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OK, we're live. Hello, everyone. Welcome to the TSGS webinar for spring. Um Sorry, not spring, autumn 2024. Thank you so much for your patience with our technical issues. I think this is a leadership lesson for um the TSG in terms of you can plan things um down to the line, but there's always going to be a careful one, but you can also learn from it and take it forward and not see it as a failure. Uh My name is Josie Cheetham. I am the outgoing chair of the TSG and it's been my immense um privilege and pleasure to be part of the TSG for the last seven years and chair for the last two years. Um And I have trained in Wales. I'm very proud of the, the kind of the level of the building of trainee leadership within Wales before I introduce the speakers that we have uh this evening. What I'm gonna do is just give you a little bit of a background to the context of this webinar and why we decided to hold it and you, some of you may have seen, you may have uh joined us at the FMM conference in March time and seen that we have a plenary session um and a discussion that was um along a similar type of um questions. Um And we had such interesting and involved um conversations there that we decided to actually make this and expand this into a webinar in itself. Um But essence, we're going to be exploring what senior leaders can do to actually enable and elevate trainee leadership because we've had done a great deal of discussion, research um and work into validating how important trainee and locally employed doctor leadership is um in the UK and internationally. Um But also we now need to shine the spotlight on the importance of senior leadership um and their sponsorship. So I've just got a couple of um powerpoints and hopefully the tech issues will be no more and this will come up neck. I'm hoping is that shared with everyone. I don't know if any of the panelists can say is that shared at all? Not yet, Josie? Ok. Yes. Um Just whilst you're talking through stuff, Josie, do you want to send me the slides and I'll share from my end I can do. But now the um actual window I'm afraid is uh blocking my, oh, there we go. There we go. We can see some, you might just need to full screen it. Yeah, absolutely. OK. So I said that we're, I'm from the trainee steering group. We've got members in the audience today and also caim in the background too. So the trainee steering group is an integral part of the Faculty of Medical Leadership and Management and it was set up in 2012 alongside FM and M. And our mission statement is to champion the value of trainee leadership across the UK and also lobby and enable trainees to access leadership opportunities regardless of background, personal finances and time and so forth. And as you can see, we produce uh quite a lot in terms of our offer um for um trainees, what we've also done over the years. So we conducted a number of surveys and these surveys have really shone a light into the importance of senior leadership sponsorship of trainee leadership. And as you can see, since 2020 all postgraduate curriculum across the UK need to have embedded in them, a series of core pillars of leadership um skills, standards and development outcomes. Um as OBC described by the General Medical Council and there are these here. But what we're really going to dig into this evening is actually what we're hearing on the ground from trainees. So we're getting some really stark responses from all of you who actually fill in your national um trainee survey every year. And we're saying year on year that the reports of access to leadership opportunities is decreasing during your placements. And this does vary by career grades. But we also understand and recognize the importance of trainee leadership from the moment you become a junior doctor or resident. Um and you can see that it also varies across specialities. And then another key um question which is asked of you during the NTS is about mentorship and access to that. And we know this is a fundamental part of um leadership development. It's the um 20% out of the 7020 10% model of leadership development that you may have come across. And you can see how few trainees have access to formal mentorship and many had to rely on informal building those formal networks that we know sometimes can be a, a space for differential attainment to um actually blossom. And here you can see some of the results from our past training surveys by the TSG that we started before the GMC started to post the leadership questions within their survey. And you can see um as we can see by the number of people who have joined tonight and the number of trainees that we have engaging in our webinars and our other um offers to you just how important leadership development is to you and also to patients that you can, it is all back in 2017. But we're still hearing this on the ground, 81% found time to be a barrier to development. And again, echoing GMC NTS results in terms of access to leadership development opportunities. So hopefully that gives you a little bit of background to why we're having this really important conversation this evening. So enough for me for now, what I uh it's my great pleasure to introduce you to our fantastic panel of senior leaders who are here with us tonight, giving up their own free time. Um And as you can see, we've got Doctor Helen Crims, Doctor S Doctor Charlotte Radcliffe and Doctor Ian Collins. And what I'm gonna do is ask them to introduce themselves. Um, so Dr Kris, if you would be able to go first. Hi, Josie. Hi, everyone. Thanks for joining. Uh my name is Helen Cri and as I put in the chart, I'm the medical director at a mental health Trust in Sheffield, Sheffield Health and Social Care Trust. And uh we've got various associations with the FML M partly being an ASO associated member of FML and I'm a, a senior fellow there, um which was an offer that um that really um came about at a time when we really needed some focus on leadership in the organization. Um But I've also worked with um the Royal College of Psychiatrists promoting the trainee, um the FM trainee commitment and um in the um delivery of the um uh Royal College of Psychiatrists um Leadership Management Fellow Scheme, which is a Psychiatry version of the National Registrar program you could say. Um and I'd be lead. I love that for the last five years I've now handed it on that to somebody else, which is what you should always do in leadership is find someone else and bring them on board to um to try and carry on the work. Fabulous. Thank you for joining tonight and then we've got doctor S great. Thanks so much Josie and thank you for everyone for joining this evening, giving your time up as well. Um So my name is si, am a consultant in Acute Medicine at West NHS Trust, as well as the deputy medical director. I'm currently leading us moving into a new hospital which is due to open in a few months time after nearly 15 years. So two acute trusts into one. So it's incredibly exciting and I've been getting all our juniors involved. It's, it's there, it's them, they're the future. Um I have lots of other hats as well. I've been working with NHS England as a regional advisor in acute medicine and I've recently been made the president of the West Midlands Physicians Association after 75 years, the first female president. So we are still making uh trying to make a change and break those glass ceilings. I'm incredibly passionate about empowering and, and lifting um the future because you guys have all the eyes and the ears and you can see the wood be between, you know, between all the mess that we can't see and um I can share with you lots of, lots of things that I've been doing with my trainees. Um But welcome. Thank you, fabulous. Really looking forward to your contributions. And we've got Doctor Charlotte Radcliffe. Thanks Josie. Um So my name is Charlotte. I'm a salaried doctor uh working in primary care in Newcastle. Um I also have another role. Uh Well, another a couple of roles um I work as a medical member on the first tier tribunal uh for the Social Security and Child support sector