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Is that it going? Sorry. Um Hi, everyone. Thanks. Thank you all for coming along to this evening, Stash webinar on the development of management skills for medical medications and junior doctors. My name is Bronwyn Stu and I'm the medical ambassador for Stash in the west of Scotland. And I will be quoting tonight with Emma and who's the stash operations representative. Um And just before we start, I just wanted to remind everyone to fill out the feedback form, an email should be sent out afterwards. Um And we'd love to hear some feedback. I'm sure Claire would like to hear feedback as well just so we can support our future events as well. Um And it means you'll receive an attendance certificate too. Um So now I'd like to introduce doctor Claire do who will be speaking about development of management skills for medical students and junior doctors, like I said, and she is a consultant physician and genital urinary medicine at Sheffield Teaching Hospital and she is the previous BS president. So Claire has been a B consultant since 2007 and has worked in a variety of leadership roles and clinical and operational management and she became the Bash conference and communication chair in 2018 and delivered a number of face to face virtual national conferences. Clears the immediate bash president and past president. And as this role, she represented the speciality at national and international Monkeypox events. And she spoke at numerous national and international conferences on ST S and HIV, no media items and select committees too. So Claire really represents specialty is in really well Um come to like management and leadership roles and she also represented the specialty at the Royal College of Sessions events and national coordination of recommendations on specialty needs and actions. So now I'll handle word to clear to go through the leads. Hi. Thank you so much. Thanks Bronwyn and Emma and thanks for joining us um on a Tuesday evening, I'm sure you've all got millions of other things to be doing. So, so thanks for that. Um Yeah, so it's a bit of um a funny topic. Um And I think it's one of those topics that if you're pre specialty training or if you are a me, a medical student, it probably seems um a little bit irrelevant and, and possibly a long way off slash something you'll never be involved in. Um And I guess I've tried to talk about this and teach and train about it in lots of different ways and I've still yet to find a way that I think really hits the mark. So, any advice you can give me about things you'd like me to not do or do, would be really gratefully appreciated. Um, so I'm gonna talk about why it's important for all people who are, you know, to become medics. And I'm hoping that through over the next hour you'll, you'll sort of begin to see, um, what the potential, um, benefits are both for you and also for the, the services that we deliver. So, um, Emma's gonna handle my slides because I couldn't manage to get on Chrome this evening. So, um Emma, if you could just forward my slides. So, yeah, I was um I was, I've done lots of leadership roles. I, I've sort of come on to explain really how, like when I was a junior doctor and a medical student, it never even crossed my mind that this would be something I'd end up having to do. Um And um it, it, it can make, makes complete sense to me that you guys might be thinking what a, what a waste of time. It, it might be to learn these things, especially now if you're an undergraduate. Um but uh it is important and um I really want to encourage you guys to have a voice. Um And that unless you kind of acknowledge some of the power that you have, which I know it doesn't feel that way. Um And, and er manage, manage yourself and develop skills to um use that power, um We won't have a forward thinking. NHS. And we need that. So the general outline for this session, um, and I'll be, I'll be, I'll be honest, II want it to be flexible. So, um, I think we've got a chat and I'm hoping that, um, that you can either, I don't know if you can put your hand up, but if you can't put your hand up and speak or if you can just put things in the chat and hopefully we can have a conversation about um questions I'd really appreciate if you could just stop me in the middle of something very happy to go off tack. So I guess I wanted first and foremost for you to understand the importance of management skills for medical people. Um and talk about the sort of the key areas that this will um require you to think about as you go further through your career. I want to give you some skills to develop a, a sort of a framework to how you can develop your personal management skills. Um And h how you can recognize the value of those within, within your career and within a setting, a clinical setting. Uh We'll talk a little bit about some real life scenarios, but very flexible if you hate that we can move on. Um I think it's really hard to understand, to relate your skills to something that you may um be able to impact in terms of service delivery unless we talk about something real that you can, uh, sort of recognize in your day to day. Um, but, but, um, we'll, we'll see how that goes and see if you, um, if you feel that's valuable and then just, uh, you know, sort of finally think about how, how can you use what I'm talking to you about and how can you develop that further, um, to, er, enhance your career progression? Um, And you know, how can you sell yourself from that perspective because you, you will be doing these things. Um I suspect most of you don't realize or recognize that those are the things you're doing. So let's, let's just see if we can draw those to the fore. So you can recognize um how acknowledging and using these skills can be valuable to you as well as to to patients. So, um next slide, please. OK. So um like I said, you go through medical school, no one talks to you really about how to manage things. Um You talk about how to manage health care, you taught how to manage problems that are to do with people's individual health, but generally speaking, certainly, um some of the conversations I have with um undergraduates and early postgraduate trainees. Um is that the, you know, nobody ever really acknowledges that this is going to be a future role of yours and you get precious little direction or training and virtually no time to even think about it and yet you're held to account on a