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Thank you so much, everyone for being with us. It gives me great pleasure to introduce the last session of the day. And what I think is going to be a fabulous session. This is the earlier year consultant, network session at Dukes Club. Ma PA is the current chair of the EC and Network. She's a robotic IBD consultant at UC W in Coventry and she's here to talk to us about how to make the transition to a consultant life. OK. Thank you. Uh Thank you for the invitation. Um I'm actually really excited to be here cos I didn't ever come to Dukes as a trainee. So I'm coming for the first time as a consultant. So uh thank you for having me. Um So I'm going to talk about um the transition to consultant life. So for those of you who don't know um earlier years, consultant network is part of ACP and is for senior trainees and early years consultants in the first five years of being a consultant. So for those of you who are coming up to per CCT fellowships or are looking at consultant practice in the next year or two, it's really good way of learning about some of those things that you're going to have to face in your first few years as a consultant. So this is briefly what I'm going to talk about. There's a lot of firsts in there. Um And I think that's what consultant life in your first year brings. It brings new experiences and a slightly different perspective to being a trainee. So, surgical training is a journey and as a trainee, you have many, many loopholes and hurdles to go through. So your endpoint becomes the point at which you get your CT or the point at which you become a consultant. The problem is you get your CCT, you walk away. Hooray, I got my CCT and then it's a little bit of an anti climax as to what happens next. So the end goal I think is pushed further back. The beginning of the journey of being a surgeon actually starts when you get that CCT and you become independent. So it's just trying to change your viewpoint. The end point of your existence now isn't becoming a consultant. It's what's going to happen beyond that. All of you have seen this before. This is some of the core curriculum competencies that your surgical training is designed to deliver and what it unfortunately doesn't deliver very well is the transition to being a consultant. But it does give you the skill set to be able to deliver some of the core components of being a consultant. So you may have all the skill set, but you may not be polished in certain areas. So the transition is about that, it's making sure you have the relevant network and support to enable you to grow in that job. So a lot of you will be sat here if you are nearing the end of your training, wondering if you're ready. So does anybody wanna just shout out when they think or how do you know you're ready? I don't know who's seen you in junior. So I don't mind any perspective on that anybody. Otherwise I'm gonna pull you far. So you've got your numbers once you've got your index procedures done. OK. Anybody else in the back? Ok. So do you think that there are consultants out there who don't need any help? No. Yeah. Anything else? Yeah. Um So like we said, competencies are ticked. Um I think that makes you competent. Whether that makes you proficient is another question. You can make decisions independently. That's very difficult to judge as a trainee because you've always got somebody you can pick the phone up to and ask so often you may feel you made the decision, but there's always that top cover when you become the consultant, that top cover goes. So suddenly you are very much the decision maker. You can cope with any complication or any operation. I don't think there's any, any surgeon in the room who thinks that they can deal with any of those. So that's not really something that you should be aiming for. You don't need to ask for help as often. The perception is that, you know, when I stop asking for help is when I feel I'm ready. But I'd argue that there are lots of instances where I still ask my colleagues and the same goes for, my senior colleagues will come and ask me. So, don't be fooled by that. It's not something you need to aim for to say I'm competent. Now is when I can't, when I don't need to ask for help anymore, because you will have to do that as a consultant. And it's actually a good thing to recognize that and embrace it. I think this is a good measure quite often consultants who are around you working with, you will know when you're ready. So when you're coming to the end of your training, go and seek active feedback and support and their advice and what their perception is and have an honest conversation about it because often you are so embroiled in what you're trying to achieve. You lose the bigger picture and the people around you are often the ones that can say, I think you're ready now and you can do it. So what happens when you arrive? So you go to sleep a as a registrar and then the next morning you wake up as a consultant. OK. So what you're gonna walk in on, on that first day? Super excited. I've got to it. I, I've got my consultant job. Well, actually there's a lot of stuff written about working in a new system and the 1st 100 days of working in, in a new system. So you very much have to take a step back. So use that enthusiasm. But don't go delving into a department and start doing crazy things without really knowing how the department works. So you want to take a step back, you want to focus on the things that you're never gonna get time to do once you start clinical work, which is all the induction and boring mandatory training. So get that out of the way, connect with as many people as you can. So go and introduce yourself to all the nursing staff on the wards uh outside of that in terms of your colleagues. So oncology, colleagues, gastro colleagues. So