and I'm a member of our local medical committee. Um I guess my leadership role comes from having um organized uh a leadership program up here in the Northeast called Next Generation GP. Um I did that uh whilst being uh a registrar and then continued it briefly once I had qualified. Um as Helen did, I then handed the mantle over. Um and one of our participants actually took over leading it. Um and is in the process of um I believe delivering the, the sixth program now, which is um is pretty good. Um Yeah. So, um that's sort of me. Uh It's really nice to be here. Thank you again for inviting me. Um I look forward to speaking to you all. No, thank you, Charlotte. And then last, but definitely last, not least it started of Ian Collins. Hi, good evening, Josie. Good evening everyone. It's great to see so many people um have joined this uh webinar tonight. So, really, really wonderful. I'm Ian Collins. Um I'm a psychiatrist in rural mid Wales. So I guess I'm representing the Celtic Fringe this evening. Um I'm also Director of Medic Professional Support and Development within our deanery in Wales within health education and improvement Wales. And I'm program director for the Welsh Clinical Leadership Fellowship, which is a program that when I started being program director in 2017, probably time to hand it over actually. Um it was just for medical and dental trainees. Um And we've continued with that program, but we've gradually expanded it to a variety of other healthcare professionals, which I'm I'm most proud of in terms of developing that program and hopefully be able to um talk a bit more about that. So good evening, everyone. Absolutely fantastic. Thank you all. So we're going to start off with quite a broad all encom encompassing question. I do apologize for me tripping over my words. I think it's been one of those days of talking all day already. Um Why is trainee leadership so important to you as a senior leader? And anyone is welcome to come in. Can I start? Would that be ok? I'm gonna be very pithy as well with the answer. Um For those of you who've managed to check out the news today, um You've seen in the news that the third stage of the COVID inquiry started today and that is examining um healthcare through the pandemic and the impact the pandemic had on healthcare. And we already know the impact uh it had across healthcare in terms of how it impacted elective care. And that's just one example of the myriad of challenges um facing the NHS right now and those challenges are only gonna mushroom I think without effective clinical leadership right across the system. And that's not just doctors, but it's doctors in training, it's locally employed doctors, it's SAS doctors and it's all healthcare professionals. What I like about the whole point of kind of encouraging leadership in trainees is trainees often get very different and unique perspectives and find unique solutions to problems. So this is why it's important to have training leadership now. But of course, as well, we need to think downstream, you know, we're gonna be hopefully um in 1020 years time I speak for me, not the rest of the panelists drawing our pension. Um And you know, we need people to follow us, we need um uh enthusiastic, compassionate um leaders of the future and that's why it's so important to start early. I mean, right at the beginning undergraduate medical school, er if not before, I think you, yeah, I mean, absolutely. And for me, it is really about making that change and I often feel that trainees feel they don't have a voice or they're not being listened to. But what I always emphasize is that you are incredibly powerful because you have the solutions and you have bright ideas and with your wide eyed and you can see what we can't see. And without our voices there, without us, our passion there, then we are going to get left behind and that, you know what's really missing in our training in the undergraduate years and then post grad is that leadership, isn't it? And then suddenly you consult and then you have to do all these things and, and I encourage it right from the beginning is come on, you need to, to do something. Let let's come and join me in a project. What do you think about this? Uh As you said, that they, they've got the solutions that we don't think about because we've been ingrained. But what I always emphasize is that do not underestimate the power you have, you guys are doctors, you've seen it from a different perspective and you can make that change and it's the voices of us as doctors collectively, as a fraternity that we can have impact. And often, you know, it's seen as a dark side, isn't it? Leadership and management? And as me, you know, um I never thought I'd be ever in this position, but what I would say is, it's been the most gratifying part of my career, massive changes to massive populations, um which I'm incredibly privileged to have been part of, but also working with different people, different skill sets, working with managers um and people that I've never dreamed of. So it actually does make you grow as well as an individual. You're not just being a medic thinking about medicine all the time. You're thinking outside the box and when you're a leader, you make mistakes, you have to make decisions and sometimes you make the wrong ones. And I've got to say as an individual, it's, it's, it's improved my resilience and it's made me grow further. And I always say to my juniors, keep looking in the mirror, how can you get better? How can you improve and leadership pushes you? Why? Because it makes you your authentic self. And that's really tough to be an authentic leader when times are tough, really, really important, Miss Susan and Helen. Yeah. Thanks Claire. That, that really resonates with me. I have to say that, that authentic leadership and it, it, and, and the focus that both of you put on, you know, tapping into that thing that made all of you want and me want to be a doctor in the first place. We wanted to be a doctor because we wanted to do good in the world. We wanted to help people. We wanted a fairer world and probably we wanted to uh probably we'd got some um experience or subsequently, we've got some experience of what it's like to be on the other side of the consulting table as patients. And if you've not got it, you've got it in your family members. And one of the things that I often think about is how we tap into that sense of, you know, this isn't about us and them, this is about me and my family as well. And my motivation for wanting medical leaders in this world is to try and put, put, right. Some of the things that I know from my personal experience and my family's personal experience go wrong in medicine. And that's really the motivation for me um for becoming a medical manager. And like you Claire, I never imagined this is where I was going to end up. No idea at all. Um But I was always really interested in um why we do it like this, you know, we, we simply are at risk of accepting the world the way it is without thinking we have the power um to actually make some changes to make this better. And one of the reasons that's so important is because we're living in a changing world. We've got a population which is growing older. We've got a more diverse population. We've got a traumatized population. I referencing your comments around COVID. But in other words, then, and we need to make sure our services adapt or take account of that and that means changed. And I'm always surprised by, you know, occasionally coming across doctors who sort of say, well, I was appoint, you know, I was appointed to a consultant 20 years ago to do this job. Why do you want me to do something different? Now. Well, the answer is because the world is a different place now and we absolutely have to, as we have always had to, that isn't a 21st century thing. That's not a government cuts thing. That's, that's the fact that we have to adapt continually to the world we find ourselves in to make sure that we are allocating our resources brackets. There aren't enough. I agree. But you know what we have in a fair and equitable way and we know that the