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Right. Thanks everyone for joining. I'm Ramy. I'm one of the F one cos for mind the bleep and I'm just hosting today's session on tackling wellbeing. Just to start off with, we've got a little message from Daniel Tyler from the BM. And so thanks Daniel for joining and if you'd like to pop your slide and we'd love to hear you. Um Yeah, so I'll just, I'll be very quick. I won't take up too much of the day, the session. Sorry. Um Yeah, so first things first. Um Obviously please be a membership. Um Please be a membership. Obviously, what we've done over the last two years has been incredible. Um And it all comes down to, to us as a collective. Um So if you're not already a membership, um and you want us to join today, er, or you, you think about joining anyway, make the most of this um QR code and the link I put in the chat. If you join, you'll get your first month membership free. So that's joining or rejoining. Um Obviously, uh this, this doesn't apply anywhere else online. You won't find this on our website. So it's just a special for, er, for mind the bleed. Um, sorry, I'm trying to move my, those on. So, yeah, I'll just do a little brief, um, little brief presentation and let you get on with the evening. Um, so I'm down, I work for the BMA, um, sort of in the London region. Um, membership. I'm on the ground at different trusts. I'm helping out with different issues. Um, I won't, I won't bore everybody with, with this. I'm sure everyone knows what the BMA is now. It's your, your Union Professional Association. So three ways of looking at how um we can help you. So obviously individually, locally and nationally. So on a national basis, you've had um the pay restoration campaign locally. If you're a group of f ones say, um you're sort of facing a similar thing. We can obviously help with that and obviously, individually, if you're experiencing something, um that's, that's individual to you, something like with your contract, your ro you come to us. So anything nonclinical, um you can always, you can always call us. Um This is a wellbeing session. I thought I just mentioned that we have a, a great wellbeing um service which is which frees everybody. Um It's open 24 7. And the pretty unique thing about our wellbeing service is um you've got a choice to speak to either a counselor or a peer support doctor or somebody who's potentially been through. Um something, something that you're experiencing. Um So, yeah, so do make the most of that as well as well if you need it BMA library. Um everything's sort of moved online so you can access all of our library and our archives um online. If you're a member, you should be getting the B MJ through the post every Friday. I know it could be a bit much. So if you'd like to turn it off, you can do and we can, you can just read it on, on the app version. Um So, yeah, we do obviously do a lot of stuff ourselves learning wise. Um Some of the popular topics on our B MJ and also BMA um Nonclinical um, learning stuff is on the screen. Um So, yeah, so you can make the most of our, of, er, learning tools there. We got a specialty explorer tool which you might might have heard of. Um, so it's essentially a uh a 20 minute psycho psychometric test which breaks down all, all, er, suits specialties and, and how, and how, and why they would, they would suit you compare, um, compared to the answers that you've given these are sort of the sort of more individual, sort of questions that we get um, from, from F ones. So this is the kind of thing that you can come to us and, and ask. Um, and obviously I, I'll just round it off, I don't think I've much more to say but um a round off just to sort of going into pay. So if you're ever, if you're ever doubtful of your pay slip, think you're being underpaid or anything like that, you can send your pay slips to us if you remember and we'll check them just to make sure that, that you're um, getting everything you should be getting in the last 14 years you'll see on screen, we've got 18.4 million back to members. So a lot of the times people are sending in pay slips and whatnot, speculatively, not thinking there's much wrong necessarily, but just want us to get to have some eyes look over it. Um So yeah, so we, we're, we're very good at this. Obviously, we negotiate the contracts um for better, for worse for dos in the UK. So we know what should be in them or what shouldn't be in them and what the patient should look like. Um, loads more things that we do. Um I'm sure if you remember, you'll get a lot of emails about this. Um, so obviously the pay dispute, um, it's over for now. Um, it was accepted back in, back in September. Um, and hopefully everyone will be getting their pay. Well, this week, we'll, we'll see. Um, we're envisaging some issues with that and, and trust not paying on time. We've already had the names of some trust that might not be doing it on time, but it should be in, in your November pay packet. Um, if it's not, you can raise it with your trust and obviously raise it with us. Um, if, if you need to. So we're obviously prepared for, for there to be issues. But yeah, we're there. If you're a member, then then please do raise it if you're not a member now is a good time to join, take, take advantage of that one month free. Um, and obviously you can, you can use us to, to help you. Um II guess it's mostly f ones on, on this. I know there might be some, some um family of med students as well. Um But yeah, this is how F one pay has changed since 2022 2023. Um due to industrial action and