you want to know the department, especially if you've never worked in that place before. You want to make all of those links because they're going to become important in those next few months. And if you don't know who to ask, you'll be more, you'll struggle to ask and then meet the managers. A lot of the time trainees don't have any interaction with management. So it's going out and seeking, who do I need to call and ask about this? Who can I who's gonna help me do this. If I have a problem with theaters, you know, it's doing all of those things and then it's dealing with the firsts of everything. So the first theater list again, go simple. Don't book anything that's too complicated under book. If it's possible, work out what equipment you may need. So I don't know how many of you have an idea of for this operation. I need this, this, this, um, I got asked and I kind of walked in and said, II can do it with whatever you give me. And you think that that's the right thing. But actually it's not because the poor sister theater is trying to work out what equipment they need to put on the tray for you. So when you're trying to be all flexible and I can do whatever, actually, it's counterproductive. So have a think about those cases and what special equipment you may need that, that hospital may not have, do your homework. So you don't want any sense surprises. You don't want somebody on your theater list, potentially that you've never met before. And that's often what happens you go in, you don't have your own patients, you pick a patient off somebody else's waiting list. Often they're a long waiter. There's a reason that waiter, so just be careful with that and do your homework on that patient ideally try and meet them before you operate on them. The first theater is, is stressful as it is. And if you're meeting that patient for the first time on the day of surgery, it's just going to make everything more stressful. The fundamental thing I think is often you go away and you think I'm gonna become a consultant. I need to become more confident. A little bit more sort of, you know, assertive, but don't become arrogant in that and don't become dismissive and treat all of those people around you, particularly your juniors with as much respect as possible. And then the f the other thing that's different is it's your name on top of the bed. So that brings AAA completely different mindset. And until your name is on top of that bed, I can't, II don't think you understand the implications of that. So when you're booking that list, just have a little think about what things you are so confident with that you can do with your eyes closed. So I was a fellow in Oxford. I booked I did two lap I colleagues what the week, the next week when I was becoming a consultant II put for my list in two weeks time, an eye colleague and a reversal of an E colleague thought that'd be fine. Our kid in law is the longest I colic and the most stressful idool I ever did. OK. So it's just being aware of the fact that there will be some emotional stress attached to doing that first independent list with the responsibility of the patient first day on call. Um So the aim is survive, you know, you want to survive those 1st 24 hours or whatever the pattern of on call is, take a bit of a step back and think about how you're gonna manage your time. So it's different as a registrar compared to a consultant, as a registrar, you're on the shop floor, you're doing everything you're interacting with all the patients, you're making some of the decisions and actually doing a lot of things as a consultant, you're managing a lot of things so you can't do and manage at the same time. So it's realizing that in order to manage things, I have to let go of some of the doing. So I've spent my first three months going to every single appendicectomy because I was concerned that the person might not be able to do it. There might be a problem. You become better at understanding what you can delegate and when you need to intervene and it's about learning those things. I have a strategy. So, you know, we I'm gonna turn up for the post state ward round. I'm gonna wait for a period of time. I'm gonna go back to S AU at this time. Cos you're not gonna be on S AU the whole time. So that's the difference. And the particular difference I think is how many of you do non resident or has, has anybody done nonresident on call? Ok. What's the challenge of being a non resident on call? Ok. Good. So, you don't, you're sort of worried about things that are happening without your knowledge, anybody else? Yes. One. Yep. So, it's the same as a consultant. You're relying on the person at the end of the phone telling you the information you want. So it's that judgment. And again, yes. And, and that's key. So you'll get called at two or three in the morning, they'll, somebody will rattle off this really seriously ill patient to you. And it's working out what bits of information they're giving you, that's actually key. And then what bits of information do you need to make your judgment? Often it's about asking them, what do you actually want me to do? If they're a junior person, they might want you to come in and see the patient. If they're a more senior person, they just want the go ahead to say I can carry on. So it's sort of deciphering in all of that. And I think for me, I have been so active as a reg that I struggled to make that transition. And so for the first few on call, I just put a bed in the office and stayed because if somebody rang me, I wanted to be able to come in and see the patient. And as time went on, I understood that how to get the information I needed to make that call about whether I need to go in or not. Um So it's understanding that bit of information and having a, a little tick box exercise in your head, you know, I'm gonna ask about