By Dr John Heyworth.
Vice President, European Society of Emergency Medicine
Reviewed by Thomas Shanahan, 3rd Year Medical Student at the University of Leeds
Biography of Dr. John Heyworth
Previously Dr John Heyworth has been President of the (then) College of Emergency Medicine, President of the British Association for Emergency Medicine, Editor of the Emergency Medicine Journal and lead Consultant in the Emergency Department at University Hospital Southampton. He has just concluded his tenure as Vice President of the European Society for Emergency Medicine.
Objectives of the talk
Dr. Heyworth presented in three parts. The first focused on the European Society of Emergency Medicine (EuSEM). The second focused on the European landscape for Emergency Medicine. The last part is an overview of Dr. Heyworth’s leadership reflections – both leading and being led.
Part 1: European Society of Emergency Medicine
The European Society for Emergency Medicine (EuSEM INPO) is a non-profit making scientific organisation whose aim is to promote and foster the concept, philosophy and the art of emergency medicine throughout Europe.
Currently EuSEM has 800 individual members from across Europe and around the world. In addition, 33 National EM Societies across Europe are members of EuSEM. It is clear there is immense energy, enthusiasm and passion from Emergency Medicine across Europe.
EuSEM has developed a two-part examination (EBEEM) designed to assess the knowledge skills and behaviours necessary for the clinical practice in an Emergency Department. The EBEEM is certified by the UEMS European Board and is based on the European Curriculum for EM, developed from a template provided by RCEM.
There is an Annual Congress, organised by EuSEM and the national emergency medicine society of the country in which it is held. The next Annual Congress will be held on 1-5 October 2016, in Vienna, Austria. The Annual Congress promotes the science and practice of Emergency Medicine in Europe, reflects the diversity of emergency work and gives members an opportunity to present their original work. The last EuSEM in Torino had 1,900 participants from around the world, including over 200 delegates from the UK.
UK Emergency Medicine physicians are invited to join EuSEM. For the annual membership fees, members will:
- Become closely involved in the development of the specialty of Emergency Medicine in Europe
- Receive online access to the European Journal of Emergency Medicine (EJEM) which is published six times a year, substantially discounted from the normal subscription price (Print editions are available for a small additional fee)
- Benefit from reduced registration fees for the annual EuSEM congresses, EuSEM courses and the EBEEM
- Be eligible to be elected to serve on EuSEM Sections and Committees
To join go to: www.eusem.org
Part 2: European landscape for Emergency Medicine
The medical landscape across Europe is heterogeneous. Over 50 different languages and cultures with different systems of healthcare and medical practice shape this variation. Each of the Emergency Medicine systems has different financial resources to draw on. Emergency Medicine as a specialty has different systems of registration. This variation causes a challenge in providing a consistent level of Emergency Medicine care across the continent.
The most important factor in the development of Emergency Medicine is the recognition as a primary medical speciality, which happened in 1993 in the UK and Ireland.
There are broadly two models of Emergency Medicine in Europe. In the Franco-German-Austrian model emergency physicians provide prehospital care, whereas different specialists staff the Emergency Department. In the Anglo-American-Australasian model paramedics predominantly provide prehospital care, whereas emergency physicians staff the Emergency Department.
As of January 2015, across 27 countries of the European Union, in 17 countries emergency medicine is a primary specialty; in 2 countries it is a supra-speciality, where emergency medicine is only recognised in conjunction with a base speciality, such as internal medicine. In two countries training is less than the recommended five years and in six countries emergency medicine is not a recognised speciality. Further work is therefore required.
Interestingly the European agenda is quite similar to what we have faced in the UK. Main issues include the status of Emergency Medicine as a speciality, providing safe care, improving quality, trying to improve flow and reduce crowding in the Emergency Department, turf wars with other specialities and recruitment and retention of emergency physicians.
Part 3: Dr. John Heyworth leadership reflections
Leadership whether locally, regionally or nationally is a privilege and great responsibility, which is summed up by a quote from the TV show Veep (2015), “I’m the President see – everything’s my fault now.”
In the previously golden days (sic) of medicine senior doctors were not uncommonly seen as distant deities, intimidating, unapproachable, career controlling, which all made them less than optimal role models. To a certain extent the medical leaders that found themselves in that role, did not all have the maturity, confidence, or ability to lead others.
There are many leadership styles. The North Korean style cannot be recommended, but its hard not to acknowledge its effectiveness. Benign dictatorship, managed democracy and flexible rigidity and are about inclusivity, getting things done, being seen to listen, having a sense of purpose and delivering. Large teams or Emergency Departments make it hard to achieve unanimous agreement and means the leader may not retain universal popularity.
The Blairite model of nuance is quite useful in leadership. It requires a recognition that you should modify your behaviour depending on who is in-front of you, whether it is the bed manger, a distressed relative, the Secretary of State or an Orthopaedic Registrar. There is not a one-size fit all approach to communication or leadership. You need to be able to recognise what works best for the situation you are faced with.
Emergency Medicine is quintessentially a team event and a relatively small area of practice. As such, dysfunctional behaviour is destructive and results in the “chandelier of trust being shattered.” Indulgence of such behaviour is not an option; so avoiding this is a key component of ED leadership.
Emergency Medicine is egalitarian with an Orwellian twist, as some degree of hierarchy is important. For example, during resuscitation or dealing with trauma patients it is important that someone is in charge and coordinating the team.
There are a number of universal principles for leadership in Emergency Medicine. It is a privilege. It is a big deal so do not misuse it. You are there for a reason; people have trust in your ability to do the right thing. It is a reasonably lonely role, but don’t let it be, use support and have confidants. Being a leader is often another job on top of your full-time job as an EM consultant. If you are to be effective, you will take a hit on the popularity front. Don’t give ground; unless you are certain that tactically it’s the right thing to do. Political expediency will not help you in the long-term. You may not change the world, but you will make a difference. Some battles you are not going to win so pick your battles.
As a leader you need to manage expectations, both your own and your teams. This requires full and frank discussions. You don’t want to make mistakes, but they are inevitable, so learn from them. Enjoy the role at the time. There is an inverse relationship between volume and productivity.
Steve Hansen, World Cup winning Rugby Union coach of New Zealand recently said: “the best leaders are not born but are forged in the crucible of intense disappointment.”
Dr. Heyworth finished the talk with reference to the following quotation, which summed up his view of leadership: “Respect is due (but not guaranteed),” H. Hill.
Summary of the talk and take home messages
The landscape across Europe and in the UK is quite similar, which is reassuring. As an emergency medicine community we are tackling similar issues and we can learn from each other. Join the European Society of Emergency Medicine to network with and learn from your EM colleagues across Europe.
The key message is leadership is a privilege, which should not be squandered. You have been chosen for a reason. As a leader you should have a clear aim to try and make a difference. But you need to be realistic. Be prepared to make mistakes and learn from them.
Have fun – think on.