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Ok. Hi, everybody. Um my name is Carrie. Um I'm one of the ones that's going to be doing the teaching session um this evening and the teaching sessions on health and wellbeing. So um we're just gonna be covering um a few things about kind of stress and anxiety at the beginning of work. Um Some things about where to get um some support if you need it and also some more practical things afterwards about contract and pay. Um I'm doing the talk with Tara. He's another F one and we're both F ones in Musgrove Park Hospital. Um And we're doing it with prepare for practice, um which is um a platform which is aiming to prepare people for F one. And we've done lots of talks on um everything from sort of preparing for, on calls and managing sick patients to stuff like this to help and well being. Um So please do go check out all our other talks um on medal if you're interested. Um So I think we'll just get started. Um So I've kind of covered objectives already. So um these are the things we're gonna be covering. Um So I thought I'd start off by just kind of generally talking about um kind of stress in the beginning of F one and things, I think it's um something that's super normal at the beginning of F one. And one of the important things is, is figuring out where, where it goes from that normal stress of starting a new job. That's, that is quite a stressful job and when it starts to become harmful. um and something that you need to seek extra help for um differentiating those can be really difficult at the beginning. And it's often when that stress becomes, um kind of starts to affect your life outside of work. Um Last for a long time is very intense. Um And we'll go over a little bit about what things you might experience if it's, if it's becoming an issue um that you need to address. Um But I thought it was important to also say about how at the beginning of f one feeling stressed and feeling overwhelmed is, is very normal. Um And it gets better with time. Um And I hope that that could somehow be reassuring for you that it does get better. Um at the beginning, um it does feel quite overwhelming sometimes on calls and things like that. But I thought something that was important to say was that you're sort of only one person and you can only do your best. And I think at the beginning, you forget that and you think that you've got this list, you need to go through all of your lists and finish everything and do everything to the best of your ability. But really, sometimes that's not physically possible and the only way to get through it is to be good at prioritizing. Um And prioritizing the skills that you get better at as you go through F one. So at the beginning, you'll find it quite difficult to figure out what you need to do first and things like that. But you'll get your own tactics as you go through. And there's things that we've, um, talked about in previous talks as well about how to prioritize that might be helpful to go back over. Um, but it definitely gets easier once you start to figure out what are the important things I need to do what jobs are. Actually, I don't even need to do that or it'll take two minutes and I can do it at the end of my shift. Um The other things that make it a lot easier as you go through is you get to know the system. So in your first week, it might take you half an hour, 40 minutes to do a referral. But by the end of your first block, you're doing it in 10 minutes. So things get easier as you're going through F one. And, um, that's important to know. Um, and you also just become more efficient I think at your job, um despite that, if you do feel overwhelmed, um one thing that I found that's really helpful and I'm sure everyone will say this is that talking to your colleagues about it really helps kind of debriefing after you go home is an important aspect of it. And I think it can really help when you realize you're not alone and feeling overwhelmed. Um And also talking to people on your shift. If you feel overwhelmed, there's things that people can often do. So if you're being bombarded with loads of tasks, sometimes if you've got kind of a coordinator who's on call and letting them know um can be helpful. So there's strategies to know when you start your F one and your shadowing period, knowing who you can ask for help and who to escalate things to is also really helpful. Um And there's people like your clinical supervisor and educational supervisor that, that um that can also help with stuff like that. The other thing is breaks. So it always feels like you don't have time for a five minute break when you feel overwhelmed, you know, you've got like three pages of jobs to do or something, but you always have time to do to have a five minute break. Like unless someone is para erratic, then you have time to just leave the ward for two minutes, take a break, take like have a walk, eat something pee um And it's surprising how much that five minute break really makes a difference to how you feel and how more achievable your list looks when you come back. Um So always take a five minute break even if you're really busy. Um So the other thing was just about kind of feeling anxious at the beginning of F one. So starting F one is really an um anxiety inducing and I think everybody feels it. So you're definitely not alone if you feel anxious about it. Um And that's