The Big Interview – Dr Amar Puttanna
Dr Amar Puttanna is a Diabetes Consultant who has worked at Sandwell and West Birmingham Hospitals NHS Trust. He is a committee member of the Young Diabetologists and Endocrinologists’ Forum (YDEF) following a successful period as chair.
He was also Royal College of Physician Chief Registrar. He has won multiple teaching awards from the University of Birmingham and the Royal College of Physicians of Edinburgh and previously been on the Royal College (MRCP) Part 1 examining board. In 2018, he won the RCP Excellence in Patient Care Award for outstanding contribution to the profession.
Why did you specialise in diabetes?
I have always been interested in this specialty – I was fortunate enough to realise this quite early on in training as a medical student. It was the ability to combine the vast breadth of knowledge with holistic patient care. It was also the wide variety of situations encountered – from those transitioning into adult care to antenatal care through to the challenges of multi-morbidity and reduction of morbidity and mortality with above all – the patient at the centre.
Tell us about your accolade at the 2018 Royal College of Physicians (RCP) Excellence in Patient Care Awards in May?
I was very humbled to receive the RCP Excellence in Patient Care Award for contribution to the profession as a trainee. It can be difficult as a trainee – trying to balance your workload, on calls, family, with training and personal development as well as trying to get involved to make meaningful changes for patients and colleagues. I was very fortunate to be involved in projects (local or national) and various other opportunities during my training which resulted in the nomination. This award was given to the trainee across all specialties in the UK who the judges felt had made meaningful and valuable contributions to colleagues and patients. You don’t expect to win awards but I was proud to receive it, even more so as it showed you don’t have to wait to be a senior in the specialty to make changes and also because it added to the perception of our specialty nationally!
You are a former chair of the Young Diabetologists and Endocrinologists Forum (YDEF), tell us about the group?
YDEF has been going strong for around 20 years now and has many well known former members. We are a group of dedicated trainees looking to support, represent and improve training for all diabetes and endocrine trainees in the UK. Our current chair is Myuri Moorthy who is a trainee in London however there are eight other members from different deaneries and we are always looking for more members! One of the key things we do is organise courses specifically with trainees in mind in areas not regularly covered by standard training. These are aimed at improving knowledge and thereby patient care however we also do a lot more such as sit on various national committees and provide support and resources to members. We have recently updated our website so have a look to see what we do.
How are you improving current education for junior doctors in management of basic diabetes and endocrinology?
I do this locally by regularly teaching and educating juniors whilst on the wards and on call as well as taking an active interest in the formal teaching programmes. I think it is important that we promote knowledge and enthusiasm in our specialty and utilise the opportunities we have to educate. It is not just junior doctors but medical students that require this knowledge. From my experience, education in our specialty is variable and many go through medical school with little clinical knowledge of our specialty which reflects in their hesitancy to manage common diabetes and endocrine conditions when they become doctors. I took charge of teaching medical students in my trust about our specialty and also was always ready to teach at training days for foundation year and core medical trainees. I also ask them to get involved in any projects/audits/posters I am undertaking so that they can develop their skills… and hopefully interest.
You are focused on ensuring that interest in the specialty of diabetes continues. How are you doing this?
This is an area quite close to my heart. I am very passionate about our specialty and try and support and promote it. One of the key aspects of improving interest of diabetes is to improve awareness. A specific project I started was our ‘perceptions of the specialty’ survey which looked at medical students and junior doctors to understand their perceptions of diabetes and endocrinology to see what were potential barriers to recruitment. The majority said they required more education and clinical involvement which is another reason to get involved in junior doctor teaching. This also resulted in the development of our first national taster day last year in Birmingham designed to increase interest in our specialty. It was an incredible success with lots of support from colleagues and enthusiasm. We plan to run the second one on 15th September in London with the help of SfE and with support from ABCD and DUK.
You are involved in the DIADEM project, tell us about this?
This is another project I am very excited about. When I had just started in the specialty, one of the consultants I used to work for mentioned about the link between diabetes and dementia. I was not aware of this and researched the area with interest to improve my knowledge. What became apparent was not only the lack of evidence in this area but also the lack of clinical management advice and data. Those with dementia and diabetes are a particulary vulnerable group that need focussed care and pro-active input by specialist teams to prevent overtreatment, reduce risks and optimise care. The Diabetes and Dementia (DIADEM) project was created after considerable planning in order to achieve its aims of improving care in this group. We reviewed all patients admitted to our trust with both comorbidities regardless of reason for admission and ensured they had up to date glycaemic parameters, medication review including simplification or de-intensification and a focused care plan. The project continues at my trust and benefits are being seen and it has just been accepted as a finalist for the Quality in Care Awards 2018 which further validates the hard work.
Tell us more about the teaching awards you have won from the University of Birmingham?
I have had a passion and enthusiasm for teaching and especially for those early in training to provide a good grounding and keep their enthusiasm for medicine. It is also a good way to ensure you keep up to date and enhance your knowledge as you have to be able to answer their questions! I won awards for 2 consecutive years from the University of Birmingham called Recognising Excellence in Medical Education (REME) teaching awards. These awards were nominated by students and given to those clinicians who the students felt had contributed most to their teaching. This made the awards all the more special as they were from the students. I subsequently also won a teaching award from the Royal College of Physicians of Edinburgh which also was very humbling.
You are one of the first group of RCP Chief Registrars, tell us more about this?
I have always supported the Royal Colleges and believe they are one of the best organisations in supporting trainees. The RCP Chief registrar scheme is one such iniative. During our training, we are given opportunities to gain clinical skills and experience in managing patients with various conditions however a large part of being a consultant/senior is leadership, management and learning how to work with others to deliver quality care. Up until this scheme, trainees had to try and gain this experience through courses or ad hoc opportunities. The chief registrar scheme was designed to allow senior trainees time to get involved in delivering meaningful quality improvement, work with senior management in their trust and gain valuable experience before becoming a consultant. We had bespoke teaching days at the Royal College on many areas and unlike many courses, were able to practice this knowledge over the year and feedback with support. I cannot recommend this enough for all trainees. It was as a result of this scheme that I have had much success with my projects and career.
What’s been your biggest achievement?
I had known since medical school that I wanted a career in diabetes and endocrinology however was not really able to harness that early in my training which was to my frustration. As a result, I wanted to keep the interest in our specialty and enthuse others – which is why starting the the national taster days with YDEF and SfE are what I consider a big achievement.
I know I am only allowed one but I would have to say a close second would be the DIADEM project which has come so far and still has so many plans going forward – it shows how far a well-designed quality improvement project can go and I am glad I can help shape care for a particularly vulnerable group.
What is the future of diabetes care in the UK?
Without a doubt technological advancement and clinical utilisation of this in everyday practice is not just the future but currently happening (though of course we can always do more). Looking ahead there is so much on the horizon to help make the lives of those with diabetes better. Future care will also need to account for the aging population and pragmatic approaches to multi-morbidity and pro-active care should also be a major consideration. Ultimately it would be nice for the future of care to be driven by those with diabetes with support and facilitation by clinicians!