inequalities that are present in society and indeed in the way that people get health care are really important. And there are lots of emphasis on trying to address some of that now, but it's challenging and we've got a great opportunity because at the moment, we've got a government who show that they're willing to listen, are willing to make changes and, and hopefully, um with the right support from us as a medical profession, we'll be able to see through some of those benefits for the um those changes for the benefits of our patients and our communities. And Charlotte. Did you have any thoughts about why you think trainee leadership is so important as a senior leader? Um I mean, I can only echo what's already been said, I think um for me, uh both uh SAB and um Ian have alluded to the fact that ultimately, it's about the, the trainees that are coming through and the fact that they have this perspective that I think a lot of us lose as we go through. Um, it, it, you know, we get bogged down in the day to day. It's very difficult to see the wood from the trees, as s said. And I think that the trainees that are coming in, um, are in the, the perfect place to see what can be changed. You know, what, what can be done to improve a, a really a struggling service and under resourced service. And, you know, and I think that's ultimately where senior leadership comes in. Um And I think if we can keep doing that, then we're going to be able to adapt to all these um uh difficulties that we face. And I think that especially in the current climate, I think it's more important than ever that the, the trainees coming through um that, that we support them to become the best leaders that they can. Um So that, that's probably my main, my main thing. There's lots of other reasons why I think training leadership is really important, but I think it's about bringing those that are coming in on board, um you know, and supporting them to, to really take, take over this, this, this service that we have, you know, it, it, it's them that's gonna take it forward and it's going to lead it going forward. So we need to give them the best chance possible. Fantastic and just building on those really, really illuminating answers. I mean, you've talked a lot of, you know, and you've given some kind of contextual background to why it's so important to you as a senior leader that we do have these trainees from the first day of F one, if you know, indeed, from the first day medical school, actually having access to leadership development opportunities and actually demonstrating their leadership um sometimes um trainees when they're confronted with leadership development opportunities or a structured way to access leadership development, there's often a focus on self and sometimes on team. Um But do you feel that there's an impact that trainee leadership can have on an organization or system level? And you don't, do you have any past examples or current examples of trainees or locally employed doctors who are really paving the way in this way? Stop. Yeah, absolutely. I mean, I could go on all day really. Um And I mean, one of the main things that I've done is used my title and my position to open up doors for others because that's, that's so important. Um And one example, I mean, we've got a chief registrar and most organizations now have chief registrars. And I think that is an absolutely fantastic role, but we need those roles throughout all levels, if not more. And um you know, I've, I've had the privilege of mentoring them over the past six years and, you know, from developing a local, um a local um, course called tomorrow's Leaders. The chief registrar has actually created this a three day course for the, the locally employed doctors, the middle grades who don't never get that sort of leadership training and so forth. And what's unique about this is that we've kept it very vulnerable, we've kept it open. Let's talk about the stuff that we don't talk about. This is not a tick box exercise of. Ok. Yeah, we can talk about what personality you are, what leadership, but let's talk about what really happens and, and let's talk about culture and this leadership course um that we've been now running over the past few years has been great because we've talked about cultures, we've talked about race, we've talked about bullying, harassment, we've talked about, you know, how do you cope with conflict? Because this is real stuff that's happening in the NHS and everyone feels empowered out of that room. And that course, thinking that I can make a change, I can make a difference. And that's what leadership is about. I mean, that's just one example, I've had other chief registrars do things like quality improvement um in um foundation doctors and, and it's interesting, they've gone to get publications and then got to speak on, on stage and these are things that, you know, improve your confidence and, and, and then you, you get to speak to lots of other people like the chief Exec which you've never ever met. Um other things that we've done is we've got our executives to come down and meet the juniors and actually show them. Ok, this is what a chief execs job is. This is what a Ned's job is. This is what chief finance officer does rather than, you know, that you get that normal, a four paper with everyone's faces on. Um, it's about connection and that's what I've tried to do in my organization, connect the board to the floor because the floor has all the solutions and if the board doesn't come down and connect with them, then you're losing it and it's quite easy. So those are just a few examples that we've done and in the tomorrow's leaders thing that we do the course that we run, uh We have a session where we grill the board are non execs, things like why is it that the board are unfortunately all male and white and middle aged, we are in a population that is the most deprived and ethnic diverse. How does that reflect our people? So, let's get you out there, let's talk about the uncomfortable and that's what I've encouraged and empowered the juniors to do. And that's just a few examples, a few examples, really fantastic examples. And you can really see how, you know, just the impact of a few leaders actually is just having huge ripple effects across, you know, 100s and 100s of, of uh of new leaders. Um Really fantastic does anyone else have any thoughts? I mean, Helen. Oh, I think he might be on me still. Thanks. You're right. Um Thanks Claire. That, that issue of representation is so important, isn't it? I've been medical director here just for a few months now and uh we've now got an ethnic diverse, a more ethnic and more um gender diverse board and that, that does make a difference. But like I said, that that can be hard to achieve, but we absolutely have to strive for that. Just thinking about some of the ways in which I think we can support trainees and some examples. Well, not just trainees but also locally employed doctors as well. I think one of the things that we've done here is to think about what the SAS advocate can do within the organization. Thinking about how undervalued our SAS doctors can sometimes be. I realize there are many reasons that people choose to take AAA Sass route and many people who want to stay in that route. But I don't think even if there are doctors who want to stay in that, that doctors don't want to develop. So what we've tried to do is to think about how to match people's interests and passions and enthusiasms, really sort of tapping into that wall. If you want to do leadership, there are a million and one projects you can do, which one suits you. What, what is it that you like to have? A go at and what is it that you'd like support with? And how can we help you in that? And that 1 may be a small project or it may be being a small part of a much bigger project. So, like you Clare, we haven't got to a new hospital, but we have got some fairly major projects going on, like a, a new electronic record um system coming in in a few months' time and we absolutely need doctor engagement with that and clinical engagement with that. And so we've got lots of doctors