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Summary

Join the last installment of OSC Express teaching session that focuses on Ethics and Professionalism, led by an esteemed doctor from the Warrington Hospital. This unique session will not only Home your abilities to manage challenging scenarios involving patients and colleagues but also covers critical updates on General Medical Council's good medical practice. It offers necessary theoretical knowledge and queries about upcoming exams, NHS policies and procedures, and potential QI and audit projects. With a strong emphasis on open, clear, and empathic communication, this session aims to guide you on maintaining the highest standard of medical practice. After attending, you will be well-prepared for the most complex ethical dilemmas, and know how to effectively escalate any issues within your professional environment. Furthermore, the interactive approach encourages you to address any concerns or comments you may have.

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Description

The Ultimate Team-Up for the Ultimate guide to Finals OSCEs.

​We're super excited to introduce the Osce Express series.

​We're collaborating with a crack-team of Foundation Doctors to bring you an comprehensive A-Z guide to finals OSCEs.

​Over 11 weeks, our expert team will give you top tips to ace those practical exams.

​Oh and did we mention, we'll be uploading exemplar OSCE videos and of course, free practise cases.

​Join us for the final session as we go through:

Ethics and Professionalism with colleagues

Recap

Click here to join the meeting

Meeting ID: 346 501 225 979 Passcode: XqRj57

Learning objectives

  1. Gain understanding of professionalism and ethics in healthcare scenarios involving colleagues and patients, as outlined in the GMC's Good Medical Practice.
  2. Acquire strategies for appropriately escalating concerns in line with NHS policies and procedures.
  3. Develop skills in handling challenging conversations and ensuring clear, empathetic communication with patients, carers, and colleagues.
  4. Understand the importance of recognizing and acting upon potential conflicts of interest and breaches in patient safety or confidentiality.
  5. Increase knowledge of the role of the Freedom to Speak Up Guardian in supporting clinicians to raise concerns.
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Computer generated transcript

Warning!
The following transcript was generated automatically from the content and has not been checked or corrected manually.

