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Um So, so if you want to start it, then we can crackle. Yeah, let's make a start. Anyone that joins late, the code is still at the top to join in on near pod. So feel free to sign in whenever or not at all, you can talk to us as well. That'd be fab too amazing. Thank you so much, everyone for coming today. My name is Zak. I'm a third your and psychiatry and I'm joined by my lovely colleague today, Sophie. Hello, I'm an S T five and Psychiatry working in Brighton in the UK. So, Sophie and I have been doing a sort of series of presentations on well being to students at Brighton and Sussex Medical School for about a year and a bit. Now, when we were approached by the CRF to maybe look at doing a presentation that was maybe adapted for, for, for yourselves. And we, we recognize that, you know, you're going through a lot of changes, a lot of difficulties at the moment um that could really impact on your well being and some of those might not necessarily resolve anytime soon. So we, we do recognize that some of this stuff might be quite helpful, but also equally, you might find that it might not help. And that's because of the situation that you're in what we do value is if you've got any input or any thoughts to, to please just ask us and we're always willing to, to try and, um, you know, trying to find what advice that we can. So, getting onto the main bit of the presentation when, um, when Sophie and I first started this presentation, we, we sort of spoke and we said that when we asked somebody how they are, they don't always necessarily respond or they will say sort of superficially how they're getting on. It's only if you ask the second or third time that you start to find out that maybe people are doing quite as well as they may be putting forward or as the, as the face that they're putting forward. So we designed this presentation just to kind of go through some of the basic concepts around sort of well being and to think about how that might be affected and what we can do to, to help ourselves. Um I'll hand that safety not to do this, um, to do the sort of total question. So our question to you guys is basically what if anything are you hoping to get out of this session? Um You can answer on your, um, whatever you signed into. I'm also going to hide your name. So that you can be anonymous but type either on near pod what you're hoping to get out of this session or put in the chat or a mute yourself and talk to us. Is there anything particular that you're really hoping that we're going to cover or that's going to be explained or that you're looking for today? I'll give you a few seconds to think about that. So someone said insight of our situation. Um So it depends what you mean by your situation. Um We're going to try and cover a variety of things in the presentation, um specific to medicine specific to what's going on at the moment. Um So hopefully that will help give you a bit of insight if it's still kind of at the end of this presentation, you're thinking, I still don't know what's going on. How, how am I gonna get, you know, a better understanding of this? Please do reach out to us. Um So that's the coping skills, how to manage stress better. We are definitely going to give you some tips and hints about, about those kind of things as well. Um I'll give you guys a few more seconds to answer if you need it. It's okay if you came to this session thinking I have no idea what this is going to be about. I have no idea what I'm hoping for. Just gonna help. Hope that it helps in some way and that's okay too. Especially if it's your first kind of talk like this. It's sometimes hard to know what to expect, but let's move on. Um Now this slide we had in the first time we, we did this presentation and we weren't sure exactly who we'd get in the group. And I know some of you guys have really shared in the chat, um, where you're based at the moment, which is excellent. It really helps us so I can see that we've got people from all over, um studying over in Kiev, but from Mumbai that's in credible. Um So if, if there's anything else that you wanted to let us know where you're based, that's really helpful for us just to know kind of what the context is for you guys at the moment. I had to check what my answers actually means. No p there are currently in Ukraine moment. Oh, okay. Someone's um, someone studying medicine is uh in the UK Cool. Okay. So we've got a bit of a mixture. So let's move on then. Now that we know a little bit what you're hoping to get out of the session, we're about your based. Let's start to think about actually what are the nuts and bolts of this then how we're going to approach your well being hand back over to Zak. Thank you, Sophie. Uh I think one of the things that we wanted to consider is that there are some factors that will be unique to what you're experiencing that are going to be affecting your well being. And it's important to bear that in mind when we're thinking about how we take care of ourselves. And if actually, maybe that's not quite going as well as we hoped. Um, first and foremost, things that, that can affect our well being outside of medicine, things like geopolitical conflicts. We know at the moment that obviously Ukraine is, is a war zone and everything that's going on there is, is highly distressing and challenging, that's gonna have a real impact on um everything that you're feeling and everything that you're going through. Recognizing that could be a real challenge. Um Obviously, the challenges around being displaced may whether that's kind of within the country of Ukraine or also if you've been having to go abroad and go somewhere else as a result, can have a real impact on your, on your well being. And so it's just worth worth bearing that in mind. Um Things around if you haven't migrated and you haven't left Ukraine, there's obviously an ongoing war and the risk of imprisonment, these things can be