involved in supporting that process. Um We also know that um you know, most organizations are now really focusing on a quality improvement methodology for thinking about how to get the best out of our services and support change. And something I sometimes like to talk about is a, a quality improvement process on yourself. So if you think about the way you are as a person, um you can quality improve yourself using the same sorts of techniques that we're familiar with with other things, the P DS A cycle really, you know, what is it? I'd like to do? How am I going to think about it? Who do I need to engage with it? How am I going to measure it and what am I going to do next? And then go around the circle. And that really taps into that idea that you were talking about of that continual development, no one becomes a senior leader overnight. You do it by iterative, putting yourself out there in some places which may feel a bit uncomfortable at times, but nevertheless, are helping you to grow. You get feedback and support from others. You, you, you succeed and you fail at some things as well and you learn and you carry on that cycle. So I think that that methodology is, is quite a useful way of thinking about how to grow as a leader as well. And please go ahead. I just wanted to pick on a couple of themes from, from Helen and Saron, both mentioned or alluded to um this sort of challenge of ensuring train trainees, resident doctors are engaged. Um and that connectedness and that buying one of the big challenges I think and, and obviously, I'm not talking about the resident doctors on the call tonight because they're here and they're, you know, they've bought into this and they're engaged with this. But actually, I think one of the big challenges when you look at post graduate education across the UK is our trainee doctors not being engaged enough. Really is a problem. And I think having chief registrars is a wonderful model for championing um that engagement of, of resident doctors because without that feeling of being connected to the organization that you work in, it's very difficult um to like that spark of wanting to get involved and, and change things meaningfully. And get involved with, with leadership and just going back to the question you posed um Josie, um and I've seen the impact that, that training leadership has at an organizational and assistant level. You know, I've, I've, I've been privileged to be the director of this, the Welsh Clinical Leadership Fellowship. And I've seen trainees deliver meaningful change right across the whole country. Um in Wales, be it, you know, obstetric bleeding, be it nosocomial infections. I've seen them deliver huge transformative system change on a on a on a national level. So, so it can be done um with the right conditions. Um the right investment, the right buy in from all stakeholders. Um The big challenge though is not just getting that engagement from trainees. The big challenge is, you know, I can't offer this opportunity to every trainee in Wales, all 3500 of them. And I know obviously in England, you've got lots and lots more trainees, we cannot offer that. And it's trying to broaden these um opportunities to, to all trainees as, as much as you can and as much as they want to, you know, seize them so many incredibly important points coming out. And I think what I am now thinking of in terms of some of these really key themes about um engaging and um trainees and residents being involved in system and organizational level and some really fantastic examples in terms of inviting the executive board members to actually, um, see face to face and engage with um early careers doctors. I'm just wondering what happens in terms of in our community spaces in our general practice space and Charlotte, whether you had any thoughts in terms of how the level of how important resident and trainee leadership is in the general practice space, especially that's a kind of system based level. Um, and any thoughts you have in terms of the level of engagement and how we could actually look into this further. Yeah, I mean, I think it's extremely important that we engage as many doctors in training local doctors as we can, whether that's in primary care, secondary care, you know, um social care, tertiary care, I think across the board, it's really important to have collaboration. And I think that by engaging those different um uh services, I think we can achieve that. Um And I think, you know, ultimately that was what the aim of the um the program that we run, you know, we, we wanted to engage as many um of those um as we could. Um And I think, you know, uh it's, it's not so much a system based change, but, you know, next generation GP started as a single program in London. Um and it engaged um enough uh trainees to um sort of develop this momentum that then spread across and it's now delivered in, in so many places in so many cities and those trainees attend the program, they then take back what they learn to their um places of work, whether that's, you know, um primarily it's primary care, obviously, hence the name. But you know, we opened the doors to um uh secondary care doctors, we opened the doors to other health care professionals, not just doctors. So we, you know, we really tried to start that process of collaboration um across all sectors. And if we can spark something in the, the people that we see and attend, they can then take that forward and maybe spark something else in their areas of expertise. You know, and, and, and you get a snowball effect and I think that's where the change comes from. You don't have to get everybody all at once. But if you can get those few, get them into the places that they're working, get them sparked and engaged, get them to take people on board. You know, that's when the momentum comes and that's where the change comes. So that, that's sort of ultimately what we aim to do. Just can I come, come in that? Absolutely. I mean, for me as a senior, it's so gratifying when you watch that spark and you watch that snowball effect and it's, and when, when they see the art of the possible, you know, their project comes to fruition change happens, you're absolutely right. You snowballs and, and something else good happens or the door may close, but another door opens and it's interesting. You're absolutely right, isn't it? It's about followers and then the followers, you see them looking at this individual as a role model, I think. Well, if she can do it as, as, as being an sh then I can do it as well. And it is up to us as, yeah, absolutely. It's a gift in our hands to make sure that we open those doors and we allow our juniors the space to be innovative and have that freedom to think outside the box. And not, you know, this is the way we've always done it. Just, just let them go and, and they will find that and, and, and actually guide them on the right path to, to enable them to be successful. But why, you know, and, and I said it was really privileged to be able to mentor the chief regs. But when you see them um successful in their project, but more importantly, when you see them and how they develop as individuals over the year is so gratifying, you know, from an individual who, who's scared to speak up in a meeting, who's now owning the meeting, who's leading, who's, who's now leading 100s of the registrars beneath them is, is just wonderful to see and, and, and really great for us as, as senior leaders to see that snowball effect. It sounds to me like there's a real giving back to senior leaders when they do actually elevate um training or resident or locally employed doctoral development. Sounds like there's something really tangible there for any senior leaders on the call who are interested in, in looking at this more. And you've all talked a lot about belonging, engaging, mentoring, um scaffolding or these kind of terms that to me really, really talk to relationship building. And I'm just wondering what you feel in terms of how that's the importance of the belonging and the relationship building, how that squares with um parent training programs of the rotational nature and how we