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Okay. Uh, can you see my slides? Mike? Oh, Helen. Yeah. Sorry. I had my microphone muted. Yes, I can see them yet, and it's recording. Thank you, Mike. Okay, so I'm going to talk a little bit about neuro diversity. Some of the ST threes have had an element of this at induction, but pre warning, you do need a piece of paper and a pen, so we're all on a journey. I think we've kind of accomplished that today, and we're all at different parts of this journey. And for me, I would describe my understanding of neuro diversity and particular dyslexia as still being an ongoing journey. And I'm learning from many of you and trainees that I've been working with up north, and I'm very grateful that for that experience, but are we actually as diverse about diversity? Um, and if you look at pub Med, there's over 300 publications on diversity, but none on your own and none on dyslexia. If you look at Ortho Media, there's one hit for dyslexia with with 280 on diversity itself. Google. I got 50 hits in and got bored and gave up, but there was absolutely no mention of neuro diversity insurgents. And so when we talk about diversity, we do generally focus on race, gender and sexuality, and we don't really hear very much about neuro diversity. For example, at the OA Um, Botha, when d. I is spoken about neuro diversity covers is an umbrella term, really, and covers quite a few conditions as well as characteristics. And I'm not going to be particularly diverse about neuro diversity. And I'm going to focus on dyslexia on this occasion because it's quite a big area to cover. Otherwise, it's important because it might directly affect you in your training. If you have diabetic tendencies, it could affect your ability to perform day to day tasks in the workplace or to prepare for your exam. It can affect you as a clinician because many of our patient's have neuro diverse conditions, and it will affect you as a trainer because at some point you will interact with the trainee that has neuro diverse conditions. It was a really good advance to be able to see that neuro diversity featured in, um, this article and has also been discussed in vogue by how how do you live with a d h d. But it's quite a sad moment that, actually one of the authors of this article still felt that remain anonymous because of their condition. And so we are dealing with a condition or conditions that have got significant stigma associated with them, and we need to normalize these conversations. And that's because 10% of the population are dyslexic, which means 10% of our patient's are dyslexic. And it was shown in a study from K S s that actually, 20% of junior doctors are dyslexic. And so the likelihood of people that are signed in today being dyslexic or trainees that you work with or consultants that you work with being dyslexic is reasonably high. So with your pieces of paper, which hopefully had time to, uh, scrub around and find, I want you to fold it in half, fold it in half again and again so that you've got eight boxes and I'm going to give you 40 seconds. And I want you to write one word in each box about what you think. When a trainee tells you they're dyslexic or if you're struggling, what you expect them to find difficult. And you're 40 seconds starts now. Yeah, Yeah. Okay. And stop. So, um, did anybody manage to get all eight boxes filled in Anybody? Helen, uh, says night, Uh, for some reason, my slides have just closed down in the background, so I'm just gonna get them open. I think I have to stop screen sharing. In the meantime, uh, Ben got five out of eight. Okay, Anybody gets seven Oscars, got sex? Not bad. Anybody get more than six? Um, anything that's ever have admitted to to Yeah. Oh, dear. Ok, so the point of this exercise was one to make you think about the things that people may struggle with, but also to think of whether or not you see any positives or just negative words featured. If you were thinking about what what you feel when a trainee says they're dyslexic, but also an exercise in how it feels under time pressure to complete what was actually a relatively simple task of writing eight words. Which may be how your s h o feels on a ward round when you're rushing them around. If they struggle to process writing, let me try and re share my screen. Can you see them again, Mike? Hello? Yes, I'm not going to ask any of you to share what you've written down on your piece of paper. That's personal to you. But certainly when I've listened to a lot of podcasts and people have spoken about what they feel about neuro diversity or dyslexia, it predominantly focus is around a lot of negative words, feeling ashamed, having a learning difficulty, very slow or feeling excluded, but not very often that positive words are put into these, um, in an exercise that actually IQ is not affected and is very often very highly intelligent, that they may have different learning styles that makes them better at problem based learning and therefore have good lateral thinking and ability to solve problems. Quite creatives. And actually the vast majority of entrepreneurs, for example, have dyslexia so very positive aspects of neuro diverse conditions that do not get discussed. It was actually one podcast that talked about, asked a selection of parents that had that we're expecting a baby, and they were asked whether they would rather have a child with a physical disability than a child with dyslexia and the vast majority of people would prefer to have a child that did not have a neuro diverse condition and accepted a physical disability, which is quite a stark, um, difference there for something that actually can be quite a positive characteristic. So why does it matter to trainees? It matters because we need to take a holistic approach to training, but also to how we work in the, uh, in in our work environment. Uh, this is optimizing training by looking at learning styles, but also our teaching styles. Looking at our ability to organize because often are short, short term memory for neuro, diverse conditions can be affected. And so trainees or colleagues who have these neuro diverse conditions may come across as being quite haphazard or disorganized or running late. Um, and so it's using out. Not being a mindful about unconscious bias is two people. With these tendencies, there may actually be something underlying that making sure that research is a C C T requirement is accessible. So if you're someone that struggles to write a lot of text or to read a lot of pros text, you may find that research is not particularly accessible to you, but actually you might be really good at research, design or even managing numbers and statistics. I've already mentioned that working memory