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Uh Firstly, thank you everybody for having me. It's, it really is a pleasure to be here. Thank you for Rupert for the invitation. Um So, as you said, my name's Imran Qureshi. I am uh Rupert's Foundation program director. Um But I, I have uh I have two roles currently actually more than two rolls it to be fair. But, but my, my most significant roles are that I'm a consultant infection at Cornell University Hospital, but I also work for Amazon's Tech Division A WS as an advisory, an innovation consultant. So, um I suppose I'm really here to talk about really my career and just more generally careers in the NHS and how we can think about them. Um uh Traditionally careers have been of a particular type, but I think that's changed over the last sort of 5 to 10 years and, and, and we can, we can sort of explore that little bit more. Um So traditionally, I suppose you're very used to what we call the conveyer belt of, of, of career pathways. So you start at your A levels, then you become sorry, I'm just assuming I'm speaking to Morris medical students here so, or foundation doctors. So air levels to medical student, the foundation doctor to shospr type, middle grade level, then two consultant and then too sort of c suite medical director, Cio CFO CEO and whatnot. Right. So there's that whole sort of very traditional pathway and change and, uh, certainly over the last five years I've been seeing that sort of being disrupted, more and more and more people are just not willing for various reasons to go along that pathway. And I'll give you sort of two examples. Um I don't know if people know who these, these two individuals are, the person on the left, maybe more familiar. His name's Ruby uh Doula, he's the doctor, he's the guy from doctors kitchen. So this is, he's a GP who essentially had, um I had, I suppose if you want to call it a personal crisis in terms of his health and he decided to become more active about his health and start looking up how to sort of eat veteran and how that would play out in his life. And he really discovered a passion for, for cooking and uh took that up sort of alongside being a GP and really just became uh an internet sensation with his doctors kitchen. Now he has a recipe book with Prue Leath and, and so on. So he's really taken that to another level. The guy on the right is John, he's a guy who is actually the founder of uh type surgery, a company that he started when he was an sho and um something that he was very passionate about, about learning and teaching education in surgery. And he essentially developed a really interesting artificial intelligence platform which he sold two years ago, I think he was to an American couple of called electronics for 500 million lbs. But, but, but, but so he had an interest really in tech and repaired an interest in, in cooking. Both, both took their passions and did something slightly different. Um, they don't necessarily work clinically anymore. But, but, but those are potential past that they took. So, um, uh you know, it's, I'm not saying that anybody who goes off the, off the track is going to end up paying 500 billion that, but I suppose I'm just meant you sort of demonstrating some, some examples of people who have done something different. Um So what I'm going to do sort of over the next sort of half an hour or so is just tell you a little bit about my story. Uh And uh, and how I've got to where I have. Um, and uh I'd like to think it was more by intentioned by accident, but I think that's not necessarily the case, but I'm hoping that there'll be some important lessons along the way that, that may resonate with you. And as Rupert said, sort of towards the end, we'll look at, you know, what we can do other ideas about how to take different parts in healthcare. So, so really, let me tell you about my story and, uh, yeah, if, if anybody ever decides to make a biopsy for my life, I want this arm need to play it. But, uh, you know, maybe by that time he'll be older and I'll be thinking of somebody younger. But anyway, um, so really, you know, careers in the NHS or careers in general, I suppose, um uh we want to think of them as very linear journeys or that we would like it to be a linear journey. But as I, as I showed you at the end, the conveyer belt theory of careers is no longer the case. And there's many sort of various opportunities that you can take um uh things that make you come along the way uh to tempt you off the beaten path. But, you know, I think part of part of what my story is hopefully will help you to see um you know, what opportunities there on and what one can do. So let me start right at the beginning as I always like to do. So um here on my parents, uh and I am one of five siblings and I am over here. So I am the second of a twin of what I call the bonus gift. Um uh My, my, my twin brother is five minutes older than me. Um So everybody says I was, I'm the bonus gift. So I like to say, well, I like to think of myself. My father is a pharmacist. Uh actually not no longer a pharmacist. He's, he's been retired for a number of years now, community pharmacist. Uh And my mother was sort of all things to me. She uh was a great significant role in my life and actually the life of my siblings as well. Um But she's also a businesswoman. She sort of set up an ice cream and Indian ice cream company uh many, many years ago in 1992 which actually still runs. Uh And, and that's one of the ways that she helped fund education, get us through school. And the reason I include this is because those type of ideas, that type of sacrifice that people make in one's life, the way that it affects you, the way that it shapes you as a person is important. Um And you value that more. Uh And it really helps to uh give you perspective about life and what things are important, what things are not. So anyway, what I did was because of my mother's very generous sacrifice earlier on in life. She, we, we managed to attend a private school in South London. Uh And some of you may or may. No, it's, it's called Gift. Um uh that's where I did my GCSES and A levels and really at the end of it, I wasn't exactly sure what I wanted to do with my life. But the one thing that I sort of got a little bit into when I was sort of 16 or 17 was computers and really it was building them. It wasn't sort of programming or anything like that. Just, you know, my, my, my brother and I used to get various bits of computers together. Memory cards, hard drives round, start biking altogether on the motherboard and put casings around it and building computers. And actually that's when we first started our very first company, what we thought was a company at that time, building computers. It didn't do very well at all. I think we made one and that was it. But, you know, when you're 17, well, you're not going to do very much. I, I say that but now 17 year olds are doing very impressive things. But back in 1998 7, I think it was, we didn't quite have the same scope maybe as people do now anyway. So what happened was I took a year out after my A levels and I worked for a risk management consultancy in the back office, sort of learning policies, procedures a little bit about the world. Um, and then I went actually to Queen Mary University of London to study computer science. So that was actually my first degree. And I, uh, I really enjoyed computer science, I must say, even though I felt the first year of my degree and failed programming, which was the only to compulsory units I had to do. I had to retake it in the summer. And then I fortunately passed it. But actually after that really, I don't like this word, but I'm going to say anyway, I really applied myself and, and managed to do all right in, in, uh, in my degree. But sort of halfway through, I thought to myself that I wanted a little bit more from my career, wanted to do something a little bit more human. Uh, and then I thought of maybe