Our Medical Directors for Professional Practice discuss their roles

Listen to RCR Officers Dr Tom Roques and Professor Mark Callaway discuss their roles as the RCR's Medical Directors for Professional Practice.

Consultant clinical oncologist Dr Tom Roques and consultant radiologist Professor Mark Callaway disucss why they applied to be Medical Directors for Professional Practice. Learn more about what their roles involve, how the Officer team works, what they have achieved and why Fellows should consider standing for election. 

 

"The College role enables us to be better doctors back at base, and I think having that perspective on medicine does change how you practice your day-to-day job and makes it better. So I think any College role, whether that's on a board or committee or at an Officer level, is enjoyable for most people and I would thoroughly encourage anyone to get involved."

– Dr Tom Roques


Read a transcript of the discussion

 

Tom Roques
Hello my name is Tom Roques, and I'm a consultant clinical oncologist at the Norfolk and Norwich University Hospital.

Mark Callaway
Hi I'm Mark Callaway and I am a gastrointestinal radiologist at the University Hospital of Bristol.

Tom Roques
I think I applied for the MDPP role having really enjoyed all my interactions with the College in the preceding few years. I've been part of one of the College committees, I've helped write some documents and guidance, and I began to learn of the tremendous work that the College staff do behind the scenes in supporting oncologists and radiologists up and down the country and I really wanted to be part of that. It also fitted quite well with my career at the time; I had a bit of a space and time in my job plan to be able to do the role, and I do think you need to somehow factor in some extra time to be able to do this role well. 

Mark Callaway
My reasons for applying for the job were very similar to Tom’s. Actually I think if you evolve up through the College, it becomes a natural progression and it gives you the opportunity to not only be involved but sometimes shape some of the policies and commitments of the College going forward, and I think it's very easy for us all on the shop floor to often moan about things within the environments we find ourselves. But this, I think, gives an opportunity to try and direct some degree of change going forward. I would agree with what Tom says about time. I think you apply thinking you've got plenty of time to do it. And then you realise that you haven't, and I think you do need some degree of flexibility in your overall working week and job plan to make time to do the role.

Tom Roques
I think you could be involved in almost any aspect of oncological leadership at a national level. So there's a number of things you're asked to do in the role on an ongoing basis. You might be a part of a committee like the joint committee for clinical oncology, national chemotherapy or radiotherapy board, there are often things to respond to: queries from members and fellows, guidance to write and draft, those kinds of things. But there's also a real chance to shape the role in the way that you want to. And I was often asked at the start, what were my major priorities coming into the role? And I think there is space within that to have some particular aims that you would like to get out of that three years, whether that's driving a particular project - we've started a big project around wellbeing, for example, in the last three years. Or just other ideas that you'd like to like to bring to the role. So there is some flexibility.

Mark Callaway
I agree. And I think that you really can develop to some extent the role around the areas within the service delivery that interest you. I think the role is bigger than that though because I think also you are an integrated officer of the College and that comes with it a responsibility to influence the other aspects of the College working – we’re medical directors for professional standards - but also there are medical directors for education and training, and yet a lot of the decision-making is a cabinet approach to decision-making of which you are a part. In addition, you often represent the College. And I think what I hadn't realised is how much I would enjoy certain College occasions, for instance graduation day and presenting certificates, which you do in your role as an officer, which is a day when everyone is really happy to be recognised for their achievements. And that's a really exciting day. I think that those are the things that you don't know that you're going to be doing when you take the role on, but are real benefits of doing the role.

Tom Roques
No, you don't have to have had a College role. I think you have to have enthusiasm and interest for the kind of work that the College does at a national sort of overview level. And you have to have drive to bring to that role, which every officer I've ever met certainly has. It's an advantage to know a little bit about how the College works, but I think for me, that was really about encouraging me to apply for the role. But there's also a six month induction period. So once you're appointed, you have six months check shadowing your predecessor, where you get to go to the boards and committees, at least one somewhere, you get to see the kind of work the College does. So I never felt that I was coming into things completely without experience when I started but like any role, it’s actually different until you actually wear the shoes and actually take on the job.