lot of um curriculum, competences and GMC, er, guidelines, both as an undergraduate and as a postgraduate about things that are basically management. Um It effectively means you're holding the reins um or you're, you're keeping house, you're making sure that your, your house is in order where wherever your, your house is and it requires a range of activities and these are, I promise you things that you are already doing. Um Why is this important? Why can't we just leave it to people who've done business and management at, at university or, or, you know, spent a lifetime managing things? Why do, why do we need doctors or nurses or anyone else clinically involved in this? Well, the thing is non clinicians, as you'll realize, as you go through your career, do not have a full understanding of the complexities of human illness and how people present to service and how that can make access to services really complex. Um Clinicians see obstacles to good career both in terms of how they are efficiently or inefficiently delivering the care that they'd like to give. And they also see obstacles to care for, for patients in a really simple way. You will be seeing this already. Um probably both as a student, but certainly once she's graduated, reducing illness for both individuals, but also populations is absolutely our job. It isn't someone else's job. Um And if you don't get involved and use the knowledge and the power that you have. Um then somebody else will be doing it and they might be doing it more crap than you would do it. So it's really important to, to think about it and to recognize that you, this is something you can influence. And then the other thing I always find is that um if you leave a nonclinician to come up with care pathways, there's always obstacles that they haven't foreseen or complexities that you then end up having to deal with in real life. So you've got a vested interest in making this simpler, not just for you, but also for the patients. Um because otherwise you'll be dealing with the consequences of those pathways that haven't really been thought through. Um And don't work. Um So next slide, please. So the GMC, not, they're not my favorite group of people at the moment. But unfortunately, we still do have to, we still do have to talk about it. And even if you um feel that a lot of what the GMC turns out is absolute rubbish, um It's useful for you to be able to recognize that about it both in applications for jobs interviews or you know, any, any in any scenario where you're trying to sell yourself to get something you want. Um It's really important to, to be thinking about what the system expects you to know and do um the DMC expects you to be able to take care of individual patients and individually that you will be managing those people. So, management skills are something. If you've already graduated or you've done quite a lot of clinical work as an undergraduate you'll already be doing. Um How does that patient get a diagnosis? How have they presented with, with uh with their current medical illness? How, how do we uh construct a diagnostic pathway and, and how do we make sure that that actually happens as opposed to just pricking your fingers and expecting it to work. You, you guys all know already that, that requires you to manage it. It doesn't happen on its own er, next slightly. Um So be aware of patient safety and how to improve it. The GMC absolute expects you to do this and when you're doing your, your er portfolios, especially as a foundation doctor, um The more you can construct examples of how you have acknowledged patients safety and sought to improve it, the easier your A CPS is, are going to be and you will absolutely bosh your ACP if you're even thinking about relating those two issues. Um and it is in reality, something that you are doing on a daily basis. Again, I'm just asking you to lean into um what you're doing possibly without even acknowledging it and making sure you make a note of it to make a, your passage through your career easier and b to genuinely acknowledge when you can improve care and get better outcomes for patients. Next, please. Um Self awareness is a very critical skill for good doctors. Um And you will know this. We all know people that we went to medical school with or we've been on a firm with who have no self awareness and the carnage that they leave behind them is unbelievable. Um And the other thing about it is is the GMC really loves to talk about this as do education supervisors. Um, because it ticks all their boxes. So if you can talk about things that have, um allowed you to be self aware, both as an undergraduate and as a post graduate, when you fill in, in your portfolios, this will make your life a bit easier and your Pfizer and the foundation TPD S and the, you know, specialty training program, TPD S will be skipping all the way home to your AC pso so, attitudes and beliefs that are really important, they're particularly important in my specialty. Um, and professional limitations that you experience both because, er, you, er, don't have the competency or knowledge because you haven't got there yet or because you are working in a multi disciplinary team and you can't influence some of the things that you'd like to happen or simply because they are things that you find personally challenging. It's also really important to acknowledge those um because we all have those as we go through our careers times when it's really hard to deal with a particular thing. Um Next, next slide, please be able to analyze access and analyze clinical data. You'll be way better at this than I am because you're actually being taught about it. Um You'll be, it's the whole range of things from admitting somebody taking a history, doing an examination, getting some bloods back, which is on a basic level, that is a person's information and you're analyzing it to make a decision about what happens. But you can also do that, you know, replicate that by 1000 patients. Um and that can help improve the performance of a whole department or the treatment of a whole condition. And this is simply what we're, you know what we're talking about when we talk about management and leadership is, is gathering those facts together and making the decision about the direction you're going in. Uh next one, please. Um Can you actually can you click a couple more because we might have to go through this a bit quicker and recognize it's trans fast