applying for medicine. So, in my second year of my degree, I applied for medicine and I got offered a place is in Georgia's in South London. And, um, the pre record, the requisite, the prerequisite for starting was to get a 21 in my computer science degree which I did. Uh, and then I started, um, at ST George's. Uh, so, um, yeah, which is actually where I was born as well. I was born in the same hospital. Uh, and, uh, you'll see that the story continues in ST George's even after that. So I did, um, probably, you know, the most boring years of my life. Uh, I must say I wasn't a big fan of med school but, you know, it's, it is what it is. Um, and I came out the other end, I want to see unscathed, but I don't think that was quite true either. There was some good moments, but like I said, I wasn't a big fan, but I started my foundation training uh in actually Croydon Hospital where I'm a consultant now. Uh It was the start of my journey as well and I actually loved uh being a junior doctor is probably the favorite. My favorite year of being a doctor was being an F one. That's not everybody's experience, but it certainly was mine. I really enjoyed it could, it was a really wonderful place to work, is a wonderful place to work. Um, and really was the start of, of many different adventures. Uh, so I suppose, uh, my innovation journey really started as an F one but really took off when I was an F two. and I was sitting in my throat. So I went to another hospital said Peter's Hospital in church. See, um, when I was an F two and I was sitting in my mandatory teaching, um, which was three hours every Thursday afternoon. And the antimicrobial pharmacist for the hospital was giving me a lecture or not just me giving us a lecture on gentamicin prescribing because it was a real problem in the trust. We didn't have gentamicin calculators back then. We didn't have sort of automated systems of calculating stuff. We used to do it with pens and papers and, and digital calculators. Um, yes, smartphones were there at that time. Only two years in we had smartphones, um and uh we used to find it tricky and there used to be about 60 to 70 prescribing incidents per month uh for gentamicin. So, so are the antimicrobial pharmacist? Really was telling us about it saying this is appalling. I'm here to tell you how to prescribe gentamicin properly. And I think I was, I, I actually became very uncomfortable with the whole idea that, you know, that there was 60 to 70 incident forms a month regarding this prescription. So, what I did was um and, and, and the, the chap on the left is Clive Grundy. He was the consultant microbiologist there at the time. And the antimicrobial pharmacist is the chap on the right honey. Uh Sure, angry Palestinian man who's one of my very close friends now. Um And I sort of emailed him and said, honey, I, I really would like to just sit down with you and understand sort of what the problem is a little bit further. So we met in our surgical HD you and I literally sat down and I said to him, tell me how to prescribe them to my sin because the wonderful F two that I was, I just kept delegating it to my f once, hoping that everything would be ok. Um And it largely seemed to be, but then I feel like I need to do something about it. And uh I sat down with him and I mapped out I did a process map of how to prescribe gentamicin. And, you know, I was a little bit horrified to discover that the, the easiest way to get from one end of that process to the other was through 17 different steps. And I remember saying to honey, I said, honey, I'm not surprised that people are making a lot of errors because there's 17 steps in this process and anywhere along that pathway, somebody can make a mistake. So, so really, um I just, I went home and I was actually just troubled. I thought, well, this isn't no wonder it's not working out very well. This, this is, this isn't a very good process. So, so with my, with my very um sort of active computer science brain, I, I decided that I was going to code an electronic gentamicin calculator, which is what I did. So this was back in 2009, I coded. I think that was the second gentamicin calculator in the country at that point. Um And but, but definitely the more comprehensive one, the the other one was a lot more basic than this. And I basically presented this to honey and doctor Grundy and I said, here's something that I feel will be helpful uh for, for prescribers of gentamicin where they just fit in the parameters um of the patient and they press dose and they will give you the answer instead of them having to figure it all out and actually, it was a massive success. Um We went from 60 to 70 incident forms a month to on average two a month. And when we looked at those incident forms a little bit more closely, we found that they were usually linked to local doctors who didn't know about the calculator and would still be trying to do it the more traditional way. So that was, that was really great, a good success and, and gave me a real buzz. Actually, I felt like I had done something really, really important for patient's and healthcare and I sort of was a little bit of a crossroads at this point. Um In my training, I was just finishing of two, I didn't really know what to do. Uh So I was just keeping my options open. So, so what I did was I came across a conference called the International Forum, Quality and Safety and Health Care. Uh And that was back in 2009. And I thought, wow, this sounds really interesting, sort of improving healthcare. That's sort of what I've just done. And I'm really quite interested in it now, but it, I was an F two, I was married at the time and I still am not to say that I'm no longer. And um but I couldn't afford the 1100 lb entry fee for the conference. So I, I sort of went to the medical director. I just walked to his office. And I said, can I have a chat with you? And he said, yeah, come one. Sure. I don't know who you are becoming, have a chat. And I said, look, I said, I spent my time, my personal time sort of making this gentamicin calculate which really has done nice things for patient's in the trust. It would be really, so I scratched your back. It would be really nice if you could scratch mine a little bit as well and pay for me to go to this conference, which he actually to his credit just said, fine, you didn't bad. And I did and said we'll pay for you to go, which was great. So off, I went to Berlin in 2000, March of 2009. And I really was exposed to many ideas that at that time, medical students, junior doctors were never exposed to the quality improvement systems, human factors, variability, you know, uh data measurement, all of the things that, you know, people get taught now, which we never had any idea about. And really, it sort of blew my mind um to think that, you know, the space existed and it got me super excited. So I remember going home, going home, going back to my hotel, the the very lovely Excelsior Hotel in Berlin. And um I was just excited, I felt the the need to, to make change in healthcare. I felt the validation to make change in healthcare that even though I was an, an F two, I'd be making change and there was so much that we could do as junior clinicians and I, I sort of picked up the, the hotels, um, no pad. And I sort of came up with this concept of this idea called depth, which was doctors advancing patient safety. So this was the birth of an organization of a quality improvement organization that I um that I sort of founded back in 2009. So I went back to my hospital and the guy on the extreme left is Mike Baxter. He was the medical director who agreed to pay for me to go really, really awesome guy, really great medical director. And I'm not saying that's because he paid for me to go. He was genuinely a really a good clinician, honest clinician really wanted to do the best for everybody. Uh The guy to the, to the right of him was Andrew Lyles, the chief execs. So I basically set up a