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It's great to see so many of you here after a splendid evening gift today. Uh, and in the early hours of this morning, my name is David. I'm the outgoing BMA rep from the committee this year, and this session has been set up as a lifestyle session. And when we thought about what mattered and what would be interesting for you as trainees, we decided to focus on burnout and strategies of how to avoid that. There's a recent survey that some of you may have participated in run by one of our colleagues, and it showed that of those people who responded, 68% of respondents said they had moderate degrees of burnout and 22% said they had severe. And if you think about that for the implications for training for the winter pressures that we have ahead and for the remainder of your career, it's clearly something which is a growing pressure, and we've chosen to focus on it with four speakers today. First up, we will have Tom from the Manchester region. He's a trainee, and he's gonna speak to us about balancing his work and his life. Then we'll have Mr action the T P D. From the Percival Pot rotation. We will have Edna and the Soma from the MD you talking about how to navigate the medical legal landscape and then Lisa Pennington from Itch MHA smear. Um, Ali is a financial expert, and we'll talk to you specifically about tax and pensions, something that may not necessarily seem hugely important at the minute where the financial implications of what we do, our work and planning for words is a key part of what we want you to hear and hopefully helps you in the future. So I'll invite Tom to come up. Tom is a S T four in the Manchester region. He's a professional ice skater who has been featured in dancing on Ice. His wife is a professional ice skater. He has research interests in sports injuries, and he's also a father husband and has two lovely kids that you may see in Hello magazine or other kind of, uh uh, magazines like that. 100 to 2. Good morning, everyone. Thank you for coming. I gather the dinner was quite successful last night, so it's nice to see some faces here this morning. Thank you. for the introduction, David and thank you to bow to for having me come and talk today. As you can see, I'm going to be presenting on sort of finding balances of trainee and how to avoid burnout so I'll run through who I am. I'll run through what I do, what I've done in the past, and hopefully that will feed into the experiences I've had within training and within life, sort of have an opinion about how best to maybe find some balance. I'll then feed that back into what I might recommend then, for people that are wanting to avoid burnout or feel the initial sort of tingling sensations of negativity that might be a cursor for burnout. I'll then sort of summarize and wrapped up with what I think I've learnt, and my hope is to avoid patronizing anyone. Some of the things I'll mention are probably simple. Some of the things are probably things that you do already, but if one or two people leave here with a little bit of an idea about things, they might be able to change their life, Then I'll consider it a success. So this is me, um, fairly standard. I did my degree in Leeds. Um, I indicated an anatomy like a good surgeon would do. And then I carried on my foundation program in Yorkshire, in Leeds and at Pinder Fields, which is in Wakefield. And then it came across the pen eyes to the Manchester region for my core training with a theme in orthopedics. And then after that, I took a slight break from training. I was a locum S h o for a year, which really was a good life for a little bit. And then, um, I was unsuccessful in my application during the covid year and took on a non training registrar post instead. Built some experience through that and then finally got my registrar training number last year. And that's where I'm at the moment in north west of England. But of course, much like those of use here today, there's so much more that adds sort of color and meaning to my life. And it's that that I want to talk about and how I sort of balance that in with my sort of training expectations. So before I went to medical school, I used to do this. This is professional ice skating. I did this as a career, really, so I competed nationally during high school and college. I then use these skills to take me away, traveling intentionally, only going for a couple of years, and it dragged out into four years. But this was a fantastic experience, and it sort of maybe meet so many different people from so many different backgrounds and so many different cultures. I also had the opportunity to perform in arenas around the world, which was fantastic, and I only did I do this before medical school. But during medical school, in the Christmas and sort of summer breaks, especially, I could take on extra contracts and filling extra things around my medical studies. Now, of course, once you enter sort of towards the end of medical school into foundation years, that free time dries up and I kind of put that side of my life to the side, Um, and sort of carried on with my medical career during foundation Year one, I got married and then in FY two, I had a little boy, so it's my son, Theo, who's wonderful, and that was a big turning point for me really it was round, about sort of core training. End of CT one, entering two CT to thinking my applications to registrar training. Then I started to have some negative feelings about the work that I was doing, and I will touch more upon