OK, we'll make a start. So uh welcome everyone to uh the final session of OSC Express. Sorry, this one's been a bit delayed. Uh We had a few kind of conflicts with the due, the timetables in the middle. So this was the next free date and obviously with PSA which came in the way that kind of delayed things as well, but this is it, we're at the end. So we started in November and now we're nearly finished. So this last session will be brought to you by NADI. Uh She'll talk to you about ethics and professionalism. So we did part one a couple of weeks back. We're just gonna pick up where we left off and cover a few other things. Um And we've left a bigger chunk of time towards the end for any questions that you guys have. We are finishing today. But if you have any questions between now and finals sys then um we've put contact details at the end that you can, that you can get in touch and, and send queries and we'll post that to the team. Um And if, and then get like a collective response and I'll just relay that back to you guys. So we'll hand over. Ok. Hi guys. Thanks for coming back. It's been a long break, but it's good to see you all here. So today is our final session, we'll be going through the rescheduled ethics and professionalism part two. And then I've left a lot of the time for the end of the session to go through any questions, queries, um, comments you have about the exams upcoming or the series in general. Um So we'll go through that a bit later. And as always, I want the session to be in track. So just pop your questions in the comments um in the chat section. And um we'll be doing a case later on as well. So if you want to volunteer just as always raise your hand up and we'll go through it. Uh But for those who don't know me, I'm li I'm one of the doctors in Warrington Hospital and um just wanted to run this case series for you guys. So you're better prepared for your aus as this result was not something we had when we were doing practice for our finals acies. So let's get on with ethics and professionalism. So the way we sort of split this uh station in our series is to go through ethics and professional professionalism in the case of managing scenarios involving patients. And the other one is scenarios involving your colleagues. So last time with Fatima we went through situations involving patients and today we go through situations involving colleagues. It is just one station though. Um and you will have eight minutes to consult with a simulator that's either gonna be a patient, a carer, a colleague or anybody else who's suitable to have a discussion with that scenario. And then this will be a conversation testing any of the ethical issues according to the GM C's good medical practice. Um I think there's been an updated version in 2024 which your mark scheme references. So just have a brief glance through it, make sure you know what all of those domains are about and there's a lot of buzzwords as well. So it's always a good idea to Google them if you're not quite exactly sure what these mean and what you need to know in relation to them. So how would you act in accordance if it, if there was anything that was breaching this quality of a doctor, how would you go about escalating in appropriate manners? Uh Because after the end of the eight minutes, what the examiner will then do is they will take over from the simulator and they will ask you questions for two minutes and this is a chance for them to check. Do you have the theory knowledge regarding ethics and professionalism? There will be lots of references to the good medical practice and um they might ask you to uh you know, basically extract uh some basically policies and procedures that are in place in the NHS to avoid errors from happening. But they might also ask you to suggest some things that you could do differently in the NHS as a way to get you to think about Q I and audit projects. But that's a very small part of the station. The bigger focus is on the consultation with the A A. So uh here's the Mark scheme, I appreciate. It's a bit tiny. Maybe you guys can't read it, but this is all in your sy briefing slides, just go through them. Um Essentially what they're testing is that you're opening the consultation as always checking the patient's details being very open ended um and setting the scene. So sort of, you know, explaining why you're here what the topic of discussion today is. Um And it follows the uh similarly to how we would break bad news. So use a bit of spikes and ice here. So make sure you have the same baseline as your patient or the simulator's understanding. Uh Are they up to date? Is there a bit of a discrepancy if there is fill them in on the gaps and then take it from there? Um And then afterwards, you know, invite them and give the information that you have, which is essential for them to know about. Um And then afterwards, there will likely be an element of apologizing to the patient carer or um a colleague uh or the colleague might instead be apologizing to you because of a mistake that's happened in the clinical workplace. So this part of the station is assessing how do you deal with uncomfortable discussions and are you open and honest and clear in your communication? Um And after this as well, there's gonna be an element of um learning from what's happened and resolving any conflicts and moving forwards for the future. So these things don't take place again. Um And then afterwards, as I said, it's gonna be two minutes for the examiner questions. And I think for the station, um you get marked obviously by the examiner, but the simulator also gives you some points um depending on how they felt you were in terms of your communication, were you empathic and so on. So these are some criteria for excellence. So are you skilled and fluent in opening the consultation and you've not missed out any major aspects uh that were given to you in your briefing? Um Obviously make sure your understanding at the baseline is matching and then uh making sure that you are covering all bases, you don't really need any additional help and the conversation flows through together. Um And then where it says give us short answers to the examiner questions with full explanation, showing a deep level of understanding, this is part of the theory content of things. So just, you know, spend an afternoon read through the good medical practice, make sure you're brushed and up to date on it. Uh, that's, that's pretty much it. And essentially with the station, there is a heavy focus on ideas, concerns expectations. I was saying, uh, what I find because of this is to start off with ice. Um So, you know, what are your ideas of what's happened so far? You know, I can see this would be a concern because XYZ has not gone to plan. Did you