and one more. Yeah. Ok. So we all um we hear people banging on about um er errors and how we respond to them. It's particularly important and there's been lots of high profile cases that you may or may not be aware of um over the last 10 to 15 years that identify when we haven't er, spotted errors learnt from errors. Um and it implemented changes to systems in order to prevent those errors from happening. So again, if you can come across something that repeatedly happens on the wall, let's say, for example, something that used to happen to me all the time when I was a junior doctor is if you work in a hospital, a pod system and you put your bloods in the pod and you w you wonder why those, those bloods are not back three hours later. And that's cos they're still in the pod, like simple things like that, identifying them and thinking about how you can um put in place a simple warning system or additional tasks for people to do in your team. Um is a simple way of responding to errors. And then you can also do that across the department across the trust and even across the whole healthcare system. And ultimately, this all comes down to understanding about quality um assurance and quality improvement, which basically means is things going well. And if they're not going well, how can I change it? And you guys really will find all of this, despite the fact that the NHS and training schemes love to wrap it in complicated language. These are things that you're already able to think about and do on a daily basis. And then the last thing which is probably actually the biggest thing, especially once you're in a training program and you're possibly going to be based within a region for a long period of time is working effectively in team. People can be a pain in the ass. Sometimes you will be a pain in the ass and it's just about understanding how you can um make sure you're all working as effectively as possible together. Um And without causing anybody too much stress. Um So I think that is a really critical bit of managing your yourself and something you can think about as you as you go through all your training. Ok. So next um next slide, please. Um So um uh we, we're talking about identify key areas of focus for the medical profession. There are a load of training programs out there which you may or may not get access to. I am permanently extremely disappointed when education supervisor or TPD S refuse people in nonspecialty training programs to go on these things, you cannot learn this stuff overnight. It is really helpful to have some um understanding of people's theory which has been collected over many years about how you can do this well. Um And you know, I definitely think that as a, as a gum gum as a profession really supports people to be involved in leadership and management. Um Not only because it's good for patients, not only because um actually some of the skills that we have lots of other medics don't have. Um But also because um it's good for you to have more than one SH TB. Um So we're gonna talk about a few specific things. The main thing I'm going to framework I'm going to use is, is one from the Medical Leadership Foundation and you can look at this yourself. So, um I will, when I send you this, I'll, I'll make sure you get some links to the website and they have some structure. Now. Um Do you want to move to the next slide? Emma, before I go on, I'm going to say to you, I do find a lot of this leadership and management sign a little bit rubbish and a little bit. Um It's like somebody's making a living out of coming up with these bizarre things, but ultimately, you do need a framework and it is quite helpful, especially when you're writing a CV, thinking about how you're going to respond to questions in a, in a, in an interview or even applying for specialty training programs. Because ultimately, the people that whether you believe in all of this or not or the, the structure that um it comes in, um the people who will be selecting, you will be thinking about these things and if you demonstrate them by, you know, specifically citing them in any application or interview, you do, then categorically, they will notice that you're a cut above because mo most people will, will not be talking about these things yet. So, um the Medical Foundation uh sorry, the Medical Academy for, for, for Leadership um has these sort of key areas. Um, and within them, there are levels of expertise and you can cite the level that you are at. Um, so if you're someone who's already delivered a lead role, you might be considered, um, exemplary or, um, you know, highly, highly achieving. And there are different bits within that and why I think it's useful is you can go, well, look, I'm a brand new foundation doctor. What level am I at? For say, for example, leading with care. Well, this is what the foundation model says I should be able to do and then lo and behold, I can cite that in my portfolio and in any applications I make. So these are the main areas um that sit within this, this sort of key er er image that's here. So, so leading with care sharing a vision influencing for results, which is a very important one and we're gonna delve into that a bit in a minute. Um Engaging the team also quite important and relatively easy for you to describe it whatever stage you're at pre specialty training, evaluating information, um improving er sorry, improving and delivering a shared purpose, that's also really impossible, er really important. But actually, um I would say that is a skill that you, that you really develop much later on. And they've described that here by putting it right in the center of this image and then other things that are really important are connecting the service to other things outside of the service. So that's about recognizing that you've got a wider view other than just the day to day patients or your own service. And again, that's kind of something you might develop later on, um, developing capability in your service. Again, that's, that's something that will happen, but it will happen later on. And we can talk about that if it, if it, if it's useful and then holding to account, which you absolutely won't ever have to do. Um, unless you decide to be some kind of clinical manager or a consultant or an education supervisor. And although it sounds quite unpleasant, it's actually a relatively straightforward thing. And, you know, we, we kind of do need to learn to do that