those in a minute. But after discussions with friends and family and senior colleagues in the region, I decided to take a break from training intentionally. And I knew that I was going to spend this locum year sort of spending more time with my family, with my son having more control over when I worked shifts and what I did outside of medicine. But the opportunity arose to be involved in this TV show. This is I TVs dancing ice. So a colleague that I had worked with before before medical school invited me to come in audition. So I got a roll on the show as a professional partner. And this, as you can imagine, is a very different experience from working in the NHS. So working with a big budget TV production like I T. V behind the camera every week, working and training from that is very different from sort of the health service that we work in. But I was still doing locum shifts on the side of it. So it was an amazing experience. I really enjoyed it. There were highs and lows, and it sort of shine the light as well into the positives of working within the health system. Aside from that, I used the time that I had to do a postgraduate diploma in sports and exercise medicine, which is something that really interests me based on the back of the eye TV thing. I was invited to go and do a bit more TV work on this morning and the BBC appearances. And again, this is another amazing experience that I had and I really enjoyed it. But it was never an intentional thing to me, which is an opportunity that came up that I sort of took on. And I was very fortunate to go on a TV a couple of times and then one or two appearances on BBC as well alongside that. This is my second child. This is Lilia, our little girl. And this is, uh, from a recent photo shoot that was in okay magazine, as David mentioned. So they are sort of like my number one priority now, and they're factoring around all my work at the same time I've been involved in research and then maybe one or two of you here in the room that were involved in this study, the path study. So I was one of the national leads on this. Um, if you are in the room, thank you for your contributions. I'm sorry it took so long to get published, but we got there eventually. Aside from that, this re areas. Recently, I sort of completed my master's degree as well in sports and exercise medicine. That's led me to do more research work with athletes, especially in my chosen field of figure skating. So that's me, really. So it's not just about the orthopedic side of things. It's about balancing and adding in things that bring color and experiences to life. So what do I do? Well, yes, I'm an S t four in trauma orthopedics. I think the main priority for me is that I'm a father, and that takes a lot of focus from me. I am still a professional figure skater. Um, I am a sports medic. In some terms I work with professional hockey teams and current figure skaters as well. Although I've dabbled in research, I wouldn't go so far as to say I'm an academic surgeon and on the side there's been a couple of TV appearances in public profile, but it's not really a priority of mine. So when we discuss these kind of things, I think burnout is a question of balance, of course, and everyone is going to have their own ways of approaching it, and it's tailored to their individual needs, their individual experiences. So these are some things that have served me well, Um, and hopefully maybe something that you can take on board and consider. So what did I experience? So I had a distinct loss of interest in the work that I was doing. It didn't matter whether it was a trauma list, an elective list, whether it was clinic. I just didn't look forward to coming into work in the daytime, and that was a big change because I've always loved orthopedics all the way through medical school. I had a distinct resentment for training goals as well. To put it simply, I was just tired of jumping through hoops, and that got me quite worn down. And the prospect of looking ahead towards registrar training going straight into that and then on to a consultant role was quite daunting for me. So I spoke to some trainings in the region then and spoke to sort of t p. D. And had a look at options available to me. Now, in terms of what you might experience, not everyone's going to feel the same. You may have some or all of these features, the things that I've just spoken about or sort of even more significant things. So you may notice a deterioration in your clinical and you're operating skills. You may notice the clouding of your judgment, and you may also find that you're going more towards depression and anxiety with feelings of hopelessness as well. And it's these kind of things that we wanna avoid happening, because while it may be a variation of things that you experience, there could be a knock on effect of both your health, health and your patient's health. So, of course we want to try and avoid that. So then what would I recommend? Okay, so I don't have all the answers, and I do still struggle at times. But hopefully, um, we can sort of come with some things that might benefit other people. So the first thing to say is, be aware of how you feel and act early. So I was very fortunate to realize that I was having these negative feelings and took positive action at the time to prevent it from getting worse. I think once you get into a really bad position where you are hating work, hating your specialty and feel like you can't go on, it's much more difficult to change tack and, you know, make improvements. I