can possibly address this in the future. Um So that we can elevate resident leadership wherever they go. I think Charlotte that you popped your hand out first. Did you? Yeah, because I think it's really important. Um because um II was one of those um trainees up that uh I was, I was in the, I'm an introvert, I'm an introvert. So I'm not going to actively put myself out there. Um And it was only because I had the support of um senior colleagues. I had uh a mentor and um and they, and they took me through, you know, um sort of coming out of my shell and um sort of showed me that I could do it. I didn't have to change who I was, but I could do it despite the fact that, you know, it, it wasn't my comfort zone and, and it, it made me step out of that. So II think it's really, really important. Um And, and it doesn't have to be a one on one thing. It can be, you can find your place in a, in a program. It could be a, a group of people that, that give you that support and elevate you. Um it can be a mentor, it can be a coach. Um II think, you know, that's what we need to be um providing trainees coming in and um local doctors is um someone and, or some people they can, they can turn to and, and really, um you know, find that support and engage with. Um and, and it, it'll look different for everybody, not everyone's going to find their place in the same, you know, with the same people. Um But there, there, there should be and will be, um, you know, somewhat somewhere for everyone. I think the house. Yeah, I mean, I always encourage everyone to be their unique selves, you know. Um I mean, that's the whole point, isn't it? You're bringing something different to the table. Absolutely. You know, when we're young, we always wanna be like everyone else, but actually, you wanna be completely different to everyone because this is where the diversity, this is where the challenge, this is where innovation really happens and that's where we really should be encouraging everyone to be their authentic selves, but be the best version of that and, and, and, and try to, you know, I always say to my juniors. Yeah, you can look around at your role models and pick all the bits that you want to be. But where's your gem? Where's your piece of uh spark that's gonna go in and what's gonna, what makes it you and I, and at the end of the day it's about the unique individuals that makes great leaders, you know, the, the um expression in your face to your, you know, little jokes to the way you carry yourself. Those are the things that we really need to um really hone into. We are, we do not want a production line. Unfortunately, what, what frustrates me is we have these bright 18 year olds with so much energy and um dreams and innovation. They go into med school and five years later, they churned out and they are in this machine, aren't they, they're produced and, and, and, and I don't know what the guys on the panel think, but you often feel that your creativeness has, has been taken away from you. And I, and I felt that as well. I mean, I uh when I did my A levels, I loved English literature and I did economics, you know, we didn't have to bulge and stuff and I am really creative and it was only, I would say in my registrar years that I could get my creativity out by the leadership by solutions. And it's a real shame because we need to hone this in when they're 18, when they're coming to us and they want, they want to find a cure for something. Yeah. Absolutely. You can do it. Um, so I think when they come out of med school, um, and I don't know what people think, you know, we have beaten out the creativity out of them and I think we need to relook at how we are producing our doctors. Um, I don't know what the folk think Helen, thanks Josie. So first line, I apologize for calling you Claire earlier on it. Uh But I really like that, that comment about creativity there and how we beat that out of people. And I think that's a real problem with the way we do our undergraduate and our postgraduate education. So I've also got a role at our university thinking as a mental health lead, thinking about how we, how we support our student. And one of the things that we've been doing a lot more of in Sheffield is to say, if you come into med school knowing that you wanna be this or that or the other, then let's give you the opportunity to do that to hold on to some of those interests, whether it's psychiatry or urology or public health. I don't mind, but actually let's give you some choice around what you, what you want to do. So we all know that in order to train a doctor, you will have to do everything or, you know, there's a baseline that we all have to cover. I'm not suggesting we don't do that. But within that there needs to be some flexibility for that creativity that you're talking about sa and for that ability to sort of express yourself in whatever it is that you're wanting to do. I think, I think uh speaking locally, at least we're getting better about doing that at an undergraduate level. And I think there's a lot more that we could be doing. But of course, once, once doctors move in specialty training, it becomes my view even more rigid. And I think we've got to get away from that partly for the benefit of our doctors and their ability to sort of think about what's important to them in life, how they want to shape their own careers, what flexibility they can have in that respect. But also because, you know, people are complex, people don't come with one disorder or another disorder, they come with a complexity of issues increasingly. So, I mean, you know, always the case, but with Polyorbis in an older generation, that's even more the case. So we, of course, we need specialists to understand psychiatry or cardiovascular medicine or diabetology really, really well. But actually, we need all of us to be able to stretch into those areas where we're not experts, but we have some capability as well. Um And because that's what our patients need, that's what our communities need, they need that specialist, but they also need us to sort of be able to stretch outside that as well. So I think we need to think in training about how we can give a little bit more flexibility to trainees, how we can treat them a little bit more like adults. I'm ashamed sometimes at the way we treat our, I know I'm not meant to call them trainees any longer. Apologies, residents. It'll take me a while to get used to that. But how we treat our doctors to make sure that we are enabling them to bring of their best and not beating that out of them. I think something which is helpful in that in that regard is the GMC emphasizing that all doctors are leaders. So leadership is something that we do. Your job is not simply to deliver good care in whatever specialty or area you're doing it. It's also to lead. And as we know from the or those of you who are familiar with the eel standards, leading means a lot of different things leading means being your authentic self and thinking about who you are. It means working together with the team. It means thinking about your organization and it means thinking about that much, much wider system of how we work together with the voluntary community sector, with the police, with education, with a whole range of other things. And if that all feels a bit big and I know it does sometimes then just pick off a bit of it. You know, just think, well, where can I stretch to or, or where does my particular project or my particular interest need to stretch to? That might be education, that might be the voluntary sector, it might be the police, it might be all sorts of other areas. So to get that flexibility for people to operate across that system. And I think that's what at the end of the day will give people not only deliver better health services at the end of the day, but also give people that sense of pride at, at being able to do what is important to them. And yeah, I just like to echo all of those. I think we there's a definite requirement to reexamine um the conveyor belt of undergraduate and postgraduate education for doctors. Um And I'll give you, I'll illustrate that with a, with