really challenging and really affect you. But then if you move to another country, the things you have to bear in mind are things like, you know, if you've been dispersed from family and friends and if your financial situation has changed as a result of having to leave the country, as we know COVID 19 has also had an impact on, on everyone's well being and it's more prominent when you're struggling, you know, in a country that's really struggling to access healthcare. So, you know, there are many things outside of just medicine itself that, that can affect your well being and affect your your mental health. The next slide that we got here is from a study that looks at the impact of mental health and in young people and suggestions that might help to reduce and alleviate that burden. And what the main thing we wanted to get from this uh slide for you is that there are a number of things and a number of services that should be put in place to try and support you and to help you feel uh and recover from the trauma and the challenges that you're going through. But a lot these services haven't been set up or put in place yet. And so it's worth recognizing that if you are struggling with your mental health or your well being, they're actually a lot of these things haven't, haven't been put in place to support you. And so there are some genuine reasons why you may be struggling and, and that is totally understandable. This particular, the statement came from the Royal Colleges Psychiatry and it was looking at the mental health of asylum seekers and refugees. And I think it was a really important person statement. Uh and it says here as it says, or displaced people experience loss in some form of their social structures, cultural values and community rituals. And what we're saying is that the day to day life that you've experienced has become very disrupted and you've lost those, those normal things that used to, used to have or that you might have, you might have enjoyed. Um And so what you're experiencing is, you know, in the context of people who have lost a lot of things and lost that, that sort of sense of normality. So we wanted to start off with this to begin with by just thinking about uh you sort of recognizing the burden of the medical degree in the burden from placement. And I'm going to hand over to Sophie to begin with just to take us through the next few slides. Thank you. Apologies to my dog that might be barking in the background a little bit then. Um So, yeah, so we're going to cover a few different aspects of what might be affecting your well being, what might affect it in the future. Um The first bit we're going to focus on is the specific burden that a medical degree um places upon you, the placements that you're, that you put through as well. Um And these things are specific um to medicine and things that sometimes people outside of medicine won't necessarily understand or be able to support with. Um So this statistic is from, from the UK and it's that 65% of students in their final years report feeling stressed. Um And that non thought help and we thought this is a helpful statistic just to highlight that it's very common to feel stressed. Um But and it's very common as medical students in particular not to seek help with that for reasons that we're going to go into. But it's so so important that you do um and notice this as early as possible so that you can put things in place to help alleviate that stress. It's not something you have to deal with. Although it's very common, it's not something that you just have to shoulder and bear alone. Um So when you're going through your medical degree, there's lots of things inside of medicine, but also your life beyond medicine, that is going to be complicating the fact as well. Medicine by itself is hard enough. You've got all the exams, you've got all of the stress, all of the difficulty of the stuff, you're learning all of the emotional experience that you might be going through as well. But you've also got all the baggage that you've got in your life as well. And that could range from anything from relationships, family finances and other stuff that's going on in the world that we've already mentioned to. So focusing on medicine, we wanted to just have a think about whether or not you've already been put in situations in your medical degree that has been really stressful. So, first of all, our first question, have you witnessed an angry patient or a patient's angry family or carer? Whoever they might be, might be in your medical degree. It might be in previous work experience you've had. So I can see already there's a few of you that are saying yes. Um, someone's very lucky and has not had that experience yet. And long may it continue? Um Me and Zack work in Psychiatry and it's so, so common to get angry patient's. Although I think really whatever specialty you go into it's going to happen at some point and it's not something that we sign up for. It's not something that we're really equipped to deal with. Um So we wanted to kind of focus on this scenario to give you a bit of help with that. So I'll hand over back to stack. Thank you, Sophie. And whenever we're dealing with somebody who is uh feeling angry or distressed or we've got that sort of, you know, very, very sort of angry emotions in front of us, it's important to bear in mind the reasons why somebody might be feeling uh feeling that way. Um And so we've got a couple of things here that might be affecting them. So the first is to consider that for many people, this is an expression of fear, um have previous background, working in elderly medicine and many of the people that I was working with would unfortunately go to pass away in the hospital and for themselves or for their family members, their anger was not because they were angry at me, but because they're afraid of what might be the unknown. And, and that can be really understanding when you see it as a, as an expression