this, this, this and then make an objective assessment of whether I need to go in. Um, and then remote access. So for me, if I get called, I can look up a scan, you know, that's what often I'll do, I'll, I'll look up the scan, I'll look up some of the, you know, E pr notes or whatever it is to make that decision for, to work out a strategy that works for you. First complication. OK. Hands up everybody who remembers their first complication as a surgical trainee. OK. Anybody want to share how they felt and then I'll share mine. Shame, shame. Why is it pretty nice? Yeah, like OK, so my first complication as an sho working in neurosurgery in Oxford was I did my first independent ICP monitor and the patient two days later developed an extradural hemorrhage and ended up needing a craniotomy. It was a 16 year old boy with learning difficulties and um had long term B patients and all kinds of things. And the one thing that I struggled with the most was seeing the family, I could not look the parents in their eyes and say this is what's happened and this is what we're going to do about it. So you basically as a reg you step that up because the stakes become higher. You know, you're doing more complex operations. The leak is obviously the one that keeps you up at night. You go up to the third of that as a consultant, you're now in charge of sorting it out. Ok. So that's a slightly different thing. It's not just the fact that the leaks happened and you've identified it suddenly you've got to work out. Do I take this patient back to theater? Do I do a drain? Do I do? And this, you know, all of those things are now your primary concern. So the first thing that happened um with a complication is you become the second victim in that. And there's quite a lot of um evidence based that basically says if you're a junior surgeon, you will think that the complication happened cos you, it was a direct consequence of your actions. Ok. So you think it's either a lapse in judgment, you didn't know what you were doing or there was some problem that happened that you couldn't control, tends to happen more with women and more with junior surgeons because they personalize the complication. So they think the complication is to do with their own actions. And often it's just one of those things and we all know everybody gets complications, but it's that perception that I have caused the complication and therefore you struggle to deal with the complication. So how do people deal with complications. This is a really nice study, basically looks at sort of the three stages of dealing with the complication, similar to possibly the three stage, five stages of dealing with grief. So first stage is denial, you know, oh my God, it happened need to run around to try and sort the patient out. So your focus is the patient. You often lose sight of who what's happening to you in that. After a period of time, you become better at understanding what's happening to you. And at that stage, if somebody comes in and gives you some objective support or you talk through what's happened, you'll get beyond actually what happened and start understanding why it might have happened and what you could do differently next time. And then the last stage is when you actually completely objectively depersonalize yourself from that situation, and you can objectively discuss it with the openness and the transparency that you need to understand the implications it's had on you as well as the patient and possibly the wider team depending upon the situation you're in. So those are the areas where you can sort of get emotional support, active support or even professional help. The main thing is to um realize that the long term effects of complications, particularly if they happen in succession can carry, you carry with them with you forever. So you really have to become good at managing yourself in that journey because you've got a long way to go. So you've got to be able to deal with it and, and then move on to the next first complaint. Very, very annoying thing to have. Um And you think, gosh, you know, I did this really good operation, the patient walked away, they had a really good outcome and then the complaint lands in your inbox. So the first thing is, don't, don't get angry about it, walk away from it, try and process it. The main thing about complaints is they're nothing to do with the outcome. They are to do with the patient perception of that outcome. So somewhere something has gone wrong in your communication or your failure to listen to what the patient's concerns were, that is often the root cause of the complaint. It usually you sit there and you criticize yourself. The main thing to do is to try and put yourself outside of that situation and try and understand what the patient went through and then relay um your comments in an objective manner and it's an opportunity to learn, reflect and improve. But I can tell you it's very difficult to maintain that sort of objective viewpoint when it does arrive in your inbox, who's been to Coroner's Court. So no trainees have been to Coroner's Court. Is that fair to say? Ok, so I say it's a missed opportunity. This is by far the most difficult thing I did in my 1st 12 months is go to Coroner's Court, I'd been as a trainee once before and I stood in the witness box and given a statement which was unusual. Um So I had some idea of it, but this is much more difficult as a consultant. You are ultimately responsible for the patient. It relates to a adverse patient event. It is a fact finding ex exercise to establish the causality around death. But it's very difficult to remain open and honest because there is a lot of emotional baggage that comes with a case that's got to coroners. So it's trying to understand what support sex network you have. So go and talk to colleagues especially go and talk to the legal