How to Train Doctors to Deliver Healthcare in an Austere Environment
Thursday, 03 October 2019
Brigadier Robin Simpson, Defence Dean, Birmingham
Robin Simpson graduated MB ChB from the University of Aberdeen in 1983. On joining the Army, he undertook Parachute training and then deployed to Northern Ireland before Officer training at the Royal Military Academy Sandhurst. He then was posted to Germany for his GP training which was completed by a year at BMH Hong Kong in 1989. As RMO to 1 KOSB he deployed to on Operation Telic in Saudi Arabia, Kuwait and Iraq. On posting to Dortmund as SMO, he became a GP trainer and GP Course Organiser in 1992. Subsequent tours were as Senior Medical Officer to Sennelager and then Episkopi Cyprus. In 1998 he returned to Sennelager as the Regional Clinical Director. This tour included overseeing the transfer of secondary Health care from BMH Rinteln to a German hospital in Paderborn. In 2001 he completed his MSc in General Practice at Kings College London. In 2004 he undertook a tour as the SMO for the Provincial Construction Team Mazar-i-Sharif Northern Afghanistan. In 2011 he deployed as the Senior Medical Officer Camp Bastion with specific responsibilities for the medical care of Captured Personnel.
In 1995 he became the Defence Professor of General Practice at the Royal Centre for Defence Medicine. His research interest focusses on care of patients on the battlefield on which he has published extensively. In 2012 he was appointed the GP Dean and then in March 2015 the Postgraduate Dean of the Defence Medical Services. He is an MRCGP Examiner (since 1995) and has had many senior roles in the senior management of the exam. He is the Vice Chair Midlands Faculty RCGP.
Brigadier Simpson is particularly interested in making GPs more aware of veteran’s health issues and co-authored the RCGP document entitled “Meeting the Healthcare Needs of Veterans”. He is now the RCGP Veterans Champion and is the Professor of Military Primary Healthcare and Veterans Health University of Chester.
In January 2018 he was appointed Queens Honorary Surgeon.
His awards include:
- Defence Medical Services General Practice Medal November 2012
- Royal College of Surgeons Mitchiner Medal December 2013
- Order of St John March 2015.
He will leave the Army later in 2019 after 35 years’ service.
Note of Meeting
Prior to the main meeting, representatives of the two charities benefitting from the May 2019 Famous for Five Minutes event attended to receive their cheques and give a short summary about how the donation would benefit their organisations. Cheques were presented to both Aberdeen Mountain Rescue and Playlist for Life.
The President, Dr Reith, then welcomed everyone to the meeting, noted the apologies (see separate sheet) and notified the membership of the death of Dr Chris Smith, Society President 1998-99. He then introduced the speaker for the evening, Brigadier Robin Simpson.
Brigadier Simpson began his talk by noting that one of the founder members of Aberdeen Medico-Chirurgical Society, Sir James McGrigor, was known as the father of military medicine. He was educated at Aberdeen Grammar School and Marischal College and laid the foundations of the RAMC of today. Much of his work was in response to battle in Flanders in 1809 where he noted that 4000 troops died due to fever and a much smaller number of 106 died in combat. He served as Director-General of the Army Medical Service from 1815-51. McGrigor introduced the stethoscope in 1821, set up field hospitals for those injured in action and generally improved the standards of cleanliness and hygiene, resulting in significant Public Health achievements.
During his tours of Afghanistan in 2005 and 2011, Brigadier Simpson noted that approximately one soldier per week was killed and that colleagues required additional competencies to deal with this on top of their standard medical training. Army doctors are working in areas where supplies are limited and the environment is not as clean as in normal hospital environments.
The role of a military GP is broad, dealing with children and elderly, refugees, having roles as a police surgeon and in public health and delivering family medicine. In Afghanistan, 25% of patients seen were children; skin conditions e.g. cutaneous leishmaniosis, diarrhoea and burns were common presenting symptoms.
The army officer selection process involves completion of undergraduate medical education and FY1 and FY2 posts. There is then a post-graduate medical officer (PGMO) course over 12 weeks at Sandhurst. The aim is to “build a doctor for the future” with not just academic ability, but with leadership skills, a reasonable level of fitness and resilience. PGMO exams cover primary care, preventive medicine, military medicine, military psychiatry, ALS, battlefield advanced trauma life support (BATLS) and the Diploma in the Medical Care of Catastrophes (DMCC). Following PGMO training, doctors are then deployed as General Duties Medical Officers (GDMO) for three years. Following this, 100% enter specialty training. The good recruitment is thought to be because military doctors belong to a regiment; participating in dinners, sport and fitness activities, travel, parades, are expected to have leadership roles and have experience of life events prior to specialist training.
In contrast, in the NHS in 2018, 40% of FY2s did not directly enter specialist training, some turning down places if offered and some opting for a career break. Morale of junior doctors was reported to be at an all-time low.
A typical military GP training programme is hospital based for 16 months (4x4 month posts) followed by 12 months in NHS primary care and 8 months in a military primary care location. There is proactive support for military doctors in training:
- Mentorship/First 5
- DMS Deanery know all their trainees
- Residential course for all trainees four times per year (one week each) based in a military setting; includes one week in Cyprus.
The Model of Service for Primary Care includes core elements (MRCGP), travel medicine, public health, occupational health, environmental medicine, training/education, sport and exercise medicine and pre-hospital emergency care. A military anaesthetic module is compulsory for all trainees starting as ST5s and provides additional competencies in analgesia and dealing with battlefield pain.
Military psychiatrists are expected to complete a MSc in war studies and military surgeons expected to complete a MSc in war competencies.
All military doctors are expected to have additional competencies over and above their specialty training. Most DMS trainees complete Fellowships. For pre- and post CCT Fellowship, an application will be based on developing additional competencies. The military chain of command believes that to become a consultant, Fellowship is required.
They also undertake pre-deployment training:
- Weapons handling
- Communication and use of radio
- Kit preparation
- Night-time movement
- Camouflage and concealment
Brigadier Simpson noted that challenges for the DMS in 2019 to ensure that trainees are fit for their role include:
- Troops no longer being in Afghanistan; this means that deployments are limited e.g. South Sudan and trainees mist wait longer for deployments.
- Funding issues; there is a move to save money on training meaning that the DMS must “fight” for its budget.
- More “run through” training programmes e.g. cardiothoracic, ENT, urology and vascular surgery have been piloted and there are plans for trauma and orthopaedic surgery; these are not good for military doctors, who require more generalist skills.
He also noted that these challenges could apply equally to remote and rural medicine. All military doctor skills are transferable to the NHS. Rural Fellowships in General Practice foster very similar skills to the military doctor competencies, particularly in relation to generalist skills.
Brigadier Simpson ended his talk by saying that he will leave the army on 1/11/19 after 35 years’ service. He is proud that NHS Deans are keen to have his trainees, who are trained for both their deployed role and working in the NHS. The evening concluded with Brigadier Simpson answering questions and receiving thanks from the President.