Mark Callaway
I don't think you have to have a previous College role, but I would say, I think it helps actually. And I think that this role, I think is evolved too often by both the influences you get and the experience you've got from being involved in perhaps other committees, regional chairs in my regard in terms of radiology or the professional standards board. And I think that they are areas of less responsibility to give you a viewpoint on what you're likely to be doing as the medical director, but you don't need to have done them. They certainly help. And I think one of the things I’m sure Tom would agree with is that the three years goes incredibly quickly. So the more you can prepare yourself for the role, the more you're going to get out of the role. Because I think it takes us all a year to really bed in and understand what we're doing, even with the experience of having done a lot of College roles before. And so I think that's where it would be an advantage, but as Tom has said, you have a six month period of grace where you shadow the person that you're going to be taking over from and that will give you an adequate insight into the role of the job.

Tom Roques
I think the other thing really helps at the start of the role is the tremendous support you get from the College staff. And that's very different, I think, to working on boards and committees in the NHS structure where often the doctors are leading those committees with not much administrative support. In the College, you're prepared to chair meetings, you come with a chair's agenda, you will meet people beforehand who will go through that agenda and tell you what the background to those points are. So you don't feel as though you're flying you know, without really good support behind you.

Mark Callaway
I think that questions around achievement when you're currently in office are always difficult to answer and I would like to think that my biggest achievement is to build and support and develop the team and College in a really fast-changing period of healthcare. I think that, to be honest, we've seen unprecedented times in the last year or so which has radically changed the way that this job has looked. Before March I'd been to London, I think 12 or 13 times. After March, I’ve been once in terms of what we do, but the team has been supportive and the work has developed. And I think that’s a reflection of the building blocks we put in place before the pandemic hit. I think in terms of personal objectives, when you come into the role, you need to set yourself one or two projects that you want to see to completion in your three-year period of time, because I think that sets a framework in which you can then develop. I've changed [inaudible] and productivity of radiologists in the UK, and they have been big and challenging pieces of work. I hope that I will have completed them by the time I demit office in 10 months’ time. I think it's only then you can reflect back on what you have truly achieved, but I think it's been an exciting opportunity and a great period of time.

Tom Roques
In terms of the biggest achievement in my time in office, I'm not sure that I am the best person to tell you that at the moment! I think that’s probably for other people to judge, and I've also got another nine months to go and lots of unfinished jobs. But I also think that a lot of the projects that I'm involved in are longer term than that three-year period. And that's part of the joy of the role is that you are given stuff by your predecessor and by other officers and you work very much in that team context and there’ll be things that I pass on for other people to finish after I've left. I think the biggest change is going to be our remote ways of working and the challenges that COVID has placed which will, I think, change the role for the better and make it easier to do things remotely and make us more productive, and able to be a bit more agile. I think in terms of actual things that I can count that we've done, I guess the two things would be the support we gave centres around COVID.

I'm really proud of my colleagues keeping going with radiotherapy and chemotherapy over the last nine months and also adapting in a consistent way so that we learned from and supported each other really well back in March, April, May time. And the other thing which is similar to that, is the consensus guidance programme, which was started by my predecessor and will hopefully continue for many years after I've left, but we’ve really cemented a framework for how to develop consensus guidance, which I think could be quite challenging for variation in practice in the UK. But I've always felt that in a role like this, if you can reduce that variation and raise everybody's quality up by 10 - 15%, that's probably going to do the most good for our patients.

Mark Callaway
I think it's important that people do put themselves forward for these roles, because I think it's the opportunity for us as a profession and us as a speciality to be heard. And it's really important as a practicing clinician that you have that opportunity to influence, and I think improve care for the patients we look after. I think this role genuinely gives you that opportunity and I don't think that there are many roles that you do where you can have national influence. You can have your thoughts, processes and influences heard at a national level, which can influence the way that not only you and your colleagues do the job but hopefully improve the overall performance that we give and the care that we deliver to our patients. So I think that it's a fairly unique opportunity to be involved at that sort of level. And I think that if you think about and care about the job that you do, and I know that all of us do that to some extent, this is an opportunity of really turning it in to a way to influence and take those thoughts further.