of fear rather than as anger in itself. Uh for many people, they may have had a previous experience of previous negative experience of healthcare. So when you are trying to deliver the best healthcare and the best advice you can to them, they may still remain angry or upset because they think that you aren't doing enough for them for other people. It might be the waiting times whether that might be waiting in for a clinic or even if it might be waiting in a wardrobe or an A and E uh in the UK, we do struggle with quite long waiting times. I'm sure that will be the same across the world as well. Um So actually getting in to see a doctor or to see some support from healthcare services may take time. We know that people who have had a recent sort of uh recently been given bad news that might be said like cancer, for example, or terminal illness or a new sort of life limiting injury. Um That recent bad news can have a real impact on people and make them feel more angry and, and quite distressed and finally the loss of independence as well. So people who were previously very mobile or fit and active, if they've had something, say like an accident where they've lost a limb, or if they've had a stroke, for example, um that loss of independence or even a gradual loss, say something like go to neuro industries or Parkinson disease can be really debilitating and really frustrating for people that are experiencing that. So, what we want to think about now is how we might try and process that anger, how can we best sort of deal with it when we're facing that situation? Um And one of the main things to really think about is to make contact with a support group that you might have around you or, or your supervisor who, whoever you've got uh in the UK or within Psychiatry as well. We have these things called ballot groups, which is a space for reflection where we can sort of sit and talk about an experience and allows us to sort of dive into it and see why we felt that way and what might help to explain it and it really helps for us to sort of process that difficulty and you may have your own equivalent support groups out there. You know, whether it might be on, you know, sort of general forums and groups or things that allow you to engage. The supervisors are really important people to speak to as well. Because they might have some extra information that helps highlight why somebody might be angry or it might allow them to recognize that actually this situation that you should not be put in and that they should maybe be looking over it and thinking about how to, how to deal with it. Other things to think about are things like healthy defense mechanisms. So within the situation, you may, you may consider using things like humor, for example, to try and, and get through that to try and diffuse the tension. But then outside of it, it's thinking about how you use that energy or that sort of, you know, that the anger that's been handed to you and how can you maybe use that in a more positive way? So it might be your hobbies and interests like crafts, for example, video games, whatever you find that allows you to, to decompress um is worth thinking about offloading, inventing can be really, really helpful. So speaking to your, to your friends and your family as a means of dealing and processing with the day, it's just worth always bearing in mind that uh family members may not always be medically trained and they may have the best will to, to want to help you, but they might not always totally understand. Um And also just thinking about if we share these things on social media, which is often a common platform for recognizing our challenges, just trying to keep things anonymous and recognizing that, you know, things can sometimes be taken out of context. And as a final point, if you are finding yourself quite regularly angry, frequently irritated and finding that these things are beginning to become more and more chronic, um, these might be symptoms of burnout and this is something that we will talk about in the presentation later on. So our next question, next scenario. Have you ever witnessed a difficult discussion between a healthcare professional and a patient? Um What we mean by difficult discussion could be anything from breaking bad news um to trying to convince someone to, I don't know, stop smoking or give up a particular unhealthy habit. Um So any discussion that perhaps hasn't gone, well, that was difficult that just left you feeling a little bit like that was some kind of way. Not sure how to process that. Wow. Okay. Overwhelming majority already of yes, that has happened and it does. You know that's the nature of the job you will be having difficult discussion's with your patient's. Um in medicine in general, there's lots of reasons why this might be. It could be because you're having to explain a diagnosis of a chronic and degenerative disease that they're not going to get better from like motor neuron disease or multiple sclerosis. It could be informing someone that they've developed Parkinson's or Alzheimer's disease. It could be discussion's around CPR, cardiopulmonary resuscitation or perhaps not doing CPR and it can be really, really difficult discussion's to have with the patient and also their family discussion's around miscarriage and abortion are always really, really emotive and it can be really, really tricky to have these kind of discussion's anyway, let alone if you've got anything in your kind of personal background or family background, that's going to make that discussion even more tricky for us. In psychiatry, we have to talk to patients about self harm and suicide. Um On that note, we also wanted to just draw to your attention statistic that one in 10 medical students experienced suicidal thoughts at some point during the medical degree. Um me and Zack fan is really striking, that's a huge proportion actually of medical students who are having these really dark and worrying