completely normal. I would say that um the things that I look back that I was really anxious about were things like um what if I can't get blood from somebody? Um And now looking back at things like that, you realize that you're never alone. There's literally always people you can escalate to and that's actually, I don't even get worried about that anymore because you can just escalate to your asset chair, escalate to your, to your bed. Other F ones, there's always someone that you can ask for help and it's completely normal to not always get blood from someone or not be able to do a procedure and particularly at the beginning if you're an F one who's maybe never done a cat before, for example, um you shouldn't be scared about doing, you should sort of lean into it if you can and try and try and put yourself in situations that make you better at doing those things so not to shy away from them. Um So the more like ABG S and things like that you do, the less anxiety inducing they'll be and the better you'll be at them. Um And failing is just part of part of learning cringey, but true. Um You will make mistakes. So I think everyone's probably made a mistake that they've gone home and really overthought and felt horrible about. Um, but just knowing that that's part of learning, um often debriefing. So talking to people who are, who are there at the time. If you can talk to your afterwards about it often ends up being quite a reassuring thing. You think that you don't want to talk to anyone about it. So you just want to keep it to yourself, but actually talking it through with someone can make you feel a lot better about things. Um reflecting on it and learning from it is the important part. Um And not to kind of let it overwhelm you and then just move on from it and with time you will forget about it or learn from it and become a best doctor because of the mistakes you've made. Um But just to know that that's a normal part of, of the process, um I wanted to finish this bit just with support. So we've talked about kind of it being a normal process of f one, but also there's anxiety and stress that isn't normal and that you need extra support for. And it's really important that you don't shy away from that as well and that you, you recognize that. Um And there's just a list of kind of um people that you can seek support from that we've put there. So people like your clinical and educational supervisor, there's normally a local wellbeing lead. Um There's more um kind of national support through the BMA. Um And there's N HSP practitioner health as well, which you can have confidential phone calls with them. Um Occupational health, they can often help with things. Um For example, if there's, you've got a certain health condition that means that nights can be difficult, then getting in touch with occupational health can be really helpful and they can help adapt to, to suit your needs. Um and talking to colleagues, friends and family um is always um a helpful way and um your GP if you're really struggling, um I need extra support. Um I think, yeah, it's important to know that even though you want to be perfect 100% of the time and I think often people that go into medicine are a bit of perfectionists. Um it's not possible to be perfect 100% of the time and there's things you won't know, there's kind of times feel overwhelmed and stuff like that, but it's part of the process and learning how to kind of learn from those things is the important part and it'll make you a best doctor at the end of the day. Um But it's also ok if you're struggling and need extra support for those things. Um So the next little bit is just about kind of the causes of harmful stress and anxiety. So some of the contributing factors that you might um experience whilst you're at work that, that lead to those, that stress and anxiety becoming, becoming harmful. Um I thought we'd mention these things just because being aware of them can really mean that you, you can sort of address them as they come along or recognize them easier. Cos often there's not things, they're not things that are under your control, but knowing about them can be really helpful and you can raise them earlier on then um before you become kind of burnt out or, or it becomes overwhelming. Um So you can sort of broadly split them into high workload and reduced capacity. Um So the things we've put under here are high workload. So often there might be jobs which are higher in workload than others. Um And often as enough, you'll go through obviously your your various rotations every four months and um every four months you go through, there might be periods which are really difficult and periods that are better and knowing that um everyone will have jobs that are more difficult um can help sort of alleviate some of that stress sometimes when you know, that like? Ok, well, I know that this job is really difficult but in four months time, um I'm on an easier job, for example, um in terms of workload. But um yeah, so it can come in kind of um in waves sometimes um highly demanding patients can also obviously increase your workloads and also educational requirements. So we've just hit ACP time now, which is the portfolio time where you have to submit your portfolio with the various things. Um And so this has been quite a, a time for education requirements in terms of that takes a little bit more time and a little bit