meeting with both of these guys when I got back and I said I need to talk to you about an idea that I have and I want to start getting junior clinicians and really junior doctors at that time involved in doing patient safety work or quality improvement work. And they were like, yeah, sure, go for it. We don't have any money but go for it. Do what do what you need to. So, what I did was I went to the next teaching session for, for junior doctors and I said to them guys, I've got this idea about doing quality improvement work who would like to join me. And I went to the F ones and there were 40 F one's in the room and 27 of them said, yeah, let's do it. Uh And, you know, as I learned over the last 14, 15 years that I've been doing improvement work, um uh only, only I think seven or eight people ended up doing a project which, you know, it's just what I find to be the norm now, but that's okay. It, we did some really good work and, and I was really pleased with what we did and what I felt was, I'm really sorry, my daughter's going to interrupt. Uh Tony, I'm just talking. Ok, sorry, my, my, my Children have a very bad habit of interrupting. Um So, yeah, so essentially, um what I did was I started to get more and more involved, started to do more and more work in this space. And um and uh and kept really going back to the medical director saying I need more resources. I need to do some, some more work in this space. And, and, and at that time, I mean, I wasn't getting anything for it. If I'm quite honest, I it was just something that I was very passionate about something that I like to do and, and what I realized was that not everybody got it, you know, like the medical director got it. But everybody else that I was speaking to just didn't really get it. And I had to really persist in the face of a lot of opposition sometimes, you know, when you go up to people and say we're going to change the things that you've been doing for a while. And I did it rather naively, I must admit um that people which is not on board, they were like, we've been doing it like this, we've been doing these systems like this for years. Who were you to turn up and tell, tell us that we need to do it differently. So I went through a massive learning process of how to make change what quality improvement means and so on. But, but, but yeah, but as the medical director, Mike used to say to me goes, he goes, you know what your problem is, you're too bloody persistent, you know, and I, I wear that as a crown. I don't wear that as, as, as any badge of dishonor. And I think it's been an important part of making change and I think it's an important part for anybody to make change. But uh the organization that I found adapts it grew, we, we, we, we started holding sort of a national conference, we started holding some schools. Uh and uh we used to work with people all over the country. Um And, um you know, we, we were sort of the founders of some really important things like the Doctor Toolbox program. Um and which some of you may have come across or not. And there was some really great work that we did. Um So, so going back to the, to my actual story of what I was doing, um I was doing all this improvement but, but obviously I'm, I'm still clinician. I still needed to, to go on with, get on with quote unquote the career. So really what I did was I, I was thinking okay, what am I going to do? And I wanted to do surgery. If I'm honest, I wanted to be a surgeon. It was something that I quite liked, um, appealed to me. I have a very surgical brain in many ways. So having wanted to do surgery, my wife somehow convinced me that I shouldn't be a surgeon and I should be a general practitioner. So I applied for GP training, got a place in GP training, did it for a month and a half and it just wasn't for me. Uh And I'm not going to sit here and denigrate general practice because I have the utmost respect for general practice. Um All my colleagues who are GPS, I think they're really fighting a very important fight, but it just wasn't for me as an individual and my wife, um, sort of said, you look utterly miserable. Why don't you just go and do surgical training like you wanted to do? So, I said, thank you very much. And I found a leftover place in KSS after a month and a half and I became a surgical trainee. And really, um, that was the only time in my life that I hadn't been authentic to myself. That was the only moment that I can think of where, what, you know, what was, what, what authentically spoke to me. I hadn't followed the path and I followed something entirely different. So then I, I basically became a surgeon, did essentially what you would consider call surgical training. But along this whole path, I had been continuing to do my improvement work and really been engaged in it and, you know, been doing some really interesting things and what I realized was that my life at that time with the quality improvement and being a surgeon were fairly incompatible. I remember when I started as a cool surgical trainee, um, one of the ct to, she came up to me and she said, let me give you some advice. She said, if you're going to make it in this career, your policy needs to be, you know, you have to put yourself first and quote unquote, screw everybody else. And I looked here and I just thought that's not really the way that I operate. Uh, and, uh, what I found was at that time, this was a long time ago, that culture did exist. Um Even when I was the urology sho I was on call one in two. So every other day, I was on call over a four month rotation. And my consultants used to say to me, uh if you want to do surgical training, you need to come to theater. And I recognize that I recognize that I need to go to theater and needed to have a log book and whatnot. My contentions with that was that I was being referred, patient's who are seeing an A and E in retention with pilo with stones and pain. And I said to my consultants, I said I would love to come to theater, but I'm on call well into and sometimes if the other person was sick or I would think we'd be doing it sort of every single day. And I said, I'm on call. So how can I come to theater? They said the patient's and any can wait, you know, come to theater and then go and sort them out afterwards. And I said, with the greatest of respect, that's not the right way around for me. I need to start the patient's in any first. And once I sorted them out, then I can think about coming to theater. So really just my own values and what I felt was important to me as a clinician as a human being. I didn't feel at that time that surgical training and I were compatible and as much as I love being a surgeon I did, um, I felt that I needed to do something different. And along this time I had been spending a lot of time with honey and doctor Grundy and rather lively. I just thought, oh, this, this infection stuff seems pretty straight forward. You know, it's, and I just phoned Doctor Grundy at the end of the phone, he just answers a few questions about antibiotics. How hard can that be? Very lively thinking that that will do the another infection training is a little bit more involved in that. But anyway, I am, I took it around, I spent a year as an any middle grade as an any reg and I uh just did a year of, of doing that and I applied at the same time for uh for training and microbiology. And rather to my surprise, I got given uh offered a place to run through training place in microbiology uh in London, uh in Saint George's Hospital uh before I sort of go on to the next part of the talking. What happens next? I really think I want to emphasize this point that it's so important to be authentic in your career. Okay, whatever you're doing, um authenticity really speaks to people. It really speaks to everybody. If, if you, if your authentic, if you're passionate about what you want to do and what you believe is the right thing to do. Everybody feels that it's a very, it's a very honest