think if you act really and you had positive discussions with those around you, you might be able to find solutions. I think it's important to say that it's that you shouldn't ignore your feelings, and no one is too strong or too committed to specialty or two talented to completely sidestep and avoid burnout. As an add on to that, I think that we need to consider our overall well being. I think it's much easier to be happier in your work life if you're free from exhaustion and ill health. So whether you're sort of noting the effects from studying work or socialising. I think it's important to prioritize sleep and you look after yourself physically. We had a recent regional teaching, and it was mentioned that burnout is closely related to over a well being, and that was linked into sort of hierarchy of needs and the things that we need to feel well as a person. And of course, you have your physiological side of things at the bottom of this hierarchy. But there's also things like belonging in the self esteem and a place of sort of being happy. And a lot of that will involve the people you surround yourself with and the conversations you have with colleagues. At the same time, I'd like to just take a moment to think about the well being of others. So it's important to sort of have that social structure around you. But we know that doctor, mental health, suicide related suicide and an exhaustion related deaths are an issue with the medicine. So I think we all have a responsibility for not only ourselves but those around us. For me, this is one of the most important things, and it can be difficult, but I think finding something that keeps life in perspective is very important. So the emotions and the feelings that we have of burnout are potentially more due to being overwhelmed with tasks that bring little value to our life, that we don't enjoy, that we feel like obligations rather than as being sort of too busy for me, especially during those years I had between training and even more so now I'm as busy as I ever have been. But because it's filled with things that interest me and things that I'm really enjoy, I don't have those feelings of being overwhelmed and being stressed and burned out. I think once you add in perspective, you realize and this may be a controversial thing to say at this conference. But life is not necessarily all about orthopedics. I think that when viewpoints changing, we sort of grasp that a bit more and we add in a bit of color and flavor to our life. Then we may deal better with burnout. So my major turning point, of course, was the birth of my son and that just shifts things completely because the small things that overwhelm you potentially. You then realize that they matter less, you know, and it doesn't become such a big worry. Now. I'm not suggesting having a child is the best way to avoid burnout at all. But I think when you can find something, whether it's a hobby, a life goal or travel that will add something extra to your life. Take David, for example, that introduced me. You may be whether he recently did around the world cycling trip. Now imagine the perspective that gave him into other people's lifestyles and the way the people live and the other people worries in the general scheme of things. That then, when he comes back into the health service, he probably feels, while albeit very down to not be on his bike anymore, a little bit more settled and happy in his training decompress. Now. This was something that, at the recent, the recent be okay Congress. There's a There's a talk from some prominent leaders within the medical field, and every one of them highlighted the importance of having a decompression valve and that had helped them maintain these prominent roles in such senior positions of leadership. Now, for one person this was a simple of going for walks with his dog, and he would vent to his dog, another gentleman. It was because he would go on a cycling trip with his son, River so often. But we all do need something that relieves the pressures from work. Because we have a high pressure job and that might be sports, it might be running. It might be meditation or yoga within orthopedics in our region. One of our trainees let a study that looked at resilience and found that those that regularly take part in meditation, hobbies and crafts and sort of weekly sport had significantly higher ratings of resilience than than those that didn't. So I think if it is physical activity that helps you to switch off and turn away from the pressures of medicine, then that as well we'll feed into your physical well being that we've mentioned, which is a positive thing with all these different roles going on, my opinion is that it's it's difficult to do all of them at one time. What happens is you then start falling behind on everything you to do list grow bigger, and you just sort of end up being bad at everything. So the way I work things is that I prioritized different things at different points. So this is one that's taking a lot of work, and I'm still still working on at the moment. But for example, when there's weeks when I'm on call or when there's productive theater lists or there's an upcoming Ercp, everything goes into work side of stuff. Okay, I know that's going to be the case for those week or two when I have sort of research deadlines approaching or you're a key part of an audit cycle. Then probably extra study time late at night, then takes priority and you lose sleep a bit because you're doing those extra things. But that's not