on a daily basis, um, to make sure that where the system fails, it can be addressed. So, um, those are the broad themes if you can go to the next slide, please. Emma. So the ones I picked out that I thought would be relevant for you regardless of what stage of training you're at pre. Um, specialty training is, um, sharing a vision, engaging the team influencing for results, connecting the service to other bits of the, er NHS and developing capability. I'm not gonna delve into these, um, all right now, um, this evening, but I, you know, I can do that at some of the stage I'd really like to do is do some kind of day face to face workshop because this is kind of stuff that's much easier to do face to face. But I'm gonna delve into a couple of these um to begin with. And I'm, I'm hoping that some of you will have some questions about what I mean? Or does it make any sense or um is it, is it something that you feel like you could do even as a medical student or as a, as a, is it as a foundation doctor? So if it doesn't make sense or if it sounds like I'm asking you to do something that you think is ridiculous and I really would like to hear while we're here. Um Next slide, please. So here is that I've pulled out that I think are, are doable regardless of your stage of training and sorry, and again, and we're gonna talk about sharing the vision. Now, what does that? Thank you. And what does, what does that really mean? So it says uh this slide says, sharing a vision as a leader. Now, when you say the word leader, people tend to think it's someone like me who's been a clinical lead or I've been, you know, the president of an organization or someone who's like the medical director or the clinical director of the specialty. And ultimately, what the GMC says is that we're all expected to be leaders of um varying degrees. And um and how would you show that? So, So the simple things that we're at that the er foundation states is that you should, you should do things that help other people mo be motivated, you should encourage people to collaborate across the team and you definitely can do that whatever stage you're in, um you should try in your actions to build trust and confidence. So if you were a clinical lead, I could describe to you how that might work, but you can also do that as a junior doctor, you can, you can, uh, work with, particularly if you, the people you come into contact with are your peers. And perhaps those immediately, um, supervising you, um, and nurses on the ward, there are ways that you can demonstrate that you've, you've built trust and you, um, are, er, gathering confidence in your ability to manage whatever it is. You're, you're um, asking, being asked to manage, manage, fostering innovation is a bit more of a tricky one. And ultimately, as a pre specialty trainee or an undergraduate, what you're really thinking is, have I come up with any ideas that might change how we do things. A even simple things can make a massive difference and you can certainly use, um, any ideas that you'll have all have had. And every time we've got medical students in the department they always ask questions. They're like, yeah, we, we don't know why we're doing that. We've just done it for so long and a simple thing can change how we do everything and everybody's capable of spotting that especially if you're fresh to an organization. Um So next slide, please in, um in a, in a, in a simple way. Now, I'm not sure how many people are on the call. Um But II can imagine that you won't want to um put your mics on and speak to me. So I guess one of the things that I would recommend is if you're thinking about, um, about how to, um, build a vision, then you could sit around when you're sat with your mates or whatever. And you, you know, I don't know, trying to persuade someone to come to the Taylor Swift, er, er, er, er, er, tour with you. Well, how could you persuade that person to do it if they don't want to? These are all skills might seem like a really simple thing. These are all skills that you use in the workplace as a leader. I know that we need to get this thing done. Please try and persuade me, um, using your skills of influencing how to do that. And ultimately, that's, that's you sharing a vision, you've decided what the vision is, your vision is. You're gonna go and see Taylor Swift in Manchester. Um, and, or no, she's not in Manchester. Is she in Liverpool? Um, a and, uh, you want at least three of your mates to come with you? How do you go about achieving that exactly the same, whether it's in a work setting or whether it's in, um, you know, something you're doing in your own personal life. These are the same things you're doing. You're identifying a, a thing you need or want you, you need to identify the benefits of that happening. You need to describe it to people and then you also need to put it into action and for that, you need other people's support and engagement. That's these are all those key skills that you're already doing. And I, you just need to reflect on your day to day um activities about how that's um how, how you do that and what your style is and how it works. Next slide, please. Um So I also want you to think about developing a framework for these skills. I'll go, I've seen, we've only got half an hour. So I'll go into the next slide. But what I'd like you to be able to do at some point is sit back and think how can I demonstrate that I have skills? Um So whether it's for a CV, or an interview or whether it's just communicating something that you want to happen. Strictly speaking, sharing a vision is communicating a credible future. That is exciting. What you're trying to do is get a bunch of people who've already got loads of other jobs to do to see that something in the future that isn't currently happening is possible. And this will not only make people's outcomes better people's care better, but it also potentially could make working life conditions better and you have to make it um this credible future. This thing that could potentially happen sound interesting in sighting enough that people will be engaged with it. And part of the way that you can do that is be visible, be available, get engaged with your team. Um How can, how do you communicate? Can you make sure that you communicate at the right time and at the right level, depending on who it is you're speaking to, you know, that will be different. Whether you're speaking to um your foundation