the work that the union, uh that the BMA and obviously all the doctors and members have, have been doing. So in 2022 your pay would have been 29,000, um 384. So it's now 36,616. So it's an increase of 24.61%. Obviously, this is basic that we're talking about, but that's how, that's how um much has gone up. You can see obviously the, the different points as well and how much has gone up by. So on average resident doctors pay has gone up by about 20 22%. Um So what, what the BMA and what obviously everyone in membership has been doing over the last couple of years. Um, has been incredible and probably probably the strongest trade union going in the, in the country at the moment. Um And yeah, sorry, just quickly on back pay. So this is approximately the amount you should be getting if you're an F one back back pay, this is your basic only. So it doesn't, um, take into kind of weekend work or anything like that. Um So yeah, you should see an increase of, of round about that in, in this month's pay back and then obviously going forward, there'll, there'll be an increase as well. So sorry, this is what I was going to. Um So for now that's, that's where we're at. Obviously. Pay restoration is the, is the end goal. Um And we're not quite there yet. So, so we've accepted this offer. But if the, if the new offer from the DDR B, then it's a that, that's doctor's review body in April is not up to scratch and not what we think should be. It should be and is not working towards pay restoration over five years, then we will um we will ballot members once again and, and possibly go on strike and so it's not over, but it, it's a good result for now obviously, but, but it's not over as, as far as we're concerned. Um So yeah, I'll, I'll finish, but thanks for listening. Um And yeah, if you're not a member, make, take, take advantage of this. This is a mind the bleep only um offer. So get the next month free. Obviously you pay monthly or annually um and see, see how you go with it. Ok. Thank you for listening. Fab Thank you so much Daniel for that. So I've got a few little slides to present and then I'll hand over to Jordy for the main body of this talk. So, so this is just a little quick introductor. Hello, it's the Fy one series that we're running at the moment. So, who are the mind? The bleep F One team? Well, it's me um over there on the left along with Manish and Viv and we of course, also have all of your reps in our team as well. So the series is called Hello, it's the fy one. It's been running since the start of October now. So we've had a good couple of months of weekly sessions, um usually on a Tuesday and the whole aim of the series is to help equip you for your on call as NAF one. And we know that these are some of the most challenging shifts that a lot of us face um and that it can be something that we can feel quite nervous about. Um And so hopefully, this series has so far helped to ease some of those worries um for if you didn't manage to make some of the other talks in the series, we are posting this as catch up content on medal on our page. Um And we also hope to collate all of the talks um in a youtube collection on the mind of the youtube channel as well. So yes, Tuesdays generally between seven and 8 p.m. and with aimed at fy ones so less relevant to be honest for this session today on wellbeing. Um but as always, um all of the mind, the bleep content is intended only to be viewed by healthcare professionals. Um We've anonymized any clinical cases. Um And we try and make sure that all of the information provided is accurate in our content. Um Obviously, despite this, we remind you that it obviously the onus is on us as doctors to keep up to date with any changes that may happen in guidelines, for example. Um and for our full disclaimers and you can see the mind the bleep disclaimers page. So if you want any further resources after this talk, we've got um whatsapp groups um for each deanery, if you scan that QR code that you can see on the screen there, that will take you to a link to all the whatsapp groups and you can join the relevant one. Um give us a follow on medal. Um And that's the easiest way to just see all of our upcoming sessions. And of course, there is the mind the Bleak website um which has all of our articles and there is also a great article on wellbeing um as part of that, which links nicely to this talk. So with that feather, I'd like to just hand over to Jordie. And so Jordie is an FY two currently and she's gonna be talking to us about tackling wellbeing for what hopes to be a really interesting session. Thanks Jordie. Thank you. And I'll just share my slides. There we go. Um So yeah, my name is Joie. I'm one of the F two S. Um And this talk is gonna be about prioritizing wellbeing. So um it's quite a quick talk, but hopefully you'll have some useful advice that um I've found in my F one about how to think about wellbeing and particularly on, on call shifts. Um So, so what we're gonna look at, so obviously, next week is change over. So starting a new rotation. So I'll talk a little bit about that, some advice for night shifts, talking a little bit about the portfolio because I think that can be a cause of a lot of anxiety and stress for some people trying to manage that whilst also being really busy thinking about a bit about life outside the hospital. And then also if you are struggling and um who you can talk to. So firstly, talking about change over. So I think my biggest piece of advice for a changeover would be a little bit, can go a long way So looking a little bit into the specialty