“I’m very happily a SAS and able to say that now with pride,” says Mr Fuad Abid, Associate Specialist in general and vascular surgery at the University Hospitals of Derby and Burton NHS Foundation trust. He did not always feel this way. “I almost felt guilty for not proceeding to CESR in the first few years of my SAS career. It was not until four or five years into post that I had the courage to say out loud that I did not want to be a consultant or do CESR. I want to develop within my grade,” he says. Fuad recalls the negative connotations attached to the title specialty doctor when he was appointed in 2008. He says, “I would worry that people would perceive me as somebody who has failed to progress.” Fuad linked this to the evolution of the SAS role and the implications arising from the way it was originally conceived – see History of SAS role.
Much has changed for Fuad since then, and he perceives a similar shift has happened amongst his SAS colleagues, which he believes reflects better recognition of the grade. Within his department, Fuad has been able to develop his skills, learn new techniques and develop new technologies. This has enabled him to develop a satisfying surgical career, and his appointment as an associate specialist in 2020 led to more independent practice.
Having carved out a rewarding clinical practice, Fuad has focused on impacting the lives of other SAS doctors via leadership in medical education. “I wanted to make a difference. I thought this group needs a voice and direction,” he says. Initially, he was daunted by the prospect of a leadership role within the trust. He says: “As a SAS doctor, you won’t experience leadership development to the same extent as consultant colleagues.”
SAS Tutor
In 2017, Fuad became a SAS Tutor in the trust. He described this as “the first important step in my leadership journey” and one that was “very rewarding and satisfying in many ways.” It was also a “steep learning curve.” It involved attending medical education group meetings, which presented opportunities to interact with the senior leadership team. “It takes time to be able to contribute and speak for the group. I learned a lot,” he recalls.
In 2018, the merger of Derby with Burton resulted in the trust having two SAS Tutors, who reported to the Medical Director of Medical Education. Fuad described the medical directors he worked with during his tenure as a tutor as “very, very supportive towards SAS doctors.” This gave him the confidence to believe that as a SAS doctor, “there is absolutely no limit to what you can do”.
Dr Tracy Tinklin, Medical Director of Medical Education and a Consultant Paediatrician, first met Fuad when he attended appraisal training. “He was committed, he knew what he was talking about, and he was really experienced,” she recalls. Her role with respect to the SAS Tutors involves undertaking an educational appraisal and providing support and advice. “Sometimes a bit of guidance or mentoring; it’s just whatever is needed,” she says.
SAS Tutors manage SAS development funds allocated by Health Education England (HEE), and they used these funds to develop bespoke programmes, often centred around leadership, professional behaviours, education, teaching and training, and research. In practice, the remit of the trust’s SAS Tutors extended beyond medical education, and Fuad recalls that SAS doctors approached him with a broad range of issues. “It wasn’t just about arranging courses and educational events. It involved mentoring and some coaching,” he says. It was only in 2021 that the SAS Advocate role was introduced to look after issues of wellbeing – the trust appointed the first SAS Advocate in England. A separate ‘LED Tutor’ was appointed for locally employed doctors (and is working on standardising terms and conditions for this group of doctors).
Associate Postgraduate Dean SAS
Fuad moved on from the SAS Tutor role in 2021 when he became Associate Postgraduate Dean for SAS doctors for HEE. This is a more strategic role, providing support to the 20-25 SAS Tutors in the West Midlands, who between them cover approximately 1,300 SAS doctors. Fuad acts as a point of contact for SAS Tutors in HEE and connects with the wider educational leadership structure: the heads of schools, other Associate Postgraduate Deans, the Lead Associate Dean for SAS doctors and the Postgraduate Deans. “It is an opportunity to influence policy change and strategic planning in terms of SAS doctors in the region. We have a national meeting every six months, so the role provides an opportunity to see what’s happening nationally, learn from each other, and try to have a consistent national approach,” says Fuad.
“I’m very proud of him, and it reflects well on the trust that we have his level of quality here. Medical education is really important in this trust, and the fact that he’s taken on a senior medical education role is really impressive,” says Tracy of his appointment.
Fuad is keen to see a move away from silo thinking in terms of leadership opportunities, emphasising that SAS doctors should be able to take on leadership roles beyond those related to the SAS workforce. “Those are the barriers we really need to break and say that a SAS doctor can be an educator for any postgraduate doctor in training; they can be educational supervisor; a training programme director; they can be head of school,” he says. He is keen for SAS to develop into a wide range of leadership roles at local, regional and national levels.
“Leadership is not nurtured in the SAS group in the same way as for doctors in training, so we have a difficult path to prove ourselves, but it’s not impossible, and there are examples of SAS who are clinical directors or medical directors or the Dean of a medical school.”