two doctor, if you're an F one or whether it's the registrar or whether it's the consultant or whether it's the chief exec who happens to be attending the ward that day. Um And you'll be doing all of these things and what we're, I'm asking you to do is consider how you do it and perhaps formally organize in your head, how you go about doing it. Um Yes. So thinking about how people can y you can show that you appreciate the team. I'll bet my bottom dollar you're already smashing that because, because um people often have to, especially junior doctors learn that skill quite early on. Um And if you want somebody to do something that they're initially reluctant to do, how can you explain it? Um So that it's something they're interested in doing. And these are all part of how you engage people to deliver better care. We talk to them and these, what leadership and management is about. Uh Next slide, please. Um So my suggestions for you would be is if you're, if you're, if you're in um a clinical placement, post, post graduation, um what are the things that you could do that you could use? Not only to develop skills and see how it works also to maybe actually improve things, but also, so you can demonstrate that you've done it. So for example, if you happen to be, if your next job happens to be cardiology, you could look at the national standards for something. Um And then what you need to do is can you demonstrate your ability to engage with a standard and how and how has the service done that that can be by simply doing a simple observation on one shift and describing it? Um or it can be um a a, you know, a wide project and perhaps one of the things you could do is ask the clinical lead of your department, what are their top five goals or targets? And, and maybe consider doing a project around that doesn't have to be anything in depth. So for example, in my department, one of our key goals is how quickly can we see symptomatic people and you don't need to gather a lot of data for that to be a viable or useful thing, simple things. We had a medical student who came to do um, an sec with us who looked at, um, we, we had all commented while they'd been there about how Thursdays were always particularly bad. And they just basically looked at for a couple of weeks at, um, what we were doing on a Thursday that was different the other days and it was really, really insightful and really useful. And then they were able to describe that they got a certificate saying they'd done it, they presented as department. So they also got um an observation that we could comment on. Um So there's lots of things that you can personally get out of this and it is building the skills that I'm talking about. Ultimately maybe speak to your local gun consultant about Q I work that they're already doing that you'd like to be part of or is there anything they've got planned? Um For example, if you're an F two, what, what you know, what are the problems on the ward? Why do blood results always get phoned through or not seen until 4 p.m. You know, simple things like that. And what you're basically trying to say is I am communicating the vision of this service by identifying a problem and trying to solve it and engaging my team members and colleagues in finding that solution and then perhaps implementing um implementing it. So like really simple things it doesn't have to be complicated. These are all ultimately things that you can um cite as things you have done and then also later, perhaps reflect on and recognize that you have made a difference and it, it is building your confidence in terms of delivering leadership or management. Um So, next uh slide, please engaging the team. Um So if we can go on again, I'm, I'm wondering about speeding up. Maybe not, We'll see how we go. I might have to speed up. But, um again, um you will do this once you graduate, you find it very difficult as an undergraduate. Well, I certainly did, I just felt like I was constantly floating about waiting for somebody to let me sit in with them. Um But once you graduate, you, you, you will find it relatively easy to um to reflect on how other people, other people's interaction with you and how that can be um impacted depending on where you're personally at. So, a simple thing I found is as you go further on through your training, um I strongly recommend you do um some specific, um they think they call it personality testing, which is a really ridiculous phrase, but it basically means you, um it's like a Myers Briggs Psychological um testing brief um survey that generally outlines the sort of type of person you are where you're comfortable and what you react to. Um And you know, there are certain things I know that, um, I find difficult to deal with because I've done that. And also if you do these, um, assessments, they very neatly outline what triggers you to perform well and what triggers you to not perform well. And that's a, you know, on a, on a very basic level that is absolutely essential for everybody. Um, and you can't do the second thing about listening to the people that you work with and valuing their suggestions really that well, unless you've examined how you work, I'll give you an example and I apologize that this shows me for being the really annoying person that I am. Um But I find people who talk very slowly, hard to listen to and I think it's probably because I've got ad HD um but if people talk very slowly and in a detailed way, I eventually begin to lose interest. Now, that was something that was highlighted in my personality theft thing. I find it very frustrating even now. So I've learned techniques not to get frustrated and annoyed with people when they talk endlessly and actually say relatively little. Um And it is quite an important thing to be able to show that you're listening whatever stage of your career you're at. Um And then making sure that you're interested in other people's contributions and that you can do that um in a meaningful and authentic way. Um Again, self-awareness really helps with that. Um because everybody expresses themselves slightly differently depending on er, where they lean into. Um So, next slide, please, all of these things are about um uh you know, how can I um demonstrate what parts of my work um require interaction and engagement with other people? Um So things like, do you understand the structure of your work area and how other people's work fits in with your work? Do you