thoughts. Um and the reason we wanted to draw your attention to that is to a normalize it a little bit. It happens people get these kind of thoughts. Secondly, if those thoughts are coming up in yourself or in your friends or people that you know, it needs to be addressed, we need to help these people and find a way to resolve where those, where those thoughts are coming from. Um The other key bit of information attached to that statistic is that talking about suicide does not increase people's risk of suicide. It is a good thing for us to be talking more about it as difficult as that might be. It's really important that we know when people are experiencing those kind of thoughts and that we are having a frank discussion with them to find out what is going on. The other kind of things we see really commonly in psychiatry. Our discussion's around previous abuse and trauma discussion's around substance misuse. All of these things are a lot to have to have a conversation about. And afterwards you might just get on with your day and it might not be till later that you get home and it suddenly comes back to you. That actually, that was really a really, really difficult discussion I had to have. And because it is part of the job, we have to find ways to process difficult discussion's first and foremost, this concept of self care. What is that? How do we care for ourselves? Is that just, you know, having a nice bath, is that putting body lotion on? It might be. But self care is doing anything that is protecting you from, from these kind of difficult experiences that are going to increase your stress. Um We often like the metaphor of if you imagine a bathtub and it's got the taps are running, that's all the stress that's coming into your bathtub. So the bath is filling up and it's only got so much to fill up before it's going to spill over and cause problems. So what you need to do, you've got your plug in the bottom of the bath you need to be taking that plug out regularly for some of that stress, some of that water to drain away. So, self care is basically anything that's going to open up that plug and let some of that stress drain away. It could be admitting that actually this discussion is something I can't actually have at the moment. It's something I need to avoid having at this point in time. And that's possible. Sometimes, sometimes you can avoid difficult subjects, especially your training as doctors. We can't always, sometimes we do just have to crack on and then afterwards we need to find a way to, to resolve. However, it's made us feel. So it's really important to give your mind a break. We know that physical exercise is gonna help you feel better, it's gonna physically make your body feel better. Um And the key is to find something that you like doing just because your mate does a spin class just because so and so plays football. It doesn't matter what matters is it needs to be something that you're going to enjoy and something is going to work for you. There's I was gonna say no wrong answer. There's a few unhealthy coping mechanisms that we want to try and avoid. But when it comes to, you know, it could be walking, it could be walking the dog. That's all I do for my physical exercise. And for me, that's enough for someone else. It might need to be playing a team sport. It might need to be going to, to the gym. So whatever you find for you is going to be the right option. Something that distracts you, something that isn't thinking about work. A lot of us will live with medics when we're training, which is great because you have that support network around you. But for some of us like me, I can't stand going home and having more discussions about medicine, I just can't, can't deal with that. So you need to find something that's going to be able to distract your mind away from it. And then again, as Zack was talking about in, you know, finding someone, some kind of support network to offload. Again, any, any kind of support group, any supervisor or colleague, a friend or family member or even a counselor or a therapist, someone that you're going to be able to talk to that you feel comfortable to, to explain exactly how you're feeling and someone who is able to give you that time and that space to talk about it. So we've talked a little bit about specific burden from medical degrees and burdens from placements. Um Now, Zack's going to talk to you a little bit more about burnout an imposter syndrome. Um So first one more question, have you felt criticized by any kind of medical professional whilst you've been on placement? It could be another doctor, could be a nurse, could be a psychologist could be another medical student. But any point have you felt like whatever you said or done has been criticized, do you say? Yes, I mean, the way the medical degree is set up, it lends itself to it, we're constantly being observed, examined, fed back and sometimes criticized and that can be really hard to deal with. What about the contents, the knowledge of the curriculum you've been taught? Have you ever struggled with whatever the content of that might be the workload, the amount of stuff that you have to learn for exams? Has that ever been on your mind? Has that ever stressed you out a little bit? A few of you saying yes, someone said no, that's brilliant to hear. Some people do cope and that's good too. But lots of us won't, at some point you're going to feel like you're overwhelmed, like you're trying to tread water and the water is just slowly coming up too high. So, if you felt like this before, how did it make you feel when you're thinking? Oh my gosh, that consultant has just criticized the way I took that history. They didn't like the answer I just gave. Oh, they didn't. Like when I did this thing earlier, I've just got this mark on the exam and it's making you feel like I'm never going to learn all of this stuff. There's just too much. I can't remember that one thing about how cells make