um and very powerful um thing to, to, to demonstrate to other people authenticity. So my advice is one of the first types of advice I'm gonna give everybody is just be authentic. Don't do things that people want you to do, do the things that you want to do because you feel that the, the right thing for you as an individual, as a human being and that's not necessary to say right for you in terms of getting ahead in your career. But that may be part of it obviously. But what speaks to you and your values, I think that's really important. And that's the first piece of advice that I would give. The second piece of advice that I would give was actually given to me by my training program director and who still she's now my clinical director and we still work together. But ours consultants and she said to me, Eamonn grew up every opportunity that comes your way and worry about the logistics after. And if I'm honest, this has been such an invaluable piece of advice in my life. And people may just think that intuitively doesn't make any sense. Like why would you not think about the logistics of whether you can do something or can't do something? And I'm not saying that this is for everybody. It's not, it really is not. And you have to look sometimes that your own personal situation to figure out whether this would work for you. But this worked for me 100%. I've always done that. I still do that every time a good opportunity turns up, I'll just say yes. And then I'll think about how to navigate all the other bits around it afterwards. Now, like I said, that's not going to work for everybody and somebody might just think that's bad advice. It is for some people, but for other people, it's really going to help you. So just think about it and for certain types of people, this is a way to supercharge what you do. But you know, you're, you're going to know whether you're that type of person or not. But for me, this was super important advice and actually that sort of leads into the next thing that um when I started my training in microbiology, II, I was presented with some opportunities and, and, and the next opportunity was that I was contacted by the BMJ and they were setting up a new division called BMJ Quality. Uh And BMJ Quality was all obviously about quality improvement. So you'll, you'll, you'll be more familiar with the journals or BMJ learning uh those other divisions in the BMJ. But this was a new division that they were setting up in 2011, I want to say, and they said um because of my background in quality improvement they said we would really love for you to be our first clinical lead in, in quality. So I spoke to my program director at the time, I said I would like to take an up which is an out program experience and they weren't happy about it, but I, I got it in the end and I spent a year working at the BMJ developing a, a platform for quality improvement. I didn't actually do any of the tech bit of it. I, I was the healthcare person, I was the clinical lead and I worked with BMJ technology be MG Generals BMJ learning uh to really put this this product together which no longer exists. Sadly, but it was, it was a great product at the time and it was a great year. I learned a lot, I learned a lot about business. I learned a lot about product development. I learned a lot about working with different teams outside of the health service. And I would also always say to everybody that if you get a chance to do something like this, grab it with both hands. It's another year of training on top, but it's okay. You know, these type of experiences are invaluable. And if I could have stayed at the BMJ permanently, I would have, I loved it so much. Working at BMA houses. Awesome. They have an awesome canteen, really great food. Um and, and not badly priced. So anyway, after my year at the BMJ, I had to return to training. I had three years left as a reg. Um and I had some exams to take which I did. Um And when I got to the end, um I basically had some options about what to do. So, um I was told that there was a consultant job coming up quick. And so the clinical director, a cordon who gave me that very piece of valuable advice, she phoned me and she said Iran, we've got a position coming up as a consultant microbiologist, we'd really like you to apply for it. Uh But what happened was that post didn't come out for 10 months after I, after I was cc teeing. So I had to really pay the bills. My wife and Children relied on that. I couldn't just be jobless. So I decided to take a job as a locum consultant out Southampton Hospital, University Hospital. Uh And what I did was I sort of lived there during the week and my wife and my kids were in London. So I would stay there during the week and come back on the weekends. And I did that for about eight months when I was low coming, waiting for this position to turn up at Croydon, which it did in the middle and then it got appointed there. So, so when I was uh but before I got the job at Croydon, I uh the people at Southampton said to me, we'd really love for you to stay here as a substantive consultant. The trust that I had done my surgical training at my f to it. And I had spent sort of six years working as a part time, any reg once a week. Uh And I've done a lot of clinical governance and improvement there, which was Ashford and ST Pierre's, the deputy CEO reached out to me and said, would you like you to be a substantive consultant here? And then of course, I had the offer at Croydon as well and this was actually not that easier decision. I, you know, I, I live in Croydon, I live 20 minutes walk from Croydon Hospital. So you would think that this was an easy decision. Actually, it wasn't, I really loved working at Southampton. I thought it offered me many different things. Um Saint Peters was what I used to call my second home. Question was my first love. Um And clearly the closest and in the end logistics one. So I became a consultant at Croydon and very much as as was in my nature, I started off as a, as a consultant, microbiologist, but very quickly, um I realized that if I was doing the work that I was actually paid, being paid to do, uh I had about three hours of work to do every day out of my, out of my nine hours. And I'm the type of person that gets, that feels unfulfilled very quickly. So I started to be proactive and started to looking at different roles and things that I could do. So I became the stewardship lead within two months. Uh I introduced ward rounds in the hospital which didn't exist. At that time, I became part of the Sepsis Committee. Um I was I think eight months, a consultant and the position of the chair of the consultant body turned up, which I really got because nobody else wanted it. So I became the chair of the consultant body of three years. Um And wanting always with my quality improvement had to make change. I started, I started setting up sort of quality improvement sessions for junior doctors. Uh And I did a lot of that in a non formal role for the first two years. Uh and then became the Associate medical director for quality improvement. In the third year, I did a lot of local campaigns. I became the foundation program director in 2018, I think is this has been five, nearly six years. I think that I've been doing that job. I, I also um started teaching computer coding to healthcare professionals. It really came off the back of a suggestion by my appraiser who is an any consultant, still is an any consultant hospital. And when he was going through my history in my backlog, he said, you know, you've got a really interesting school in an it encoding. Why have you ever thought about teaching it to other people. I said not really. But then I did, I started teaching in December of 2018 for free. I just started teaching healthcare professionals at my hospital to code once a week. I would do it for 12 weeks and I did that for about three years. I just would teach throughout the year computer coding to different