sustainable either. And then when you say my partner is working more and I spend more time with the family and look after the kids, they will take focus and I'll direct everything towards them. I think to do this, though it takes a good support structure which I'm very fortunate to have. But it also means that you have to get comfortable in falling behind a bit on something while accepting that you will change your focus and you will catch up and just being comfortable in the fact that it's not sort of a long term thing that you're putting this to the side. But know that you've got a plan and you will turn and you will get this done eventually. That also goes that getting comfortable with saying no and I'm sure there will be people here that are along a lot further along their training pathway than I am. But I feel like when you first start, you get offered lots of different things and you feel that you have to take everything on because the goals you have to meet and the training objectives seems so numerous that you have to take everything. But the key thing is that if you take on too many projects, nothing gets done. You're waiting this growth you to do. This story grows longer and you end up just sort of falling behind on these projects that you've agreed to do instead. If you focus on things that are probably going to do you well, you will then prove yourself to be reliable and even better opportunities will come your way. Those features are being reliable, enthusiastic and interested. They'll all disappear if you become overwhelmed with too many projects all at once, and then you'll stop getting the office to do the really good things for me. I only take projects that either give personal gain so something I'm really interested in or career gain. So whether it's a chance for publication, a presentation or a leadership role, and if something doesn't meet either of those goals, then I won't do it just for the sake of saying yes. So I'll say no. And if you've realized that the early stages of a project that it's going nowhere then potentially bailout early as long as the collateral damage isn't too big Oh, just one more thing and that on that, get comfortable saying no, I think that it's really important that we distinguish our leave from our working time. We all know that out of office replies are heavily used by admin and management stuff, and I think we need to get on that trend as well because as soon as you run leave, I think, especially our level. There's very little from a clinical patient care point of view that can't be dealt with someone that's at work or once you get back from work. So I think that we need to start embracing out of office, put it on as soon as we leave work and have that separation from the things we're doing outside of work and things were doing it. Okay, um, another one. So So when I was talking to my wife about this and sort of what she thinks that might be worthwhile, she mentioned that she feels like I tend not to get too flustered about things, which I was surprised that because I don't often feel that way. But I enjoyed the compliment. So try not to worry about the uncontrollable. So I think that there will always be many inconveniences that tax our time unnecessarily. Um, I if we consider sort of the circle of influence, the things that we can change and we can adapt to, then great. There's got a lot of things that are in your circle of concern where you have no power over. And it's at that point that I think we need to start letting that go there. I think there's always one placement within each Dina re that either is a long commuter way, has poor training opportunities or has really low operating numbers. And often there's. There's no way around it. You go to these places and that's it. So the thing is to try and adapt as much as you can. So an example, really is that Last year I was at hospital. It was a short commute in a place that I had worked before, and I knew well, so I took an extra sort of working opportunities. I took an extra research and extra learning. This year, my commute is up to 75 miles one way, so I've taken on much fewer projects. I don't take anything on that involves me staying that worked longer because I know that as soon as my duties are finished there, I want to get out and go away and do something else to interest me. I mean, that may even just be extra stuff like this that I don't need to be at work for, and I can do in my own time. But yeah, trying to plan ahead as much as possible. Long commutes. I've tried to download podcast to listen to them, but I'll be honest. It's 50 50 split. Whether I have that motivation to listen on the way home, I think that we shouldn't be guilty about that either, because we do have a tiring job the fast. The final thing, I would say, is also sort of find out what your training program can do for you, um, whether it's as drastic as you just overwhelmed. And you may need to consider going less than full time because you've got other obligations that, in theory has become more available to us. So in the past, Category one was for care needs. Category two is for ill health, but there's now a Category three that we should be entitled to apply for a certain points throughout the year. There it's in it's early stages and there are rumours that it's there's some resistance on a local level due to staffing and do two rotor problems. But the Parents and surgery report from the Royal College of Surgeons recently highlighted that if this is implemented, well, then the retain mint of staff