energy and, you know, all those things that you have to learn in your medical degree. How does that make you feel when you're, when you're having that kind of your crisis? Rubbish? Yeah. Good. A really good summarizing statement. It does make you feel rubbish extremely low and for some time afterwards as well, sometimes it's not just, you know, those first few seconds after someone said something to you, sometimes it's days and weeks afterwards you're thinking, oh, that last time I did that thing. So and so said this frustrated. Yeah. Sometimes I wanted to stop it all. Yeah, I've had that thought, let's just sack it off. I can't do this anymore. That's really common as well. Feeling overwhelmed. Yeah. Feeling like a failure. Absolutely. We're gonna go through that kind of feeling as well in a sec. I felt miserable but still push through. I absolutely love that. That is the thought that I think every doctor has because that's what's drilled into us. We just have to carry on. We just have to do it. You know, especially when you've got this patient in front of you. You've just got to push on for them. It might be that you're pushing on for your family if your friends, you know, because you've got that student debt that you feel like you have to justify now out for whatever reason we just push on and meanwhile that bathtub is filling up and up and up and up. Yeah, maybe I should change question. There's days where I think I should have been a flower arranger or something like that content. Consulting criticize um is fine by me that Christian is supposed to be constructive and for learning, it's the colleagues that I hate. Yeah. So sometimes it's easier to take criticism from some people than others. And specifically when you've got a supervisor, a consultant who is supposed to be there giving you feedback and sometimes that's fine because that's criticism, constructive criticism that you've asked for that you signed up for that you need in order to grow as a doctor. But sometimes it's that unwanted bit of criticism when a colleague or someone that is, you know, the same level as you that says, oh, you shouldn't have done it that way or why don't you do this or you see your marks compared to everyone else is sometimes that is the harder part. Absolutely. Yeah. Ever am I ever going to belong here question which leads us very nicely into the next topic I'll hand over to sack. Thank you Sophia. And I generally do sort of resonate over some of those uh those comments and things that people have felt like we have all felt that I think at some point through our medical career. Um and even when we go on to being junior doctors and and more senior doctors as well, we we will have those, those feelings I can only say that for myself and what starts to happen after a while if you start to take on lots and lots of criticism and you start to kind of question, you know, your clinical knowledge where you should be on the degree it really takes, takes a hold and you might find that you start to uh to find some of these statements or resonate with some of the things that, that you can see here. So thinking you're a fraud or that you're going to get found out for not knowing enough or that you'll never be good enough or even things that, you know, you, you feel, you feel like a fake and what this is getting out these things, it's um it's known as a something called imposter syndrome. Um and this started to come out a little bit more of the last sort of decade or so in terms of raising awareness about it. So, so the question is, what is, what is impostor syndrome? Well, for stars, it affects a lot more people than you believe. So, we know about 60% of people in um in the general sort of workforce um feel that they struggle with imposter syndrome and to simplify what it is, it is the, what we call the externalization of success whilst we internalize our failures. So what that means is that when we succeeded something, when we do quite well or when we, you know, when we're successful. We say actually, you know what? I got lucky that wasn't down to my effort. Or, or it must be a mistake. And, you know, even if you are successful, you think, well, why am I here? You know, other people that could probably do this better than I can. But what we do is that we take on those failures that we have. So if we do get criticized, if our histories aren't good enough, or if we haven't done that examination where we say, oh, it was my fault. I was the one at fault. I've done this terribly wrong. This is, this is all because of me. Um And it means that we don't necessarily take the wider context of why we might not done well that day. It might be that we've, we've had a rubbish cold for the last couple of days and felt really poorly. It might be that we had some really difficult news about family or a loved one. And so it's just bearing in mind these things around us that could be affecting why we didn't succeed. And it also comes down to a question about how we define competency. What does that actually mean? And for a lot of people, um it sort of means having all the information, all the knowledge to answer every question in front of us. Um But I think another way of actually looking at competency for us as doctors is knowing where we can find the resource for the right information. There are some things that we are going to need to know and that we will find helpful. But other things that we can say, well, actually who is the right source of knowledge that can give us that information? Now, just kind of going on. I want you to kind of sort of go through this for the next 30 or so seconds and just see if you have these are yes, no questions. Um So just ask yourself if you felt more negative about medical school or, you know, tied before attempting lectures, let alone afterwards. Um If you felt more worried and anxious about going to placement, um if you felt drained after studying or if you've just felt less, um less supportive and