can be affected, and so that does actually play quite significantly into our jobs on a working basis. Particularly, for example, if you have an S H. O or a junior registrar with you, for example, who may struggle with an on call just from the sheer volume of work that goes on in a short period of time, we need to be able to sort support people not only in sitting their exams but actually in the workplace, which sometimes for people who have received diagnosis of dyslexia, it's this part that doesn't get looked at so well. And we need to be mindful that, actually, in people with neuro diverse conditions, there are often other neuro diverse conditions present, and it may there is an increased risk of anxiety, so we need to be mindful of well being in those situations as well. It's not all about making the exam more accessible. It's actually also about making sure that the run up to your exam is accessible so you may be entitled to additional study Lee, for example. But as I've said, cognitive well, being in these situations, for everybody, regardless of neuro diverse conditions, is really important. But in neuro diverse conditions, being mindful that actually anxiety, depression and other neuro diverse conditions are much more common. Jennifer Aniston had an adult diagnosis of dyslexia, and I think this quote sits quite well in explaining that light bulb moment where, all of a sudden everything that has happened into her in her life, up till then has suddenly started to make sense to her for the way that she processes information we have. Hopefully, most of you participated in it. The neuro diversity study, Um, survey in east of England. And I won't go through how we did it because hopefully most of you participated. But we found five potential, uh, people with characteristics that could have led to a diagnosis of dyslexia that had not previously been known. And of these people that we found only 40% of them would actually have been eligible for testing through the professional support yet because the prerequisite here is that you have failed an exam at least once, and so we need to be mindful that. Actually, some of you will be training with the neuro diverse condition and do not know about it yet. You may argue that if you're passing your exams, does that matter? But actually thinking from a cognitive well being point of view Are we supporting you in the best way? And are you supporting your trainees in the best way that you possibly can? We asked you about perceived barriers to formal assessment, and the biggest perceived barrier is stigma. And this highlights the need that we need to continue to normalize conversations about our learning styles and conditions that we have that may impact on our workplace. Um, in a safe way. This isn't that you have to share this information with everybody, but also that it's a time consuming process to be able to, um, go through to get an assessment which impart maybe true speaking to some trainees that have been through the process. Um, but the ability, inability to be able to self refer makes quite a It's quite a big perceived barrier. Still, with nearly a third of you reporting that and just wanted to highlight in this moment that if you have eggs have failed any exam once before, I your MRCs you are able to self refer before you have an attempt at your f s. Yes, these are some of the quotes that I've come across not just from the east of England but from trainees outside of the east of England as well. And, um, some of them, really It's quite amazing that these things are said still and that these effects happen in this day and age. But it's for us to be mindful of these now and try to make changes in our practice. So I'm going to talk through some of them in a little bit more detail and about how I I personally am trying to change my practice with regards to neuro diversity but specifically dyslexia. So following this conversation, I now actively try to encourage reframing. So a trainee said to me, I'm sorry, I'm dyslexic, but actually we had a conversation and said, I asked what what does that actually mean? Because there's so many different different effects of dyslexia in terms of mild to and how severe it is. What is it that is affected for you? So actually reframing that too I am dyslexic, and that means I might struggle with writing in the notes on the ward round. But it means I'm actually particularly good at communication skills and building a rapport with my patient's so it gives a much more balanced representation of the skill set. And perhaps the negative is that is one, but also highlighting the positive skill sets that that particular trainee has, and that really empowers the trainee. But further can go one step further. So one trainee felt that they get left out of research projects because they're slow and struggled to write them up. But they're really good with numbers, so have already reframed. They found a positive in their skill set, and actually this is an opportunity to make efficient use of their time and pair them up with the training. Who is able to do the writing element of it while they're able to do the data collection and processing of the numbers and actually working together means that you both get a project out of that, and actually, you may be able to get two or three projects done together in the same amount of time it may have taken that trainee to do one. It hopefully gives a sense of achievement and by considering our skill sets hopefully empowers the trainees to continue and may access more research in the future. We've talked a little bit about bystander training, but actually ally ship, which hopefully we'll hear a little bit about later on this evening is also really important. And this came about after a trainee was laughed at in a trauma meeting for the way that they had spelt a word. Uh, and they were embarrassed, embarrassed, and end up apologizing to the consultant. So this word had been spelt in the way that it sounded and didn't represent when you looked at it on paper anywhere near the word that we expect. But everyone could read it and knew what it was in the context. Uh, it was an entirely inappropriate event that took place. And so just being there as someone for that trainee to talk to is really important and talking about strategies to deal with those situations is equally important. But even more important is then speaking to the department as a whole and those particular colleagues that were involved about making them aware of neuro diversity and offering neuro diversity training, which is actually very difficult to access in the NHS. I personally hopefully have changed my teaching style by the interactions that I've had. Hopefully you noticed I don't use black text