have any other concerns? So invite a lot of questions and ask the person in front of you to offload whatever is in their mind. And that means you don't miss out on any cues for the actor. And whenever you are having a new piece of information, often it might be two or three pieces each target. So you know, address one park the other for a bit. Um Make sure you're giving those breaks and checking, understanding has been achieved both between yourself and the other person. And throughout this whole discussion, make sure you're being calm, you're empathic. Um And again, you're reflecting on this and you're actually showing it to the other person as well that, you know, that's reflect on what's happening. And this is something we can learn from for the greater good of everybody in the team or everybody. Uh that is looking after a patient as well. So this is just reiterating what we discussed about in the last session So these are some example themes. Um There'll be topics covering confidentiality, consent, and mental capacity, duty of candor and safeguarding. Now, these four areas are all patient focused um and they will require a different set of communication skills because um obviously you are in a caregiving position whereas the patient or anybody else is not and they are actually relying on you to be open and honest in um in a more of a duty of candor type of manner because they may not always understand the medical jargon and why things can often be an issue. So that will require a different communication, skill set compared to when you're discussing things with colleagues, which often falls under these two domains, which are a conflict of interest. Um Now what that means is the other person you're talking to may be acting in a manner which does not always match the guidance set out by the GMC because they have something to gain for themselves, often for selfish reasons and something that doesn't match the um the morale and the end goal of the team or the N HSS values. So often it's financial gain or it's because they will be in a position of power or they have um something that will put them in a better light compared to um how they would have otherwise been seen. Now, the other one is also raising and acting on concerns. This often involves patient safety as an element as well because often the concerns we do raise with regards to a clinician's practice involve harm occurring to a patient at the end of the day. So this will mean you need to know about your dates and uh what policies and procedures are in place in the NHS or your trust guidelines. Um The other things where you might be concerned is if a colleague is not contributing enough at work, they're repeatedly coming late. Uh They're not uh being honest and there is a lack and a breakdown of integrity in the team. Those might be some things you would be asked to have a station about. Um And al as always remember, there is also a freedom to speak up guardian. This is where their role will be discussed more in the examiners questions they might ask you. So this scenario has happened. How would you make sure that your concerns are listened to you if you don't feel comfortable addressing them uh face to face with your colleague who's maybe deviated from the path of doing things in the right way. So, um with this station, then uh let's just go on and explore examples and what example scenarios involving colleagues a little bit further. So as we said, anything that would put patient safety confidentiality or their right to know things at risk is one category. Um And anything that you know it off license or deviates from the track of any or nice guidelines. Demonstrates it's a conflict of interest. Now, uh common scenarios, as you said earlier, I'll let you read through them. So these are the four main ones you would encounter. And I think a lot of these scenarios were covered in the S JT exam, which you guys have not had to do. But if you do find yourselves, you know, coming across some papers from previous years would be worth just having a read through the mock schemes. They're not always the best out there because you know, uh when you have to rank things in the exam, they don't always match what you would do in real life and what you should do. So just have a read through it to make sure you know that the domains you uh need to know about are not missed, you're covering all the bases and just use that as a guide for certain scenarios that could come up in your exams. So um I'll give you guys two minutes. We'll go through an example scenario and uh if there are any volunteers, if you want to just raise your hand, uh we'll give you mic access at the end of it. So this is essentially your first medical job as an fy one. And you notice there is concerns regarding a colleague's practice. So I'll give you your two minutes talking now. Ok. So how are people doing for time? Would anyone like to volunteer? Yeah. So Rinko do you want to practice the session station with me? Ok. I take it June. Do you want to practice? Oh, yeah. I, I'll be fine practicing for this. Yeah. Yeah. Ok. So we'll do it like it is in the exam. So I'll give you eight minutes. Let me just get my timer up eight minutes. Ok. Yeah. Ok. Whenever you're ready, just let me know. So, um, so I just, um, hi, my name is June. I'm one of the F I ones as, you know, we've been working on the same walk together. Um, and, you know, so it's come to my attention that, um, I don't know whether you've been brought up to speed as well with what's been going on. But, um, basically, um, the consultant recently, he's, he's brought to our attention that there's been lots of specialty referrals on the ward that's been missed. And, um, do you, do you have any idea what's going on with that? Um, no, no, tell me a bit more. Nobody's told me about this yet. So, basically, um, for the past few weeks I think they've been doing, uh, they've just been trying to figure out if there's been any, if, um, any of the specialty referrals have been missed and they have noticed that it has been happening quite frequently and, um, I'm not sure if, um, if that's been a part of your work rota, but I've noticed that, um, that in the past few weeks as well. You've been kind of coming in quite late for rounds and leaving quite early. Um Oh, sorry, she's, she's a colleague. She's the colleague. Yeah. Wait. Um so you're talking about the person? 