department in your trust. They will be able to offer you some insight into the process, but also in how you write the statements and how you respond to the actual inquest. So consultant life is different to trainee life and the main things that are different are responsibility, expectations of those around you and the patients that you treat you are suddenly the independent decision maker. So you've got to start thinking about things that you didn't think about before. How many patients am I seeing in clinic? How many patients do I on my, on my first endoscopy list, what cases am I gonna do in theater? How am I going to prioritize them? So those are things that you won't be exposed to directly and you've gotta navigate new things job planning, appraisal, teaching, research governance. You're suddenly in charge of these things that you weren't directly in charge of before. So how are you gonna prepare? So how are you gonna behave as a consultant? Something you really do need to ask yourself, am I gonna behave like a trainee? Am I gonna behave like this person that I've worked with? What am I going to change? What kind of surgeon do I want to be? What kind of team leader do I want to be? I like flat hierarchies. I spent my first few months when I became a consultant sitting with the registrars in their corner that far. I know that everybody sits in and I was very much like I want to be one of the registrars. The difficulty with that is when something bad happens or you have to discipline somebody or you have to respond to an adverse outcome or something like that, it becomes very difficult to suddenly take on the consultant hat. So it's understanding that you want to be one of the team, but also you are responsible and you are the top cover. So you have that comes with that responsibility. It's also having a wider lens. Suddenly you start having to think about the department where the department sits within the other hospitals around you. You start looking at resources and governance and then what the wider NHS political landscape looks like. These are things again that you don't directly think about. But when you become the consultant, I became a consultant, I was made IBD leads straight away. I was looking at how we reshape IBD services that changed my entire perspective. So what can you do now focus on your non technical skills? The entirety of surgical training is focused on technical skills. It's all about ticking the boxes to make sure you are competent in all of the different operations and procedures. But I can't stress how important it is to actually focus on the non technical elements. Act up as much as you can. OK? So if you work in a in a hospital where you have the consultant, support, say to the consultant, I want to be the on call consultant for the next 12 hour shift and you can sit in the office and I'll come to you if I need you. But I want to give it a go, you're not gonna learn by not doing it. So act up, make decisions. So when you ring your bosses and say this is what's happening, say I think we should do this. What do you think? So you've already got an idea of where you want to go and then you're telling the consultant, this is what I want to do. What do you think? Rather than asking the consultant for the decision, you're willing to hear criticism and seek feedback of all on those things, on the softer skills on the non technical skills, go back to your consultants and ask them whether there are elements in your communication, in your behavior, in theaters, in your ability to work in a team and ask them for feedback, do some admin. So I never did really any admin. I hate admin. Um and I didn't do it as a trainee. And suddenly you realize that it's a large work part of your work doing admin. So do as much admin as you can if it's possible attend consultant meetings. And I think fellowships are very important for maturity of surgical thinking, but also an opportunity for you not to be focused on the tick boxes and actually take time out and do the things you enjoy. Support network. So it would be great if those who are senior and going into first year consultant, life join the Y CN, we will be posting webinars and things that will help but also seek informal and formal support. So have mentors that you can ring in your first six months of consultant practice either inside or outside of the hospital who can be that person that can listen and give you another perspective, self preservation. Far, I will tell you I'm very bad at it. Um But it is a work in progress. Learn to say no, don't say yes to anything. For the first few months, I'd say until you've established what, where you are in the department and then start taking on roles and enjoy the ride. Thank you. Thank you boss for a fantastic talk. I wonder if anyone from the audience has any burning questions for Miss Patel they would like to ask. Yeah, yeah, we're just gonna keep it to one or two questions and then Miss Patel is seeing for dinner so you can chat to her. Go ahead. 275. Mhm. So set boundaries in terms of what your professional in your personal life is going to look like. Um So I think a as a trainee, you have a very fixed schedule, you know, you come in, you you do the ward round at eight, you do whatever else you need to do. You go to theater, you have set timetables as a consultant. You don't, you have the flexibility to work out what you want to do and when you want to do it. So it's been strict about sticking to the job plan and setting boundaries in terms of what clinical workload you take and then in terms of what impact that has on your personal and professional life. So it's working out what you want to achieve in those 1st 1218 months and staying true to that rather than taking on too many things that will mean you'll struggle to deliver it. Thank you. Thank you so much for that boss.