people. And uh I used to teach, teach it locally, but the pandemic change things. I had to move it all online and then it sort of expanded. Now. It's sort of a rate international thing and we're uh 18th, 17th cohort of it, but I'll sort of mention it again later. Uh I started obviously coding some things from my hospital. We, we wrote an antibiotic calculator. Uh I set up the outpatient antibiotics service in our hospital, which took me about two years to do that. Like I said, I, I became the Associate medical director for Quality improvement and research and development. So I didn't, you know, I, I used to do a lot which has changed now because obviously work part time, working part time for Amazon. I don't have all of these roles anymore. Some of them still exist but lots of them don't. But I think one of the important things was and this comes back to being persistent tenacious and, you know, it's really important that if you want to and I didn't do these things necessarily because of mobility within hierarchy. I did them because they spoke to me, um improving improvement has always spoken to me, especially in healthcare. And I did these things really because I felt that they offered something to, to people. Uh like I said, even computer coding, I talked it for free for three years. I didn't take any money from it because I naturally felt that, you know, healthcare professionals have brilliant ideas and we need to bring those brilliant ideas to the front. And if teaching people how to code, help them to do that, then, then that's something that we should do. But what we did actually was during the pandemic, we turned it into an online thing. We formalized as a company and it became uh the company code med, which I don't know if anybody on this platform said about it, but we started developing software, we started teaching online cohorts. Um We initially had just people from the UK, but we've had people from all over the world, from India, South Africa, America, Candida. Uh I think it's various European countries and obviously um doctors from the UK and we teach all sorts of healthcare professionals, not just doctors, we teach them how to code. Um And like I said, we've been doing that for a while. So that was something that I started as well uh in, in the, you know, in amongst my, my job as a consultant and doing all the other things that I was doing on the previous slide. Uh I then also got invited by the University of London to become an associate professor for teaching quality improvement on the Global Health MBA program, which is something I still teach on. Uh In fact, I did a session just earlier today. Um and I basically spent a year developing the module, putting all the material together, putting sort of course works examinations together. And yeah, I, I teach that module uh remote distance learning. I don't teach it in, in person. Uh But it's been a really interesting experience. I've learned a lot from it and I'm hoping that people who have been a part of the global health MBA have learned a lot sort of not long after that, following that with my, with my it hat on, I came across the NHS England's Clinical Entrepreneur Program. I've always been interested in entrepreneurship and I applied to the scheme and I got accepted into that scheme in 2021. I think it was January 2021. Very exciting. Um I really quite enjoyed the bits and pieces that I was doing with that. So lots of things are happening in the background, like, and what you'll find is that lots of these things happened really less by, in tension and more by accident. But again, you know, when, when, when people see you authentically in a space, when they, when they know that you're doing things because you passionately believe in something those people will come to you. I didn't necessarily go to anybody else, right? People would come to me and come to me with opportunities because or you know, he's not looking for anything. He hasn't got enough to, you're a motive. He genuinely sits in this space because these are the things that he's passionate about. It doesn't have to be quality improvement, could be made, it could be anything that you're passionate about. But, but that passions always is, I mean, people just feel it, they really feel it. They really feel if you're in that space. And I think, you know, people knew me for, for the work that I didn't quality improvement that and that really helped. And then obviously with my it how and I started doing things like this. And then of course, the scenario that the situation changed on, on February 15th 2021 where uh on my linkedin, I got a message from uh somebody from Amazon. Uh uh you know, it was a little bit out of the blue. I didn't expect it at all. And they said, uh we've had a look at your profile. You seem to be somebody who were looking for, for a particular position and we'd be really interested if you would think about applying to work with us. And um I, if I'm honest, I didn't really know what to make of it. Um They couldn't even tell me exactly what the job was. Sort of like a vague idea but nothing specific because there was a little bit of secrecy around the job and I didn't know what to do if I'm honest, it may just sound like, oh, that's like a no brainer. Big tech company wants you to work with them, but that's not how it panned out. I was very unsure the whole time. I was very unsure. I think I'm the type of person, as I said before, that I'm going to go for an opportunity in any case. And I did so I was like, okay, I'm definitely going to investigate it, but really all along the process, I wasn't sure if this was something that I wanted to do partly because, and I'll be honest that I'm a socialist and I'm not, I don't really, I'm not really a capitalist in that sense. And I don't say that as in any sort of modesty, people might even think I'm crazy and not a socialist. But for me, it almost went again, my political and personal values to work for a company like Amazon. But I spoke to a number of my friends and they gave me some really good advice about it being an opportunity to learn. And I think that's the way I sort of approached it. And in the end, I went through a nine stage interview process, nine stage interview process one day, which was like seven or eight hours of in tvs in a row and I got offered a job, Amazon. And I think the thing that I made very clear was that I'm not going to leave the NHS to work for Amazon. That was something that was non negotiable for me. It remains non negotiable for me. I like being a clinician. I don't like everything about being clinician, but I like being a clinician. I like doing the work that I do in clinical medicine. Um And that's always been a point of non negotiation for me. And even now, um if Amazon pushed me to become full time, I would drop Amazon and remain being a clinician in the NHS. I'm not saying that I work full time for the NHS. I would never do that anymore, but I wouldn't give up being a clinician in the NHS. Uh So, yeah, in July of 2021 I started working in Amazon uh in a particular division and at that time, uh I was doing a lot, you know, I was doing, I was held at that time, all of these roles, right? And um I think people will think, well, how the hell did he do that? I think I'm not saying that everybody can do it should do it right? I have a very, very forgiving wife. She's very forgiving. I'm very fortunate like that not to say that she doesn't matter me at times. She does with good reason. I don't, I don't begrudge her the morning that she does. I think she's very right that I'm one of those people who lacks a little bit of balance in life, quite a lot of balance in life. But I'm one of those people can't sit still who, who loves to innovate, who loves to be entrepreneurial. These things really take all of my boxes. So for me doing stuff like this is super important. Now, that's not to say that people have to do this or they should do it or even if it