Neurologist Riffat Tanveer won the runner up award at this year’s Raising the Bar meeting for his poster looking at neurology trainee’s views on taking on MS as a subspecialty.
‘Of all the neurology subspecialities, MS is a booming landscape and management is very specialised.’
Riffat credits his own pursuit of MS as a subspeciality to an enthusiastic mentor who engaged him practically through active roles in clinics and patient management, and guided him to different sources of learning and understanding.
After discovering at the 2019 Raising the Bar meeting that he was just one of three trainees in attendance, he decided to find out why there were so few MS trainee specialists there, and what might be affecting trainees’ decisions to specialise in MS. His poster outlines the validated questionnaire he developed and his findings.
‘Sometimes it’s just because people have already chosen their specialism because of a personal link, but often it’s because there’s a disconnect between the trainer and the trainee.’
Riffat has been trialling a new way of working with trainees in his service to encourage interest and foster confidence in working in MS.
‘We have made some changes – it used to be that a trainee might see a patient 1 or 2 times in their 6 month rotation. You don’t follow a patient, you might see a diagnosis, or a follow up, but not a connected picture.’
Riffat’s trainees follow a model that he is still tweaking, which currently combines a mixture of practical clinic work alongside him every other week with the trainee seeing patients on their own in the alternating week.
Trainees in his department also take a vital role in MDT meetings, from completing the relevant proformas for the MDT which helps them to understand the journey of the patient, to attending and presenting the case in the meeting.
‘My mentor got me to MDT meetings, to understand the service and the other roles involved. Doing this for my trainees helps to engage them, gives them confidence and helps them to feel valued.’
We heard at this year’s Raising the Bar meeting in Jeremy Hobart’s overview of his workstream’s audit findings (day 1) that neurology trainees are rarely in attendance at MDT meetings, suggesting that this practice is uncommon, but could be a positive step for improving neurology trainee’s overall understanding of MS management, and potentially impact the uptake of MS as a specialism.
Riffat was very clear, however, that there is a balance to obtain between providing opportunity and mentorship, and overwhelming people.
‘You can feel pressurised as a trainee – we don’t want to overburden people. Training clinics have to be designed to help the trainees -giving them plenty of time per patient, restricting numbers for them, and designing a structure of clinic with plenty of discussion time.’
Calls to action
This work has potential implications across the whole MS community and there are a number of ways that you could get involved.
‘If we can start this interest in the early years, we’d have trainees who can take posts where they can take a leading role early on, redesigning services, getting involved. If we don’t change things, we can’t sustain our MS services. Without a specialist interest, the treatment breaks down, it increases variance.’
An inclusive approach to training – building the next generation of MSologists
Are you keen to see more MSologists across the country? You could make a difference directly.
- Share your own enthusiasm: An enthusiastic mentor is one of the top reasons for choosing a specialism – you can be that mentor!
- Support independence and build confidence: Find ways to work with your trainees to both build knowledge alongside you, and have freedom to be responsible for elements of the service, such as running clinics with trainees as Riffat describes.
- Introduce the whole patient and the full care pathway: Getting trainees involved with MDT meetings, both completing MDT proformas and attending the meetings to share that case can help trainees understand the complete picture, the way services interlink, and the rationale for different outcomes.
‘By improving the numbers of specialists across the country, we can reduce the variance in practice, improve services, and raise the bar for MS.’
If you are interested in modifying your training style to improve uptake of MS as a specialism in your trust, and you would like to work with Riffat to test models and record how they impact trainees in the long term, please get in touch with him.
Riffat is hugely aware that the uptake of MS as a specialism is not confined to consultant level. He plans to research why MS nurses are becoming scarce and what can be done to encourage nurses to specialise in MS.
‘The MS nurses are my lifeline – we need to take care of them. We need enthusiastic nurses taking up MS specialist nurse roles.’
Planning to pause until the pressure on services caused by COVID-19 settles down, Riffat is keen to then tackle this area. If you are an MS nurse and would be interested in helping him further this work, please get in touch with him via MS Academy.
Learning from other areas: nurse education
The challenges around developing new specialists is not confined to MS alone, and Parkinson’s Academy have recently begun creating an online-only Nurse MasterClass in Parkinson’s, developed by and for specialist nurses. MS Academy is currently exploring the nurse education programme for 2021, considering developing similar sessions through experienced MS nurses.
Posted in: MS Service Provision: Raising the bar