00, so sorry. I, I'm II misunderstood the, the, sorry, my bad I read scenario. So yeah, so um II am the colleague who's been coming late? Yeah. Oh, ok. Oh, sorry, sorry. No. Uh yeah. Yeah, that way. Yeah, sorry. So yeah. Um so I'm speaking to the colleague about um what's been going on? Ok, so um yeah, don't worry. And I've just been wondering, you know, has that um um have you been able to finish all your work during that amount of time or have you not been? Well, you know, I mean, ii try to and, you know, some days it's, it's quite difficult because the ward rounds are very long, you know, we're on medicine. Uh you know how it is June, like they can go on until 3 p.m. and it's just things are left for a very short amount of time like, you know, I have to go home in the evening as well, so one hour, two hours is often not enough to finish the jobs. So I've sort of been having to prioritize, you know, and leaving some jobs for the next day. Um I'm, I'm really not sure if it might be one of my referrals that got missed. Ok. So um have you? So I know you said you've been prioritizing, you know, leaving some jobs for the next day. But have you, so would you say you haven't been able to complete all the jobs that you've been assigned on that day as well? Yeah. And I think this, this rotation has just been so busy that it's just happening. It's probably happened to you as well. You know, where you've not been able to finish your jobs in the one day. Ok. Ok. Um Have you tried to seek any kind of assistance or any help from anybody on the team? Uh Well, no, II thought I was sleeping on top of jobs even if it's not the same day, I've been trying to do it the next day. Um And, you know, I admit there might be one or two referrals that were probably left off my list, but II didn't think it was causing too much harm to anybody. Ok. Ok. So at least, um, from my end, I would say that, you know, um, it can be quite dangerous for you to kind of um, leave jobs for the next day because sometimes, you know, it's quite important that they get, they get done on the same day as well. And if you're ever feeling like you're unable to, unable to finish your workload, I think it's really important to just kind of have a discussion with the team about it. Explain, you know, why you why you might find that you don't have enough time just so that we can all try and help, help out in that sense and try and accommodate for 11 another. Does that make sense? Yeah, absolutely. And you know, honestly, I really appreciate that you've been covering for me, you know, when I've been coming in late and having to go a bit early as well. So, so thanks for that. Yeah, so every everything you do a hand over. Ok. Ok. And is everything ok. Like are there any other reasons why you, you feel like you need to go home that you would like to talk about as well? Um Well, I mean, see, we're, we're friends. So the thing is, you know, my mom's been quite unwell, she went on the skiing holiday and she ended up fracturing her bone. So I've sort of been going to her house in the morning, making sure she's all right, getting up out of bed, preparing breakfast for her and then I've been driving up to work and it's, it's just taking, you know, a good 1, 1.5 hour out of my day. I see. I see. Ok. II can definitely understand where you're coming from in the sense that, you know, you're, you're not just working as well. You are caring for your mom at home and that's been causing you a lot of stress. I think it would be really helpful as well. If you were to try and bring this up to the team, we could try and see if there's anything in there, if there's any way we can kind of just help you out to see if we can try and like, maybe lessen your workload or see if there's any, any kind of services we could help provide for your mom. And that way you'll be able to, you know, you would be, you would be fine. Um You'll be able to finish a workload um during the amount uh during the allocated hours. And that makes sense. Yeah, yeah, I appreciate that. It's just, you know, II didn't wanna make a big deal. II saw you were, I see, I see uh spotting for me covering for me. So I appreciated that. But uh yeah, how, how is it for you? Has that been affecting you? I think it's, it's definitely been quite um it's definitely been affecting me as well just because um we're trying to help out with everybody. Um It can be, it can be quite tough as well because I've had to be the last one to leave sometimes as well just because I need to pick up um any of the unfinished tasks there's been um left as well and as well with um and um the team has also confronted me as well because they think that it's um wait, sorry. Um The consultant is also um the consultant has also thought that it was my responsibility for these patients and that's why, uh I'm also getting quite a lot of flak for this. So I think it's, it would be good if we kind of, you know, we went to the consultant again and just kind of told, explain to him the whole situation, just, just so that everything's cleared up. Oh, man, I'm so sorry to hear. Um, that, that must have been really tough. Um, you know what, I'll tell you something, let's work on this. Um, and we'll, we'll sort something out, but I really don't wanna talk to the consultant. Um, she's, she's very scary, you know. So II don't wanna approach her in that way if that's all right. Hm. Well, just because it's already been brought up by the consultant, I think it's, I think it is important that we go together and if you are worried about, you know, talking to the consultant, you know, just, just, um, just to let you know, I'll be there as well so we can, you know, have a discussion together. It won't just be sorry, we can speak to the reg as well. We can speak to some of our other seniors as well. I think they'll be, they'll be happy to try and explain where we're coming from as well rather than just the both of us, like speaking in the, to the consultant alone. Mhm. Mhm. Ok. Yeah, I see where you're coming from. Um, I, if it's all right with you can, I have a bit of a think about it just, you know, prepare myself, get myself in the right headspace and then we'll take it from there. Yeah, I'm, I'm sure that's fine. Just, um, yeah, that, I think that's, I think that's reasonable as well, but like, um, we're trying to make sure that we get it done as soon as possible. So hopefully by tomorrow we can um we can come up with a plan to get it just cause it'll be better than leaving it until um it it will be better than just letting it kind of continue and yeah, and our main concern as well, you know, uh because we're in the team and working together, we just want to make sure that none of no, none of the patients are you know, us um none of the patients suffer from this because right now like there hasn't been any big issues that have like occurred but you know, we if we miss one day it might, you know, it might cause some patients some serious physical harm. Mm Yeah, I si see where you're coming from. Yeah. Yeah. Yeah, II agree. Ok. Thank you. Thank you for listening as well. Bye. Ok, so that is the end of the eight minutes. Um let's go through