would sue everybody, it's not, I'm just talking about me, I'm not talking about anybody else. And like I said, I'm not advocating particular understanding a way of life. I'm just telling you about my journey. So um so now, uh you know, two years on, I um interestingly the first division that I was in, in Amazon, which really was focused around diagnostic. So flabby type stuff. I became the medical director for Amazon's laboratory and um I didn't do any lab work, but I was there thinking about how to make diagnostic product, which we could sell to different groups of people. And I was really fascinated to start learning about things like supply chain product development. Um You know how to think about sales, have to think about marketing things that I don't normally touch. What a great learning experience it was, it really was. But then Amazon global and, and this is one of the problems of working the private sector. Of course, Amazon Global decided that they want to shut, they wanted to shut down the diagnostics division and they sort of said to me, um uh oh, you know, where, you know, we're essentially going to make you redundant. And that was a new experience. I've never been made redundant before. It doesn't happen. The NHS. And I was like, okay, that's an interesting moment. But they said we want you to stay and we'd like you to move elsewhere. So I moved fortunately into a WS which is the tech division and I work within the healthcare vertical in an, in an advisory and innovation capacity. So I think of new technologies to bring to the NHS too improve the way that the NHS can work from a digital point of view. That's really what my journey has been up to this point. Um So, so uh I know that I've spoken for a long time and I want to give an opportunity for people to ask questions and do that sort of thing. So it's a really, I want to talk a little bit about what you can do. And I think what's really important that, you know, I've been a consult for most seven years now. And the thing that I learned in my journey, right was we don't have to do the traditional path of, of what people think we should do. We can, we can definitely carve our own paths. And I think that's just becoming more and more than norm. And I would strongly say to those people who don't want to do something traditional. You should think about what really matters to you. About two years ago, three years ago, I can't remember now. One of my previous f one trainees, she went to work at the PRU and she, she sort of messaged me and she said, I really need some help and advice. Can I come and see you? So, yeah, of course, you can. So she came to see me, she came to my office and she sat down and within five minutes she was just crying and crying and crying. And I said to, I said, look, you know what happened, what's going on? She goes, I'm, you know, I'm, I feel like my career is not going anywhere. All my friends are sort of moving along with the careers and I'm just nowhere. And I, and the first thing I said to, I said, I said, what do you want? You know, what do you want from life? She goes, you know, I want to be anaesthetist. You know, that's really what I want to, I want to aesthetics, but I really want other things. And I said, so what is the other thing? She goes, it's going to sound really stupid. But I want to cook professionally. And I said to her, what's stopping you from cooking professionally. And she goes, I just feel like I'm going to be left behind. And I said, that's just what you're telling yourself. Nothing's actually stopping you except for you. I said, why don't you just take a year out? I said, look, um, on the side, I said, do your professional course that you want to do and really investigate the option. Don't live this life with regrets about, I didn't do this or I didn't do that. And that's really what she went and did, you know, she really did that. She did some low coming. And now actually she lives in Australian, I think is doing an aesthetic training in loving life. Um But, you know, I think that often replaced restrictions on ourselves. We put the expectations of others on ourselves about what we need to be doing. And really what I want to do is I want to present, you know, five possible tracks. This is not by any stretch of the imagined the be all and end all of anything. But these are five ways that I think that, you know, people in your position should, should maybe be thinking, right? So I've called them tracks and the first track is your traditional track which is run through. So this is you in the very traditional, you know, uh escalator pathway or elevated pathway of getting through medical training, right? So you start as an F one and then you finish it as a consultant just, just going to a GP or whatever it is going through the motions. Okay. And that, that works for some people. Right. But I, I'm seeing it work less and less. Right. So, over the last five years that I've been a foundation program director, I've anecdotally noticed that about 80 to 90% of the F ones that I sort of pastoral look after end up doing an F three. Okay. When I was a junior doctor, that was very rare. Now, it's just very common and I don't say there's a criticism, I think it's a really good thing for people to take some time out, really evaluate what they want from life, you know, see the world locum, whatever is they want to do. I'm a great advocate for, I think it's great. People feel they need to be in that space equally. I'm an advocate for people who wanted to run through. I think whatever floats your boat, whatever speaks authentic d to you. That's what you should be doing. So, so run through is obviously the most sort of, you know, it's, it's a common thing that people know about, but then this is a less than full time unless the full time training. Certainly, when I was a junior doctor, it was very difficult to do less than full time training. You had to come up with a very decent excuse, either you had to have a child or to be married or you had, I don't know, there was so many weird things that you had to justify why you wanted to do less than full time training. Now, it's completely different. If you want to do less than full time training, it's actually very easy. Uh, if any of my foundation trainees ever said to me, even if it was in the middle of the year, just on a train full time any more. That's okay. You would train less than full time. Yes. Do you want do 80% 70% 60% 50% whatever you wanna do, speak to the foundation school, sit up, let them do it. It's actually that easy now. Certainly from foundation. I mean, I can't speak for higher training because I have a lot of program director and higher training, but certainly in foundation, it's super straightforward. Um And there's no real barriers to doing it. And I think again, everybody has to look at themselves in their own individual situations. Think is this for me? You know, is this what I want to do? Do? I want to do sort of, um, less than full time training. And for some people it works brilliantly well, they do 80%. They work four days a week. It really helps the mental health. They feel like they can really give 100% to their work. And I think that's super important. Uh No, the other one is track three, which is where people sort of want to keep the toe in but are looking for other things, you know, beyond medicine. So they say, well, do F one and F two will be fully registered, have all the competencies if we ever want to do, um, come back and do specialist training, but they want to go investigate other things. So they'll do fellowships or they'll go and work for a tech companies so they will apply to KPMG or Deloitte or, you know, or, you know, accents or anybody else, right? And I'm just various companies names, you know, um but they'll go and investigate life at that point and, and many of them will, will go on to stay in those industries. Um I think that's really fine, you know, I think if you want to do