understand how your team interacts with another team? So, for example, a key one might be as you're a surgical f one. How do you interact with the radiology department? What are the things that are difficult about that? What have you learned about how to get um somebody to respond to you um when you need it urgently? Um Are you aware of um changes that happen in the system? And do you keep up to date? Um Can this constantly comes up, do I hand over effectively others for others and take responsibility for continuity? I really hate that word phrase, but it comes up time and time again. And if you want to get through your Mr ACP, then I strongly recommend that at some point. Um You uh you do some kind of reflection on handing over um because they flip and love that. Um Next one, right? I'm gonna pause momentarily. Does anybody have any questions? I can't see anything in the chat. Does anybody I don't even know if you can speak? Um because I can't remember and I'm sure Emma told me before. But does anybody want to stop and ask anything right now? Can't see any hands? So I'm, I'm gonna carry on. I hope that's ok. Um, feel free to interrupt me. Um, so next slide, please, um, connecting the service a again to the next slide. I'm gonna talk about this because I think it's a relatively easy one for junior doctors to, um, look at and it's not a lot of work and yet you can um you can cite it as developing your leadership when you go to an interview or when you apply for a job. Um So, um again, this is about taking responsibility and keeping up to date with changes. Er, oh sorry, that's the same slide. I there was another slide, I don't know why I put the same slide in, but again, it's about er thank you. Yeah, so you can move on. Yes. OK. So one of the things that I wanted to highlight and it is in all the documents around medical leadership is um is connecting with others is absolutely not about certain things which ii certainly from Twitter, er I get the impression completely understandably that lots of junior doctors completely understandably and medical students are really hacked off. Um and they feel disenfranchised from the system they're in and this structure of medical leadership sort of tries to draw attention to the fact that that is not um that is not what we're about now, personally, I think it's perfectly reasonable that current junior doctors, um, and medical students are really hacked off. I could come up with a list of about five things off the top of my head which would annoy the living crap out of me. Um, but nevertheless, it is that they want you to think about how you engage and if you want to, um, make your life easier, I'd strongly recommend you cite these things in, um, your various, er, obstacles that you ha you have to leap over simple things. Like I'm not always gonna be right. That often isn't only one way, there is literally never one way to do anything. There are often three ways, excuse me, and you have to choose the least crap one. and actually the other two are just slightly worse. The one that you've chosen is not the best one, but it is the best one right now. Um, you have to demonstrate that you're interested in other people's views and often I've personally certainly experienced that, um, you might start out with an idea of doing something this way, but three other people contribute and then you've effectively amended the way you originally set out to do it. And ultimately, that leads to a better solution that also people are more engaged with. So, actually, there is, despite the fact that some of this, I feel is slightly irritating the way it's described, um, is actually meaningful and a way to um improve the systems that we're working in. As you'll know if you've ever watched any of the other things I've done with stash is politics isn't a dirty word. You must be engaged. You can influence. I suggest, I suspect that I don't need to tell you guys that because you seem very engaged. But um by no means, um are you in a situation where you can't change anything? Even though I know it feels like that a lot of the time. And um this is really a consultant aimed jab is that focusing solely on the depth of your experience at the extend of the broader services is, you know, is, is a failure. Um And that is a, a critical thing that you will um see some consultants is focusing on my, you know, my, my special list um uh or my, my special area of interest and not being at all interested about the other bits. Um And that isn't about patients that's about themselves and that is something to be avoided. Um Even though of course, we've all got things that we have more passion for, we still have to consider the others. Um Right, I can come. So Jessica's question, I can come to it in a moment. Um Can we go on to the next slide? I can't remember? Mhm OK. Now I'm gonna address Jessica's question again. I can't remember if you can say anything back to me, but if I say anything that doesn't make sense. Um As I answer, Jessica's question, please do um come back at me. Um So Jessica says, what kind of leadership or management roles are available for doctors in their careers without, well, sorry, out career in their careers, out with clinical medicine. But within healthcare, that's a very good question. And I think what you mean, Jessica is that it's, it's not a clinical management job but it is still um leadership. Is, is that what you mean? It's probably, probably, that's what you mean. But sorry, my thing is a bit slow, I think. Um, well, if that is what you mean, there's loads of things that you can do. So there's a lot of talk these days about portfolio careers. Uh Yeah. Ok. Thanks Jessica um about portfolio careers. Um So you can, it, you know, you can, you can go through your career, whether you end up being a consultant or not, whether you'd be a sa doctor or, you know, or you know what, you know, whether you become a GP whatever. Um you do, there are always um bits of leading that you can do. So the classic one that lots of people got engaged with is education, leadership. So, um a simple thing of being involved in er, teaching and training undergraduates or post graduates and developing that part of your skill set. There's lots of courses out there for people who are interested in, you know, they're virtually all free for health education in England or now, NHS England um to develop yourself as an educator. Um And, um, you know, that's a, that's a, a really regular