a couple of examples. If I may think about how we select our doctors um of the future now, increasingly academic um which you know, has its pros but also potentially has its disadvantages as well. When you look at the proportion of medical students who are neurodivergent, great, but the education around them needs to support them and needs to be sensitive to how they learn. And then think about our post graduate training, doctors moving around and sometimes geographically distant locations every 6 to 12 months. Of course, that's gonna have a huge impact on their abilities to develop as leaders because they're not able to really invest in developing, seeing through projects and seeing the outcome and the impact of those projects um down the line. So, so we need to reconfigure how we train doctors. And I'm only speaking as an individual now rather than on behalf of an organization. But I know when you, you know, you speak to the GMC, you speak to the Statutory Education Bodies, they're all thinking about this um as well. And the biggest statistic that we really need to look at currently is not the rates of burnout, which are eye watering still. It's that GMC statistic that shows you the different proportions of the medical workforce and how all of them have remained relatively static over time, apart from those doctors who decide to go that locally employed doctor route that is rising exponentially and people are voting with their feet. Um because of the way postgraduate medical training is, is configured. And so, first of all, we need to look at that how we can ensure that training meets the needs of our modern resident doctors. And secondly, what we can do to support locally employed doctors because actually with the portfolio pathway, um I'm doing myself out of a job here by saying this, there are other routes to becoming a specialist um these days. And we need to be, we need to ensure that, that we are supporting the diverse range of our resident doctors to both grow and to become leaders in the future. And we need to think about that right from the day they enter med med school, really fascinating point there. And it all sounds like all four of you are very much ascribed to increasing flexibility, really embedding leadership development and also giving any learner, be it an undergraduate or postgraduate learner, the license to actually choose where their talents and their interests lie and to develop those um you know, alongside clinical training and just, just thinking about that for a second and we've kind of explored some of the potential structural changes, the organizational changes that need to take place. But how would you convince senior leadership teams or executive colleagues? Be it from a clinical background, from a nonclinical background or what one of our audience members is very apt co the cynical senior leader. How would you convince them of the value of resident leadership and to enable better environments for locally employed and resident doctor leadership, Ian, please go ahead, go ahead. I have um I mean, I can speak for my own organization. Um You know, I think I'm, I'm very lucky that I already work in an organization that really embraces, you know, uh the importance of training leadership amongst our senior individuals or exec execs um within um H IW. But I think the arguments are compelling if I was trying to persuade a, a less than enthusiastic colleague. Um And I think there are several elements to them, I think without harnessing um trainee leadership today, we won't recognize the NHS um of the future. Um We might not even have potentially an NHS of the future without that voice from today. Um And the other big area is I think you cannot um separate um leadership in one hand from wellbeing. Um in another, they are two, they are in intrinsically linked um without um effective um compassionate, collective leadership, which, you know, I'm proud to say we kind of embedding right throughout our, our trainees in, in Wales. Without that, you won't have, you know, staff who feel valued, who have um good wellbeing cos it's without those doctors and other healthcare professionals delivering that change and thinking about how we can improve wellbeing through a compassionate and collective approach. Um you will lose and you're already seeing this, you will lose doctors from the NHS and other healthcare professionals. And that's one of the biggest challenges facing our NHS workforce now and we're seeing it day in day out and it's gonna be a huge challenge um over the coming years. Um Unless we start really making that case for strong, effective er leadership and that link between that and enhanced wellbeing in our workforce. So please go ahead. Yeah, I mean, ii mean, I work in an organization where, you know, all all our juniors are, we're encouraging them to do more and more because as I've said earlier, they are the, the answers to the, the, they've got the answer to the solutions that we're looking for because we're not there 24 7. And I always describe them with the eyes and the ears of our acute hospital trust. You know, if you, if you want the solution, go down and speak to the medical registrar, go on down and speak to the houseman, who's the fy one who's, who's, you know, there at two o'clock in the morning, you know, experiencing what's really happening. If you really want to know what's happened to our patients, go down and speak to the patients. So, um I'm lucky I II don't really have that cynicism. But what I would say is that I would really worry if there was that, I'm sure there are places where there is but leaders in themselves at the top need that challenge and that challenge needs to come from the bottom. But also, as I've said, I've often felt inspired many, many a times, a lot of stuff I've done is because I've been inspired by my juniors. They pick you up when you're down, they come up with great ideas that you never even thought of. They give you the energy um which is required often as, as, as a senior leaders and you know, it, it's, it's a tough, it's a tough gig and it's lonely at the top but they're the ones that keep you going. Um, because they've got that energy, they've got the bandwidth and there's stuff that they know that a lot of us haven't got a clue about, you know, I mean, you know, that they're really advanced in a lot of the, it side of things, um, and stuff that I can't do. So it's about complementing one another and I think it, it's incredibly short sighted and incredibly foolish if organizations don't lap this up because you, you're the solution, you are part of the solution to, to all the issues that we are facing within the NHS, whether it's urgent emergency care crisis, to post COVID to morale, to well being in every area, there should be junior doctors sitting at the board, sitting in those big meetings, being listened to and heard in the board meetings and not be afraid because they are incredibly powerful, Charlotte. Yeah. Uh Josie, I think I would just echo what s said there. Um I think from my point of view in terms of convincing uh senior leaders, one, I would be a bit concerned if I'm having to do that, but it does exist. Um And to let, let them do it for themselves, let the trainees, the residents, the local doctors, let them do the convincing. I think what our role should be is is linking up the, the the current senior leaders with those that are coming through. Uh And just give them a platform for which they can, you know, um introduce themselves. Um They, you know, they'll shine through, it will become very clear that, that they're the ones that are able to, to make the change and that uh that should be making the change. So, II think, you know, in terms of convincing, I think we shouldn't have to do much. I think we just need to, to allow, you know, those things to happen and be sort of the the catalyst to that. Um And, and it will, and they'll speak for themselves, they'll shine through. So it's all about that sponsorship that keeping the ladder down, opening doors, making introductions really important point there, I think. Thank you. Um and also really quite empowering, but