the questions that would follow with this case first and then we'll come back to finishing the reflective cycle. Is that OK. J oh sorry. Yeah, the questions. Yeah, you still have my access. Great. OK. OK. So let me just skip past this and come around to the example questions. OK. Right. Let me go back because I don't want to show you that. Oh, so uh some of the, so you'll have two minutes to answer questions from the examiner. OK. So I'll start off. So the first question for you is explain what means of support are available to your colleague, experiencing personal hardship. Um So, I mean, um if they are finding it quite tough to deal with um their job, I know that I know that you do have a educational supervisor that kind of monitors how you're going through the foundation year program. I would say there's definitely somebody they could try and talk to about this. If they're finding it quite hard to cope with the job or again, they could try and approach um the team as well, but maybe they feel more comfort, comfortable with the educational supervisor. Yeah. Ok. So explain what means of support are available to you, given the scenario and the events that have per uh that have ensued. Um hm So I guess in this case, um I could also speak to my clinical supervisor and just kind of see what they would think would be the best course of action if I felt quite, if I felt quite lost about like how I would tackle this just because it seems like in this scenario I'm being, I'm getting, um, I'm taking on the responsibility of somebody's actions. So I think that would be quite useful. Or I could try and talk to somebody in the team as well. Someone slightly more senior, like a registrar. Mhm. Yeah. All good ideas. All good ideas. Um, and then if there was a patient that has come to harm, how would you go about it? Um So if I have chosen to take on the responsibility of this patient, it is um even though um let's say that person was supposed to be taking care of the patient. If I've made the mistake, that will be on me because I've chosen to take up the responsibility to follow the patient's care. However, um to prevent this from happening, it would be important that I speak to a senior as well. Um, before this so that I can and I would also, oh, sorry. Yeah, that's a very interesting point. So I will come to that in a minute. Um and I own uh own the actions and the consequences of it. Yeah, go on and then um I could also refer them for um they could um date which is like you could make a form complain if they don feel happy with their care that they receive. Yeah, that's right. OK. So just the last question then uh give some suggestions on how junior doctors can be supported. To prevent such incidents. Mhm. How junior doctors can be supported? Um, so I think it's important. Um, so, so from support within the team, you know, um, if you see that one of your other foundation, your doctors are also having, going through a lot, like going through a stressful time and they are unable to cope with the work. I think it's important to try and reach out to them and talk to them about it and see if you can kind of help them out in any way because it's important to kind of, it's important that we work as a team so we can get through, we can get through the, the job together. But it's also um um hm. Yeah. So what I'm hearing is it's important to put a focus on picking up on these issues already before there's any patient harm that's come that comes through. So that can mean, you know, regular check ins and making sure your teams all well looked after. Um Yeah, I would say so. OK, good. So uh that's the end of the station. How was that for you? How did you find? Uh I mean, I wasn't really sure how to kind of go about it, but I think based on like, like previous experience, not, not being a foundation, your doctor, but like based on previous working environments, I would say, like I tried to kind of like work through it that way that makes sense from my personal experiences. But yeah, absolutely. Yeah. So a lot of, you know, these kinds of conversations, we do experience them through our working relationships, trips at school, uni whatever and it doesn't always get easier. It's so much different talking about it in a scenario, like we've just role played compared to doing it in real life. Um, so well done. It's, it's a really difficult thing to do, firstly to raise concerns and approach a colleague who's at the same level as you and talk about something that's so difficult where um you know, a patient hasn't actually come to harm yet. But it's because you've experienced something from a senior, your consultant shouting at you and it's a case of, you know, things have to change now because it's getting to this dangerous point where things could um become dangerous for our patients in turn as well. So it's a very difficult thing to do. Um give yourself a pat on the back. You did really well, you were very calm through the II didn't feel as if you were, you know, threatening me or blaming me for any of my actions throughout this. Um You opened up in a really nonjudgmental matter like, you know, uh have you noticed this thing has been going off? Do you think you might have been uh struggling with your workload? So it's taking an approach where you're trying to support your colleague, which is what the examiner will be looking for in the station. Thank you. Ok. And then uh let's just go through a possible approach and then we'll come to your point about ownership of uh blame when things are not quite right. Ok. So just generally how you would normally approach a consultation with, you know, a colleague or anybody else would be established a rapport at the scene exactly as how you did uh begin with an open question. Ask them, do they know what's going on? Just check the baselines matching if it's not, then sort of explain why you two are having this discussion now. So the colleague is also in this mindset and they are prepared to listen to what you are going to say and then obviously listen to your colleagues point of view as well. So um it came a little bit later when you asked me, but that's also fine to do because you had a different approach first where you wanted to um clarify what the issues were in the workplace and if the person was struggling and then you asked, what was the reason they could have been struggling? So that's still fine as well. Me, as a colleague, I still told you, I'm having struggles with my mom at home. Um And then it's very important actually to explain what has made the situation a problem for you quite early on because I think that sort of puts the other person in a mind frame that, you know what? It's not just a one off matter. It's actually something that has been going on for quite some time and