before you go, I think, can ease a lot of worry and just having a little bit of an idea of what to expect and I'm not saying to go home and spend a lot of time looking into stuff, but having a bit of an idea about what the common presentations might be, I think can just make that transition a little bit easier requesting your leave early. Um I think is important for two reasons. Firstly, a better chance that you'll actually get it. Um but also having leave sch scheduled in um and knowing when it is and being able to plan around, it can just break up a rotation and make it seem a little bit nicer um thinking about any Teaster weeks. So again, planning these things early, making sure that you might actually be able to get them. But also if it is a specialty that you're interested in and you want to spend a little bit of time in, it can be something to look forward to. Um I think just in a separate note that doing a Teaster Week, if you can um is a really good idea for if this rotation that you wanted to do and it didn't quite work out or you didn't get it in your set of rotations. Um Having a Teaster week is a really good way to have some more experience in that, you know, if you actually like it. Um thinking about dots and mini texts. So I think every trust is different. Um in my trust, they recommend trying to have five per rotation. So that's a combination of dots and minis and CBD s all combined trying to have five per block. I think some trust is more, some is less. But I think to be honest, if you do anything just having the confidence to ask somebody to sign it off, people don't mind. Um And yeah, but if you, again, if you have that in your mind when you're doing something, um And then I think as I said, a all of this kind of together, if you just plan things like a little bit, it, it can make things seem a bit less scary and you can think about what you have to look forward to and just have a better grasp of what your rotation is gonna involve. Um So now you're thinking about night shifts. Uh So I think the best piece of advice that I was given for a night shift was to view it as one shift at a time. So if you have a set of a, again, I think every trust is different. Um II think some trusts as well, you don't have night shifts as an F one. But if you do it can either be a set of three or a set of four. And I think if you first see that, that can seem quite daunting, particularly if it's something that you've not done before. But if you just do it as one at a time, so, rather than I've got four night shifts to do just, I have this shift tonight, get through it and then think that for the next one, it actually makes it seem a, a lot more manageable. Um, don't be afraid to ask the med. Um, if they're around, I think people don't mind ask being asked questions. Um They'd rather you ask a question one. So you don't make, it makes you less likely to make a mistake. But also then if you ask it and you learn from it, then you'd be less likely to ask it again and you're building up on your knowledge. Um So I think uh honestly, people don't mind it all being asked questions. Don't forget about your portfolio on an on call or a night shift. You can still do things and dos mini texts, CBD S maybe with the med bed if it's not too busy at night or send it to them a little while after. Um and you'll soon be able to rack up quite a few. Um lots of snacks. I think it's really helpful people like prepare different things but, and I think it makes the night go a little bit quicker trying to work out a sleep pattern that works for you. So I think a lot of the times people think this is that way that you have to do things and, you know, this person's stays up late the night before and then sleeps in, in the day. So then that means I have to do that and then you're trying to do that and it's not working and you're just building up quite a lot of stress. I think honestly, just working out what works the best for you and sticking with that and not minding that other people might be doing it a little bit different. Um, and sometimes that's just do trial and error in practice and that's ok. But I think, yeah, it's quite an individual thing. I quite like to get some fresh air before the first shift. Um I think it makes me sleep a bit better on that first day. Um, and then I think it's also nice to try to plan something fun for after. So not something that you definitely have to do and then if you miss it or you feel too tired or too sick or whatever, you end up having to cancel on something important or something that you've booked, but having a least plan of something fun to do after, I think, can it, it's just nice to look forward to it, but also it can help you go back into the sleep schedule for the daytime. Um, so now you're thinking a bit about portfolio, which I think a lot of people can get a bit worked up on and I think, start early in this rotation. So if in the first rotation, you were just getting used to being an F one, which is very understandable. That's OK. And don't worry about that. But I think in the second rotation, if you can start a bit early, that's a good time to try to really get to grips with your portfolio. And I think doing little and often so not leaving it till the end of the rotation to get all of your sign offs, all of the summary narratives and um trying to get the tab really last minute, I think that can be a bit overwhelming, but just doing it little and often um makes it seem a bit more manageable uh thinking about varieties. So by that, I mean, um people might not like it if you send them it mini