I'm just, I'm reflecting on some of the, the answers from those questions, which was really, really interesting in terms of it sounds like you feel that there's a uniqueness to the leadership qualities that resident doctors have and that they can actually bring something that you can't be sourced anywhere else and therefore health care or patients are missing out if residents aren't actually at the leadership tables or haven't their voices heard? I mean, do you think um something like creating an actual speciality of medical leadership or subspeciality training program where you could do training and leadership and management, do you think that that would bring anything in terms of um seeing a future where residents are at those key um, pivot points in the NHS. It's a hot potato question, isn't it? Helen and Jessie, I'll, I'll take that one. Didn't see that one coming. Uh um II mentioned the GMC earlier on and, and how important I felt it. They, they feel it very important. Something I support that we all see ourselves as leaders as doctors at whatever grade. And I think something s said a minute ago is, don't forget the power that we have as a profession. We have immense power, but we need to use it wisely. Something that I sometimes see from um, more junior doctors, um is, is an absolute passion and desire to make something change, but also an anger which I understand, you know, there's a lot of anger around at the moment, um that people aren't listening and that those changes can't be enacted. And one of the things that I'm keen to do is to try and bridge that gap between those people with all the good ideas, not just doctors, but also doctors and those people who are trying to enact change from the top of the organization or indeed beyond the organization who are wanting things to change as well. And I think quite often the distance is not too far apart but they recognize one another. So people wanting to, you know, there's a thing called the People plan. I don't know how many people have seen it. The NHS people plan if you read it as junior doctors, you'd love it. Honestly. You would. I mean, you wouldn't love reading how many different pages it is. But what it says is absolutely what you want. It talks about flexible careers, it talks about how, what it experience is, it talks about how to support people in different ways, you know, all sorts of things and yet, you know, and the organization is trying to enact that and the, and the, and the juniors are wanting it and we're not bridging that gap well enough. So to come back to your question, Josie, who is it that can bridge that gap? Well, perhaps you're right, perhaps um doctors who see themselves as having a role in what might be called medical management or leadership, a sort of more formal role. I mean, I think just an answer to Mariana's question earlier on, what do you mean by trainee leadership? We're all leaders. Yes, we are all leaders. That's one narrative, correct narrative. And yet there's some leaders are gonna be more leaders than others. You know, some people are going to get more involved in the nitty gritty of actually making that change happening and joining those things together, the organization and the system and the actual experience on the ground. And that takes time. And for many of you, you won't have time. Um it also needs support and you need, you know, time to reflect on the sorts of ways that you're being the sort of um the impact that you have and how you can most effectively use yourself to try and bridge that gap and make those changes. So, yes, you know, the, the National Registrar programs or the versions of those that we've got are brilliant for those people who are on them, but it's not enough for many people. And we definitely need an additional tier of people who have an ambition, who have an interest, who have an enthusiasm for working this way. And not everybody does. I completely accept that and they will be the people who become the future senior leaders who, who spend a lot of their time, like, you know, probably in, well, probably all of us here do um in actually not delivering clinical work, but in actually trying to make the whole system work better together. Um So, so yes, introducing people earlier to that, I think is really important um in, in the me in medical careers, something I experience a lot and I'm sure others will, will identify with this is that we go do doctors go through an excellent training scheme. They come out superbly clinically qualified. At the end of that, they land their first consultant job and they just sort of feel overwhelmed by the different types of responsibilities that are expected of them at this point. And whatever our training does, it may be very good clinical training, but it doesn't actually prepare doctors for the job that needs doing um at the end of the day. So I think something that we could, you know, something having it more on the curriculum, having people having a special interest session building in joint training schemes or something like that. I think uh Marian's just answered the question. Thanks for joining in Marianne. What are the programs you have at the moment? So, Chief Registrars, yeah, we've got leadership fellows in Psychiatry, but we also have um out of program approach um offers from um at what used to be hee but you know, there are various types of out of program offers. I think they vary across the country. Um There are also, I think you also can see leadership in other opportunities. So we have quality improvement specialists, for example, roles. And if you, if you think about quality improvement as a type of leadership activity, then you can build it into that. We also have teaching fellows. Do you know what teaching is not only about teaching, it's also around all the governance and the organization of teaching, which is a much bigger. II think it's much more important actually than the actual, no, maybe I shouldn't say that but the actual teaching that's done 1 to 1 because it actually ensures that everybody gets a good training or teaching experience. So seeing the leadership in other activities, I think is another opportunity for, for elevating that concept as something that you know, we all have to some degree but you can develop to a higher level. So, yeah, absolutely echo that. And I think we definitely need to start looking at these roles but these roles can't be, you know, like sort of a four month or, you know, it's difficult to do anything in that with the NHS, with any kind of work that you do, you need to be able to see these projects through and this takes time because you meet with lots of teams and you know, getting stuff done with NHS does take time. There's a lot of obstacles, but that's the whole learning process. Um And, you know, leadership has to be businesses usually can't be, it has to be seen as the norm rather than as an extra thing or it's, you know, like, you know, how teaching was and, and, and management and leadership, it's something else. It's part, it's got to be part and parcel of clinical medicine and to drive clinical medicine and to make change that definitely um needs to be sort of in, in ingrained within the culture of, of the NHS. And what other thing that I would really be passionate about is that when juniors come and seniors, when they become consultants, they still do not know how an organization works, they still do not know the structure of organization, how the clinical groups work, how the governance works. What is the role of an Ed if you ask lots of consultants, what is the role of the medical director? They will tell you the wrong answer. They will just say that his or her job is to fight for us clinical clinical consultants. That's not the right. That's not the answer. The answer is the medical director will pursue the organizational clinical objectives in line with the clinical hat on. And it's really interesting even at senior level that is not understood. So I think we need to get the basics understood. How does the organization work? How does the organization fit into the NHS? How does the money work? The, these are the