it's affected the other person is why they are the one who's approached you. Um Yes, you two are friends but you're also colleagues in this situation. So it's important to say uh we share the work and it's important we pull our weight. So say exactly what is the problem for you because that's you being respectful to your colleague in a way and showing that you care about them is why you are the person who's saying this to them in a nonjudgmental matter. And there's not been any formal complaint that is now coming from a top down approach to your colleague. OK. So um you extracted the colleague situation leading to the problems at work and then you all were also empathic throughout and uh some of the lines of support you offered were discussing with the educational supervisor, uh discussing with the whole team as well and then offering to go talk to the consultant and being there for support as well. So these are all three really good ideas. And then you also mentioned, you know, at home, if uh there's struggles around looking after the mom, there can be things that can be done in that sense as well. It was a very holistic approach, which is what I really liked and then also um explain the need for the current working situation to change. So yes, you are tackling the situation that has happened now, but you want to have a future forward approach to things. So you need to explain um why things need to change. And you mentioned patient safety could be affected in the future is why we need to negotiate a plan of action. Um And I think within the moment it can be quite difficult to come up with a plan of action because, you know, ay are all role plays. It's not like real life where you're gonna come up with solutions um in the span of 10 minutes, that doesn't happen in real life, it takes a good 2030 minutes or even like two or three discussions. So, um you know, some of the things you could say are there are three issues we are facing at the moment in the situation. Actually, firstly, the colleague is arriving late to work. Second is they're leaving early and the third is they're not finishing their jobs in time. So you could say, OK, let's talk about these three things and see if we can make any changes for that. And then um that can be a way you structure your response to uh creating a plan of action for things in the future. So um what I find really useful is in the two minutes reading time, I just use my pen and uh basically just, you know, make sure I know which are the key areas. I just write it down on my sheet. Like I need to make sure I talk about why the colleague is being late, why they're leaving early. Uh And the main issue here which prompted you to discuss was the consultant shouting at you. So just, you know, make sure you've addressed that to an appropriate degree with the colleague as well. Um And then once you've done that, draw out any further concerns from the, it just to say, you know, this is a very difficult discussion we've just had, I know it can seem as if, um you know, it's a very personal thing to say, but actually, this is just to make sure you're supported, you're well looked after as well and no one's being left behind. So say things in a nice positive manner so that the other person feels good about the discussion overall and it doesn't affect your team working relationship in the future, which I think you did really well, Jim, you were like, ok, so this is how we're gonna do things if you need some time when I asked you, I need to just go away, have a thing, be in the right headspace and then we'll approach things you like. Yeah, that's fine. I'm gonna give you the time, I'll wait for you to come back and then we'll take things forward from there. So we ended on an overall positive note that's what you want to essentially do with these scenarios so well done. And then as we were saying, uh, these are some of the avenues of support you can have. Educational clinical supervisors are great. Uh, avenues. Do people know the difference between an educational and a clinical supervisor? Just pop a yes in the chat if you do or no, if you don't give you guys five more seconds. Yes, I can see. There's been some uh really good suggestions there about some time off games and body support as well. Yeah. Ok. So um when you're a foundation doctor, you will have two avenues of support. So one is an educational supervisor and the other is a clinical supervisor when you first. Yeah, when you first start off, the educational supervisor stays with you throughout the year and they're sort of like your clinical academic tutor equivalent at UNI. So they stay with you throughout the year or the two years and they will be in charge of making sure you're meeting your learning checkpoints and making sure your training is adequate. And if you have any concerns like postoral side of things, mental health or struggling with any issues with colleagues, especially in the clinical workplace where you don't feel confident raising it within the team just yet, you can go approach them. Um So they're sort of your um like parent supervisor. Um And then if you have any exception reports because you have been staying late at work or there's been some safety incidents. Your educational supervisor also gets notified about them and you can go have a discussion with them and they'll sort of help you up with ways to tackle it within your working environment. And then your clinical supervisor. On the other hand, is someone who changes with each of your rotation. They're usually the main consultant you work with. So on medical wards, you have one clinical supervisor. When you move to surgery, you'll have a surgical clinical supervisor. They're essentially in charge of uh making sure your work is up to scratch and you're meeting the requirements of being a competent foundation doctor in that specialty. So, are your ward round notes? Good. Um Are you doing the jobs appropriately? Have you been coming on time? Have you been leaving on time? Um Have you needed any support? And if you do, they'll be there to still provide you support in the clinical environment. And again, similarly, if you have any issues within the workplace, in terms of how the team is functioning, you can bring it up to your clinical supervisor still because they're overall in charge of the team there during that four month period. So that's the main difference, but there's a lot of overlap between those two supervisors as well. Um In addition to this, when you're in your foundation doctor jobs, you will also have a foundation program director that sort of like um um like the people who are in charge of making sure the foundation program is running smoothly within the hospital and they're the overall lead for all of the foundation doctors, F ones