more stress. Um So trying to be on top of your portfolio throughout the year is a way to kind of mitigate that um reduced capacity. So stuff like understaffing, lack of senior support, low morale instability at work. Um and personal issues or health issues can also um lead to stress and anxiety becoming more on the harmful side. And all these things are things like understaffing and lack of senior support or things you should be raising to your clinical or educational supervisor if they're starting to affect you at work because these are things that should be able to get addressed. Um in terms of recognizing when um stress, anxiety becomes harmful. Um I hope this isn't patronizing, it's not meant to be patronizing. Um But it's just to kind of highlight some of the um some of the things that you can look out for um to um figure out when those, those symptoms and signs might mean that you need to kind of have a think about um ways to, to address what's going on. Um So symptoms, things like fatigue, low mood um starts to affect your sleep. Um If you start to feel very anxious all the time, poor concentration, irritable or physical symptoms, like headaches and stuff like that. Um signs of harmful stress, anxiety. So inability to prioritize, degraded judgment, sensitivity to criticism, reduced social interaction and increased consumption of food, alcohol or cigarettes. Um So these are just examples of things that, that might trigger you to think. Ok, this is um this is not part of the normal stress and anxiety of work. This is getting overwhelming and becoming harmful and I should try and seek some support. Um So yeah, hope that bit was helpful. Um But these are just more strategies to help with those things if you start to recognize some of those, some of those symptoms. So it there's various things you can do. Some of them self care and some of them, this is sort of what you do in a sy style for um for for patients with um kind of stress, anxiety. But um so self care things you can do. So sleeping well, eating and drinking, well, things like that. Um we all know about but harder to do in reality. Um Things like I would say, practically booking your annual annual leave really early on is really essential. Being able to have those moments where you know that you've got annual leave coming up or you can really reset and have a break and planning fun things on your annual leave. Um often that can take more energy than, than you think and planning things can drain you of energy. But I think making sure that you have fun things planned even if you don't feel like it um can really help rejuvenate you at the end of the day, um reducing stresses. So um learning to prioritize like we talked about can help with workload um and taking just a two minute break if you're feeling overwhelmed um in the day can also really help um when these things haven't helped, obviously, we go on to the more things, but you might need to go and seek help from your GP counseling, meditation, um medication um can help with stuff like that. And then we've already talked about some of the support that's available. Um So Tara's now just gonna go on to talk a bit more about um kind of practical things um about F one. Please feel free to send any questions if you have them. Um And we'll just talk a little bit about contract and pay and stuff like that. Now. Hi Carrie, thanks. Um Yeah, so um my name is Tara. I'm another one of the F ones working at Musgrove. Um, and yeah, so with contract and pay, I think the first time I ever got a pay slip, I was just, I was so confused because no, no aspect of it made sense to me. I didn't understand whether I had been paid the right amount. I didn't understand what all the codes meant. Um And so it was just, it was really confusing, I think, yeah, the most important thing is to read the contract before you sign it just so you know what it says. And then the BM has a contract checking service which you can use and it is quite helpful and you can al they're also very easily contactable if you had specific questions that you wanted to ask them, um, about your contract or just about like any contract of pay related things in general. Um Yeah, so always, always check your pay slips because they do make mistakes. And I think from my experience and just speaking to other f ones, they make mistakes quite often and it unfortunately does sometimes come down to you to be checking your pay slips and like checking them thoroughly. So that if there is a mistake that you're aware and that you can raise it with whoever payroll with, with the payroll department at your hospital. And at least in, in Musgrove, they have a phone number so they are fairly easy to get a hold of even if you all you want to do is ask them a question or clarify something that you don't understand on your pay slip. And what I found really helpful is I just screenshot all my payslips and I put them in an album on my phone so that I can sort of quite easily compare from month to month how much I'm getting because sometimes that helps to like highlight if maybe for a particular month they've overpaid you or underpaid you. Um And then, yeah, the, the bit about student finance, that's not something that should be coming out of your payslip when you first start. And if it is, that's something that you should highlight because they can take quite a lot and it can make your monthly pay quite