Tom Roques
I'd agree entirely with that as the reasons why you should do the role for other people. But I think the main thing is you’re going to really, really enjoy it. I mean I don't know any officer that's not thoroughly enjoyed their time with the College. In fact, we had an officers’ away day last year and the sort of rating score that we all gave our time at the College was incredibly high. And we all also reflected back that that's the College role enables us to be better doctors back at base. And I think having that perspective on medicine does change how you practice your day to day job and makes it better. So I think in any College role, whether that's on a board or committee or at an officer level is enjoyable for most people. And I would thoroughly encourage anyone to get involved.

Mark Callaway
I think it's a challenge and I think it's a challenge that you can easily underestimate. The way that I personally have done it is I actually took a reduction in my overall PA working environment to free up a day, because I think you need to have that flexibility of at least a day a week in order to do the work, that's when most of the committees were held in London on a Thursday. And clearly you need to be away from your own base hospital over that period of time. I think what you don't realise is all the stuff that goes on in addition to that, and you have to have some further flexibility of time. So I think it's very, very easy to underestimate the amount of time the role requires. And I think you have to have the support of your organisation. So I think if you are thinking about this type of role, you need to have a discussion with your clinical director and / or I would say with your medical director as well, just so that they're aware of the fact that you are taking on a big responsibility in a national organisation. And I think in the modern NHS, there should be a degree of flexibility around that to allow you to deliver that different form of health care, but information is required.

I think you have to be disciplined and I think you have to try and keep on top of things, but that's quite hard, I think because there's a huge amount of information that gets passed your way electronically, as you can appreciate these days and you have to be able to be flexible to react. So I would say, I think you have to be honest to yourself about the time that role takes. I think you have to be honest with your colleagues and your organisation in planning for the role, because I think they need to be supportive of that role. If they're not, I think you're in for a very hard time. And I think you have to really ask us, speak to us and just get a feel for how much time the role takes.

Tom Roques
I’d agree with all of that! And I think you also probably should ask your family as well because they probably have some say in it, but I would like to think the impact on them has been positive because of how much I've enjoyed doing it. I think the other thing to say is that everybody in the College is very much aware that these are volunteer roles and I've never felt pressurised by anybody from the College staff that I've got to do something by a very urgent deadline, if I'm busy doing clinical work. So I think there is real understanding that they are volunteer roles. Like any role, the more time you put into it, the more you get out of it. I'm probably not that good at separating out different parts of my role and I'm one of those people who probably tends to read emails too much in the evenings. But that's the way I've enjoyed working, and the way I've thought I can give the best to the job and get the most out of it.

I think again, the new ways of working are changing this, and it used, as Mark says, to be Thursdays in London, when you could sit on the train and do College work and then be in meetings and committees all day and kind of do the College work. That is now changing - it is more of a five day, seven day a week role, but equally that gives you the flexibility. And sometimes it's easier to have a two hour meeting at the end of the day when you're not and your colleagues aren't travelling up and down to London. So I think you perhaps need to be even more hard-lined about the time you spend on College work and the time you spend on clinical work, given that you can be more flexible. But I don't think that's impossible. And as I said, I think the more time you put into the role, the more you get back from it. 

So I would definitely take on the role again, I've enjoyed it even more than I thought I would, partly because I didn't come with that many preconceived ideas. But also I don't think I'd appreciated the real benefits of the kind of cabinet approach of officers and the senior leadership team. So we've met on a very regular basis. We discuss everything from the governance around the College, how the College should organise exams, meetings, external events, political pressure, communications. And I think being involved with like-minded fellow doctors, but from very different perspectives, none of whom I knew well before this role, has been a really rich and rewarding experience. And I think we function at a much higher level than any group or committee that I've been involved in before, and that’s really developed me I think.

Mark Callaway
I’d definitely do the role again. I think it's been everything that I wanted it to be and more, and I think that you think you know what the role is, but I think that as you get into it and you develop and you realise that it's bigger than just the Medical Director of Professional Standards, and you do realise you have a responsibility to provide a direction and leadership to the organisation, to the organisation within the world of your faculty and to the organisation within the external world of healthcare. You begin to realise just the huge enormity of all that surrounds it. But I think you get a huge degree of support in that. And I think that's the exciting bit because I think you then get to be involved in, discussed with with, and take forward real opportunities to change and influence policy.