on white backgrounds because it's very difficult for some trainees or for any colleagues. Sorry, um, to read who have got dyslexic characteristics and I try usually to make my teaching hopefully realize as interactive as possible with as little text and as much speech. And I try to deliver these in small chunks. So that is not too many words that are overwhelming on a text in one go slides are hopefully interactive, and Anish has already shown us that he's using an interactive pole to try to engage as well. You may not have heard of Miro M i R o. Uh, this is a website that you can create, uh, electronic mind maps, which is really great revision tour. But it's actually a link that you can drop into a chat box and you can all update a mind map at the same time. So using shared mind maps to make virtual teaching more interactive is really useful, but particularly mind maps for people with neuro diverse conditions is a really useful revision technique. And there is actually an entire, um academy, if you like, called the Bullet map academy who look at teaching people with neuro diverse conditions how to actively and correctly mind map. And I think the biggest changes to my teaching have come from discussing with neuro diverse trainees. So I'm incredibly grateful to the advice that I get from those trainees. And at the end of the day, we are all learning, Um, the biggest strategy, I think, uh, to your learning is actually teaching someone else because you find out where the gaps in your knowledge come from. I've already mentioned mind maps, but me I personally learned very well from drawing. Uh, and, uh, Mike will vouch for this When you come came to my house before my fr CS, The house was entirely covered with notes that were stuck on the wall and drawings of, um, different ways for me to remember the information for the exam. And I put difficult topics by areas that I go too frequently, which is generally the kettle, because I drink a lot of tea and coffee. Um, and I make myself recite them when I'm I'm near them or I have a pad there and I will draw it out until the kettle boils. Um, so it's another way to go about repetitive learning and bearing in mind that audio or podcast might work much better for you if you're someone that struggles with reading or using adjuncts like color overlays, which you can buy for a couple of pounds off of Amazon, or from the British Dyslexia Association, which make it much read and take away that black text from white background. And you might find that actually, text to speech conversion pens are quite useful for you as well. If you're struggling to get certain books on, audio's revision strategies are pretty similar. But just to be mindful of the environment, particularly light levels can be overwhelming with neuro diverse conditions and trying to minimize distractions. Having a revision timetable is very helpful. Um, you will need to start earlier than you think, and that goes for anybody, but particularly if you struggle with processing volumes of text, um, which you would expect with someone with dyslexia. You will probably need to start earlier than you imagine. But having short frequent revision sessions with regular breaks will help you retain more information as well as looking after your own well being. Uh, color coding can be quite useful and in particular annotations. Uh, and if you don't want to be writing in your textbooks, you can get clear. Post it notes that you can put into the text books and annotate over drawings, for example. And just be mindful that, um, everybody will have a different way of learning and actually addressing how you learn best is going to target how you well, you revise. And what revision strategies work best for you. Um, but generally speaking, multi sensory modalities and using two or three of those will probably help you to remember better than just using one modality. And just be mindful that dyslexia is not always an isolated, neuro diverse condition. So about 30% of people with a D. H. D are also dyslexic and may benefit from, uh, coaching around specific issues, your organization or timekeeping, for example, short term memory and actually working on your ability to focus, which might help you not only in the workplace but also in preparation for your exam. And about 40% of those with autism are dyslexic as well, and that obviously affects our patient groups. So it's being mindful that individual neuro diverse conditions are not necessarily present in isolations. I mentioned cognitive well being already we know from a study of young adults and adolescents. Really, that self esteem in those with dyslexia who struggle with their pace of reading is much greater. Over 80% reporting low to very low self esteem compared to less than 20% of those who have normal reading pace anxiety had similar numbers as well as insomnia, having quite a high percentage rate as well, which again is something to recognizing the run up to your exam and a general feeling of failure was much higher in those with dyslexic tendencies than those without. And I think, um, I hadn't realized that these numbers were quite as high as this. This is generally speaking in those, uh, 12 to 18 years old. So again, if you have an interest in pediatrics and you have a child with dyslexia in clinic, this might be other things going on outside of um, the work outside of their school place and what they're coming to see you in clinic with. What are we doing in east of England? Uh, well, we have done the survey. We presented it, um, at East Anglia this year. Um, there is some work going on in h e around your diversity particular insurgents, which hopefully you'll see, come out later this year. We've had conversations at the STC meeting and a submitted a proposal to try to get some better access to neuro diversity training and webinars. And again, we may see some slow bits. We progress in that over this year. I wanted to highlight that. Not only is the mind mapping software free, but also, if you haven't used it before, Graham Early is also has a free version. And this will check your work before you submit it for publications. So that will read and correct. Not only spelling, but also your grammar. And realistically, the question that we have is whether or not the criteria for testing needs to be widened. Uh, and this is a slightly controversial issue at the moment. I'm going to leave you with these two quotes. Um from two celebrities that had adult diagnoses of dyslexia because I think actually, they some up in quite a good way. Some of the positive skill sets that having dyslexia as a surgeon bring, uh, and not always focus on the negatives of a condition, but actually look for some of the positives that that condition brings as well.