that, go for it, it's, it's a really good idea. The one thing that I will say though, um just from my experience of having a working for a big tech company is that um having entered at the level of a consultant. Okay. The first thing I got a, I got a very good leadership position, which was important, right? But I'm still a clinician. I will always be a clinician and my specialist knowledge will always be valuable if you leave after foundation training. I'm not saying there's anything wrong with it, but the risk that happens with doing something like that is that you leave at a very early time of your training. And whilst you have skills transferable skills as a doctor, at one point in time, you'll stop being useful as a clinician and you will just become like any other consultant, tech company, right? That's my perception of other people who have done that very early in their career. And whilst you may continue to read about medicine, if you're still not at the chalk face of healthcare, you can't bring those really valuable insights. And even now I'm just telling, I'm giving a lecture. Okay, even, even now, right, I think um even now, I think what's really uh important is that I keep a toe in healthcare. Not just because I like being clinician. I do is because I'm still relevant to the company. I still bring something else that nobody else is bringing to my vertical. I'm really the only clinician, the vertical. So I add something which nobody else is adding. I think one of the problems are not being in that space is that at one point you'll still be relevant as a consultant in, in, in um in that type of company, but you'll lose the edge that you have. So that's just another reflection. The first one obviously is non entry. Like you think I've done medical school, I don't want to be a doctor. I never want to be a doctor and that's absolutely fine. It's not for everybody. Okay. And I think if you take that step and you're, you're certain about that, I think, you know, or power to you. There's plenty of people have done that. They've, they've gone into startups doing amazingly well. Uh, I think. Right. I think absolutely. If that speaks to you should do it. And then of course there's track five where people do, what I call rebound is that they come into medicine, they do it for a little while. They're not that happy about it. Maybe, maybe because of various experiences, they leave and they start doing other things. But then they sort of want to say okay, actually, I probably want to come back to healthcare and they rebound into healthcare and that's fine as well. So there's no right and way, there's no right way and wrong way of doing anything. It really depends on who you are or your motivations up what speaks to authentically, right. You know, what is it that you want out of life? Is it tech? Is it education? Is it um Well being, you know, what is it that really floats your boat? And that's the thing that I would advise that you look for during your training. So, um just as a last night, I'm just going to do a shameless plug for, for uh for our teaching course on programming. If anybody's interested, uh you can go to code Bye dot co the UK uh course. And you can find out more about, of course, uh feel free to have a look and with that, I'm going to stop and just let people ask any questions that they want to thank you for listening to a very long talk, but I hope that it was useful. Um And I'm happy to take any questions that people may have or not have the same time. Uh Yeah, I don't know how this works. I don't if people want to text or there may not be any questions. Um But if there are feel free, there is one question in the chat. So, but that that voice is very crackly sorry. I can't really make your sake. Yeah, the chat function. Um I think Rupert said okay, so sorry. There's a question here in the chart. I didn't see. What about caring for sick parents who have been admitted on towards where you work as a full time. F one can we get hospital accommodation and stay in one place without moving around? That's an interesting question. I think it really depends. I think if you, if you have sick, sick parents and you need to look after him and your main carer, then that is definitely something that you can speak to your foundation program director about and, and then the school I think there's, there's definitely scope for that. Um uh The only problem is that you have to flag these things early. If you flag them late, it becomes much more difficult to, to, to help. But if you flag it as early as you can, uh then that, that definitely becomes a possibility. And certainly in my experience, foundation schools are sympathetic to that you just have to flag it early and provide the evidence that they will need. But yeah, possible definitely. If anybody wants to um you and ask a question, please feel free or put in the check if that's something that you, that you want to do. Uh That's a question about how do you a mute? I'm not sure. Uh I'll leave that to Rupert maybe to answer about that. Okay. So then here's some more questions coming in. So I'm just gonna read about giving your overview of the tech field. I wanted to ask your opinion on the disruptive impact of A I. Do you see any emergent rolls that may be a good fit for clinicians? Okay. That's a really good question. I should give a talk on A I in healthcare in my hospital today is the grand round. Um uh the disruptive impact of A I. Uh firstly, a eye is, it's been here for a while. You know, the only reason that, you know, healthcare is looking at it in any sort of greater way is because of Chat GPT. So Chat GPT as you know, came out in November 2022 and really, it's sort of lit a fire under healthcare and actually not just healthcare many in different industries. Um And it's definitely going to disrupt space. Let me, let me start by saying that I don't believe that it's going to replace clinicians. I really just don't believe that in any fashion. Do I think it's going to disrupt healthcare? 100%? Do I think it's going to be helpful to clinicians and help them to do their jobs more easily? I definitely believe that other emergent rolls that may be good for clinicians definitely are the only thing I will say about getting involved with big tech companies is that you will have noticed over the last year and this really is a consequence of COVID. Okay, that many of the large tech companies are Amazon Microsoft Google. Uh and so on, there's a lot of hiring during the pandemic because there's a lot of people working from home, there was a lot more online activity going on and there was a lot of over hiring that happened. And now there's been, you may have seen in the news, there's been a lot of culling of stuff which I think probably has now settled, it's stabilized now. So what you're going to find in the next year, 12 to 24 months, you're going to see more hiring happening again. And I definitely think um that there's going to be roles for clinicians. I mean, think about it, I'm the only clinician in public sector healthcare in Amazon. And I keep saying to my bosses, we need more clinicians, you know, we've got developers, we've got some, you know, account people and just like the other advice that we need more clinicians. I genuinely that it's not because I'm a little bit lonely as a clinician in Amazon. And I think I just want a friend. It's because, you know, clinicians bring something to the table in big tech companies and I think that's really important. Um So I hope that that answers Chang's question. Eleanor has got two questions. I think with this, with working less than full time during the foundation training would extend that. Yes, absolutely. Every time that you go less than full time, it extends your training time. That's just a given. There's nothing that you can do about that. The only exception to that and that's not really less than full time training is if you take a type of out of program year, you