less empathic towards your friends and family or all patient's. And if you have said yes to any of those questions, um you might be struggling with something called burnout, which is something that we spoke about a bit earlier in the presentation and I'm going to hand over to Sophie just to kind of go through burnout and what that, what that means. Yeah. So burnout is class is a chronic psychosocial stress. Um In the sort of simpler sense of the term, if you look in the bottom left of this quite busy picture, there's a set of scales and it's got on the left hand side that you've got the demands of your job, the stress, the psychosocial stress that's going on for a long period of time. If the demands of your job is outweighing on the other side, your resources to cope, then that is when burnout is likely to occur. What burnout is essentially a crisis in a person's sense of professional competency. So all those questions of, I'm not good enough. I don't belong here. I should give up, you know, I should go and be a florist. All of those kind of thoughts is when burnout is starting to creep him, it can affect the body and also the brain, it can actually mimic depression. Um but the causes are slightly different and the way we kind of think about it, it's slightly different. But it include include stuff like on the previous slide. So you might just feel very much less motivated. You just can't be bothered anymore. You might have a growing emotional depletion. So the inability to empathize and really care about other people because you're so drained, trying to care about what you're doing. You might become more cynical and depleted in general about your medical degree or as a doctor about patient's state of the healthcare service in which you live. Um It might just simply be fatigue retired. You just physically can't get to that lecture. You just can't do anymore vision because your body is so busy trying to cope with this chronic stress that has been under. So just to be clear, stress doesn't cause burnout. It's the stress and the inadequate support and the resources to cope with it. So really, we think about it more as like a workplace safety issue, there should be things put in place by your workplace in order to help you cope with the stress that's putting on you. So when you've had all day of patient shouting at you people criticizing you not enough staff, not enough resources, then that is when burnout is going to become more likely the onus is less on you being resilient enough to cope with it rather than the workplace being too stressful for you. That doesn't mean to say there aren't things you can do, can't do to prevent this and make it less likely. Um But it's not your fault if you're feeling this way because sometimes some things are outside of your control. Um So now we've said about how awful medical degrees are being a doctor, which is not true. There's brilliant moments as well, but it can be really stressful. So we've acknowledged that we're hopefully normalized that. So now we're coming onto the part of this presentation where we're gonna give you some tools and strategies and resources that will hopefully help you with this. So before we move on and just give you a list of things that we think are going to help you, um We need to recognize that you already know what's going to help you, you know what you enjoy, you know, what's going to make you feel better and sometimes just hearing from each other is more helpful than us giving you an exhaustive list. So, if you're happy to share with us, how do you like to distress? What sorts of things do you do when you need to decompress after work or study? Oh, that's lovely. One. Spending time with friends and family. Yeah. Paying video games or solving puzzles. I adore video games because you have to concentrate completely and there's no space to worry about what you've done in the day. Go to the gym and coffee. Nice massage. That's amazing. I love a pedicure personally, but massages brilliant eating food, watching movies of series TV. Yeah, I'm signed up to like Netflix, Disney Plus Amazon Prime. All of them love, love binging series sports, like tennis or basketball. I love that. Been to watch your, yeah, sleeping, cycling, nice. We've got a great mix here. Some really great physical activities but also some stuff that's literally just distraction we have sometimes seen in the past that some people have suggested that it might use uh sort of alcohol and drinks as a means to, to sort of relax. And we're not necessarily, you know, here to encourage or discourage having a drink or two. Being able to relax and have that environment in good social company can be really pleasant and really relaxing. But I think it's when it starts to become, become your main way of managing and dealing with things. Um, and if it becomes, you're only way of, of dealing with things that act, the alcohol can sometimes be more harmful than it is helpful. And the same goes with, if you're using other substances as well, that sometimes those things that might not be, you know, might be more harmful and detrimental than they are beneficial. So, whilst, you know, we can't encourage more discourage it, I think it's just worth going in mind if you are using it more and more and you haven't got these other things around you just about that in mind. It might not be as helpful as you believe it might be. Yeah, that's a really good point. A couple more. We just had as well going on holiday. It's so important to take annual leave, take time off and do something with that time. Um It does wonders and I really like this one as well. Time away from social media. Sometimes the doom scrolling can just add to that stress. It's just turning that tap a bit more quick. So yeah, coming away from social media can sometimes be really helpful too fabulous. So one thing that me and Zack wanted to kind of I've provided to you as a potential tool in your toolbox of things to help the