thing that you can combine with clinical, with clinical medicine. Um They are all obviously also, you know, as you'll, as you'll know, you can be involved in a, in a, in a, in a, a specialty body. So for example, Bash or the Royal College of Physicians or um you know, your, you know, another specialty um area. Um and that isn't clinical, you can do a variety of things, you can do simple things like um being on a special interest group. So Bash has a number of special interest groups we have. Um for example, let's say the thing you're really interested in is trans healthcare. We have a gender and sexual minorities, special interest group and you could, you could definitely join that and that will definitely count as some leadership and management because you're effectively setting the vision for bash around gender and sexual minorities. They hold specific events that you can speak at. So getting involved in a, in a, you know, at the, at the beginning will take you in a direction you're interested in. You can also consider applying for um there's lots of fellowships out there which will help you concentrate on delivering a program at national level or regional level. Um And there are lots of um the dasi and the um other regional Fellowships Leadership fellowships where usually you get given a project that they want you to lead on. Um And then there's all o other things like with, you know, within a hospital, you can be um the senior registrar, um which I think it, it's probably not called a senior registrar anymore, is it? I do know what it's called. Um But basically where, um you look at the working conditions of a group as opposed to, um for example, if you, you know, the, the, the senior medic will look at the working conditions of, of people who are um in the school of medicine and they'll um work within that trust and possibly even regionally and often across organizations. Um There are other things that you can get interested in. So, for example, coaching and mentoring. Well, you know, it kind of runs alongside um education but isn't, you know, strictly speaking, embedded in developing workforce. Um You can also look for national posts that um are about looking at a particular area of expertise or interest um strategy development at a national level. There's, you know, there's lots of post graduate roles for people to do that. Um And then also the other thing I'd probably recommend is that if you're undergraduate and you're interested in these sorts of things that are undergraduate roles within your local um N HSE workforce training and education group, which you should call health education England or the Deanery. Um, and so there's loads of things like that that you could consider doing. Um, so loads of things. Um, the other thing I would say though is that my experience at least? Oh, and the other one is quality improvement. That's a big one. And I did a bit of quality improvement leadership at some point. It's quite interesting and it is, you know, one of those things that's a buzz word so that, you know, most trusts have somebody who's um or a de a whole department of people who are, who are developing uh quality improvement programs across the trust. So that gives you exposure to outside of your particular area of interest as well as um as well as in uh the leadership and management aspects of it. Um And then the other thing I would say is that certainly in my experience that most people don't start out saying I'm gonna be the bash president, most people end up going well, nobody will do this role. I'll just do it for a couple of years and see what happens. Then something else happens. You go, oh, maybe I should do that because actually I'd like that thing to improve and nobody else seems interested. So I'll do that role and then before you know, it, you've developed a particular area of interest. Um So the other key thing is, is research is really critical part. Um I find that difficult to talk about because I'm not, um, in an academic role. Um, and, you know, there are, you probably currently as it stands, although I think this is a crap, but, you know, as it stands, you probably need to set out from the beginning thinking about what your, um, what your goals are in terms of academia because you, you'll need to have some experience in an academic post, whether that be at foundation or later on. Um So that's probably something you do need to think about a bit earlier. I'm gonna move on because we've only got 10 minutes left and there's a couple of things I want to say, you keep going, you and again, years, right? OK. So these are my suggestions, which kind of cover what I've just said to Jessica, but let's, you know, managing things is what we do. You're all managing things where you're at, don't be put off about managing things. Don't think that managing is only for somebody else. The thing that worries me is that people, often, the people that are the very people that can see problems can understand how solve them are the people who put off from doing it because they think it's only a certain type of person that does it. And perhaps my voice isn't really that essential, your voice is essential diversity of voices is very critical. Um And I strongly recommend that you engage with it and and, you know, don't, don't be turned off by some of the people that you see doing it badly. Um, deciding what works best for staff, for patients is no different than deciding what works for populations, you know, D DD. You know, if I gave you the problem of how do we deal with the fact that PA S are now getting jobs that really should have been for, um, junior doctors, they're getting paid more and they're often not having to do all the extra things that you're having to do. How, if I gave you that problem to solve, you'd probably come up with some pretty good things and then you'd be able to start deciding about how you would, um, implement that. That's, that is, you know, that's exactly what I'm asking you to do. I'm asking you to get involved and go hang on a minute. No one else will solve this. I can solve it. Maybe we can solve it. Um, it's the same thing really. Um, when you find something that doesn't work, which it will be practically every day, ask why be, um, use evidence in front of you and be curious about what the problem is and why it's a problem. And I don't just mean the, you know, practical specific thing. I mean, what are the cultural reasons and people's