Dr Louise Shaw - Education and Training Committee Chair

Dr Louise Shaw MB, ChB, FRCP, MSc, PGCTLHP, FHEA

I am Clinical Lead for Stroke and Consultant Stroke Physician at the Royal United Hospital Bath. We are a busy medium-sized District General Hospital admitting up to 700 people a year with acute stroke. With 4 consultants we provide hyperacute and acute stroke services with in-house 24/7 stroke on-call and TIA clinics. Our patients access thrombectomy via Bristol and we cover a large rural area of Wiltshire and Somerset with community hospitals and 2 community stroke rehabilitation units. We successfully recruit patients into multicentre studies which are investigating new stroke treatments or answering clinically important questions.

I have always been passionate about improving stroke services and this led to me initially becoming involved in the Doctor Foster Global Comparators programme stroke goal, where we looked at understanding data and comparing outcomes to improve healthcare across different global healthcare systems. I then undertook a Masters in Healthcare Leadership via the NHS Leadership Academy to develop my service improvement skills further and broaden my thinking by studying with people from a wide range of backgrounds.

I have always seen Education and Training as integral to service improvement. I am Training Programme Director for Severn Deanery Stroke Medicine, Regional Specialty Advisor for Stroke, and have been joint Quality Lead on the Stroke Specialist Advisory Committee for several years. I am also a strong proponent of training and development for all healthcare professionals and enjoy teaching on our local multidisciplinary stroke course and my role as Clinical Tutor for Physician Associates at my Trust. I have been a member of BASP T&E committee since 2016 and am very much looking forward to chairing the committee over the next 3 years just as the TakeUpStroke Fellows commence their roles. I believe Education &Training is the key to delivering the future stroke workforce.

Stroke and Me

As a house officer in 1992 I am mortified to say I quite liked clerking in stroke patients as it was quick: they often couldn’t talk to you to give a history and all you had to do was put up a drip and wait for a brain scan to happen in the next week if you were lucky. Then a few years later a medical talk caught my interest: it flew quickly over the fact that aspirin within 48 hours of stroke made a significant difference to long term outcome but mostly we didn’t give it as we were waiting for the scan result, and the presenter spent the rest of the time talking about a new expensive treatment for another co-morbidity that had fractional evidence of benefit and everyone got really excited about that. I wondered why nobody was interested in ensuring the cheap aspirin was reliably given as this would have much more overall benefit? The thought stayed with me through training in geriatrics and general internal medicine, first in Sheffield and then in and around Manchester, but I had no fixed subspecialty interest and in 2001 I found myself applying for a post in geriatric medicine in Bath with a special interest in stroke. It seemed the perfect place to move to and bring up my family. I arrived to find I was the first ever stroke specialist in Bath and that almost nobody else in the hospital even believed there should be such a thing as specialist stroke care. The earliest stroke audit forerunners to SSNAP in 1998 and 1999 showed the local stroke care to be alongside the worst in the country.

So my journey of service improvement began and I gradually left my geriatric medicine commitments behind as building the sort of stroke service our patients deserved was taking all my time and energy. I can’t describe how fortunate I still feel to have found myself slightly accidentally in the perfect specialty: it includes acute emergency work, ward-based care, rehabilitation, prevention, working closely with families and MDTs: it just didn’t exist to choose when I was starting out! I have had the privilege of setting up a new department in Bath, nurturing it and watching it grow and other people come on board over nearly 2 decades. A highlight 5 years in was standing by the trolley of the first patient I ever thrombolysed, whose large stroke melted away in front of my eyes 45 minutes into the infusion. He lifted his earlier 0/5 arm to wave at me and gave a massive grin and spoke. Instead of weeks in the rehab unit he was discharged home back to normal 48 hours later. The ripple of excitement spread throughout the hospital. There is still so much to do but these are exciting times again with thrombectomy and the potential to prevent so much disability and make a life changing difference. It’s the reason most of us went into medicine in the first place, and I want to inspire and equip the next generation to step up and enjoy a career in Stroke!