low if they're taking too much early on and if it is, yeah, that's how you can message them and they can sort of give the money back to you. Um Another thing that's quite helpful just more in your free time is there's a Medics Money podcast that sort of goes over the same sort of thing that we're going over, but in more, in more depth. And I found that quite useful as well. Um And then with your rota and leave, they, so sometimes it depends very much on the job. So sometimes you might get your rota, not with some jobs, you might get your rota earlier than others. But when you, as soon as you do get it, try and start planning and booking your annual leave because there will be some times where like you can maximize your time. So for example, if you're working the weekend and you have days off on a Monday and Tuesday, you can like you, you'd only need three days annual leave to effectively get a week off if that makes sense. And so if the earlier you do it just the more flexibility that you have when it comes to booking annual leave because all, all wards have a certain number of ha ha will have a minimum staffing number. And if everyone else has booked their leave before you, sometimes that can put you in quite a difficult situation if you really need leave on a day that everyone else already has leave, and then you might end up being quite limited in your options. Obviously, in, in difficult situations, you can always speak to your colleagues. And like if it's for something in particular where you really need a specific day. In my experience, people have tried to help out and switch their annual leave around if they can. But in general, the earlier that, that you do it, the more flexibility you have when it comes to picking your dates. And it's just, it's just helpful really to know, I found it quite helpful to know that I have like things that I've planned and that I'm looking forward to. So that even if you're having a really difficult week or a really stressful weekend, you know, what's coming up. And that's, yeah, that's quite nice. Um, and then also to know how much annual leave. So, for us it's like 99 days per job. And at least at Musgrove we also get study days as well. But that can vary between hospitals. And if there are any issues you, every, a hospital, every different job will have a rota coordinator. Sometimes it's like actual doctors who are also working in the department and sometimes they hire someone specifically to manage the rota. But regardless if you have any issues or if there are any swaps, like you, if you really need to swap a weekend or you need to swap like an, like a on call, you can always, you should always be able to contact them and sometimes they even have an office if you need to like find them in person to sort things out. But then obviously if, if that's not working and you're not able to do things in a fair way, then you can always again raise it with your supervisors on the ward, but also like your clinical supervisor, educational supervisor. And I suppose if all of that's not working, you can always escalate it to managers or the guardians of safe working. But that is quite, at least in my experience that's quite rare that it ever comes to that. But it's just so you know, your options. Um, and the next one is dealing with sort of un unpleasantness at work, which obviously ideally doesn't happen, but sometimes it does and it can, it can be, sometimes it's between members of staff. Sometimes it can be from patients, from patients relatives. I think when it comes to, I think it's very easy to feel as the f one that you, that you shouldn't, that you can't stand up for yourself and that you shouldn't defend yourself because you're, you know, quite junior um compared to the doctors. But sometimes, you know, II always, especially when I started, felt junior to the nurse as well because they've all been working on the ward for much longer than I had. And they knew a lot more about the ward in general than I did. And so I think it's very easy to feel like I shouldn't say anything. Um I don't want to look like I'm, I don't know, causing problems, but it is, you are well within your rights to, to address something if people are being unkind or unfair to you. And, you know, we all deserve to walk in a place that is pleasant and fair that where people are polite and respectful. Obviously, that doesn't always happen because the nature of the NHS is very stressful and everyone is under a lot of pressure and everyone is trying to juggle 10 different things at once. And I think sometimes in the midst of all that, it can be easy to forget that while you're so absorbed with your own tasks, everyone else is too. And so if you feel like someone's not being helpful or they're being unkind, I think it helps to remember that they're probably dealing with a lot at the same time. That being said, I think it does situations like this do also need to be addressed because in my experience, at least people who are, who have been maybe not so kind, maybe a bit rude often don't realize that they have been that way or it's things that they've done or said in the moment. But then as soon as you mentioned to them, you can even say something like, you know, I felt that your tone was a bit unfair when you, with the way that you spoke to me earlier, anything like that? II found that people are very often like quick to apologize, usually