Mark Callaway
Before COVID lockdown we had great opportunities for networking. We've had some fantastic - and they are working - dinners with the real leaders in healthcare in the UK. And actually that was a great opportunity to meet people in a different environment and to hear people in different spheres of delivering health care at the highest level, talk about their thoughts, plans, actions, or ways forward. And that's something I didn't realise I would be exposed to, but it's been a real educational opportunity to understand really how healthcare in the UK works on a bigger platform. So there's nothing that I would have changed in terms of the job. I thought three years would go very quickly, but I'm just amazed how quickly it will have gone.

Tom Roques
I think this role is all about supporting doctors up and down the country to do their job a little bit easier and a little bit better because it's tough working in medicine. It's tough when you're part of a specialty where the demand keeps increasing and whilst we will continue to advocate for more oncologists and more radiologists, those numbers are not going to grow as quickly as we want them to. So I think the role is all about supporting people up and down the country. And if those doctors seeing patients every day feel that some of the work that the College do - whether that's a document about how to treat lung cancer in the consensus guidance, whether that's some of the wellbeing resources, whether that’s our campaigning behind the scenes for more trainee numbers - if that makes jobs a little bit easier on the ground, then I think we've been successful.

Mark Callaway
Again, I think it's really difficult to know what your legacy will be or what you think your legacy will be when you're still doing the job. I think that you don't tend to think about what people are going to think about you after you’ve gone from the job. I think if I can say anything, it's really what I'd like to leave is one or two things that have made an impact on the way that people deliver and support the radiological community. And I think that if after my time here, when people say, well, actually that was done when he was doing it, that would be a really positive thing. Or people recognise that during that period was when we started to do things in a slightly different way. As Tom has already alluded to, often you pick up a lot of projects that other people would have picked up or started and that's part of it. So I think really it's all about a feeling that you've contributed to a great organisation that really is influencing two great specialties at a really hard time. And I think that if in some way we've influenced and changed a little bit of that, that's a really good thing to have achieved.

Tom Roques
So the officer team becomes a very close knit body of pretty senior experts, but from very different places. So we vary a little bit in our ages. We certainly vary in where we come from in the country. And of course we vary in being both oncologists and radiologists who bring complimentary views to some of that decision-making. It’s changing a bit again because of COVID. So we now meet once every fortnight for an hour and a half to discuss operational or strategic issues. But there's lots of discussion by email and WhatsApp and phone calls in between those times. And I think we're a pretty high functioning group of senior people who bounce ideas off each other, who will challenge each other and who hopefully will come to sensible and appropriate decisions, even if we don't all agree all the time. But I think one of the things I've enjoyed most is working with that wider officer team and meeting other people who are very committed to this kind of role, but coming from different places and bringing different things than I would bring to the table.

Mark Callaway
Your relationship with the officer team is the sort of relationship [inaudible] you will have during your period as an officer, because that's the time that you debate and decide the strategic and operational direction of the College and during the three years that team keeps changing. So you build these relationships up over a course of a year [inaudible]. Coming in they're experienced, they tend to be your mentor. And before, you know it, they've left because they’ve come out of their office, there are changing teams. And I found that a little bit of a challenge, but it's also an opportunity and it greases the diversity of people you tend to work with. And it means that you have to be prepared to operate as part of a team and recognise the strengths and weaknesses with everyone else in that team and be supportive of the new members joining the team in order to keep the momentum going over your three year period of time. And that takes you through probably through three changes. And I think that in the end, although it's a challenge, it's also one of the most interesting aspects of working in this organisation because you work with a real diversity of people during that period.

Tom Roques
I think the other thing about the officer team is that we have a lot of fun actually. So when we're down in London we would often go out for meals or drinks after work. I've met I think all of the people who left in the last officer round socially since they've left. I hope that all, if not the majority, of the people I've worked with in these roles will be friends long after I and they have left their College roles. 

I think in terms of cross faculty working, I think oncologists are very used to cross disciplinary working because we all work in cancer teams and we all recognise that the radiologists, pathologists, whatever, of the discipline bring a huge amount to that and I think the two specialties are very much complimentary. I think the radiology perspective, I mean the radiology workforce, is much larger than oncology. I think they're much more hidden and I'm very much aware that radiologists just perhaps have to work harder than we do to get themselves on the map. And I think we can perhaps help that with the cancer label. But I think they also, you know, bring a perspective of wider medicine - medicines, not just about cancer. And I think understanding that and understanding how radiologists try and manage that has been fascinating too. So I think they're very much complimentary and I would hate to see those two parts of the College divorced in any way.