basics. And, you know, I've only learned that as, as when I started going to, you know, my sort of de TMD role really late into it. It's like, oh, right, ok. That's why we're doing that then. But we should learn that on sort of day one of med school because it's, it's about everything that we're doing. So this is basic stuff that we're missing. And then that's what will drive us, whether we're juniors or seniors to wanna make that change and understand. We've got taxpayers money in our hand, how we're gonna use it. That's essentially how organi organizations operate. I, I'll just be quick because I know we're short on time just to say. So it took me a long time to work out how money runs through the NHS as well. Well, into my consultant um career. But I think going back to your question, um Josie, I don't think separating it out and having some kind of formal um training in as a separate program as it were. Is, is, is, is, is, is probably gonna cut it. Actually. One of the big frustrations I have about our leadership program in Wales is for a year, our trainees are out of training. Um They're immersed completely in quality improvement, leadership change and then they go back into training and they find themselves kind of feeling totally disempowered um without the opportunity to change things. And I think the real solution to this is, is, is trying to create more portfolio opportunities. Um like Helen mentioned in, in all of those different disciplines, be that education, be that research, be that leadership and, and, and ensuring those portfolio opportunities um are extend right the way through training. So they're longitudinal um rather than just a, a year or two years. And by doing that, we'll really be able to sort of intertwine both the clinical element and the leadership or the education um or whatever it is, the challenge with that is, is potentially that could extend training for some um and the opportunity to get our people with our CCT S, you know, cos we need, we need consultants. Um you know, we've got a, a dearth of, of, of specialists in, in the UK. So there's, there's that tension um between doing that versus having doctors specializing and specialists coming out at the end of training. So, you know, um the other opportunity and I think we, we've, we've not talked about it probably enough and II talked about it, the FMM conference. I'm going to talk about it just briefly again, is, is multiprofessional learning is absolutely key to leadership development. And that's why we've extended our program broadly in Wales to include many different healthcare professionals. And we have found that that has done nothing but enrich that learning environment and that leadership development environment. But I will stop that. Josie cos I know we're short on time just, just very quickly. I II think also just to add to what you've just said, I is learning from our patients. Those patient stories are the real drivers for us as clinicians and the MDT team for our purpose in life. You know, you get yourself in a room of, of, of patient group is, is so powerful to hear what they go through. So let's not forget about the patient as well. They, they are, they, that's why we're all here really for our patients. That was an absolutely fascinating conversation fac conversation still can't speak, can I? And do you know at the end of the plenary session when I sat down with my colleagues, I thought there was so much more for us to explore and that we could do this in the webinar. But do you know, I think we could still talk about this for hours and hours. So I do wonder, no promises, but I do wonder whether a podcast may be in the progress in the next year or so kind of picking up on some of these points, so much richness in that conversation about authenticity, weaving in leadership development and everyday leadership into undergraduate postgraduate, inter locally employed doctor roles throughout um and the key importance of the enabling of senior leadership, but in a way that it actually empowers the resident rather than um in a way that actually disables them. Um So thank you so much for your time. What I'd like to do is just go around you all and just feel your parting thoughts. Something that you'd like any attendees take away from this conversation in particular, stop. I mean, this is a thing that I live by but be the change you want to see and we haven't once mentioned imposter syndrome um in this webinar. So what I'm gonna say, and it's been one of the philosophies of my life is sees opportunities and even if you feel you're not ready sees them, you'll, you might, they might never come around again if you don't. Fabulous. And Helen, what do you think? Yeah, I'd absolutely echo both of those, especially the opportunity. Never have a plan as to where your career is going. Always wait and see how it develops. Um And, and seize those opportunities as they come along otherwise you miss them. You're right. But I think the biggest thing I'd say is something I like to talk about is being brave. Um, and that, you know, sort of speaks to your comment about imposter syndrome. Um, Ian, you don't lose that f enough. It's still there have seen you out of place overwhelmed, like you're the wrong person in the room and like, you don't know what you're doing frequently and II say I can feel like that. Uh But you give it your best shot. You be brave. You recognize that you've got a whole set of people behind you wanting you to succeed here. Um And a profession which is well respected, so be brave. And um and don't give, don't give up hope. There's a lot of hopelessness around at the moment. But actually the skills and the competencies and the, and the, and the passion that we have in our profession gives us reason for hope. I think so. Don't, don't be one of those people who gives up fantastic and Charlotte last, but not least you took the words out of my mouth. Helen. Um You used brave. I was gonna say just step out of your comfort zone. Um You know, I II do it every day. I always like to do it, but it's made me better. It's made me a better leader. It's made me a better clinician. Um And yeah, I just think it's um really important to do it. Fantastic. Thank you all for your time and thank you for the audience for your time. We hope you've really enjoyed this webinar as much as we have. Um Please do fill in your feedback forms, really keen to hear what you're thinking about. Um Please do be as honest as you need to be. I really apologize about the technical issues to begin with. And also if there's those questions that we haven't been able to pose, we are um banking those questions and we look out for future TSG features because I'm sure that we're going to return to these because some really, really important questions. If any of you are more curious now about the F MLM or the TSG, we are currently having a website update. It's just been launched today, but some of the changes um the web pages will be changing over the coming weeks. Um But please do a go on there, have an explore and feedback to us about what you think we're doing for you, what you think we could do better and so forth and in particular, perhaps have a little look at the TSGS Leadership Commitment Charter, which we launched 34 years ago, which essentially is something to use as a partnership between the resident or um the early careers leader and the senior leaders within an organization working together to bring a series of evidence based leadership development opportunities um accessible to any um resident within a hospital, regardless of financial background time, it should all be within your working hours um regardless of any other protected characteristic. And you can work alongside senior leaders in your organizations to implement that for lasting change. And we've seen partnerships like that occur across the UK and there's been real diffidence for years after Helen's been one of our fantastic senior leaders um pioneering that with um some of her past resident doctors. So again, thank you so much for your time and for your patience with the technical issues and hope to see you very soon. Yes.