they'll say that they were stressed in the moment. And yeah, obviously, in the center of all this patient safety should be the most important thing. But I think a a good working environment directly contributes to patient safety because people just work better when they feel like they're a valued member of the team. And if people aren't being, you know, polite and respectful to each other, it's very difficult to feel like you are a valued member of the team. Um And obviously, if, if, if it's you who hasn't been, maybe the as polite or respectful as you could have been, which is very possible. You know, being an F one, as we've said can be very stressful, especially on calls when you've got 500 things to do and everybody wants something from you and it can feel like everybody is just relentlessly asking you for something constantly. It is very easy to, to snap at nurses who's like to snap at a nurse who's asking you for a discharge summary when you're busy trying to sort out medications for an unwell patient. But I think it's important to be aware and realize that, you know, that you maybe weren't fed someone else and then to apologize to them to reflect it, to try and avoid doing it again. Yeah. Um, but obviously if, if things are happening where you are concerned and maybe that's becoming a bit of a pattern in terms of how people are treating you, then it is, it is important to raise those issues. And again, like it, I think it is very tempting to feel as the f one that you can't say anything or you shouldn't say something or that it will reflect badly on you for whatever reason, but it really won't. Um And there will be members like I in terms of how to raise the issue. I obviously, it's always ideal to raise it with the person individually first to try and explain how you felt mainly because in, from what I've seen it very, very often the situation is that someone was just very stressed and sort of took out that frustration on you because it was i in the heat of the moment. But if, if you've tried that, if you've tried speaking to the person directly and you're not really getting anywhere and you don't feel like they're being understanding or they're being apologetic or that they're even acknowledging that they may be treated you badly. There is always other, there are always other people for you to raise it too. You can try speaking to like other seniors that you have on the ward. Um And then every trust will have like an official policy for raising concerns. I don't know how often people actually use the official policy. I think very often what happens is you, you speak to the person and if that doesn't work, you will try and find another senior member of the team to raise it to, to get advice from and II think that can be quite helpful because everyone, everyone will have been in a similar situation. Nobody sort of gets through without some sort of m minor encounter with someone else cause like we said, it can be stressful and people some sometimes your emotions get the better of you. And so I think getting for advice and talking things through is always really helpful. Cool. So I think we've kind of finished the talk. That's kind of gone very quickly. So, um it's only 25 past seven. So a bit of a quick one. but are kind of key learning points that we were hoping that you guys um would take away from from this one was to always kind of look after yourself, put yourself first. No one else is looking out for you. You're the best advocate for yourself. Um So yeah, take a, take a break when you can make sure you eat, have a breather. Um And remember to weigh um it can be really easy to not do those things on an on call. Um And they always, always make you feel better after um and make you better at your job. Um So, yeah, definitely remember to do those things. Um Early recognition intervention is key. So um recognizing when stress and anxiety things that might become harmful or if behaviors on the wards are escalating and um instability kind of brewing the knowing, recognizing it early and addressing it um helps um being self aware and paying attention to how you're feeling about things and talking to people and getting help if you need it. Um Remembering that everyone struggles at one time or another. Um And don't be afraid to acknowledge that um and act on how you're feeling um and to debrief with people about it. Um and to lean on those around you. So your best support system will be your, your fellow F ones. Um So talking to them about how you're feeling, sharing stories, stuff like that can really help um after a tough day at work, um, and be available to the other F ones and your friends as well if they need you. Um And then lastly just check your contracts, your pay slips and your rota. Um I'm sure they'll, they'll give you talk to, you start F one in a bit more detail about those things, but um some of the things that Tara mentioned are really important, so check, checking your contract, making sure they're paying you right. Um And booking your annual leave early is the main takeaway. And so I hope that was helpful and if anyone has any questions or anything, um sorry, it's a bit of a short one. But um yeah, we're here for any questions if you have any and otherwise enjoy the rest of your Tuesday. Um and the catch up content will be on me afterwards if anyone wants to get back to anything or see any of our previous talks.