Mark Callaway
I completely agree with what Tom said, and I think that it's a real opportunity to see how someone who we work closely with on the shop floor, delivering patient care, we're now working within that environment. And I think it it's become more apparent in recent times that there are a lot of issues that we were both aware of -  wellbeing, burnout, all of the pressures that are often delivered within the health service affect both oncologists and radiologists alike. I think the College is really beginning to really exploit those connections [inaudible] between us. And I think if anything [inaudible], getting closer between the faculties since I started is a really, really positive thing, it's been really outstanding. I think in terms of the support you get from the team, as Tom said, I've never felt under any pressure to deliver. I think people are very aware of the fact that you are doing this role in addition to the role that you do in the hospitals that you work at. I think people are interested and I'd feel we're very interested when we’re in London, we'd often have lots of conversations about, about our day to day working and what we did. I felt that they were really interested in supporting me to deliver the stuff that I felt was important to patient care. And I felt completely supported and guided during my period of time working in this directorate in the College. I will miss the people I work with in the College more than anything else in my activities in this role.

Tom Roques
Yes, I would agree entirely. And I think the other thing you really get is that most people in the College don't come from a healthcare background. Many of them have actually come from parallel charitable sector work and things, and that again gives you a really fresh perspective and makes you challenge the way that you work, it challenges the way that you run committees and organisations and MDTs, it even challenges your clinical practice, I think, because it makes you think differently about the world. So I think those different perspectives that are uniformly of a very high quality have been very invigorating.

Mark Callaway
To be completely honest I haven’t thought about what's next. I, like Tom, am trying to make sure that I complete the stuff that I wanted to complete during this last year. I think it would be a really sort of funny feeling when I hand over in July or August next year. And I think I should get to September, which is traditionally a very busy month for the College officers and I'll miss it. And I think that'll be the first time I realise that it's all over to be honest, because I think up until that point, I've got a lot to do to make sure that I'm ready to go. I think that then that will be the point that I will reflect on what's next. I think it gives you a huge degree of experience and a portfolio that's recognised for what it is. You know, you're leading one of the big medical Colleges in the UK in operational strategic direction. And that's a huge thing to have done. But now I'm just concentrating on finishing. And I think it's been interesting during this period of time because we've had to change the way that we do the job. And I think there have been some major advantages and disadvantages. I think, [inaudible] to build on the changes we’ve seen in the last 18 months. And I think that what I would hope is that we take the benefits of some of those changes and fuse them with the benefits of the way that we worked before. So I don't think we will be actually as London-centric and London [inaudible], but I hope we do maintain some of that because the benefits of the face-to-face meetings, there was a lot of benefits and the opportunity to network, which I think we've maintained, but are much harder when you're doing them over a Zoom call or a Microsoft teams working. However, I think there's some advantages and flexibility of utilising those mechanisms as well. And I have to say I'm the biggest slowest person in adopting technology in the world, so actually for me to have adopted it and run with it, I think that shows some of the benefits. 

Tom Roques
I'm not quite sure what I'll do for the next three years, but as Mark said, you couldn't have predicted the last nine months. So I'd just like to get the next nine done and, and tick some things off the list. I completely agree that this role has equipped me better to do whatever I do next. And I think it will give opportunities too actually and I'll feel that I can give more to other similar roles in the future. In terms of where the College goes next for the next three years, I think the point we've made that the officer team changes every year means it doesn't feel like you've got a sort of three-year thing. It feels like you're much more part of a fluid moving train. And at the moment change is even easier if you like. I think we've got all the different ways of running meetings and conferences, which we're all trying to embrace. There's a new chief executive, there's a new structure within the College in terms of changing the different directorates. There's an increased vision for how we can work internationally. And I think all of these are very exciting. But I'm not going to predict where we're going to be in three or four years' time, except that if you join this role and you're successful, I think you'll have a great time on the journey.

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