and F twos. Um, they can often be two or three of them as well. That's, it's not something that's limited to one person. Um, and then you have support on the admin side as well who's like your foundation coordinator. They're the people who will sort of be sending out your bulletin sorting on the admin issues. You have um that kind of thing. And then on the other side, you have rota coordinators as well, which are people who will make sure you're um getting your annual leave sorted, getting time off in you sorted if you do put in an exception report through. So these are like the four or five main roles you should be aware of when you start working as a foundation doctor. But then just bringing this back to this station, the two roles you should really know about are your educational and clinical supervisors? Ok. Um So the next question I asked you was what support is available to you? Given the scenario events. So of course, you will approach your education and clinical supervisor if you're ever stuck. How do I approach this discussion with my colleague who's been coming late? They can guide you. Um Whereas also if you've been staying back late from work, it's very important to exception report because it highlights to the team that maybe there is some issues with short staffing or because the uh ward's jobs are too much for people to manage in the daytime. So they can then look into it further. Uh And if you feel there's been a safety incident, you can exception report as well as data and they both get action in um a very similar manner. Whereas where data is sent to the clinical team and exception reporting is sent to your educational supervisor as well. Um If ever you feel as if you're not confident um raising any issues within the team, you can also approach your freedom to speak up guardian. Now, this is a really big hot topic. So I'd really advise you guys to read up on what a freedom to speak up guardian does cause you can mention them quite frequently for these reflection questions at the end of the station. Um and then give some suggestions on how junior doctors can be supported. This is a really broad question. Um They can phrase this question in many different ways, but I think essentially the third question a lot of us got asked at the end of the station was yes, the NHS has some policies and procedures in place. But what would you like to suggest that would help make things a bit better? So this is sort of you putting your critical thinking hat on and saying if I were management and I was trying to come up with ways to make colleagues feel confident um and safe that they can raise concerns. This is what I would sort of do. So you, you can put anything down here. These are just the two ideas I had, you know, your supervisors could decide to arrange regular meetings and check ins with you and there could be anonymous forums. So people feel a bit more um supported in having the questions they have answered promptly. So just anything that comes to your mind, you can mention it in this question. OK. So any questions about this station from anybody so far, I'll give you guys a few seconds to type. And then I think Jim, you mentioned something about um oh, if you take over the responsibility from your colleague for that patient, it comes down to you in a way. That's not necessarily true. I can see why you think that because you decided to take on the jobs for that patient. And if things go wrong, it's sort of you who were the last clinician to act on it in theory. Yes, that makes sense. But remember at the end of the day, you're working as part of a team and we all will be in a situation where one person has more jobs than the other person and someone who has fewer jobs will be like, you know what, I'm not having such a busy day. Today, let me step up, help you out, help you with your jobs and it is a team, team environment and you're both working for the same consultant. So it's, it's not to blame on any one person. It's for the team. And whilst that said, if you do find yourself in a scenario where you need to apologize to some patient or relative, you can say, I'm sorry this has happened. And I would like to apologize on behalf of the team. You should avoid to take blame on yourself because that's not really how the NHS works. There's a lot of different safety checkpoints and different people are in, are involved in making sure processes flow smoothly. So I would avoid taking the blame on yourself or even to a colleague admitting that it's sort of coming down on you because essentially it's everybody's um job and responsibility. So any tips on words and how you would start to bring up with the issue without sounding accusatory. So do you mean in terms of how the consultant has uh shouted at you? Yeah, absolutely. So, uh this is something you want to do in a private setting, something that would make your colleague feel comfortable and feel as if they're in a safe environment where uh they can, you know, talk to you openly, they're not feeling threatened by anything and you know, it's gonna be a difficult discussion for anybody to face, especially if there's other, you know, home life stresses in the background. So just make them feel comfortable and say, you know, this is me saying it from a friendly point of view, but this is something we do need to discuss because it's affecting the workplace. So I just want you to take this constructively and I have no hard feelings against you. So just say it as you would with a friend. So what you're saying is so the consultant shouted at us, how would we stop to say to our colleague without signing or blaming them? Yeah. So um what I would do is I would sort of start by saying, you know what, there's been a few incidents on the ward where a lot of the patients who needed some important referrals have not had them done in a timely manner. And, you know, there's various reasons for this happening. We've just spoken about a few of them. Uh But I think what happened recently is it came to the consultant's attention and um you know, the way the team works is we often look after each other's patients. And I think what happened at that time was um the patient belonged to you, I believe in the day. And I think the consultant mistook me for being the person was responsible for looking after them. And I'm not saying this to put the blame on you. This can happen to anybody. So sort of admit that this can happen to anybody. Uh, but I think it's just important that you knew about it as well. So you heard it, um, firsthand rather than through any gossip channel. So, say it in a way that makes it seem, um, like you are on the same page as them, don't make them feel threatened that you are there to complain and make them feel guilty about it because that should be