Fuad’s career journey
Engaging SAS in leadership opportunities
“It’s really important to encourage SAS doctors to take on these additional roles, to extend their experience and keep them interested and motivated,” says Tracy. “If you’re a SAS doctor, you could be in the same clinical job for many years, at least as long as a consultant … and once you’ve fully developed your expertise as a clinician, then a lot of people will be looking for something else as well. For me, supporting medical education is going to be it.” She describes Fuad as a great role model for other SAS doctors: “He puts himself forward for things. He’s not afraid to speak up.”
Fuad agrees that engagement by SAS doctors can be a challenge. “One of the big issues we have is actually engagement from the SAS group in terms of helping themselves,” he says. He links this to cultural issues and the number of SAS doctors who, like him, qualified and trained overseas before coming to the UK. Fuad explains that international medical graduates (IMGs) often train within a hierarchical culture, and a reluctance to challenge is often carried into SAS roles. Tracy believes SAS IMGs can face an “uphill struggle” in pursuing leadership roles, observing a tendency towards lower levels of confidence. This is linked, believes Fuad, to barriers within the national training system, which does not recognise experience gained overseas. “For most international medical graduates, if they have come to the UK after a period of experience abroad, entry into specialty training is very difficult,” he says.
Sometimes SAS doctors face barriers arising from a departmental or trust culture that is not supportive of SAS doctors taking any type of leadership role. Fuad highlights how some SAS doctors are excluded from departmental meetings, adding: “If you’re in an environment where people don’t think you’re good enough to be at the table, it’s a huge step for SAS doctors to put themselves forward for any form of leadership role.” Part of the trust’s SAS development strategy is to support SAS doctors in developing skills around negotiation and communication and help them to challenge barriers in an assertive manner.
Fuard points out the pitfalls in assuming that SAS doctors share the same aspirations in terms of leadership. “There are a group of SAS doctors who are happy being specialty doctors. They do their clinical work, and that’s all they want. There is a good number who want to progress within the SAS grade, become specialists, take extra responsibility and be rewarded for it. A smaller number want to become consultants, and even smaller numbers want to go back into training. So, we shouldn’t expect all SAS doctors to behave similarly. Some SAS doctors do not put themselves forward for leadership positions or wider roles within their department because they genuinely do not want to do it.”
Organisational perspective
The trust is trying to do more too. The medical leadership team meets regularly with SAS leads across the trust, including Fuad. The aim is twofold: to discuss SAS issues and strategies to support and engage, and to consider how to encourage SAS colleagues to go for leadership positions. This has led to a change in job descriptions for roles, such as sepsis lead or safety lead, to alter the language around inclusivity and ensure these opportunities are available to SAS doctors.
A SAS doctor has been appointed to the trust’s Responsible Officer Forum, and another has become the trust’s LocSSIPs (Local Safety Standard for Invasive Procedures) Lead. The trust wants to embed an approach where it is ‘less interested in what the badge says and more interested in what the person can do’. The message to SAS doctors is simple: You are valued.
Advice on getting into leadership roles
- Look for opportunities and take baby steps towards leadership, such as department audit lead or rota manager – “that small step will give you the opportunity for wider engagement with managers and your other colleagues,” says Fuad.
- Attend department meetings to immerse yourself in the issues facing the department – “If you’re not sat at the table, it is hard to push boundaries,” says Fuad.
- Develop allies in your department who are not SAS doctors – to strengthen understanding amongst the wider team of SAS issues.
- If you have an interest in medical education, explore opportunities to become an educational supervisor for postgraduate doctors in training – with expanding numbers of foundation doctors, more clinical and educational supervisors will be needed.
- Speak to your SAS Tutor about opportunities for training in leadership development and/or educational supervision.
- Get to know your Director of Medical Education and the support they can offer in terms of professional skills development.
- Tracy advises starting with undergraduate educational roles and clinical supervision of postgraduate trainees and then building up to become a trained educational supervisor.
History of the SAS role
Fuad has explored the history of the SAS grade, which has existed in one form or another since the formation of the NHS in 1948. The role was originally created for service, not for training, which he believes is key to understanding perceptions of the SAS workforce.
Listening to SAS doctors
Healthcare organisations wanting to better understand their SAS workforce may wish to learn from the approach taken by University Hospitals of Derby and Burton NHS Foundation Trust:
- In 2021, the trust held a listening event for SAS doctors. This was attended by the Medical Director, Medical Director of Medical Education, Trust Board Chair, Chief Executive Officer, and SAS Tutors. These provided a better understanding of the challenges experienced by SAS doctors, such as around recognition and the terminology used to describe this workforce. Reflecting on these events, Tracy said: “We aren’t perfect, but the first thing is making sure that the senior leaders appreciate the contributions of SAS doctors.”
- That same year, they undertook a gap analysis of the SAS Charter. The SAS Advocate and SAS Tutors meet regularly to discuss the implementation of the SAS Charter. The trust is “more or less on target except for one or two areas,” says SAS Advocate Gauri.
- Tracy joined a SAS development day run by the SAS tutors to talk about educational roles. She now has several SAS doctors on the waiting list to become trained educational supervisors.
