seek learning experiences from a variety of sources. The introduction of simulation and online learning modules is also designed to supplement training opportunities. The MDT is an ideal vehicle for the sharing of skills and knowledge across all levels within the hierarchy. For example, prior to my first postgraduate examination I spent time with the audiology department to increase my knowledge of audiograms. Hearing tests are often difficult to interpret, and using the expertise of the audiology team increased my confidence in this area. Head and neck cancer nurse specialists are other valuable members of our MDT. They are adept at changing both tracheostomy tubes and speech valves for
patients. They often have simulation models for training, and also have a rapport with patients that fosters an environment that allows a novice to learn new techniques. Making the most of all opportunities in the workplace can lead to improved patient care, and to a better knowledge base and skill set for clinicians. We should look outside of just our consultant colleagues when searching for CPD opportunities, and make use of the knowledge of all those in the MDT. REFERENCES 1.
Liberatore MJ, Nydick RL. The analytic hierarchy process in medical and health care decision making: a literature review. Eur J Oper Res 2008;189(1):194–207.
2.
General Medical Council. The doctor as a teacher. London: General Medical Council; 2009. Available at http://www.gmc-uk.org/ Developing_teachers_and_ trainers_in_undergraduate_ medical_education_1114. pdf_56440721.pdf. Accessed on 10 October 2014.
3.
Johnson RF, Stewart MG, Wright CC. An evidence-based review of the treatment of peritonsillar abscess. Otolaryngol Head Neck Surg 2003;128(3):332–343.
4.
British Medical Association. EWTD for junior doctors. Available at http://bma.org.uk/practicalsupport-at-work/ewtd/ewtd-juniors. Accessed on 10 October 2014.
Corresponding author’s contact details: Anna Harrison, Clinical Research Fellow, Tameside Hospital NHS Foundation Trust, Fountain Street, Ashton-under-Lyne, OL6 9RW. UK. E-mail: [email protected]
Funding: None. Conflict of Interest: None. Acknowledgements: None. Ethical approval: Not required. doi: 10.1111/tct.12427
2 © 2015 John Wiley & Sons Ltd. THE CLINICAL TEACHER 2015; 12: 1–2