your moral agenda. You shouldn't be there to try and put blame on them. What you're there for is to help them through the situation. That's a hardship for them. Does that sort of answer your questions soon? Yeah. OK. No worries. And there's loads of, you know, videos online. Uh I think ResMed did quite a few ay stations for ethics and professionalism as well. So just have a listen to them because they can give you quite a lot of buzz words and techniques to uh raising questions and concerns in a uh empathetic manner. So just, you know, a few days before your exam just have a view of the videos and they'll put you in this mindset where you're compassionate in the way you raise concerns. Support, escalate. Yeah. OK. So any other questions about this scenario? Um I think there's quite a few on youtube. Uh but don't worry like there's a lot of online resources that even if they're not videos, they do provide general mark schemes of how you should approach a station. Like this. Um There is a lot of websites online which what we'll do is we'll just this of them and send out this handout. Um So that's something you can use to practice. There's quite a few books as well. One I really like is a few cases with mark schemes. That's a really, really good book. Um And I believe the library has a few copies. Um So that's a really good one. Maybe you can share one out um use it in your clinical group practice together. Um And then just take it from there. I think, I think it's a really good way to practice with a book which does provide a map because often the medical school uh be and books like this and people who have written books like this to design these cases always verified by people within the university and then it gets externally verified as well to make sure that cases are at a standard similar to other medical schools. So the content is pretty, pretty similar to other medical schools. Yes, the recording will be up on metal. Yeah. So don't worry, we'll send out a document with all of the resources that the foundation doctors found useful when we were revising for our finals. So we're down to our recap and Q and A. Um I think just some general pieces of advice which I've gone through some of our previous sessions and come up with some new ideas here. As well is practice little and often with your friends and in your study groups, uh it's a really good idea to go somewhere like the library or the medical school and practice with other groups as well because it means you're picking up skills from other people and you're also sharing the cases with each other, which means you have a wider pool of cases ready to prepare and practice with each other. And what we did was in my group, we created our own cases and we practiced with each other, which meant that we were subconsciously going through the mark scheme. And we were also revising the theory so that we were able to create these cases. And what we, what we decided was we weren't going to repeat the same medical case for the oss, which meant we were revising medicine, surgery. GP all of these topics and each one of them was a new case. So we were revising for the written exams as well as uh my huge tip is practice with a timer practice with the timer early because that means it gives you an idea of what five minutes is like quite soon in your revision. Uh because in the exams, five minutes flies by very, very quickly. So something my group even did at one point was we only gave each other four minutes because we wanted to make sure that we were covering all the important information in those four minutes. And that gives us that one minute to in the real station in the real exam to basically pick up the cues from the examiner or the simulator and just gives you that thinking space when you're really there in the, uh, time push setting in the exams, um, keep an ear out for simulator cues as well. Um, as you always say, they will always be trying to help you. They're on your side, they're not trying to trick you. Um The cases can have a lot of, lot of reading to do, especially in those two minutes. So uh just lay all of the resources out in front of you, keep referring to them as you're talking to the simulator or the examiner. Um And if you miss out on something because there's so much reading material, they know that as well. They will give you those views as well. Um And the online resources we'll share them up with you. Um What is also really useful is in the two minutes, reading time, devise a strategy for how you're gonna use it in final year. There's so many different kinds of stations that they all need a bit of a different strategy. So if you're in a history taking station, you probably want to use that time to uh you know, create a grid for what the most likely diagnosis is, what the diagnosis you don't wanna miss is. Um And any questions you want to make sure you're asking your history like red flags, especially for the Uncertainty Station because that one does not have a clear diagnosis. So it's up to you to make sure you are ruling out the red flags in that station. Whereas for um, this ethics and professionalism station, you might want to just, you know, write some buzz words down or you might want to write down, um, just what you want to mention at the end, like des or freedom to speak of God and just those words that are there in front of you to give you an idea of what to mention. Um And then as always, uh there's a lot of communication stations in the final year os as well. So the core and the key to all of these stations is to ice your patient. What is their idea? What is the concern? What is their expectation? Always talk to him in an empathic manner, make sure you are at the same level as them and never tell a patient what to do, never force them to pick up your recommendation, try a motivational interviewing strategy. So you can say these are some things that have worked in the past. Would you like to pick this up? Would you like support with something? So, always offer things and allow the patient or the simulator to pick up your advice, never tell them what they should do. Um So yeah, just some general tips. I'm sure there's loads more and you guys will have picked up on so many more throughout your last uh four years at you. You've done so many acies yourselves as well. And I have a good feeling that you guys will all do. Great. So, yeah, uh Here's the feedback link and we'll sequentially be releasing all of the resources over the next 2 to 3 weeks on our channels. Uh We'll send more information out through emails and through our social media channels. Um And in the meantime, we're here any questions you have, just feel free to shoot away in the chat. And thank you so much for being a great audience and engaging with these sessions.