texts. But if you think about on my, on your night shift, who you can send them to then during the day shift, then during a twilight shift, trying to have a variety of assessors. I think it's good because it's more likely that they'll actually sign it off for you rather than sending one person those of things. But also then you get more of a variety of feedback that you can learn from, which I think is quite helpful. Remembering to ma the entries, I think this is a good thing to do early because if you leave it to the end. Um It can be quite time consuming and it can be quite, um it can be quite confusing as well. So trying to do that early. Um I'm not forgetting about it and then as well, you know, what things um you haven't mapped to what points you haven't mapped to. So you can try to guide to a CBD or a mini CEX that might link to that point and, and then I think reflection is really important. Um I know that the people that look at their portfolios and decide if it's a pass or a field, they are really keen on reflection. But I think it's also quite useful for your own wellbeing just to take some time to think about a case that might have been tricky for whatever reason or might have been really positive and just having some time to write about that, I think is good practice. So some things that you might want to reflect on, I'm sure there's lots more that you can do, but some things that I reflected on um any communication scenarios that you have. So if you've had a particularly challenging com communication with a family member, or if you had a nice communication with a family member or a patient, and I think that can be quite important to think about and learn from. I know a lot of people reflect on their first priority call. So what you know what they did how they find it, what they learned from it the first night shift I think is a good thing to reflect on. Um, and also any teaching experience you've had and the feedback that you got and what you would learn from it taking forward, I think is good as well. Um And I think part of the portfolio that often gets overlooked, but it's actually very useful and, and people like in specialty applications and training posts as whatever specialty that you'll be applying for, whether it's GPI MT anesthetics, whether you're taking a year out to do a fellow job, and they'll all ask about leadership. So I think having a good track record of that in your portfolio is really useful. Um And I think it's, it's good for your own learning. Um And this leadership skills that you learn, it's also good for the hospital. And if they have people that are willing to, to put that effort in and, and it's a good way to make it change. So if something is bothering you or your colleagues rather than complain about, I know we're all busy, but rather than complain about it, trying to think about, well, what can I actually do to make a difference about this and make it a better environment for yourself and your colleagues and for the patients? Um And often it's something that you can get a poster out of which is good as well for different reasons and So an example that I did last year as an F one was um a colleague and I were really bothered by in one of our doctors offices. Um when I was in the medical admissions unit, there was a big board with loads of bits of paper stuck to that people for referrals so that, you know, for referring to different specialties and things and it was really confusing and often people would just put a piece of paper on top of another one and things would get lost. So we digitalized that and so had copies of all of those forms on the shared folder. So then people could just go to that and click on it and, and then we were able to clear that board and just have like really useful, clear guidelines that you might want to look at in a hurry rather than just loads of random bits of paper. So that was something that was really easy to do and, but it proved to be quite effective and it, you know, didn't take a long time or a lot of thought that um yeah, it's a small thing that I think had quite a big impact and audits and quits I think are something that people get a little bit worried about. I know, I it was something that I was a bit worried about when I first started F one just because it wasn't something that I had a lot of experience in. But I think knowing, firstly, knowing that it's something that doesn't have to be groundbreaking and it doesn't have to be a big change. And, you know, small, it's small, things can actually be quite effective and have quite a big impact and, you know, you can do something small and actually manage to complete it and see the change and take and complete the loop or rather than trying to take on a really big project that you just get bogged down in and it's difficult to see the end goal and you kind of just get lost in it. Um, trying to get started on your audit early is good, um, to want to make sure that you can actually manage to complete it and see the impact. But also for a lot of specialty applications, they talk about completing the lab or completing the cycle. So, and you know, doing the audit for the first time in seeing the change and then re auditing again. And, and so the earlier you start, the more likely you are to be able to complete that and, and I think when people are trying to audit or make improvements with things, you know, you're unlikely to be told to know. And so it's worth asking and seeing what, what can be done, what you can get involved in. Um And yeah, if you again, if you start early, you'll be