attitudes that's led it to be ignored for so long if it is a problem, um, take advice and pick people's brains. Um I still to this day pick the phone up and go, what do you think about this? And I'll often, if I'm doing that, I'm asking 34 different people so I can get it considered. Opinion. Go on a course, consider in our program experience once you've graduated and consider collaborating with Bash or an other agency that might uh you know, that might help er fire interest or help you develop something that um is a uh a key in terms of changing things. Um Next slide, please, any questions, there is one in the chats. Um I'm really um keen to answer any of the questions. I recognize it probably all seems a bit dull if there's anything you'd like me to do differently or do better if I get an opportunity to speak to you again, do let me know. Um And with that, I'll, I'll hang back over to Emma and Bronwyn. Thank you so much. That was really interesting. Um I was, I actually had a question myself and I was just wondering, is there any role that you've done personally that you feel is like most greatly impacted your management and leadership skills? Well, loads, actually. Um I'll just tell you a little tiny story when I was um a house officer. Yeah, that's, that's how old I am. Um back in the day when you just did one year and you had to do six months of medicine and six months of surgery and that was it folks, there were no other options. Um I was told during my surgical attachment and which I had mainly done because I knew I was gonna do medicine and not surgery. Um, and it was a very medical job. So the, basically the medics, the, the junior doctors did all the medicine. Um I was told by a senior registrar on that surgical team that I needed to care a bit less about patients and I need to make less of a fuss. Um, otherwise I was going to be very unpopular. Um, and, er, I had been told that many times since. Um, and the, the first management role I did was as a consultant. I um, became a consultant in 2007. I had um a baby and then came back from ma leave and somebody said, oh, I'm leaving, you're gonna have to be clinical lead. Um, and from that moment on my, my journey has, you know, has continued to, to go. Um, I, I'm still learning about how to manage things. I'm still learning about how you get things. Right. Um Those first three or four years were a real learning curve. So to answer your question, I think I probably learned the most about myself and about how other people function during that time, as I've already said on this call, I didn't really know at the time when I became a clinical lead. That I've got ADHD, I guess I should have guessed it really. But I have, and I definitely think that that's impacted my learning journey and my approaches to things. So I, you know, strongly recommend if, if you think there's neurodiversity anywhere, um, get that diagnosed soon because it helps you figure out what winds people up and what doesn't. And, and also it helps you to pre empt other people's uh, rigidity, um, or inflexibility um, to change. And so, yeah, I repeatedly get told, I'm, I'm too challenging and I'm difficult and I've just learned now not to be bothered and usually means I'm doing the right thing. Yeah, that makes sense. Thank you. And then while in the chat, I don't think, no, I don't think there's any more questions in the chat. I just wanted to say one more time and thank you again. And if people could feed it and in the feedback form on the email, that would be great. Um, as well. Yeah, I mean, the other thing I wanted to say, which isn't really on the topic of management and leadership, but I do want you to all hear this and I think you are going through an extremely difficult time at the moment and I completely understand that and I think most, most people, um who are consultants do, um that um things will get better. So when I qualified in 1997 when I arrived at the A&E um, uh, you know, for my night shift as a, as a first year sho um, there were ambulances around the block. I was the most senior person awake in the hospital between midnight and eight as a second year graduated doctor. Um, and it was awful. It was like, you know, it was, it was recognized to be really terrible, um, for patient care, but also for, for us and then it got better And the thing about it is you're also young, you, you probably won't remember when it was really shit and now it's really shit again. Um But what I basically am saying to you is it can get better. It absolutely will. There are lots of us fighting for that to improve your working conditions and what happens to you in the future. Um And I just don't want to get too down about how things, how bad things are at the moment. Cos II promise you we're working on it. Thanks so much. It's really encouraging to hear that because it was a bit of time and thank you so much for the talk. It's not something that we get much teaching on or experience officer really appreciate. Thank you. Of course. Yeah, I mean, the other thing I was gonna say is what I'd really like to do is some kind of system with stash where we do some specific management, um like accreditation, um management and leadership. So what I'd really like to do is, is, is do a little, um, session on things that I think you should go off and do and then like really simple things. Um, or we can do CBD S or, you know, reflections and, you know, I'm really happy to do those with people so that, you know, you can actually get an opportunity to talk about how you develop your, yourself. Um, because, you know, no, nobody ever thought I could ever do anything of any interest I've, you know, I've I II don't think you need to be a shining star to do anything. You just need to be interested and motivated and somebody's there going, you can do it, go on, you can do it. And so I'd, I'd really like to, to do that at some point in the future. If anybody wants to reach out to me for any further conversations, please, uh, you know, please do. Yeah. Thank you. I'll definitely bring it over for the rest of the good. All right. Well, listen, I'll, I'll let you all go and have an evening. Thank you so much for joining me and taking time out of your evenings to, to partake and let me know if there's anything else I can do or if there's anything you'd like me to do, uh, in a different way. Thank you so much again. That was great. Thank you. No problem. Take care. See you guys. Bye bye.