BSIRT: trainees COVID experience in the west midlands

Created - 01.09.2020

The first COVID related death in the UK was recorded on the 6th of March 2020. At this time around 3300 deaths were recorded globally.

Over the next few days I received family WhatsApp pictures of bare toilet roll shopping aisles in both England and Queensland, Australia, and enjoyed some of the amusing memes. My anxiety grew as the death rate in Italy quadrupled over the next six days, and footage from our Italian colleagues was shared online. I cancelled my flights and accommodation booked for the EBIR exam in Vienna due to take place on the 11th of March. Phil Haslam sent an email replying to the cancellation of the BSIR Annual Scientific Meeting planning day due to take place in Glasgow on the 23rd March: “there is a storm on the horizon...”.

The leading edge of the storm progressed in slow motion relative to the light speed of social media and thunder of the mainstream news. There was incredible flux in day to day planning and a palpable friction of knowledgeable professionals making plans against an apparent void. I remember heading to work on Gold Cup day (13th March) and seeing hundreds of flat caps and tweed jackets boarding trains for the Cheltenham Races. Italy was already in lockdown having 250 COVID related deaths on that same day, with cases rising exponentially. Before storms hit land the tide goes out, and in the words of Warren Buffet that’s when you find out who is swimming naked.

The UK Government imposed “lockdown” rules ten days later on the 23rd of March, the same day I took part in a teleconference for the Scientific Programme Committee. Our London based leader was demonstrating the primary symptoms of infection and it was clear that the virus had taken a hold in the Capital. Its inevitable spread to the Midlands was now being acted upon, anxiety levels had peaked with rumours of worse case scenarios filtering from the bi-daily planning meetings. Our hospital had closed nearly all regular services, with an unheard of bed vacancy rate. I was amazed so many patients could be discharged at such short notice, with average days spent fit for discharge dropping from 12 to 3.

Reporting pots were emptied and training opportunities in diagnostic and Interventional Radiology were un-evenly reduced across the region. In our large IR department Consultants went onto a 4 days on 4 days off rota. Several ideas were vocalised as to what the senior IR Registrars and Fellows should be doing (Redeployment, Diagnostic Radiology, ITU lines service, acting up as Consultants on the ‘surge’ rota etc...). We ended up on a 4 days on 4 days off IR Registrar rota continuing to cover regular IR duties and on-call, and also taking over all US guided procedures. It was a relief to know that I would continue my training located in a high-volume centre that maintained a busy service throughout. Our efforts as senior Registrars allowed the IR Consultants to set up training sessions for the ITU line insertion service team and offer assistance and oversee difficult access cases on ITU. It was great to see a sharing of ideas across specialties to ultimately provide the most efficient and best patient care. This highlighted the importance of the whole system approach, getting out of your silo and forming links between specialities. This behaviour spilled over into the BSIRT as we joined the Vascular and Endovascular Research Network (VERN) in contributing to the COVID-19 Vascular Service (COVER) Study. It was great to put politics aside and make connections with our vascular surgical colleagues.

Some of my trainee colleagues were not as fortunate and were re-deployed to ‘the front-line’. In some cases this was short lived due to there being more doctors than patients – “11 doctors and 9 patients”, one of my colleagues told me “I put in one cannula and prescribed oxygen over my 2 week deployment”. Occasionally in the initial weeks of April re-deployed radiology trainees were sent home due to overstaffing and the inability to safely social distance on the wards. After the initial spike these trainees were sent back to their radiology departments to continue training, albeit in a limited environment, where access to crosssite Interventional Radiology lists were restricted, and the diagnostic workload depleted. Prof Hamady launched the BSIR training webinars on the 12th May, which have been a tremendous success and a fantastic educational supplement in the challenging circumstances. Taking inspiration from this new format Niall Burke the founder of RISE UK presented the “tasteIR” webinar series from his home in Ireland, supported by BSIR, BSIRT and a host of inspirational Speakers. This 3 week series, available on the BSIR website too, was aimed at introducing medical students and junior doctors to Interventional Radiology. Excellent feedback was given with total attendance rates of over 300. 

In other cases, particularly amongst our junior trainees, re-deployments lasted from more than a month to two months. These trainees underwent additional training and worked on respiratory wards, Intensive care units, and in emergency departments. Many of these trainees, a high proportion of whom were new to the region were isolated and found this time difficult. Our Head of School, an Interventional Radiologist, set up a weekly online forum for all trainees to attend throughout the peak months of the crisis. This was an excellent initiative and allowed trainees to be updated on training status and raise concerns regarding their current circumstances. 

Someone once said that crises are not character building, but character revealing. It is heartening that as this crisis progresses great qualities are revealed within the Interventional Radiology community including collaborating, educating, and caring. Trainees have revealed their fantastic qualities too, including commitment, flexibility, and resilience. 

As we continue to weather the storm it is difficult to process the enormity of change. However, it is important to reflect on the positive revelations. Although initially it may have felt like we were swimming naked we are trained professionals, and have been wearing bathers, wetsuits, and lifejackets since medical school.

Dr Conor Aleman BSIRT Chair, West Midlands