able to follow it through. Um, ok, so now we've talked a little bit about um the on call shifts and the portfolio II thought I'd talk a little bit about what um what stress is. So, just thinking about it from a, from a science and medical perspective, um I'm sure this is something we've all seen before in finals. But um basically, we have our stressors to say if it's um you have an unwell patient on the ward and it's um causing a lot of uh it's causing a lot of anxiety then that um so that impacts your hypothalamus which has um then releases cortico releasing hormone or C Rh um which goes to your pituitary gland and then you have adrenocortical releasing hormone or a Rh going to the adrenals which then releases that adrenaline um and has the impacts on your sympathetic nervous system. Um And then that really releases cortisol which then has the negative feedback and that's this like, I'm sure um it's something we've looked at before. But, you know, these are things that we might look at in our textbooks and think about how we're gonna apply this to patients or in different situations. But I think it's important to remember that, you know, we're all human and this, this happens in doctors too, this is going on in, in our bodies and we're e experiencing and feeling these things too. Um And if you are feeling like that you're not alone. And so the um the ma did a paper that last year that found, um, they did a survey which had nearly 3000 junior doctors responding to it. Um, and 78% of those doctors said that they felt unwell as a result of work related stress. So it's a really high statistic and, and it's not to, to scare anybody or to put them off, but it's just to make you aware that if you are feeling like that, that it's ok and you're definitely not alone in feeling that way. Um And I think it's important to know what steps we can take and who to talk to if you, if you are feeling like that. Um So the first thing is to recognize stress and, and you can think about this firstly, in thoughts and firstly in behavior. So if you find yourself some of the thought patterns that people can experience in their stress, particularly in a work environment and in the hospital environment, and it's firstly thought patterns start to change, to think about things like the worst case scenario in a situation um focusing on the challenges of the situation. So if you've been asked to do something rather than seeing the kind of benefits pe and the things that we can do about it, people might start to think about the challenges of why you, you can't do something or why it might be and why it might be difficult to do it. Um And turning positives to negatives or only seeing the negatives in a situation rather than the positives. So there are thought patterns that people might have and then that can then impact on your behaviors. So people might start avoiding doing certain things and, you know, it might not be either laziness or uh if not wanting to do it, but just the stress and anxiety behind doing it. People might find that they're working for longer and being less effective because their, their minds are having these negative thought patterns. Um And then people might also need to take some time off work to, to get away from the stress. Um So I, I'm not sure if you might have seen this before, but um they've done studies and found that when people are hungry, angry, late or tired that it um significantly negatively impacts your decision making. Um Sometimes and people also um add in a full bladder to this as well. And I'm sure we've, we've all been in situations when we felt that we're too busy to stop to have lunch or we get angry about an interaction with something or we find that we're running late to get home or late to go to um go to go do something. And all of this can make us very tired, but we're too tired and busy to stop. But actually taking five minutes when we're feeling all of these things will actually have a better impact on decision making than if we just try to work through. So I think it's important to, I try to recognize when we're feeling these things and, or when a colleague might be feeling like this and actually say, you know, it's ok, let's actually go for lunch today and not work through or should we just go and get a quick coffee and then, and think about that and then come back, you know, that's ok to do and that's gonna better impact and make a more effective decision making than if you just try to work through. Um, ok, and I think one of the best ways to manage stress, um, as a doctor is to try to have a good work life balance. And I know that this is, uh, might seem more easier said than done. And I think that's the first thing is to recognize that, you know, it's ok if we can't do these things in the first few months of being a doctor because we're just so really different and busy each all. But it, and it comes with a lot of pressures and a lot of responsibility and it might just take time to get used to that first of all. And that's definitely ok. But, um, some of the things to think about when you do feel more settled in your job is and trying not to lose any hobbies or interests. And so to try to make time for them when you can outside of work and trying to be social in whatever way works for you and however, um you want to, but um trying it in a way to detach work from home. So, you know, this can take time but trying and, and trying to separate work from taking it home and thinking about those things and dwelling on them a little bit because, you know, if you don't take a break, it's gonna