stress. It's not called mindfulness. And I'm sure you've heard of this already. You might already be practicing it. Um, but for those who haven't, haven't tried before, aren't sure exactly what's involved. It's basically any act that's focusing your awareness on the present moment and acknowledging and accepting any thoughts and feelings and sensations that are in your body at that moment in time. And that sounds like a bit of a fluffy explanation. Well, why is it important? It's a really good technique to stop yourself worrying, to stop any repetitive or negative thoughts that are getting stuck. It's also really helpful to recognize bodily symptoms of stress. I've just recognized that while I've been talking, my shoulders have been up here. And when I said, recognized bodily symptoms of stress, I literally allowed myself to just relax my shoulders back again because I know by the end of this talk, otherwise I'm gonna have a headache because that stress will just be feeding back into my body. And if you don't take a moment to recognize those symptoms, you just won't, you'll just keep carrying on until you get home at the end of the day with a horrible back ache and a headache. You're thinking, why not, why not find my feeling this way? It also helps when you're starting to feel overwhelmed or panicked. I really rate mindfulness just before an exam, especially practical exams, like Os Keys and things. How can you do you mindfulness pretty much anyway, you like. So we're going to take you through one technique which is called box breathing, but there's lots of others. So one type is body scanning. This is a way of going through your body bit by bit and just recognizing what symptom sensations you might have in that, in that part of the body and consciously just trying to relax it. Guided imagery is a really common one as well. The kind of imagine your, in your favorite place on a beach, imagine the waves, imagine the wind and that's really nice if you don't actually have your holiday to go to at the moment. Um The five cents scavenger hunt is a really nice one for panic because it forces you to concentrate on something else. So you go for five things that you are able to see in the room. Four things that you are able to hear. Three things that you are able to feel. Two things are able to smell and then something either that you can taste or you then focus on a breath in. And by the time that you've managed to do that, and it takes longer than you expect. Your, your body is calmer because you're just focusing on that. And more importantly, your focusing on this present moment. So it can be helpful for people experiencing flashbacks or anxiety about the future. It's just bring you back into the present. You can also do a mindful, literally anything you like. I've recently started mindful tooth brushing because I really struggled to just sit down and take five minutes doing nothing. Whereas when I'm already brushing my teeth, it feels like it still productive. But I'm able to just focus on brushing my teeth rather than worrying about the next thing I have to do. So, as I promised, going to take you through a box breathing technique, so, what you need to do is make sure that you're hopefully sitting on a chair, that's probably the most easiest, but doesn't matter if you're set on a bed or whatever, but try and just make sure your feet are both flat on the floor. No kind of resting one leg over the other, make sure they're nice and grounded on the floor. If you've got a back support, that's quite helpful. You don't have to be that kind of straight, just somewhere relaxed where you're able to kind of take a deep breath, keep your hands on your lap or at least, you know, not holding a phone, not holding your laptop, just keep them empty and relaxed. We're going to start focusing on your breathing and the picture in the slide will hopefully help with this. Um The idea is that we're going to slow down our breathing. If it starts to make you feel lightheaded, you're allowed to not do what I'm saying. I don't want you passing out on me sometimes if you haven't done this before, it can make you feel a bit breathless. So just be mindful of that. The idea is that we're going to follow a box. So we're going to breathe in for four seconds. You're going to hold that breath in for four seconds, you'll breathe out for four seconds and then you're going to hold that breath out for another four seconds. I'm going to guide you through it. So don't worry too much about it. As I say, if you need to pause anytime, please do. Um But what I'd like you to do is get yourself into that comfortable position. Just bring your awareness just onto your breathing. Notice where you are in your breathing cycle. Notice how it feels as you breathe I/O, whether it's through your nose or your mouth, it doesn't matter if any other thoughts are coming into your mind, that's fine, that's normal. You can notice those and just let them go again and focus back on the picture of the circle increasing and decreasing. If you're already going a bit fast with your breathing, just try and slow it down a little bit in readiness for us to start. And that's correct. Yeah, and and hold and out. Thank you. Oh Yeah. Now that you're breathing, go as fast as it needs to try and just focus on keeping on your breathing, just how you're feeling after that, they might be feeling breathless. What you saying, Karma just extend your awareness back to the room that you sat in, come back to this dish. Come back over 10, it's back. Thank you so much, Sophia. I always feel a bit calmer after I've done that exercise. It really brings me down a little bit. So it's really helpful to practice. And I know you said that you used to use it for just before going into the Yassky is as a, as a quick way to bring your heart rate down. So, but the find what works for you. And I think one of the things that we've spoken about is for some people that might be apps, the things that