should negate any issues on understaffing, so hopefully that will become something more that we can see. It may be much more simple, though. A discussion with your t p d. About what you're struggling with and what they can help you with. And it may be that, you know, you end up looking sort of out of program experiences on that side of thing, and everything will need to be tailored to yourself, as I'm sure my stretching is going to mention because everyone is very different. But don't just struggle alone. Try and find out what help is available. I do believe that training programs want to retain trainees because they put so much effort and time and money into training us to this point that they don't just want us to drop out. So what I learned? Well, I'm not afraid to say there is more to life than orthopedics, Um, and that we can, you know, fill our lives with so much more. You can't do all things at all times. Um, I think that a full life is possible and it's beneficial to both yourselves and your patient's. And I do think that attitudes are changing. It will do even more so as we see sort of newer consultants come through that realize that you know you can have a bit of work. Life balance. I think balance and avoiding burnout isn't necessarily about doing less, but rather finding fulfillment in your life alongside your training and clinical work and something to distract you from the bad days that we will have and decompress from the stress that we will experience. And that's really got to say the last thing I will say is just consider that a rested, enthusiastic and passionate trainee will achieve more and give more back into orthopedics than one that burns out just before or after. C C T. Thank you all very much for listening. I'm happy to take any questions. There may be fantastic. Thank you very much for that. Do you have any questions at all on on what Tom's just gone through? Thanks, Tom, for that. Very, um, Frank and incredibly insightful. Interesting. Talked. You talked a lot about how you adapt to the job, but when you reflect back, do you think there's any way the job could have adapted to you to prevent you from having the burnout or whatever you want to call it? Yeah, I mean potentially. I think I think I was at fault for especially it sort of in the early stages of of having those negative feelings of not taking it to my clinical supervisor and educational supervise to talk more about the things that I was feeling to sort of make changes. Then I felt like it was more kind of like a dirty secret that I couldn't be vocal about. So I spoke to, as I say, sort of the senior to the ST Sevens and eights in the region, and they were the ones that sort of help guide me a little bit. Um, whether or not there could have been anything that happened, that changed my pathway. And it meant that I fed straight into training. I don't know. Um, I don't think as well that it was a negative thing. Me not applying. I think that that was right for me at that point in my life as well. And I think even having sort of the year when I was sort of doing S h o work, that was like easy, breezy, fine. And then the year I had as a non trainee registrar actually sort of was really beneficial for me entering into ST training. So I think definitely there. There may have been some things that could have changed, and I could have dealt with better at the time and discuss with people that may have had the power to change things. But at the same time, I don't necessarily think that that would have changed my pathway and probably wouldn't have improved the position I'm in now, so to speak, kind of thing. Anything else yet? Oh, thanks. That's great talk. Um, you mentioned about your S h O year being good because you have more control over when you were working. Have you cracked any secrets about how to gain control over when you're working? The on call shifts your rotor. Do you have any top tips about how to manage that, apart from miserable swaps, out of on call into another on call where you have heavier time where you're going to be away from your family? Yeah, I think I think it is really difficult. And it does vary a lot depending on the road to Iran and whether you're doing sort of resident shifts or not. I've been really fortunate in that all my training posts so far have been nonresident on calls, so that that makes you feel a little bit more free in terms of your time. But again, you're you're restricted in what you can do outside of your own court periods kind of thing. A lot of the time I have ended up making swaps that then mean I do quite a few one calls in one week, and at the time I kind of regret it. But afterwards, it's been quite nice because it has been a really rough week. But I tend to do a lot and learn a lot and do a lot of surgery and lot cutting during that time. It's very useful in terms of an educational point of view. I do need a break afterwards. I feel knackered for one for a better expression. But that has been the way that works for me now, Whether that's something that works for yourselves, it depends on how well you cope with that Sort of like a week of hell kind of thing have always been on call or not, Um, but I I do agree. It's really difficult when you stuck in this rotor, and especially if you don't get advanced notice of it. Um, and it's very inflexible, so I don't have any magic cures. Unfortunately, Tom. Fantastic. Thank you so very, very much. Uh, it's been a real pleasure to have you fantastic talk, and we'll follow your journey with interest. Thank you.