can make it count towards your training. That's not really in foundation that happens. A specialist training it's called and who are, but there's a lot of paperwork that you have to do around that, but you can take a year out and make it count towards your training if it's relevant and fulfill certain criteria. But otherwise if you're less than full time, it will, it will just extend your training. There's nothing that you can do about that. Thank you for that question. And your second question was also, which role have you enjoyed the most of the longest you have and why, and which have you found the most challenging and why us? Really, really good question. Um, I think that I don't do anything if I don't want to do it. Right. I, I, uh, everything that I've done I've liked, uh, and I've liked them for different reasons and I've disliked them for different reasons. So, if I just take my Amazon roll, I imagine it's probably my favorite role. I imagine so. Right. And one of the reasons for that is because I have a lot of autonomy. I'm getting to innovate. Um I get paid well. Um, there's a lot of perks of working for that. It's super interesting. Um, it comes with its own problems, you know, redundancy is a possibility, you know, not something I've, I've experienced the NHS. Um, I also do less clinical stuff. Um, I don't think I'm the best foundation from direction the world because I don't spend much time in the hospital. I don't know if we put things differently, but I, I certainly reflected when I was full time in the hospital and what I am now, I don't mean like the fact that I don't know my trainees as well, but, you know, you make sacrifices for all the things that you do. So there's positives and negatives to everything. But if I really thought about it, yeah, I think working for Amazon has definitely been my favorite role so far, but not to say that I don't like the condition I do but just for very different reasons. Um uh I think it's Gina John. Her, her question is I'm changing careers and entering law commercial. Well, excellent. I picked up on your advice about keeping your USP as a clinician. I was wondering if you can give any advice on how to keep my license to practice for as long as possible. Given that my Lord job will be full time. Very full on. Excellent question. Very easy. You have to just, I would say just low commit mitten tely with your local company or you need to do is to re validate um uh to have appraisals, regular appraisal to re validate when you need to, you can keep your registration, you don't need to get rid of it at all. Um uh I suppose the only thing that people will say is that, you know, do you want to do that if you want to do an awful time? I imagine that you might, we'll go into medical legal sort of work that would be the natural fit for, for something that you're doing. But, but yeah, I'd definitely say keeping your USP in a different field is super important. Um If you can maintain both people open once a month or something like that, I think it's fine. Uh Like I said, but you would need to do appraisals and revalidation, you'll still need to keep up with your learning and your CPD, which you'll need to do in your own time. Arguably, you could say that some of your law teaching will be part of your COPD. But, but that's something that you should discuss with the people are praising you. But yeah, I think definitely possible, definitely should do it. Maintain the USP. It's, it's what makes you stand out uh came in here. Thank you very much. I'm so glad I came to listen. Do you need to be tech savvy to learn on code med? No, you don't need to have any prior experience to come at all. We have. So the, the two people who founded the company with me, Aaron and Joe, uh they were my first cohort. Um and they're never coded before in their lives and they have coded software that they've gone on to sell to other hospitals. Um They learn another program language before me, help me to learn it called flutter. Um So yeah, it's um you don't need any prior experience. You just need the will and the enthusiasm to learn. The last time I did compete was back in school. I'm ST six now. But this talk to me. So thank you. I'm glad the talk was enlightening. And don't let the fact you're on ST six be a barrier. We've had consultants on our course, we've had GPS and of course, I have a consultant psychiatrist at the moment of the course. So don't feel like, you know, if you're too old to than something new. Uh If you want to have a separate conversation about whether that's the best thing for you at this point or not in your career, happy to have that conversation separately. I'm sure Rupert can give you my, my details uh More than happy to have a conversation if that's helpful. Uh Dr Addy again, what is the upper limit for duration that you have to complete F one? And can you offer to work voluntarily clinical attachment regain skills if wanting to resume after time off? I think the total limit within which you can complete F one is 24 months off the top of my head. I can't remember exactly, but I think it's 24 months. Um And yes, if you come back after having been out, especially come back into training programs, training programs have the facility and often give you the option of doing some, some time to regain skills. Um uh It's, it's, it can be called return. You know, now we have school return to training leads in every hospital. There should be returned to training lead who could help guide you through that process. So you might not do maybe even if you start in a clinical role. So as an example, people who take time out, come back after maternity leave, maybe for three months, they'll have a phase return. No one calls, 50% come back slowly. Until they come back full time. That should be in every hospital. If it's not, should be. It's part of the part of what happens. Now, do ask the people who know more about who, who will be the, the RTT leads in your hospital? Um Great. Thank you for the questions, really insightful questions. Um um uh If, if people have more questions, please do feel, you know, here's another one. Thank you for your eyes just following from what you said, I'm probably eventually going to go into sciences door. So Pharma and Biotech mergers acquisitions, great idea. I know this is a very general question, but I was wondering how to use my seaview is both a doctor and a lawyer. And I was wondering if you had any advice on what other career opportunities there would be for someone like me in the future. I think, I think that actually uh you have so much potential. I mean law and medicine actually gives you entry into any, any area like you could enter Google Amazon accent to any, any company, those skills are super transferable. So I wouldn't just say that farm about, you know, Amazon M and S would be the only place you could sit, but it may give you breath. Uh And, and certainly a lot of kudos in any organization, I think the world's your oyster with both of those qualifications. And I think, I don't think that it just has to be a medical legal thing or that you're in one space through the other, you could have a very hybrid role. Um, like tech and med is my hybrid roll. I think if you want to think about it that way. Um And I don't have to do that if I wanted to, I could say in Amazon, I just want to do product development. Now, I want to go into that part of it. These skills are very transferrable. So, so don't think that you have to pigeonhole yourself. I think just be open to different ideas, different possibilities, potentials and, and yeah, go for it. Um Thank you for everybody's comments. That's I'm glad that it was useful and then I gave you some two things. Um Do you think about um always happy to for people to get in touch if you want to have one on one and talk more more about your personal situations? Always happy. But thank you guys. Um I think I've spoken a lot and I will leave Rupert to close the session.