you can use on your phone or other devices. And the way that I've always seen this is the equivalent of the oxygen mask. If you want to be able to solve, help people and those around you, it's worth putting that oxygen mask on yourself first and then that gives you the best means possible to support those around you. So there were plenty of apps available and you can always find the ones that work best for you. These are a couple of ones that we have, I've had a look for that. We've been used both in the NHS and outside that, that you might find helpful. And so the first one is a, an app called whatsapp, which is not to be confused with whatsapp, which is extraordinarily unhelpful, but it is a, an app that uses a few different psychological therapies. So something known as CBT, which is cognitive behavioral therapy, as well as something called a CT, which is acceptance and commitment therapy. And what that's kind of getting at is using these different ways to help you manage with stressful situation. And if you're finding your, your mood and your mental health is not quite where it used to be. Um it can help with depression, with anxiety, with stress and, and quite a few other things as well. Uh It can help you look at some of those common negative thought patterns. It can help you sort of monitor your thoughts and give you diaries and examples of what you might, right? And even though things like grounding games just to kind of get you distracted and to bring yourself back into the moment. Um and the app is free as well, which is really important. We know that, you know, some of these apps you have to pay for, but this is one that's free. Headspace is a very famous one that sort of become more and more famous over the last couple of years, provides tools for meditation and mindfulness as well as sleep and habits. I can help you improve your mental health. Unfortunately, headspace has a two week trial that is free after which it is at 50 lbs a year. So it's a paid subscription to access some uh two accesses features after that trial. Another app is something called com and this is a free app. That provides help with sleep meditation and, and ways to relax again. This has a free seven day trial, but the difference is that some of the content is locked afterwards. You'll be accessing, protecting some of it but not all of it. Um You can pay 28 lbs a year for it or a 300 lb lifetime purchase. Um So it's kind of up to you what you choose to do. The final one that we've got here is something called mind shift. And there is a free app that is designed to support people with anxiety. Um And it uses several tools to help you manage that. So things like thought journals, coping cards to help you get through experiments around your beliefs and thoughts. And it also has a community forum that you can engage with other people that might be struggling with anxiety and that one's free and, and that's uh that's all the apps that we've kind of spoken about. So to conclude, we've spoken a bit about the tools and strategies that you might use to support your well being and some of the resources available that you might use through the use of absolute things. We've also spoken a bit about burnout and imposter syndrome and we also spoke a bit about some of the things in your degree and emplacement that might be affecting you. So to conclude, we know that medicine can be daunting as well as it can be wonderful. Um And if you are finding it challenging, that is totally understandable, especially with everything that's going both within medicine and around your lives. At the moment, it's being able to accept that or at least recognize it. So it helps you get a better footing and a better grounding um access to actual support. If you are struggling, that's the most important thing that there is no shame or no harm in using those services and using what's available to help you to help you move forward, take a bit of time and think about how you're coping. Um You may use that time to find out if you're struggling with burnout or if actually people around you might be struggling with that as well and help them come to realize that maybe they need some help and support. And finally, if you are struggling with any of these issues, then please access to services and things around you to help you. It's the most important thing that we would want you to take from this session. And I believe that that brings us to, to an end we have on this slide, a sort of list of resources that you might find helpful and that might be sort of pertinent to your, your current situation. Um So a couple of websites just for um practicing the Ukraine Medical Associated UK, the mission statement from the Royal Culture Psychiatry that we referred to earlier about how displacement can affect you. Um and also this European Students Union that had quite a sort of wealth of information and, and to stop help you support if you're struggling, we also provided I E mails as well. So if you did want to sort of email or get in touch with us, you know, in terms of things about well being or, you know, sort of things you might want to ask the support that were welcomed more than happy to be contacted as well. That's the end. Thank you so much guys for taking part. It really makes it more interesting for us when, when you, you talk to us. So thank you for that. Um There is also a little questionnaire at the end just for us. It's just to make sure we're making this um this presentation as useful as we can for you guys. Um And we rely on you to tell us what has been useful and bits that weren't so useful so that in our subsequent, hopefully, if you're invited back in our subsequent talks, we can make sure that we were really making this as, as good as it can for you guys. We've got a couple of minutes left. If anyone does have any other questions, please do, pop them in the chat or shout out. But again, thank you so much for listening and I hope it was helpful.