lead to burn out. And I think trying to take a break when you can is really important. Um And it's definitely ok in those breaks to, to do nothing and not want to have a million and one plans but to just to just chill, that's, that's ok. And I think having zero days and days of leave when you maybe just have a chill day is, is good as well. Um So, um one of and during COVID, the NHS released some guidelines for um workers on how to manage stress during what I'm sure we can all remember to be a very difficult time for healthcare workers. Um So, one of the things they mentioned was um I think I said before a few slides ago but um recognizing that you're not alone when you're feeling stressed and it's not a personal thing and you don't need to internalize it because actually a lot of people are probably feeling the same way that you are um trying to be active physically. So I think these, these guidelines are things that you think about. What if a patient came to you and said that they were feeling, um, very stressed and anxious and maybe a little bit depressed. What kind of advice would you give them? Um, and I'm sure we all know about the benefits of exercise and what that does for mental and physical well being. Um, so yeah, that's talking about nutrition, exercise and trying to get enough sleep. Um Recognizing that you're stronger than you think and not being too hard on yourself. Um Recognizing that being a doctor is challenging and we can deny that but try instead of thinking about that negatively, trying to embrace that where we can um and thinking and just taking time to look after yourself and take, taking some time for yourself without feeling guilty or that you're too busy to do so, but actually taking that bit of time, it's a lot better in the long run. Um And if you are feeling that you're stressed and everything is becoming a bit too much, I think, knowing that those people to talk to can be very comforting and, and there's a lot of different ways that you can go about this. Um So I think Daniel at the beginning from the BMA mentioned that they have a, a service um that you can use in. So in the hospital, there's your educational and clinical supervisors um who you can go to, I think sometimes people might want to go to somebody detached from their ward or whatever. And that's also ok. And, and there is a staff wellbeing service for that. Um, there's an NHS, um, freedom to speed up service. So that's, um, each hospital will have a guardian and, and that's where you can go to if there's something in your workplace that you feel, maybe something hasn't gone quite right or something's bothering you with a colleague or you just feel like something isn't right. And you would like to talk to somebody about it and that's what they're there for. Um My hospital has a mentoring service um called Connect where if uh they, I'm sure lots of hospitals have this and, but you can, you have a mentor for being an F one and so you're, you're partnered with a more senior doctor. Um And that's, if you have any questions about any of your jobs, it's an F one or responsibilities, it's an F one and whether there's something that you're not sure about, you can go to them and then they can either advise you or gi give you direction for somebody that might be able to help more. So that's something to look out for in your hospital as well. Um And there's always your GP as well. Um So I think I'm a bit of a Harry Potter fan. So, and I turned to Dumbledor for some advice and, and I think knowing when to ask for. Help is really important and that's the first step to managing burn out and, and your wellbeing. So help is always given um to those who ask for it. Um So just some messages um I see the shifts will, night shifts will be ok. They'll be, they'll be, they might be scary. They might feel overwhelming. There might be moments where you're not sure what, what's going on, but um they will be ok and you will get through it. And there's always people to ask if you're unsure, remembering to start your portfolio early in the second rotation. And so you are not missing any opportunities and you can make sure that you're on top of it and getting it done and remembering that you're not alone and lots of people, they experience stress and very night and, and it's a known thing in a lot of workplaces in the NHS and those people that you can talk to. And I'm thinking if a patient came to you and said that they were feeling stressed, what things would you tell them and trying to not be too hard on yourself and remember that doctors get stressed too. And so thank you f one side. That was quite a quick talk about wellbeing. Um If anyone has any questions or would like any further information on anything, I'm happy to answer any questions. Um Yeah, if anyone has any questions, thanks so much, that was really interesting and like some really nice little pills of wisdom, enjoyed the Harry Potter content as well. And so for everyone who's attending, I popped the feedback form in the chat now. And so please please do provide feedback for Jorie. It's really useful as we've been talking about portfolios as well. It is useful for that. And also for us in terms of knowing what sort of sessions you guys like and want to see more of. Um and it'll also, if you fill out a read back form, then you get a lovely certificate for your portfolio that you've attended the session out of it. Um Do you just pop any questions as Jodi said in the chat and she'd be happy to answer them. We'll hang around for a few more minutes. I'm just gonna stop the recording there.